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Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation

Japanese encephalitis, an inflammatory brain disease prevalent in Southeast Asia, usually presented with fever, headache, convulsions, brain stem signs with pyramidal and extrapyramidal features, and altered sensorium. Acute transverse myelitis, as the initial manifestation of Japanese encephalitis,...

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Autores principales: Ankur Nandan, Varshney, Nilesh, Kumar, Dibyaranjan, Behera, Ashutosh, Tiwari, Ravi, Anand, Arvind, Anand
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621150/
https://www.ncbi.nlm.nih.gov/pubmed/23585973
http://dx.doi.org/10.1155/2013/487659
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author Ankur Nandan, Varshney
Nilesh, Kumar
Dibyaranjan, Behera
Ashutosh, Tiwari
Ravi, Anand
Arvind, Anand
author_facet Ankur Nandan, Varshney
Nilesh, Kumar
Dibyaranjan, Behera
Ashutosh, Tiwari
Ravi, Anand
Arvind, Anand
author_sort Ankur Nandan, Varshney
collection PubMed
description Japanese encephalitis, an inflammatory brain disease prevalent in Southeast Asia, usually presented with fever, headache, convulsions, brain stem signs with pyramidal and extrapyramidal features, and altered sensorium. Acute transverse myelitis, as the initial manifestation of Japanese encephalitis, is an unusual manifestation and is seldom reported. We hereby report a case of 13-year-old adolescent boy who presented to us with fever and acute onset paraparesis with urinary retention initially, progressing to quadriparesis and then followed by headache and altered sensorium. Brain MRI revealed bilateral basal ganglia that were grossly swollen with vasogenic edema tracking along internal capsule and midbrain. Adjacent ventrolateral thalamus and internal capsule also showed mild abnormal intensities. Spinal screening showed abnormal cord intensities in entire cord with gross edema in cervical and conus regions. He had elevated IgM titres against JE virus in cerebrospinal fluid. The patient was treated conservatively along with intravenous methyl prednisolone for 5 days. He regained near normal power at 3 months in followup, but hesitancy, dysarthria, and slowness of movement still persisted. To conclude, a young boy presenting with ATM in an endemic region of JE, then a possibility of Japanese encephalitis, should be sought by clinicians as early use of immunomodulator shows survival benefit.
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spelling pubmed-36211502013-04-12 Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation Ankur Nandan, Varshney Nilesh, Kumar Dibyaranjan, Behera Ashutosh, Tiwari Ravi, Anand Arvind, Anand Case Rep Infect Dis Case Report Japanese encephalitis, an inflammatory brain disease prevalent in Southeast Asia, usually presented with fever, headache, convulsions, brain stem signs with pyramidal and extrapyramidal features, and altered sensorium. Acute transverse myelitis, as the initial manifestation of Japanese encephalitis, is an unusual manifestation and is seldom reported. We hereby report a case of 13-year-old adolescent boy who presented to us with fever and acute onset paraparesis with urinary retention initially, progressing to quadriparesis and then followed by headache and altered sensorium. Brain MRI revealed bilateral basal ganglia that were grossly swollen with vasogenic edema tracking along internal capsule and midbrain. Adjacent ventrolateral thalamus and internal capsule also showed mild abnormal intensities. Spinal screening showed abnormal cord intensities in entire cord with gross edema in cervical and conus regions. He had elevated IgM titres against JE virus in cerebrospinal fluid. The patient was treated conservatively along with intravenous methyl prednisolone for 5 days. He regained near normal power at 3 months in followup, but hesitancy, dysarthria, and slowness of movement still persisted. To conclude, a young boy presenting with ATM in an endemic region of JE, then a possibility of Japanese encephalitis, should be sought by clinicians as early use of immunomodulator shows survival benefit. Hindawi Publishing Corporation 2013 2013-03-25 /pmc/articles/PMC3621150/ /pubmed/23585973 http://dx.doi.org/10.1155/2013/487659 Text en Copyright © 2013 Varshney Ankur Nandan et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Ankur Nandan, Varshney
Nilesh, Kumar
Dibyaranjan, Behera
Ashutosh, Tiwari
Ravi, Anand
Arvind, Anand
Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation
title Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation
title_full Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation
title_fullStr Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation
title_full_unstemmed Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation
title_short Acute Transverse Myelitis (Ascending Myelitis) as the Initial Manifestation of Japanese Encephalitis: A Rare Presentation
title_sort acute transverse myelitis (ascending myelitis) as the initial manifestation of japanese encephalitis: a rare presentation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621150/
https://www.ncbi.nlm.nih.gov/pubmed/23585973
http://dx.doi.org/10.1155/2013/487659
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