Neurological Status Of Patients Research Articles

Treatment of Spinal Fractures in Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory spondyloarthropathy with the potential for progressive spinal stiffness that ultimately makes patients susceptible to spinal fractures with traumatic spinal cord injury from even low-energy trauma. Treatment of patients with AS and spinal fractures (AS+FX) is controversial because, although these patients need especially rigorous stabilization, surgery has been associated with an increased risk of complications and persistent neurological deficits. The purpose of this retrospective case series was to profile patients with AS+FX from a 19-year period within the authors' county hospital system, including differences of neurological status in patients treated operatively vs nonoperatively. The study group comprised 11 patients with AS+FX (9 men and 2 women; mean age, 63 years [range, 38-91 years]). The authors reviewed available clinical notes and imaging reports. Six patients had posterior operative fixation, and 5 were stabilized nonoperatively. By the time of either discharge or final follow-up, 3 of the patients treated operatively deteriorated neurologically (2 of them preoperatively) and 3 remained stable. Of the patients treated nonoperatively, 3 remained neurologically intact, 1 deteriorated, and 1 recovered completely. The most common complications in all patients were pneumonia and urinary tract infection. Operative and nonoperative management produced acceptable outcomes in most patients. The authors recommend individualized treatment, accounting for patient preferences and comorbidities.

OVERLAPPING MOLECULAR SIGNATURES IN PARKINSON'S PATIENT LEUKOCYTES BEFORE AND AFTER TREATMENT AND IN MOUSE MODEL BRAIN REGIONS

Parkinson's disease (PD) is a chronic and progressive neurodegenerative disease with worldwide increasing incidence. PD is the second most prevalent neurodegenerative disease and the first that involves motor symptoms. The great majority of cases, defined as sporadic with non-familial disease, show a highly variable risk of disease due to environmental and genetic factors that remain largely unknown. Furthermore, the neurodegenerative process typically initiates decades prior to the appearance of hallmark motor symptoms; therefore, clinical diagnosis is enabled only when most of the relevant neurons have died and current treatment is palliative at best. Here, we review the application of genomic scale microarray based research aimed to enable early diagnosis and identify novel targets for therapeutic intervention. We demonstrate that blood leukocytes can serve as a feasible and reliable tissue source to test for disease-induced and treatment-related transcript changes. We cover our reports of transcription and alternative splicing modifications in PD patient's leukocytes based on 3' and exon microarray analyses and the identified inflammatory modulations. We further describe the effects of deep brain stimulation (DBS) neurosurgery on the leukocyte transcripts as reflecting the patient's neurological status. A focus is gained on common genes identified both in the molecular signature of human PD leukocytes and in brain RNA from engineered PD mouse models subjected to risk and protection manipulations. Finally, we discuss potential future directions of high-throughput RNA research as facilitators of the PD knowledge base through next generation sequencing technologies of both long and short RNA transcripts including microRNAs.

Primary histiocytic sarcoma of the brain mimicking cerebral abscess

Histiocytic sarcoma is a rare malignancy with only 10 reports confirmed primarily involving the CNS. The diagnosis is dependent on the finding of malignant cells with histiocytic morphology and immunophenotype. The authors report a case of pathologically proven HS of the CNS. A 16-year-old boy presented with headaches, emesis, and altered sensorium. Noncontrast head CT scanning demonstrated a left parietal mass consistent with a tumor. Surgery was undertaken. Intraoperative findings revealed green-yellow exudates consistent with an abscess. Cultures were obtained and broad-spectrum antibiotics were started. The patient subsequently underwent multiple surgical procedures, including drainage and debulking of abscesses and hemicraniectomy. Two months after initial presentation, the patient's diagnosis of histiocytic sarcoma was confirmed. Pathological examination demonstrated necrotizing inflammation with preponderant neutrophil infiltration, variably atypical mononuclear and multinucleate histiocytes, and numerous mitoses. Additional immunohistochemistry studies confirmed immunoreactivity for CD68, CD45, CD45RO, and CD15 and were negative for CD3, CD20, melanoma cocktail, CD30, CD1a, CD34, HMB-45, and melan-A. Once the diagnosis of histiocytic sarcoma was confirmed, antibiotics were stopped and radiation therapy was undertaken. Despite treatment, the patient's neurological status continued to decline and the patient died 126 days after initial presentation. This case represents a rare confirmed example of CNS histiocytic sarcoma. A profound inflammatory infiltrate seen on pathology and green exudates seen intraoperatively make the condition difficult to distinguish from an abscess. Immunohistochemistry showing a histiocytic origin and negative for myeloid, dendritic, or other lymphoid markers is essential for the diagnosis. Further research is needed to establish consensus on treatment.

