Acute Flaccid Paraplegia Research Articles

Transverse myelitis associated with Mpox infection

Neurologic manifestations of mpox (monkeypox) infection are common. Rarely, transverse myelitis has been associated with mpox infection. We describe a case of longitudinally extensive transverse myelitis in a patient with recently diagnosed mpox, presenting as acute flaccid paraplegia. The patient underwent an extensive work-up that included serological and cerebrospinal fluid (CSF) testing and magnetic resonance imaging (MRI). They were treated with tecoviromat, high dose steroids, and intravenous immunoglobulin, followed by plasma exchange. Despite these interventions, there was minimal neurologic improvement. This case underscores the importance of instituting measures designed to prevent mpox infection, including public education initiatives.

Acute longitudinally extensive transverse myelitis: A case report

Introduction: Acute Longitudinally Extensive Transverse Myelitis (ALETM) poses a problem of etiological diagnosis. The etiologies are diverse; infectious, degenerative, inflammatory and auto-immune. Case report: We are presenting the case of a 19 years old patient, with no prior medical history. He presented with acute flaccid paraplegia, urinary retention and fecal incontinence. The magnetic resonance imaging concluded to ALETM and the etiological investigation allowed us to confirm the diagnosis of myelitis inaugurating systemic lupus erythematosus. The treatment was based on the association of corticoids, cyclophosphamides and four plasma exchanges. No real improvement in the neurological deficiency was noted. Conclusion: The lupus origin of ALETM, although rare, should be considered in young patients since it could, as in our case, the diagnostic circumstance of systemic lupus erythematosus. Keywords: myelitis; lupus erythematosus; systemic; paraplegia.

High Energy Blunt Thoracic Trauma Requiring Endovascular Reinforcement

A 72 year old man was admitted after a road traffic accident. He was conscious and clinically stable, though presenting with acute flaccid paraplegia. (A) Computed tomography angiography revealed severe fracture dislocation through T8. A fractured and bevelled vertebral body was compressing the descending thoracic aorta, without aortic rupture. (B) A tapered thoracic endograft (Zenith Alpha; Cook Aortic Interventions, Bloomington, IN, USA) was deployed with the patient on the radiolucent spinal board, reinforcing the aortic wall, and allowing safe patient mobilisation. In ventral decubitus, the dislocation was reduced and a posterior stabilisation performed. The patient is alive and well at the 20 month follow up.Image 1

Acute aortic thrombosis as a presenting feature of COVID-19: case report and review of literature

Acute aortic thrombosis is an uncommon vascular emergency that can present with neurologic symptoms like acute paraplegia due to spinal cord ischemia. It frequently causes mortality unless appropriate diagnosis is followed immediately by proper management. Individuals with COVID-19 have coagulopathy with hyper inflammatory response which predisposes to both venous and arterial thrombotic events, especially in severe patients. We report a rare case of 63-year-old COVID-19 patient presenting as acute flaccid paraplegia with hematuria secondary to acute extensive aortic thrombus. CT scan showed bilateral COVID-19 pneumonia inspite of absence of respiratory symptoms. All patients with thrombotic events should be investigated for COVID-19 pneumonia as patients may not have typical respiratory symptoms.

Acute aortic occlusion presenting as flaccid paraplegia.

A 67-year-old male known to be hypertensive and diabetic had a sudden onset of severe low back pain and flaccid paraplegia with no sensory level or bladder affection and the distal pulsations were felt. Acute compressive myelopathy was excluded by MRI of the dorsal and lumbar spines. The nerve conduction study and CSF analysis was suggestive of acute demyelinating polyneuropathy. The patient developed ischemic changes of the lower limb and CT angiography revealed severe stenosis of the abdominal aorta and both common iliac arteries. We emphasize the importance of including acute aortic occlusion in the differential diagnosis of acute flaccid paraplegia especially in the presence of severe back pain even if the distal pulsations were felt.

Acute Disseminated Encephalomyelitis Associated with Cytomegalovirus Infection in an Immunocompetent Subject

Purpose: Fulminant acute disseminated encephalomyelitis (ADEM) associated with cytomegalovirus (CMV) infection in immunocompetent hosts is rare, and the MRI findings might be atypical. Case report: A 17-year-old immunocompetent man presented with acute flaccid paraplegia accompanied by bladder and bowel incontinence. The serum virology tests revealed the presence of CMV IgM and IgG, indicating reactivation of latent infection. MRI studies of the brain and the whole spinal cord showed diffuse gray matter lesions of hyperintense signals in T2. After aggressive rescue therapy combining intravenous immunoglobulin, pulse methylprednisolone and plasma exchange, the patient made a complete neurological recovery 6 months later. Conclusion: This report demonstrates the association of CMV infection with ADEM in an immunocompetent subject. Although the treatment regimen and timing for patients with ADEM need further investigation, aggressive rescue therapy by adopting multiple immunomodulatory treatments may be warranted.

