Acute transverse myelitis and Guillain-Barré overlap syndrome with serological evidence for mumps viraemia

Abstract

Both acute transverse myelitis (ATM) and Guillain-Barré syndrome (GBS) occur as rare associations with mumps viraemia but to our knowledge, concurrent ATM and GBS related to mumps has only been reported once previously. We describe the case of a young woman presenting with confusion and collapse 2 weeks after a flu-like illness. An initial diagnosis of transverse myelitis was made on the basis of the clinical findings and radiological evidence of a swollen spinal cord with uniform high signal change on T2 weighted MRI. The patient was treated with intravenous methylprednisolone without significant recovery. The diagnosis was later revised to include GBS on the basis of worsening facial diplegia in the setting of a flaccid tetraparesis, and neurophysiological evidence of a sensorimotor axonal polyradiculoneuropathy. Acute mumps viraemia was confirmed on serological grounds. The patient made an improvement in ventilatory capacity with intravenous immunoglobulin treatment.

Encephalomyelitis following mumps

“…4 We also found three more patients diagnosed as acute transversemyelitis and Guillain-Barre overlap syndrome. 5,6 Discussion Of all patients with mumps parotitis, at most 10% develop clinical meningitis. Much less frequently, mumps may be complicated by acute encephalitis, which is generally mild, without focal signs, and with low mortality and few sequela.…”

“…A still more rare but more severe encephalitic syndrome presenting as a form of immune-mediated postinfectious encephalomyelitis follows an estimated 1 in 6000 cases and develops 7-15 days after parotitis. 5 A high percentage of these patients exhibit seizures, hemiparesis, severe obtundation and a mortality of 10%. 4 While well recognized among children, ATM following mumps in adults has been poorly reported.…”

Campylobacter jejuni-induced acute transverse myelitis

“…Moreover, in some articles ATM is considered as an overlap syndrome with GBS and cases have been described of patients with evidence of both diseases. 16 Remarkably, all patients with Campylobacter-associated acute demyelination survived and, as far as reported, evolution to a good clinical neurological recovery was observed (Table 1). ATM is a rare heterogeneous disorder often associated, however, with poor neurological outcome, that is, persistent paresis.…”

Mumps Associated Acute Motor Axonal Polyneuropathy

“…Asymptomatic pleocytosis is seen in 40-60% patients with mumps parotitis; meningitis in 15% and encephalitis in 0.1% [1,2]. CNS involvement may precede, co-exist or follow parotid swelling.…”

“…It is a rare complication of mumps, only a few cases of Gullian barre syndrome; overlap with transverse myelitis have been reported [2,3]. Isolated cases of cranial nerve palsies including optic, facial, trigeminal and oculomotor nerves have been described.…”