Does laminoplasty really improve neurological status in patients with cervical spinal cord injury without bone and disc injury? A prospective study about neurological recovery and early complications

Cervical spinal cord injury without bone and disc injury in patients with spinal cord compression is a fairly common problem in Japan. Because elderly Japanese population tend to have cervical spinal canal stenosis. However, there has been no consensus in the treatment of these patients. We conducted a prospective study to evaluate treatment outcomes and complications of these patients. Twenty-five patients had been enrolled in this study. Patients who had paralysis of ASIA impairment scale (AIS) A, B or C were included. With each new patient, we alternated whether he/she received surgical treatment (group S) or conservative treatment (group C). Eleven patients were assigned to each group. We compared the two groups' courses of treatment and complications by evaluating their neurological symptoms using the AIS and ASIA motor score (MS) documenting them at the time of injury and 3months later. The majority of clinical paralysis was found at the C3/4 level for both the groups. According to complications, there were seven urinary tract infections and four pneumonias in group S and one urinary tract infection and three pneumonias in group C. Both groups had an average MS of 42 at the time of injury. Three months later, the average MSs were 59 points in group S and 65 points in group C. In the present study, we found no significant difference in paralysis improvement between surgical and conservative treatment, although we observed a higher frequency of complications with surgery.

Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

Background:Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes.Objectives:To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma.Materials and Methods:We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery.Results:Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed.Conclusion:Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

Problématique de la prise en charge des traumatismes graves du rachis cervical en pays sous-développé

Background and purposeThe management of cervical spine injuries requires a multidisciplinary approach based on emergency management and rehabilitation. In our context this chain fails, especially on the post-hospital care. Our goal is to explain the difficulties we had in the management of these patients in Dakar. MethodsThis retrospective cohort study (2005–2009) included 99 patients admitted for severe cervical spinal cord injury in two hospitals in Dakar. The clinical signs, treatment and outcome were studied. The follow up was between 3 and 54 months. ResultsThe average age of patients was 36.1 years and the traffic accidents were the main etiology (73.7%). Medical transport of patients was done in 65.7% with an admission average time of 64.86hours. On admission, 57.6% of patients had Frankel score A or B. Dislocations (59.6%) and Tear drop fractures (16.2%) were the main lesions. The surgery was performed in 83.8% with a mean interval of 128.84hours after the trauma. Outpatient rehabilitation was offered whatever the patient's neurological status. Recovery was complete in 20.2% and partial in 31.3% with a mortality rate of 37.4%. Most deaths occurred between 1 and 6 months (59.5%) mainly due to decubitus complications (56.8%). ConclusionThe efficacy of the management of severe spinal cord injuries is based on reducing the preoperative time and rehabilitation.

Effects of Interferon β-1a and Interferon β-1b Monotherapies on Selected Serum Cytokines and Nitrite Levels in Patients with Relapsing-Remitting Multiple Sclerosis: A 3-Year Longitudinal Study

Objective: Interferon (IFN)β treatment is a mainstay of relapsing-remitting multiple sclerosis (RRMS) immunotherapy. Its efficacy is supposedly a consequence of impaired trafficking of inflammatory cells into the central nervous system and modification of the proinflammatory/antiinflammatory cytokine balance. However, the effects of long-term monotherapy using various IFNβ preparations on cytokine profiles and the relevance of these effects for the therapy outcome have not yet been elucidated. Methods: Changes were compared in serum levels of TNFα, IFNγ, interleukin (IL)-6, IL-10 and nitrite between RRMS patients given 3-year treatment with intramuscular IFNβ-1a (30 μg once a week) or subcutaneous IFNβ-1b (250 μg every other day). Only the data from patients who completed the 3-year study (n = 20 and n = 18, respectively) were analyzed. Results: Three-year IFNβ-1a or IFNβ-1b monotherapy reduced serum nitrite levels by 77 and 71%, respectively, lowered multiple sclerosis relapse annual rate by 70 and 71%, respectively, and significantly and similarly lowered Expanded Disability Status Scale scores in both study groups (by 0.9 on average). The two monotherapies showed little if any effect on cytokine levels and cytokine level ratios after the first year, but exerted diverging effects on these indices later on; the only exception was the IFNγ/IL-6 ratio that showed a monotonous rise in both study groups over the entire study period. Conclusion: During long-term IFNβ monotherapy, the levels of the studied cytokines show no relevance to the course of RRMS and neurological status of patients, whereas there seems to be a link between these clinical indices and the activity of nitric oxide-mediated pathways.

