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Longitudinal extensive transverse myelitis with cervical epidural haematoma following dengue virus infection.
Eur J Paediatr Neurol. 2016 May; 20(3):449-53.EJ

Abstract

BACKGROUND

Longitudinal extensive transverse myelitis associated with dengue infection is rare with no reported paediatric cases.

METHODS

We report a 12-year-old girl who presented with flaccid quadriplegia 8 days after onset of acute dengue fever. MRI spine showed T2 hyperintensity associated with epidural hematoma at C3-C6 level of the spinal cord. Transcranial magnetic brain stimulation revealed absent motor evoked potentials bilaterally. We also summarise and compare the reported cases of transverse myelitis associated with dengue infection.

RESULTS

Immunomodulatory treatment was given which included pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis. Six months post-admission, there was a good (near-complete) clinical recovery with the repeat MRI showing mild residual hyperintensity at C4 level and complete resolution of epidural haematoma.

CONCLUSION

This is the first reported paediatric case of longitudinal extensive transverse myelitis following dengue infection. It is also the first to illustrate that in patients with concomitant epidural haematoma a good outcome is possible despite not having surgical decompression. Clinicians should be aware of parainfectious dengue-related longitudinal extensive transverse myelitis in children and consider prompt immunomodulatory treatment.

Authors+Show Affiliations

Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia. Electronic address: cyfong@ummc.edu.my.Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia; Paediatric Neurology Unit, Yangon Children's Hospital, Yangon, Myanmar.Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.Department of Biomedical Imaging, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.Division of Neurology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.Division of Paediatric Neurology, Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

26900103

Citation

Fong, Choong Yi, et al. "Longitudinal Extensive Transverse Myelitis With Cervical Epidural Haematoma Following Dengue Virus Infection." European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society, vol. 20, no. 3, 2016, pp. 449-53.
Fong CY, Hlaing CS, Tay CG, et al. Longitudinal extensive transverse myelitis with cervical epidural haematoma following dengue virus infection. Eur J Paediatr Neurol. 2016;20(3):449-53.
Fong, C. Y., Hlaing, C. S., Tay, C. G., Kadir, K. A., Goh, K. J., & Ong, L. C. (2016). Longitudinal extensive transverse myelitis with cervical epidural haematoma following dengue virus infection. European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society, 20(3), 449-53. https://doi.org/10.1016/j.ejpn.2016.01.012
Fong CY, et al. Longitudinal Extensive Transverse Myelitis With Cervical Epidural Haematoma Following Dengue Virus Infection. Eur J Paediatr Neurol. 2016;20(3):449-53. PubMed PMID: 26900103.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Longitudinal extensive transverse myelitis with cervical epidural haematoma following dengue virus infection. AU - Fong,Choong Yi, AU - Hlaing,Chaw Su, AU - Tay,Chee Geap, AU - Kadir,Khairul Azmi Abdul, AU - Goh,Khean Jin, AU - Ong,Lai Choo, Y1 - 2016/02/08/ PY - 2015/01/11/received PY - 2015/10/12/revised PY - 2016/01/24/accepted PY - 2016/2/23/entrez PY - 2016/2/24/pubmed PY - 2016/12/15/medline KW - Demyelination KW - Dengue KW - Paediatric KW - Spinal cord KW - Transverse myelitis SP - 449 EP - 53 JF - European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society JO - Eur. J. Paediatr. Neurol. VL - 20 IS - 3 N2 - BACKGROUND: Longitudinal extensive transverse myelitis associated with dengue infection is rare with no reported paediatric cases. METHODS: We report a 12-year-old girl who presented with flaccid quadriplegia 8 days after onset of acute dengue fever. MRI spine showed T2 hyperintensity associated with epidural hematoma at C3-C6 level of the spinal cord. Transcranial magnetic brain stimulation revealed absent motor evoked potentials bilaterally. We also summarise and compare the reported cases of transverse myelitis associated with dengue infection. RESULTS: Immunomodulatory treatment was given which included pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis. Six months post-admission, there was a good (near-complete) clinical recovery with the repeat MRI showing mild residual hyperintensity at C4 level and complete resolution of epidural haematoma. CONCLUSION: This is the first reported paediatric case of longitudinal extensive transverse myelitis following dengue infection. It is also the first to illustrate that in patients with concomitant epidural haematoma a good outcome is possible despite not having surgical decompression. Clinicians should be aware of parainfectious dengue-related longitudinal extensive transverse myelitis in children and consider prompt immunomodulatory treatment. SN - 1532-2130 UR - https://www.unboundmedicine.com/medline/citation/26900103/Longitudinal_extensive_transverse_myelitis_with_cervical_epidural_haematoma_following_dengue_virus_infection_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1090-3798(16)00032-5 DB - PRIME DP - Unbound Medicine ER -