Aortic dissection-induced acute flaccid paraplegia treated with cerebrospinal fluid drainage

Acute aortic dissection is a life-threatening event in which prompt and correct diagnosis is associated with better outcomes. In most cases, there is chest or back pain. However, in rare cases, patients have little or no pain and other symptoms are more conspicuous at presentation. The autors reports the case of a 47-year-old female patient who sought medical attention for sudden-onset paraplegia. The physical examination was normal except for bilateral lower limb flaccid paralysis, with abolition of deep tendon reflexes and paraesthesia in both feet. Computed tomography showed aortic dissection, with partial thrombosis of the false lumen, starting after the emergence of the left subclavian artery and extending, toward the bifurcation of the aorta, to the left iliac artery. After cerebrospinal fluid drainage, the evolution was favorable.

Paraneoplastic necrotizing myelopathy in a patient with advanced esophageal cancer: An autopsied case report

We report the first autopsied case of paraneoplastic necrotizing myelopathy associated with esophageal cancer in the literature. The patient had acute flaccid paraplegia and urinary retention, and had a good recovery of strength of both legs in response to corticosteroids. MRI showed a characteristic lesion with post-gadolinium enhancement of the cervical to mid-thoracic spinal cord at the onset, which has never been reported. Taken together, these results suggest that there is an underlying autoimmune mechanism in paraneoplastic necrotizing myelopathy.

Poster 79 long-term electrodiagnostic and clinical improvement in acute flaccid paraplegia associated with west nile virus: A case report. Evan L. Rosenfeld, MD (Rehabil Inst Chicago, Chicago, IL); Christina Marciniak, MD, e-mail: erosenfeld@rehabchicago.org

Poster 79 long-term electrodiagnostic and clinical improvement in acute flaccid paraplegia associated with west nile virus: A case report. Evan L. Rosenfeld, MD (Rehabil Inst Chicago, Chicago, IL); Christina Marciniak, MD, e-mail: erosenfeld@rehabchicago.org

Poster 167: Initial and follow-up motor scores and functional status in patients with West Nile virus infection: a report of 4 cases.

Setting: Acute inpatient rehabilitation hospital. Patients: 4 patients (age range, 29–72y) with West Nile virus (WNV) infection and weakness. Case Description: The patients presented to community hospitals with myalgia, headache, neck pain, weakness, areflexia, and normal sensation. All patients had positive titers for WNV in cerebrospinal fluid or serum. 2 patients had acute flaccid paraplegia; one received intravenous (IV) steroids without improvement. 2 patients presented with diffuse weakness and meningoencephalitis and required prolonged ventilatory support; 1 received IV gamma globulin without improvement. All patients were then transferred to an acute inpatient rehabilitation hospital. Assessment/Results: On admission, 2 patients had electrodiagnostic studies that revealed motor axonal loss without sensory abnormalities consistent with anterior horn cell involvement. Initial motor scores ranged from 30 to 66 with a mean of 43.5 (normal, 100). Initial score ranges on the FIM™ instrument ranged from 6 to 22 for self-care, 2 to 6 for sphincter control, 1 to 5 for mobility, 1 to 5 for wheelchair locomotion, 13 to 14 for communication, and 15 to 20 for cognition. All patients participated in comprehensive in- and outpatient rehabilitation programs. At 6-month follow-up, electrodiagnostic studies showed evidence of reinnervation in all 4 patients. Motor scores ranged from 32 to 70 (mean, 48.5). Follow-up FIM scores also showed modest improvements. In self-care, scores ranged from 10 to 37, with all patients showing increased independence. 2 patients were continent of bowel and bladder, and 2 patients were transferring independently. In locomotion, scores improved to a range of 6 to 8, however, no patients was ambulating independently. Communication and cognition were within normal limits. Discussion: WNV can cause severe neurologic disease, including acute flaccid paralysis and meningoencephalitis. There are limited data regarding functional recovery in such patients. Conclusions: Patients with WNV-associated weakness appear to make modest improvements in strength and function over time. Persistent weakness in the lower extremities limits ambulation skills at 6 months.

Lyme borreliosis associated with complete flaccid paraplegia

We report the case of a patient with concomitant Lyme borreliosis and acute paraplegia. The paraplegia was complete, flaccid and of upper motor neurone type. The diagnosis of borreliosis was based on the detection of large amounts of IgM and IgG borrelia antibodies in the acute phase serum and on the complete disappearance of IgM antibody during the review period. IgG borrelia antibodies were also detected in the CSF, but leakage of antibodies from the blood to the intrathecal space could not be ruled out. Lymphocytosis and increased total protein concentration in the CSF were signs compatible with neuroborreliosis. Ceftriaxone therapy effected dramatic recovery of the patient. This case suggests that borreliosis should be considered a possible cause of acute flaccid paraplegia.