The clinical significance of isolated traumatic subarachnoid hemorrhage

Mild traumatic brain injury is a clinical diagnosis predicated on a patient's neurologic status and encompasses a variety of pathologies on computed tomography. We wondered whether isolated traumatic subarachnoid hemorrhage (iSAH) without other intracranial pathologic diagnosis is a more benign form of minor head injury that does not warrant extensive (and expensive) observation and follow-up. This is a retrospective review of patients identified prospectively via a trauma registry during a period of 7 years, who had the computed tomographic finding of iSAH on admission scan and a Glasgow Coma Scale (GCS) score of 13 or greater. There were 478 patients identified, with a mean age 61 years, and 223 were male. Median Injury Severity Score (ISS) was 10 (range, 9-48), and the distribution was 415, 54, and 12 for those with GCS score of 15, 14, and 13, respectively. In-hospital follow-up imaging in nine patients demonstrated increased pathologic findings, but subsequent imaging showed stable or decreasing blood, and none experienced a neurologic decline or underwent a neurosurgical procedure.Among those with no other injuries (ISS = 9, n = 118) patients spent a mean of 2.0 (95% confidence interval, 1.1-2.9) days in intensive care unit and 4.9 (95% confidence interval, 3.9-6.0) days in hospital. The likelihood of discharge home was significantly related to age (p < 0.0001), ISS (p < 0.01), and admission GCS (p < 0.01) (stepwise logistic regression), but not progression of SAH.At 6-week follow-up, one patient (0.2%) developed bilateral chronic subdurals requiring drainage, without neurologic sequela. In this largest reported series to date of iSAH in the setting of mild traumatic brain injury, the finding seems to be benign and can likely be managed without routine follow-up imaging or intensive care unit admission in the absence of other significant trauma. Epidemiologic/prognostic study, level III; therapeutic study, level IV.

Conus Medullaris-Cauda Arteriovenous Malformation and Klippel-Trenaunay Syndrome: What is the Treatment Goal?

A 29-year-old man with Klippel-Trenaunay syndrome (KTS) presented with a symptomatic conus medullaris-cauda arteriovenous malformation (AVM) manifesting as back and right limb pain, which abruptly worsened with the onset of right limb weakness and urinary retention. He was treated by multisession endovascular embolization resulting in improved neurological status. KTS is a sporadic disease with unknown etiology, but genetic susceptibility may lead to the over-expression of angiogenic factors and increased angiogenesis. KTS may be exceptionally associated with slow-flow spinal AVM, but there is no consensus about the optimal treatment for these symptomatic lesions. Embolization treatment may represent a safe option to minimize complications and possibly improve the neurological status in patients with spinal AVM associated with KTS, if one or both legs are already impaired by hypertrophy or other vascular malformations. Genetic analysis may reveal an underlying angiogenesis change, so closer follow up might be indicated in selected patients.

Percutaneous Vertebroplasty in Adult Degenerative Scoliosis for Spine Support: Study for Pain Evaluation and Mobility Improvement

We evaluate the efficacy-safety of percutaneous vertebroplasty (PV) as primary treatment in adult degenerative scoliosis. During the last 4 years, PV was performed in 18 adult patients (68 vertebral bodies) with back pain due to degenerative scoliotic spine. Under anaesthesia and fluoroscopy, direct access to most deformed vertebral bodies was obtained by 13G needles, and PMMA for vertebroplasty was injected. Scoliosis' inner arch was supported. Clinical evaluation included immediate and delayed studies of patient's general condition and neurological status. An NVS scale helped assessing pain relief, life quality, and mobility improvement. Comparing patients' scores prior to (mean value 8.06 ± 1.3 NVS units), the morning after (mean value 3.11 ± 1.2 NVS units), at 12 (mean value 1.67 ± 1.5 NVS units), and 24 months after vertebroplasty (mean value 1.67 ± 1.5 NVS units) treatment, patients presented a mean decrease of 6.39 ± 1.6 NVS units on terms of life quality improvement and pain relief (P = 0.000). Overall mobility improved in 18/18 (100%) patients. No complications were observed. During follow-up period (mean value 17.66 months), all patients underwent a mean of 1.3 sessions for facet joint and nerve root infiltrations. Percutaneous vertebroplasty in the inner arch seems to be an effective technique for supporting adult degenerative scoliotic spine.

