Challenging neurological presentations of varicella virus infections in Sudan: Clinical features, imaging and recommendations

Elsayed, Muaz; Aladil, Omer; El-Sadig, Sara Misbah; Ahmed, Mohamed H.; Noori, Suzan

doi:10.4103/jfmpc.jfmpc_183_19

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…This study reports a case of acute transverse myelitis caused by VZV infection in an adult immunocompetent patient. Several cases of VZV myelitis in adult patients have been described in the literature [11,[14][15][16][17][18][19][20][21]. Some of these cases concerned immunocompetent patients aged 20 to 79 years [14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

“…He was negative on HIV testing with the Middle East were Central Nervous System (CNS) involvements followed by skin diseases, varicella pneumonia, and gastric diseases [9,10]. Previous studies in African setting, notably in Sudan [11], Burkina Faso [12] and Guinea [13] had reported few cases of myelitis, meningoencephalitis and stroke as neurological complications of VZV. In this study, we describe a rare case of transverse myelitis caused by VZV to emphasize the possibility of its occurrence in an immunocompetent subject.…”

Section: Introductionmentioning

confidence: 99%

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Myelitis due to Varicella-Zoster Infection in an Adult Immunocompetent Patient at Yalgado Ouedraogo University Teaching Hospital (Burkina Faso)

Dabilgou¹,

Dao²,

Dravé³

et al. 2021

Int J Trop Dis

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Background: Varicella Zoster Virus (VZV) is a ubiquitous virus and is causing both diseases of varicella and herpes zoster. VZV reactivation may lead to neurological complications, including transverse myelitis. However, transverse myelitis caused by VZV reactivation is rare in immunocompetent patients. Case presentation:We reported a case of transverse myelitis caused by VZV in an immunocompetent young patient. A 42-year-old man was presented to the Neurology department in June 2019 with the complaints of cutaneous rash, lower limbs weakness and anal and urinary incontinence. The neurological manifestations occurred at twelve days after cutaneous rash. Spine MRI showed extensive intramedullary T2 hypersignal of C6 to C7. White blood cell showed hyperleucocytosis. Cerebrospinal fluid (CSF) showed leukocytosis (40 cells/µL) with increased levels of protein (1.134 g/l). CSF culture for bacteria and fungi were negative. The patient was treated with oral acyclovir, corticotherapy and functional rehabilitation. Complete recovery occurred after 4 weeks of treatment.Conclusions: Transverse VZV myelitis in an adult immunocompetent patient following cutaneous rash is extremely rare in our context. Clinical outcome was favorable after recommended dose of acyclovir, corticotherapy and rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Myelitis due to Varicella-Zoster Infection in an Adult Immunocompetent Patient at Yalgado Ouedraogo University Teaching Hospital (Burkina Faso)

Dabilgou¹,

Dao²,

Dravé³

et al. 2021

Int J Trop Dis

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“…Non-surgical causes of BSS are treated conservatively without a need for surgical intervention. They include spinal cord ischemia and infarction, many infectious diseases, such as varicella virus infection, treated with acyclovir and steroid [27,28], and neurodegenerative dis- eases, such as multiple sclerosis. Spinal cord ischemia, usually followed by infarction, occurs due to diminished blood supply to the spinal cord.…”

Section: Overview Of Medically Treatable Etiologies Of Bssmentioning

confidence: 99%

Non-traumatic Causes of Brown-sequard Syndrome: A Case Series and Clinical Update With Systematic Review

2021

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Background and Importance: Brown-Sequard Syndrome (BSS) is a rare neurological condition resulting from a hemisection injury to or unilateral compression on the spinal cord. The common causes of BSS that are amenable to be treated surgically can be divided into traumatic and non-traumatic injuries. Traumatic injuries are often reported as the main cause of BSS. However, non-traumatic injuries of the spinal cord are more seen in recent years. This study aims to classify and update surgically treatable causes of BSS. Case Presentation: Retrospective data of 17 patients operated for BSS between 2008 and 2020 were included. The long-term outcomes of these patients were evaluated. In addition, a comprehensive search in PubMed, Scopus, and CINAHL was conducted for the retrieval of all relevant studies. Results: Magnetic Resonance Image (MRI) of our patients revealed Cervical Disc Herniation (CDH), spinal canal stenosis with cervical spondylosis, epidural hematoma, and ossification of the posterior longitudinal ligament. The postoperative outcomes of our cases ranged from partial to complete recovery. While the patients with acute epidural hemorrhage achieved complete recovery after surgery, neurological deficits in the other patients, especially those with severe cervical spinal canal stenosis, persisted despite adequate surgical decompression. The systematic literature review revealed that CDH is the most common non-traumatic surgically treatable cause of BSS, followed by spinal cord herniation and spinal epidural hematoma. Conclusion: Non-traumatic injuries of the spinal cord accompanied by narrowed cervical spinal canal pathologies are prominent surgically treatable causes of BSS. Contrary to the definition made 100 years ago, BSS can occur spontaneously due to underlying pathologies rather than major traumatic injuries.

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Idiopathic myelitis presenting as Brown-Séquard syndrome: two case reports and a review of the literature

Peng

Wang

2021

J Med Case Reports

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Background Brown-Séquard syndrome often occurs in spinal cord injury, and few myelitis patients present with Brown-Séquard syndrome. Case presentation A 33-year-old Han man was admitted with neck pain plus numbness in the right limbs for 2 days and weakness in the left limbs for 1 day. Examination was significant for left limbs with grade 4 muscle power, positive left Babinski sign, diminished vibration sensation in the left limbs and decreased pain below the right clavicle dermatome. The cerebrospinal fluid (CSF) cell count was 24 × 106/L, and the protein count was 185 mg/L. Cervical magnetic resonance imaging (MRI) indicated abnormal swelling signals in the medulla-cervical cord long segment and enhanced signals in the C2-3 region. In the second case, a 47-year-old Han woman was admitted with weakness in the right lower limb and numbness in the left lower limb for more than 20 days. Examination was significant for the right lower limb with grade 4 muscle power, left knee hyperreflexia, positive left Babinski sign, diminished vibration sensation in the right lower limb and decreased pain below the right T2 dermatome. Cervical MRI indicated hyperintense and enhanced signals in the C7-T2 region. In these two cases, CSF culture, oligoclonal band (OB) and aquaporin 4 (AQP4) antibody were negative. Brain MRI was normal. Their symptoms and MRI results improved after treatment with methylprednisolone. Conclusions Myelitis can present as Brown-Séquard syndrome, providing an extended reference in terms of the differential diagnosis for clinical physicians.

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Challenging neurological presentations of varicella virus infections in Sudan: Clinical features, imaging and recommendations

Cited by 3 publications

References 10 publications

Myelitis due to Varicella-Zoster Infection in an Adult Immunocompetent Patient at Yalgado Ouedraogo University Teaching Hospital (Burkina Faso)

Myelitis due to Varicella-Zoster Infection in an Adult Immunocompetent Patient at Yalgado Ouedraogo University Teaching Hospital (Burkina Faso)

Non-traumatic Causes of Brown-sequard Syndrome: A Case Series and Clinical Update With Systematic Review

Idiopathic myelitis presenting as Brown-Séquard syndrome: two case reports and a review of the literature

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