小儿急性脊髓炎临床分析

目的探讨小儿急性脊髓炎的临床特点，诊断，治疗及院内感染。方法回顾我院儿科1998-2007年收治12例小儿急性脊髓炎的病因、临床表现、实验室检查结果、治疗及院内感染进行分析。结果12例患儿的主要临床表现有：运动功能障碍100％，90．2％为首发症状，感觉功能障碍占41．7％，括约肌功能障碍占83．3％，18．2％脑脊液异常，64％脊髓MRI异常，16．7％合并院内呼吸道感染，50％治愈，41．7％好转，8．3％无效。结论小儿急性脊髓炎临床表现较不典型，脑脊液、MRI检查是诊断的关键，治疗上以糖皮质激素为主的综合疗法，治疗效果好，但呼吸道院内感染率较高。     

鼠神经生长因子治疗急性脊髓炎恢复期的临床疗效研究

目的探讨鼠神经生长因子(mouse nerve growth factor,mNGF)对急性脊髓炎恢复期症状的治疗作用。方法急性脊髓炎恢复期患者50例,治疗组35例,对照组15例,对两组治疗后的患者的脊髓神经功能恢复程度及MRI进行考核。结果治疗组:患者脊髓神经功能恢复程度较对照组有明显差异(P<0.01)。MRI病灶分布减少的节段数亦应明显优于对照组。结论急性脊髓炎恢复期患者中使用鼠炎神经生长因子能显著改善患者神经功能恢复,减轻患者神经功能受损的程度。     

Combination of transverse myelitis and arachnoiditis in cauda equina syndrome of long-standing ankylosing spondylitis: MRI features and its role in clinical management

The cauda equina syndrome (CES) is a rare neurological complication of ankylosing spondylitis (AS). Imaging diagnosis of CES in long-standing AS patients (CES-AS) using myelography, computed tomography (CT), and magnetic resonance imaging (MRI) were reported in the literature. They, however, demonstrate only the chronic abnormalities of CES-AS, i.e., dural ectasia, dorsal dural diverticula, and selective bone erosion at the posterior elements of the vertebrae. To our knowledge, imaging features of acute intradural inflammation in CES-AS were not described. We report a patient of CES-AS in whom MRI disclosed acute transverse myelitis and arachnoiditis along the lower spinal cord, and discuss the pathogenesis of CES-AS and the role of MRI in clinical management.     

Spinal cord injury in patients with systemic lupus Erythematosus——Clinical manifestations, imaging characteristics and treatment

BACKGROUND： There are fewer reports on systemic lupus erythematosus （SLE） related myelitis, and definite and uniform therapeutic program is not available. OBJECTIVE： To observe the clinical manifestations, imaging characteristics, results of laboratory examination and treatment of SLE. DESIGN： A retrospective case analysis. SETTING： Department of Neurology, the Second Affiliated Hospital of Sun Yat-sen University. PARTICIPANTS： Totally 1 052 SLE inpatients were selected from the Second Affiliated Hospital of Sun Yat-sen University from January 1995 to May 2005, and they all accorded with the diagnostic standards for SLE set by American Rheumatism Association in 1982. 124 of them were diagnosed to have damage of central nervous system. Inclusive criteria： Patients with one of the focal physical signs, including mental and behavior disorders, headache, seizure and involvement of nervous system. Exclusive criteria： Patients with hypertensive encephalopathy, damage of nervous system due to uremia and infection of central nervous system. Spinal cord lesion occurred in 15 female cases of 23 - 51 years old. Informed consents were obtained from all the participants. METHODS： The physical signs, laboratory examinations, therapeutic program and prognosis were recorded in the 15 patients with symptoms of spinal cord lesions. All the patients underwent MRI scan of brain or lesioned segment of spinal cord, and 8 cases of them underwent lumbar puncture to determine intracranial pressure, routine and biochemical examinations were cerebrospinal fluid were performed. The disease activity of SLE in systems beyond central nervous system was evaluated with modified lupus activity criteria count （LACC）. MAIN OUTCOME MEASURES：① Incidence of SLE related myelitis, attack age distribution and its association with the activity of SLE; ② Comparisons of the clinical characteristics, cranial and spinal cord MRI manifestations, different therapeutic program and prognosis. RESULTS： All the 15 SLE patients were involved in the analysis of results. ① The incidence of SLE related myelitis was low （1%, 15/1 052）. ②SLE related myelitis occurred mostly when the SLE symptoms were active, and only a few occurred at the stable period. ③ Among the SLE patients, MRI displayed abnormal changes in 71% （10/14）, the typical changes appeared abnormal signals at corresponding spinal segments, manifested as prolonged T1 and T2 signals, thickened spinal segments. Lumbar segments were mostly involved. ④ Of the 9 patients treated with hormone impact, 7 cases （78%） had obvious improvements, and the effects were better in those treated with immunosuppressor combined with intravenous immunoglobulin of large dosage. CONCLUSION：① Myelitis is a rare complication of SLE.② MRI serves as a valuable supplementary approach in the diagnosis of SLE related myelitis without specificity. ③ Steroid pulse combined with immunosuppressor and intravenous immunoglobulin of large dosage is effective in the treatment.     