Acute Paraplegia Secondary to Thoracic Disc Herniation of the Adjacent Segment Following Thoracolumbar Fusion and Instrumentation

Proximal junctional disease is a well-recognized postoperative phenomenon in adults who are undergoing long thoracolumbar fusion and instrumentation, and is attributed to increased a junctional stress concentration. In general, the onset of symptoms in these patients is insidious and the disease progresses slowly. We report on a contrary case of rapidly progressing paraplegia secondary to acute disc herniation at the proximal adjacent segment after long posterior thoracolumbar fusion with cement augmentation at the upper instrumented vertebra and the supra-adjacent vertebra. The patient was treated with a discectomy through the costo-transverse approach combined with extension of the posterior instrumentation. The patient's neurological status improved markedly. Stress concentration at the proximal junction disc space may have caused accelerated disc degeneration which in turn lead to this complication.

Fractures of the cervical spine

OBJECTIVES:The aim of this study was to review the literature on cervical spine fractures.METHODS:The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed.RESULTS:Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures.CONCLUSIONS:Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative.

Intrathecal Trastuzumab Treatment of the Neoplastic Meningitis due to Breast Cancer: A Case Report and Review of the Literature

We report the case of a 65-year-old woman, diagnosed with a breast cancer human epidermal growth factor receptor (HER2) previously negative, who developed leptomeningeal carcinomatosis and was treated with intrathecal (IT) trastuzumab (TST). After five doses of IT trastuzumab, at escalading doses, once weekly, the patient's neurological status stabilised, and that result was maintained for two months. There is evidence in the literature that breast cancer receptor status may change over time, and when it occurs, it may modify the therapeutical approach. We reviewed the pertinent literature and concluded that IT trastuzumab might be a promising treatment for patients with HER2-positive breast cancer leptomeningeal carcinomatosis.

Neuro/Trauma Intensive Care Unit Nurses’ Perception of the Use of the Full Outline of Unresponsiveness Score Versus the Glasgow Coma Scale When Assessing the Neurological Status of Intensive Care Unit Patients

: This study compares the Full Outline of Unresponsiveness (FOUR) Score scale with the Glasgow Coma Scale (GCS) when evaluating a patient's level of responsiveness in the neuro/trauma intensive care unit of a large medical center. This new scoring tool evaluates 4 functional categories: eye response, motor response, brainstem reflexes, and respiratory pattern. : A total of 57 patients 18 years or older were randomly selected as a convenience sample of those admitted to the neuro/trauma intensive care unit and were assessed using both the standard GCS and the FOUR Score scale. The raters then completed a short survey (43 completed) to compare the 2 tools. : Rater agreement was very good with the FOUR Score scale and for the GCS; however, nurses favored the use of the FOUR Score scale (81.4%) over the GCS (0.00%) to assess the neurological responsiveness of their patients as the generally accepted assessment tool. : The FOUR Score scale provides a reliable neurological assessment of intubated patients where the GCS does not differentiate patient status once intubated.

Jamar hand-held grip dynamometry in chronic inflammatory demyelinating polyneuropathy

BackgroundFew studies have evaluated the functional and electrophysiological correlates of hand-held grip dynamometry in neuromuscular disease. The practical value of normative values remains uncertain in clinical practice. We aimed to ascertain the value, clinical and electrophysiological correlates, as well as utility of normative values for grip dynamometry, in a cohort of subjects with chronic inflammatory demyelinating polyneuropathy (CIDP). MethodsWe performed a cross-sectional study of 31 prospectively recruited subjects with CIDP, using Jamar hand-held grip dynamometry, conventional clinical assessments and electrophysiology. ResultsGrip dynamometry correlated highly with motor, sensory and functional scores in the upper limbs as well as with global function. There were significant correlations with summated median/ulnar, and ulnar compound muscle action potentials. Patients’ readings were significantly lower than median normative values but comparable to fifth percentile normative figures. ConclusionsJamar grip dynamometry is a reliable measure of global neurological status in patients with CIDP, not limited to upper limb or exclusively motor function. At optimum level of function, CIDP patients had comparable dynamometry recordings to fifth percentile normative values, which may represent a realistic aim for treated subjects with the disorder, with currently available therapies.

