Concomitant Transverse Myelitis and Acute Motor Axonal Neuropathy in an Adolescent
Children's Neurosciences Centre, Royal Children's Hospital, Melbourne, Victoria, Australia.Pediatric Neurology (Impact Factor: 1.7). 12/2007; 37(5):378-81. DOI: 10.1016/j.pediatrneurol.2007.05.020
A 14-year-old boy presented with acute paraparesis with sensory and sphincter disturbance. Imaging and neurophysiologic studies were diagnostic for transverse myelitis with acute motor axonal neuropathy. He was treated with both intravenous immunoglobulin and high-dose corticosteroids, and he made a slow and incomplete recovery. Acute motor axonal neuropathy is an unusual variant of Guillain-Barré syndrome. Concomitant transverse myelitis and acute motor axonal neuropathy were not previously reported in childhood, although there are reports of coexisting transverse myelitis and other variants of Guillain-Barré syndrome. Such dual lower motor neuron pathology may be associated with a poorer outcome, and indicates simultaneous central and peripheral immune-mediated injury. There may be a place for combined therapy with immunoglobulin and corticosteroids in patients with transverse myelitis and inflammatory neuropathy.
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- "GBS and transverse myelitis can occur simultaneously in the pediatric population. This may be explained by a shared epitope between the peripheral and central nervous system myelin. "
ABSTRACT: Guillain-Barré syndrome (GBS) and transverse myelitis may occur coexistently in the pediatric population. This may be explained by a shared epitope between peripheral and central nervous system myelin. Coexistent transverse myelitis, myositis, and acute motor neuropathy in childhood have not been previously described. We describe a 14-year-old female patient with transverse myelitis, myositis, and GBS following Mycoplasma pneumoniae infection. She presented with weakness and walking disability. Weakness progressed to involve all extremities and ultimately, she was unable to stand and sit. Based on the clinical findings, a presumptive diagnosis of myositis was made at an outside institution because of high serum creatine kinase level. The patient was referred to our institution for further investigation. Magnetic resonance imaging of spine revealed enhancing hyperintense lesions in the anterior cervicothoracic spinal cord. The electromyography revealed acute motor polyneuropathy. Serum M. pneumoniae IgM and IgG were positive indicating an acute infection. Repeated M. pneumoniae serology showed a significant increase in Mycoplasma IgG titer. The patient was given intravenous immunoglobulin for 2 days and clarithromycin for 2 weeks. She was able to walk without support after 2 weeks of hospitalization. This paper emphasizes the rarity of concomitant myositis, transverse myelitis, and GBS in children.
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ABSTRACT: A mapping system for studying the mechanism of electrical defibrillation is described. The specific benefits this system offers for defibrillation research are a dynamic range that extends from microvolts to hundreds of volts, the ability to respond to real-time events, and the ability to record data continuously for up to one hour. The analog processing, real-time display, recorder interface and minicomputer interface are described. The role of the system microprocessor in controlling the mapping system functions and generating real-time data is also discussed.< >
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