Acute transverse myelitis and acute motor axonal neuropathy developed after vaccinations against seasonal and 2009 A/H1N1 influenza.
ABSTRACT Acute transverse myelitis (ATM) has been described as an uncommon complication of vaccinations and is rarely accompanied by inflammatory peripheral neuropathy. We report a case of a 77-year-old woman who developed ATM and acute motor axonal neuropathy (AMAN) following vaccinations against seasonal and 2009 A/H1N1 influenza. She manifested ophthalmoplegia, quadriparesis and sensory impairment. MR imaging showed a longitudinally-extensive spinal cord lesion, and nerve conduction study revealed motor axonal polyneuropathy. Despite prompt treatment, her symptoms poorly recovered. While concurrent ATM and AMAN may suggest the presence of a common antigen, their scarcity indicates the importance of other factors causing immunologic disruptions.
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ABSTRACT: Background:ADEM is a central nervous disease that leads to myelin damage as a result of autoimmune response that develops after infections or vaccination. Herpes Simplex Virus (HSV) infection rarely leads to ADEM.Patient:25-month-old male due to urinary retention, paradoxical respiration and muscle weakness after herpetic gingivostomatitis diagnosed as transverse myelitis. In follow-up with cranial and spinal magnetic resonance imaging multiple lesions were demonstrated. Electroneuromyography findings were compatible with acute sensorimotor neuropathy, serum anti-GM2 antibodies and Herpes Simplex Virus (HSV) Type 1/2 IgM / IgG detected negative and positivite, respectively. With these findings he was diagnosed acute disseminated encephalomyelitis (ADEM) following HSV infection. Although acyclovir, intravenous immunoglobulin, methylprednisolone and plasmapheresis therapies, he is still in intensive physical therapy program with heavy sequel.Results:In our case, ADEM demonstrated transverse myelitis clinic after HSV infection which is rarely seen in literature. As well as clinic and spinal imaging findings, cranial imaging findings helped establishment of ADEM diagnosis.Conclusion:To our best knowledge, HSV is a rare etiological and probably the poor prognostic factor of ADEM.Journal of child neurology 02/2014; · 1.59 Impact Factor
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ABSTRACT: Guillain-Barre syndrome (GBS) and acute disseminated encephalomyelitis (ADEM) are clinically distinct demyelinating disorders that share an autoimmune pathogenesis and prior history of viral infection or vaccination. Concurrent GBS and ADEM are uncommon with few reported cases. Our patient is a 10-year-old girl who presented with acute quadriparesis, areflexia, and urinary retention. Lumber puncture revealed mild pleocytosis and elevated protein. She required mechanical ventilation and failed to improve after intravenous immunoglobulins. She subsequently developed double vision and disturbed level of consciousness. Brain MRI revealed multiple white matter lesions suggestive of ADEM. Based on the temporal association and exclusion of alternative etiologies, we made a diagnosis of GBS and ADEM. She improved remarkably after intravenous methylprednisolone. We conclude that co-morbid GBS and ADEM is an uncommon entity presenting with severe neurological morbidity. Prompt recognition and treatment can hasten the recovery and therefore improve the neurological outcome.Neurosciences 04/2013; 18(2):166-8. · 0.39 Impact Factor
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ABSTRACT: To illustrate that acute, even dramatic, demyelination of the central nervous system and encephalitis can occur after viral i.e. influenza A/H1N1 vaccination or infection.Clinical Neurology and Neurosurgery 06/2014; 124C:8-15. · 1.25 Impact Factor