Epidermoid cyst mimicking an intrinsic brainstem tumor

To describe an atypical clinical and radiological presentation of a brainstem epidermoid cyst in a child and to provide a review of the medical literature on brainstem epidermoid cysts in children. Review of medical records and operative notes of an unusual case of a patient with a brainstem epidermoid cyst. MEDLINE literature search using the terms brainstem, epidermoid cyst and children. Gross total resection of the cyst was achieved. The patient had an uneventful recovery. Epidermoid cysts are rare tumors of the brain and children. The management of these tumors can be quite challenging. A good clinical and neuroradiological evaluation pre-operatively is fundamental for a successful surgical treatment. Surgical resection should be as radical as possible without putting the patient's neurological status into risk.

Posterior Vertebral Column Resection for the Treatment of Dystrophic Kyphosis Associated With Type-1 Neurofibromatosis

Case report. To describe the use of posterior-only vertebral column resection and postoperative traction for spinal deformity associated with type-1 neurofibromatosis (NF1). Vertebral deformity, namely, thoracic scoliosis, is the predominant orthopedic manifestation of NF1. Patients may present with debilitating pain and rarely, myelopathy. The commonly dystrophic nature of these deformities makes them particularly recalcitrant to surgical correction. Traditionally, circumferential arthrodesis via combined anterior and posterior approaches has been recommended. Clinical and radiographical case review. A 14-year-old adolescent boy with NF1, severe cervicothoracic angular kyphosis, thoracic dislocation, and myelopathy presented status postmultiple anterior and posterior spinal fusions. The patient underwent posterior-only vertebral column resection after 6 weeks of halo-gravity traction. The surgery consisted of thoracic laminectomies, total corpectomies of T3 and T4, circumferential fusion, and posterior instrumentation from the occiput to T11. Autologous rib and iliac crest grafts were used as fusion substrate. Postoperatively, a halo vest was worn for 4 months to support the correction of his chin-on-chest deformity. The patient's neurological status returned to normal by 6 weeks postoperatively, and solid fusion was radiologically evident after 1 year. We think that posterior-only vertebral column resection represents a safe and efficacious but technically challenging option for the treatment of angular kyphotic spinal deformity and associated neurological deficit in patients with NF1.

Feasibility, Safety, and Periprocedural Complications Associated With Endovascular Treatment of Selected Ruptured Aneurysms Under Conscious Sedation and Local Anesthesia

Endovascular coil embolization of ruptured aneurysms is performed under general anesthesia at most centers for perceived improved image quality and patient safety. To report the feasibility of and outcomes associated with endovascular treatment of subarachnoid hemorrhage (SAH) patients with ruptured cerebral aneurysms performed under conscious sedation with local anesthetics. Between January 2005 and December 2009, 187 patients with aneurysmal SAH were treated with coil embolization at the authors' hospital. For each patient, procedural details, mode of anesthesia, and clinical and radiographic outcomes were reviewed retrospectively (retrospective case series). A total of 197 coil embolizations were performed: 112 under general anesthesia, 78 under conscious sedation with local anesthetics, and 7 converted from conscious sedation to general anesthesia. None of the patients who presented with Hunt & Hess grade IV or V were treated under conscious sedation. For patients who presented with Hunt & Hess grades I, II, and III, 79.2%, 66.7%, and 32.6% of patients, respectively, underwent successful completion of treatment under conscious sedation. The symptomatic procedural complication rate was 2.5% overall and 2.4% for the conscious sedation group alone. Among the 14 interventions with intraprocedural perforation, 11 were performed under general anesthesia and 3 were performed under conscious sedation. In the authors' experience, conscious sedation with local anesthetics for endovascular treatment of ruptured intracranial aneurysms is feasible and safe in most patients with low-grade SAH. It may allow direct evaluation of the patient's neurological status, potentially leading to earlier detection and response to intraprocedural complications.

