Neurological manifestations of mycetoma

A Hussein,A Ali,N Motasim,R Tofaha Alhusseini,M.M Fadel,K Mohamed Ahmed Abbasher,M Abbashar,H Abbabshar,A Siddig,M.A Ibrahim,E Elbahi,M Malk Aldar

doi:10.1016/j.jns.2019.10.891

Abstract

Mycetoma is a chronic specific granulomatous progressive and disfiguring subcutaneous inflammatory disease. It is caused by true fungi (Euomycetoma) or by higher bacteria (Actinomycetoma), in 2015 Mycetoma was named as one of the neglected tropical diseases by the WHO. It mainly affects lower limbs, upper limbs, back and rarely head and neck and other sites. It’s mainly transmitted through trauma with infected sharp objects. To determine the neurological manifestations of mycetoma. A cross-sectional community based study. Almost 160 patients were included in the study, 90% of them were male. Two patients presented with entrapment neuropathy, one presented with proximal neuropathy, one patient has peripheral neuropathy, one patient has dorsal spine involvement presented with spastic paraplegia with sensory level, one of our patients has cervical cord compression, and one patient has repeated attacks of convulsion due to tumor like mass caused by fungal infection affecting the right cerebral hemisphere. Although it is rare clinicians should highly suspect neurological involvement in mycetoma patients. Mycetoma infection( wither bacterial or fungal) can cause peripheral or central nervous system damage(At the level of formation of papule and discharging sinuses which can lead to entrapment neuropathy, or direct destruction of the bone which can cause nerve damage or cord compression. A rare manifestation due to spread of infection from the skull to the brain causing convulsion or hemiplegia.

Highlights

SSPE is a fatal slow virus disease which requires clinic-radiological, electrophysiological and biochemical correlation for diagnosis
Improvement was noted with the second line of treatment
A rare manifestation due to spread of infection from the skull to the brain causing convulsion or hemiplegia

Summary

Introduction

SSPE is a fatal slow virus disease which requires clinic-radiological, electrophysiological and biochemical correlation for diagnosis. Autoimmune encephalitis is a group of treatable immune mediated noninfective encephalitic disorders with spectrum of presentation They share clinical, radiological, and immunological features with a spectrum of disorders including SSPE and diagnosis depends on careful integration of clinical, and laboratory features. Mycetoma is a chronic specific granulomatous progressive and disfiguring subcutaneous inflammatory disease It is caused by true fungi (Euomycetoma) or by higher bacteria (Actinomycetoma), in 2015 Mycetoma was named as one of the neglected tropical diseases by the WHO. It mainly affects lower limbs, upper limbs, back and rarely head and neck and other sites. On examination had behavior disturbance, lower motor neuron type of quadriparesis, sensory ataxia, asymmetrical cerebellar signs, left upper limb and neck dystonia with ninth and tenth cranial nerve involvement

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