International Journal of Clinical and Experimental Neurology
ISSN (Print): 2379-7789 ISSN (Online): 2379-7797 Website: http://www.sciepub.com/journal/ijcen Editor-in-chief: Zhiyou Cai, MD
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International Journal of Clinical and Experimental Neurology. 2013, 1(1), 1-4
DOI: 10.12691/ijcen-1-1-1
Open AccessCase Report

Acute Disturbance of Consciousness as the First Clinical Manifestation of an Elderly Patient with Acute Transverse Myelitis

Feng Li1, Ran Chen1 and Zhiyou Cai1,

1Department of Neurology, the Lu’an Affiliated Hospital of Anhui Medical University, Lu’an People’s Hospital, Anhui Province, China

Pub. Date: November 06, 2013

Cite this paper:
Feng Li, Ran Chen and Zhiyou Cai. Acute Disturbance of Consciousness as the First Clinical Manifestation of an Elderly Patient with Acute Transverse Myelitis. International Journal of Clinical and Experimental Neurology. 2013; 1(1):1-4. doi: 10.12691/ijcen-1-1-1

Abstract

Acute transverse myelitis (ATM) is a rare entity in the elderly. This case report summarizes the clinical features and treatment of an elderly patient with ATM. The aim is to be expected to benefit the diagnosis and treatment of ATM in the elderly. A 68-year-old mail presented with a 5-hour history of acute loss of consciousness and high fever for one day. The examination showed that pin sensation disappeared below the level of the 8th thoracic spinal segment. The patient had paraplegia, muscle hypotonia, urinary incontinence and the disappearance of limb tendon reflexes. Magnetic resonance image (MRI) scan showed extensive increased T2 signal in the spinal cord from medulla oblongata to the first thoracic spine level. The combination treatment was used with 500mg methylprednisone and immunoglobulin (1g/kg) intravenously. On the10 days of hospitalization, the muscle strength of limbs was significantly improved. Methylprednisone was taken orally for one month (80 mg/d) and the amount of oral medications was gradually reduced, maintaining for two months after hospital discharge. After three months from hospital discharge, the patient could walk independently and had no sensory disturbances and urinary incontinence. This case highlights the rare presentation of an elderly patient with ATM which experienced acute disturbance of consciousness as the first clinical manifestation. This case also highlights that the prognosis is better under the acute ATM occurrence in the elderly if treated timely.

Keywords:
acute transverse myelitis elderly disturbance of consciousness

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References:

[1]  Hsu MC, Hung MH, Chen JS, Cheng YJ: Acute transverse myelitis after thoracic epidural anesthesia and analgesia: Should anesthesia and analgesia be blamed? Acta Anaesthesiol Taiwan 2013, 51(1):37-39.
 
[2]  West TW, Hess C, Cree BA: Acute transverse myelitis: demyelinating, inflammatory, and infectious myelopathies. Semin Neurol 2012, 32(2):97-113.
 
[3]  Verma R, Praharaj HN, Patil TB, Giri P: Acute transverse myelitis following Japanese encephalitis viral infection: an uncommon complication of a common disease. BMJ Case Rep 2012, 2012.
 
[4]  Pourhassan A, Shoja MM, Tubbs RS, Sadeghilar A, Kerr D: Acute transverse myelitis secondary to Salmonella paratyphi B infection. Infection 2008, 36(2):170-173.
 
[5]  Schulz SW, Shenin M, Mehta A, Kebede A, Fluerant M, Derk CT: Initial presentation of acute transverse myelitis in systemic lupus erythematosus: demographics, diagnosis, management and comparison to idiopathic cases. Rheumatol Int 2012, 32(9):2623- 2627.
 
[6]  Bourre B, Zephir H, Ongagna JC, Cordonnier C, Collongues N, Debette S, Fleury MC, Outteryck O, Hannequin D, Vermersch P et al: Long-term follow-up of acute partial transverse myelitis. Arch Neurol 2012, 69(3):357-362.
 
[7]  Perumal J, Zabad R, Caon C, MacKenzie M, Tselis A, Bao F, Latif Z, Zak I, Lisak R, Khan O: Acute transverse myelitis with normal brain MRI : long-term risk of MS. J Neurol 2008, 255(1):89-93.
 
[8]  Patel V, Griffith NC, Blackwood E, Dias M, Cordato DJ: Spectrum disorder of neuromyelitis optica in a patient presenting with intractable vomiting and hiccups, transverse myelitis and acute encephalopathy. J Clin Neurosci 2012, 19(11):1576-1578.
 