Neurological complications of herpes zoster

We report 31 cases of herpes zoster (HZ) with neurological complications: 14 with cranial nerve deficits, 1 with cranial nerve deficit associated with segmental motor disorder, 3 with segmental motor, deficits, 2 with meningoencephalitis, 2 with meningoencephalitis associated with cranial neuropaty or myelitis, 2 with meningitis, 2 with hemiplegia contralateral to the ophthalmic HZ, 1 with hemiplegia and motor deficit and finally 1 with hemiplegia and a cranial neuropathy. Smoking was the putative risk factor in 53% of our patients together with diabetes, which has already been mentioned in the literature. We frequently observed more than one complication in succession (19.3%) that could not easily be related to the cutaneous distribution. Acyclovir had no demonstrable positive effects on neurological complication in our patients.

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Sommario Riportiamo 31 casi di HZ complicato: 14 casi di deficit di nervi cranici, 1 caso con deficit di un nervo cranico più deficit di moto segmentario, 3 deficit di moto, 2 meningo-encefaliti, 1 meningo-encefalite con deficit di un nervo cranico ed 1 complicata da mielite, 2 meningiti, 2 mieliti, 2 emiplegie controlaterali a HZ oftalmico, 1 emiplegia controlaterale più deficit motorio ed 1 con deficit di nervo cranico. Come possibile fattore favorente le complicazioni proponiamo il fumo di sigaretta (presente come unico elemento nel 53% dei pazienti), oltre al diabete già menzionato in numerose casistiche. Molto frequenti nella nostra casistica le associazioni di più complicazioni diverse in successione temporale (19,3%) anche non facilmente spiegabili in senso topografico. Non dimostrabile nei nostri pazienti l’influenza positiva della terapia con acyclovir.

     

Syringomyelia complicating syphilitic spinal meningitis: a case report.

An association between syringomyelia and spinal syphilis was described in the early literature but has not been the subject of reports subsequently. We give details of a contemporary case, affirmed by magnetic resonance imaging. The patient showed significant clinical recovery following penicillin treatment, while the imaging appearances became less pronounced.     

A blessing in disguise: resolution of tardive dyskinesia with development of cervical myelitis.

Tardive dyskinesia (TD), which is frequently seen in patients treated with dopamine receptor blocking agents, is difficult to manage. We report on a young Chinese man with bipolar disorder who developed TD after haloperidol treatment, involving the trunk, limbs, and orofacial area. TD persisted despite switching to atypical antipsychotic agents and treatment with valproate, benzodiazepines, and tetrabenazine. Resolution only occurred years later when he developed quadriplegia arising from infective myelitis of the cervical cord (C4-5). He had concomitant vertebral osteomyelitis, which was successfully treated with intravenous antibiotics. With intensive rehabilitation, he recovered the use of his limbs, but had no recurrence of TD. We attribute the resolution of orofacial dyskinesias with a cervical lesion to the interconnections between the orofacial area and cervical spine via the trigeminal nucleus (which has fibers descending as far caudally as C6), as well as to resetting of cortical maps.