Background: Varicella zoster virus [VZV] is a latent virus that can remain in the central nervous system. Reactivation of the virus can cause some neurologic manifestations, and myelitis is one of the rarest of them. In this report, we aimed to present the MRI features of long-segment cervical myelitis after VZV infection, which is rarely reported in the literature. Case Presentation: A 69-year-old patient, who was diagnosed with varicella zoster two months ago and treated with valacyclovir, was admitted to our clinic with worsening of his complaints and weakness in the right upper extremity. Neurological examination was normal in the left upper and bilateral lower extremities but the muscle strength in the right upper extremity was evaluated as 4/5 grade. While rare leukocytes [10 leukocytes/mm³, 50 erythrocytes/mm³, high protein level [46 mg/dl, ref.15-40 mg/dl]] were seen in the cerebrospinal fluid [CSF] analysis, no microorganisms were seen, and no growth was observed in the culture. VZV antibody-immunoglobulin G [Ab-IgG] was positive in CSF while polymerase chain reaction [PCR] for VZV was negative. On cervical MRI, lesions showing T2 hyperintensity were observed from the C3-4 level to the C7-T1 level, eccentrically located in the right paramedian spinal cord. On post contrast images, patchy heterogeneous contrast enhancement was noted in these regions of the spinal cord. When the patient's history, CSF features and MRI examinations were evaluated together, the lesions were consistent with VZV myelitis. The patient was started on valacyclovir treatment, and during the follow-up, the patient's complaints decreased, while no progress was observed in neurologic symptoms. Conclusion: As a result, we aimed to report the MRI features of this rare complication of varicella zoster and emphasize the necessity of keeping this in mind in the etiology myelitis, especially in cases with patchy enhancement, to achieve early diagnosis and treatment.
Objectives: The aim of this study is to investigate whether white matter (WM) integrity is impaired in vitamin B12 and folate deficiency with Diffusion Tensor Imaging (DTI) in older patients. Methods: All the patients aged ≥65 years admitted to the geriatric clinic and performed DTI-MRI were included in the study. DTI parameters (fractional anisotropy, ADC, axial diffusivity, radial diffusivity) were calculated by ROI-based method in white matter tracts. Deficiency threshold for vitamin B12 were defined as <200 pg ml−1, and <400 pg ml−1 separately; and for folate as <3 ng ml−1, and <6 ng ml−1, separately. Results: DTI was performed to older patients having serum vitamin B12 level (n = 106, mean age = 80.7±7.7, 66% female) and folate level (n = 101, mean age = 80.7±7.5, 67.3% female). Significantly lower FA and higher ADC and RD levels were observed in multiple WM areas including superior and middle cerebellar peduncles, cingulum and genu of corpus callosum in patients with vitamin B12 <400 pg ml−1 (p < 0.05). DTI indices also showed significant changes in the genu of corpus callosum, and right and left superior longitudinal fasciculus in patients with folate <6 ng ml−1 (p < 0.05). Conclusions: Deficiencies of vitamin B12 and folate may be associated with impaired white matter integrity in elderly even at high laboratory levels, and DTI is a useful method to detect it. Advances in knowledge: Early detection of impaired WM integrity caused by micronutrient deficiencies poses a great significance in terms of prevention and intervention, and DTI is an effective non-invasive method to be used for this purpose.
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