Neuromyelitis optica (NMO) is an inflammatory-demyelinating disease of the central nervous system classically characterized by optic neuritis and severe myelitis. New diagnostic criteria defined neuromyelitis optica spectrum disorder as limited forms of NMO or diverse neurologic presentations in the presence of specific antiaquaporin-4 antibodies. We report the case of a 57-year-old woman admitted in our department for recurrent attacks of optic neuritis, tetraparesis with severe painful tonic spasms of the left limbs and brainstem involvement. Painful tonic spasms have been described as movement disorders associated with multiple sclerosis, but a growing number of reports describe them in cases of NMO.
Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique, which removes large molecular weight particles such as autoantibodies from plasma. TPE is accepted by the American Society for Apheresis as first line treatment for some severe neuroimmune disorders. Double filtration plasmapheresis (DFPP) is a newer technique in which plasma is not entirely removed, only the antibodies, using special filters. High-dose intravenous immunoglobulins are an alternative treatment for these patients but are much more expensive. We reviewed medical records of 20 patients with severe neurological diseases requiring TPE or DFPP. We analyzed the indications, complications and efficacy of these procedures. After completing the procedures, neurological improvement was recorded in 80% of the patients, 5% had no improvement, and the mortality was 15%. The rate of neurological improvement was similar to other studies. None of the patients presented catheter related complications. Systemic complications were mild, transient and completely reversible.
Guillain-Barre syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide, having an incidence of about 1/100,000 across several studies in a number of countries. We present the case of a 60-year-old female patient, with known hypertension, admitted to our department for paresthesia and muscle weakness predominantly in the distal upper and lower limbs. Symptomatology had an acute onset after 14 days from influenza vaccine administration. Lumbar puncture revealed CSF glucose (91 mg/dl), CSF protein (0.508 g/l) and no pleocytosis. Electromyography supported the presumptive diagnosis of polyradiculoneuritis. The patient underwent three sessions of double filtration and the final diagnosis was Guillain-Barre polyradiculoneuritis secondary to influenza vaccination. Approximately 80% of patients with polyradiculoneuritis recover completely within a few months to one year; however, 5-10% of these patients experience one or more recurrences. It should be emphasized that acute-phase rehabilitation must start immediately and include an individualized program of gentle strengthening, and manual resistive and progressive resistive exercises.
Key words: polyradiculoneuropathy, influenza vaccine, neurorehabilitation,
Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique which removes large molecular weight particles, like autoantibodies, from plasma. Double filtration plasmapheresis (DFPP) is a newer technique in which plasma is not entirely removed, only the antibodies, using special filters. Myasthenia gravis (MG) is a well-known autoimmune disease characterized by antibodies against postsynaptic nicotinic acetylcholine receptors and fluctuating weakness, sometimes life-threatening. TPE is a therapeutic modality well established in MG with a positive recommendation based on strong consensus of class III evidence and in the category I of American society for apheresis. There are no adequate randomized control trial, but many cases report short-term benefit from plasma exchange in MG especially MGC. We analyzed the cases of neuroimmune disorders that were presented to our Emergency Care Unit between 2012-2020 and we concluded that good acceptance of procedure (TPE/DFPP) was observed in 72% of patients. TPE is cost-effective rapid therapy for myasthenic crisis and progressive myasthenia gravis. It reduces ICU stays and improves outcome.All in all recent studies show that the combination of rehabilitation and other forms of treatment, appropriately selected activities contribute to alleviating the symptoms of the disease, improving physical fitness, increasing muscle strength, and thus improving the quality of life.
Keywords: therapeutic plasma exchange, plasmapheresis, neuroimmune disorders,rehabilitation,
Noticeable advances have occurred in the field of traumatic brain injury in the past ten years. Brain imagery provides a more precise representation of what occurs in the brain, diffuse axonal injury being an important cause of morbidity and mortality in patients with traumatic brain injury. We present 2 cases that were admitted and discharged from our department. Actually we want to emphasize differences and similarities between the two cases and to highlight different sequelae that traumatic brain injury can do in young patients. Both patients were admitted in a critical state – GCS 4 points and were discharged with an improved neurological status after approximately 30 days. We decided to present these cases to issue a warning about the rehabilitation for these patients which most of the times have a prolonged hospitalization. We wanted to highlight that the rehabilitation does not consist only in the motor part, but in the psychiatric and behaviour part too.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.