An Extreme Case of the Syndrome of the Trephined Requiring the Use of a Novel Titanium Plate

Patients with large cranial defects can manifest a secondary neurological deterioration known as the "syndrome of the trephined." This is the case of a 66-year-old female with a left-sided acute subdural hematoma, treated with decompressive craniectomy. Six months later, a cranioplasty was performed. However, it was complicated by an infection requiring removal of the bone plate. A week later, the patient became comatose; her craniectomy flap was sunken. After ruling out all other possible disorders, we suspected an extreme syndrome of the trephined. The patient's neurological status drastically improved after she was placed on a Trendelenburg position regiment. A second cranioplasty was performed only 3 months after the infection using a novel custom designed titanium mesh, the least porous material used in synthetic bone flaps, to decrease the risk of infection. The patient had an excellent recovery; at her 6-month follow-up she was neurologically intact, cosmetically satisfied, and free of infection. The treatment of extreme cases of syndrome of the trephined in the setting of a recent infection can be challenging; successful treatment can be achieved by using a custom titanium plate.

Immunoadsorption for paediatric post-diarrhoea haemolytic-uraemic syndrome with severe neurological involvement

The haemolytic-uraemic syndrome (HUS), a thrombotic microangiopathy, occurs often secondary to an infection due to Shiga-toxin-producing Escherichia coli (E Coli), the most threatening complication being neurological involvement [1]. Plasmata exchange has been shown to have some efficiency [2, 3]. Use of complement cascade-blocking antibody eculizumab is becoming the first-line treatment in the severest cases [4]. At the onset of spring in Europe in 2011, IgG depletion through immunoadsorption was reported to be effective in treating the severe neurological complications of HUS in adults [5, 6]. In October 2011, a 26-month-old girl presented with HUS requiring dialysis, with hepatic, pancreatic and cardiac involvement, seven days after the onset of E. coli enteritis. Eculizumab was administrated to treat severe neurological symptoms (unresponsiveness, comatose state, hypertonic quadriplegia, Glasgow score 8/15) due to bilateral thalamic infarctions seen on MRI one day after the onset of HUS (Figure 1). On day 3, a session of plasmapheresis was performed followed by a second eculizumab infusion because of the absence of neurological recovery. Despite this treatment and a slight increase in the platelet count, the patient's neurological status worsened, with recurrent occipital seizures and the need for mechanical ventilation. A third eculizumab infusion was carried out on day 8. Diffusion MRI sequences showed new lenticular lesions associated with right occipital-cortex lesions. In this life-threatening situation, we decided to perform IgG depletion by immunoadsorption as a rescue therapy (six sessions over five days, starting on day 9). A moderate clinical improvement (cessation of seizures, extubation on day 14) was associated with a rapid improvement in the disease activity (platelet count >150.109/L on day 16). Dialysis was stopped on day 13. The patient was discharged on day 60 with severe neurological sequelae: absence of eye contact, quadriplegia and major cortical and subcortical atrophy on MRI. The creatinine clearance rate was 45 mL/min, with 2 g/L proteinuria. Screening for complement function abnormalities (CFH, CFI, MCP, C3 and C4) and anti-CFH antibodies was negative. Three months later, surprisingly, the patient recovered her previous level of motor function with an independent walk and previous language skills. The creatinine clearance rate stayed at 45 mL/min. Thus, in this child with severe neurological HUS, eculizumab and immunoadsorption treatment were associated with an unexpectedly favourable evolution in the medium term. Fig. 1. Course of a 26-months-old girl with severe post-diarrhoea HUS treated by administration of eculizumab and by immunoadsorption. (a) day 1 MRI: diffusion-weighted image, axial view: marked bilateral hypersignal in thalami. (b) day 8 MRI: diffusion-weighted ... The effectiveness of plasmapheresis is controversial [2, 3], and despite encouraging results with eculizumab [4], this treatment is not effective in all forms of post-diarrhoea HUS with severe neurological involvement. We suggest that immunoadsorption, considered a therapeutic option in severe neurological HUS in adults, also be used as a rescue treatment in children. However, studies and protocols are needed to determine the relevance of the association between the two treatments and their timing in neurological forms of post-diarrhoea HUS in children.