ObjectiveTo describe a case of sarcoma associated with NMOSD presenting with myeloradiculitis.BackgroundNeuromyelitis optica is a demyelinating disease of the CNS that predominantly affects the spinal cord and optic nerves. Reports of NMOSD occurring in the setting of cancer suggest that aquaporin-4 autoimmunity may have a paraneoplastic basis. Here, we describe a patient with metastatic sarcoma who tested positive for aquaporin-4 IgG consistent with NMOSD.Design/Methods66-year-old man with left thigh soft tissue sarcoma with metastasis to the lungs admitted for 2-day history of urinary retention. Neurological exam showed bilateral lower extremity weakness, with decreased patellar reflexes. MRI spine showed cord swelling with enhancement from C6 downwards into the thoracic spine with associated syringohydromyelia and diffuse enhancement of the cauda equina. MRI brain was normal without abnormal enhancement in the optic nerves. CSF analysis demonstrated elevated protein and 0 oligoclonal bands. Was started on methylprednisolone 1 gram daily for 5 days empirically for transverse myelitis. Extensive serum and CSF workup for other causes of myelopathy including rheumatologic, infectious, and nutritional etiologies were unremarkable until NMO IgG antibody came back positive at 1:10000 titer. He had minimal clinical improvement after methylprednisolone course and so was started on plasmapheresis for five days. His weakness improved slightly but continued to have urinary retention. Discharged to a long-term acute care facility on prednisone 60 mg daily with intermittent bladder catheterization and plan for follow-up with Neuroimmunology.ResultsNA.ConclusionsMyeloradiculitis has been reported with anti-MOG disease but is not a typical finding for NMO. We report this case to highlight this unusual finding. In addition, sarcoma is an uncommon cause of paraneoplastic syndromes and to our knowledge, this is the first report of sarcoma being associated with paraneoplastic NMOSD.
Transverse myelitis (TM) is an inflammatory syndrome of the spinal cord that presents with acute-to-subacute neurological deficits. The differential for TM is broad and includes demyelinating, infectious, neoplastic and paraneoplastic, autoimmune, and metabolic/toxic etiologies. With the novel severe acute respiratory syndrome coronavirus pandemic, more commonly referred to as the coronavirus infectious disease of 2019 (COVID-19), there have been increasing reports of neurological complications. In this case report, we describe a novel case of longitudinally-extensive TM associated with the Moderna vaccination.
Introduction:
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high in-patient mortality and with long-term cognitive deficits among survivors. With widespread adoption of standard neurocritical care practice in-hospital mortality has decreased while long-term cognitive impairment (CI) among survivors is not well characterized.
Hypothesis:
To investigate whether temporal change in practice has resulted in improvement in long-term CI.
Methods:
Single-center retrospective chart review of aSAH patients admitted to a comprehensive stroke center between January 2012 and December 2016, were identified from a prospective database. Cognitive status was evaluated between January and December 2018 using Telephone Interview of Cognitive Status (TICS). The study cohort was divided into two 2.5 year periods and TICS score of >32, 28-32 and <28 were classified as normal cognitive function, mild and moderate-to-severe CI respectively. The median TICS scores by groups were examined by Wilcoxon or Kruskal-Wallace tests. Categorical variables compared using Chi-squared or Fisher’s exact tests.
Results:
252 patients were admitted during the study period of which 46 patients could be reached and consented to participate in TICS. Median TICS score was lower in earlier study period compared to later period [31.5 (IQR 22, 36) vs. 33 (IQR 27, 38), p=0.038]. Similarly, TICS score <28 was seen more often in earlier period as compared to later period [7/22 (6%) vs. 1/24 (0.7%), p=0.044]. Patient who were smokers and had hyperlipidemia had lower TICS score compared to other groups in multivariate model (p=0.007). We found no statistical association between duration of time between discharge date and date of cognitive assessment and TICS groups (Kruskal-Wallace test; p-value=0.074). However, if we treat TICS as a continuous variable in a linear model we observed a significant association between time elapsed and overall TICS score (p=0.0197). For every month increase, there is a decrease in overall TICS by 0.09.
Conclusion:
Smoking and hyperlipidemia are identified as risk factors for CI among aSAH survivors alluding to a role of vascular pathogenesis. Progressive CI over time might justify long-term cognitive rehabilitation in this population of patients.
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