[9]  Rath JJ, Ronday HK, Wirtz PW: Acute transverse myelitis in psoriatic arthritis. J Neurol 2010, 257(3):457-458.
 
[10]  Bigi S, Aebi C, Nauer C, Bigler S, Steinlin M: Acute transverse myelitis in Lyme neuroborreliosis. Infection 2010, 38(5):413-416.
 
[11]  Sato N, Watanabe K, Ohta K, Tanaka H: Acute transverse myelitis and acute motor axonal neuropathy developed after vaccinations against seasonal and 2009 A/H1N1 influenza. Intern Med 2011, 50(5):503-507.
 
[12]  Korn-Lubetzki I, Dano M, Raveh D: H1N1 vaccine-related acute transverse myelitis. Isr Med Assoc J 2011, 13(4):249-250.
 
[13]  Wolf K, Schmitt-Mechelke T, Kollias S, Curt A: Acute necrotizing encephalopathy (ANE1): rare autosomal-dominant disorder presenting as acute transverse myelitis. J Neurol 2013, 260(6):1545-1553.
 
[14]  Bhat A, Naguwa S, Cheema G, Gershwin ME: The epidemiology of transverse myelitis. Autoimmun Rev 2010, 9(5):A395-399.
 
[15]  Pohl D: Epidemiology, immunopathogenesis and management of pediatric central nervous system inflammatory demyelinating conditions. Curr Opin Neurol 2008, 21(3):366-372.
 
[16]  Berman M, Feldman S, Alter M, Zilber N, Kahana E: Acute transverse myelitis: incidence and etiologic considerations. Neurology 1981, 31(8):966-971.
 
[17]  Jeffery DR, Mandler RN, Davis LE: Transverse myelitis. Retrospective analysis of 33 cases, with differentiation of cases associated with multiple sclerosis and parainfectious events. Arch Neurol 1993, 50(5):532-535.
 
[18]  Young J, Quinn S, Hurrell M, Taylor B: Clinically isolated acute transverse myelitis: prognostic features and incidence. Mult Scler 2009, 15(11):1295-1302.
 
[19]  Wolf VL, Lupo PJ, Lotze TE: Pediatric acute transverse myelitis overview and differential diagnosis. J Child Neurol 2012, 27(11):1426-1436.
 
[20]  Pidcock FS, Krishnan C, Crawford TO, Salorio CF, Trovato M, Kerr DA: Acute transverse myelitis in childhood: center-based analysis of 47 cases. Neurology 2007, 68(18):1474-1480.
 
[21]  Masood SA, Ibrahim S: Acute transverse myelitis in children. J Ayub Med Coll Abbottabad 2006, 18(2):90-92.
 
[22]  Hobaika AB, Cancado CL, Dettogni PL, Guedes VC: Hysterical paraplegia simulating acute transverse myelitis after general anesthesia. Acta Anaesthesiol Scand 2008, 52(3):449-450.
 
[23]  Royo MV, Canales CL, Moreno FG, Hernandez AM, Condon PV: [Urinary retention in immunocompetent patient: acute transverse myelitis]. An Sist Sanit Navar 2011, 34(3):523-526.
 
[24]  Yamada T, Ogura T, Masue N, Nishino Y, Takahashi Y, Ishihara S, Deguchi T: [Acute transverse myelitis with urinary retention due to mycoplasma pneumoniae infection: a case report]. Hinyokika Kiyo 2003, 49(7):393-396.
 
[25]  Nakajima M: [Descending control of quiet standing and walking: a plausible neurophysiological basis of falls in elderly people]. Brain Nerve 2011, 63(3):233-239.
 
[26]  Hubbard RE, Woodhouse KW: Frailty, inflammation and the elderly. Biogerontology 2010, 11(5):635-641.
 
[27]  Stevenson J: When the trauma patient is elderly. J Perianesth Nurs 2004, 19(6):392-400.
 
[28]  Alvarenga MP, Alvarenga RM, Santos AM, Thuler LC: Anti-AQP(4) antibody in idiopathic acute transverse myelitis with recurrent clinical course: frequency of positivity and influence in prognosis. J Spinal Cord Med 2012, 35(4):251-255.
 
[29]  Miyazawa R, Ikeuchi Y, Tomomasa T, Ushiku H, Ogawa T, Morikawa A: Determinants of prognosis of acute transverse myelitis in children. Pediatr Int 2003, 45(5):512-516.