Ann Rehabil Med.  2015 Feb;39(1):142-145. 10.5535/arm.2015.39.1.142.

Concomitant Acute Transverse Myelitis and Sensory Motor Axonal Polyneuropathy in Two Children: Two Case Reports

• Chung H
• Joa KL
• Kim HS
• Kim CH
• Jung HY
• Kim MO

• KMID: 2273032
• DOI: http://doi.org/10.5535/arm.2015.39.1.142

Abstract

Acute transverse myelitis (ATM) is an upper motor neuron disease of the spinal cord, and concomitant association of peripheral polyneuropathy, particularly the axonal type, is rarely reported in children. Our cases presented with ATM complicated with axonal type polyneuropathy. Axonal type polyneuropathy may be caused by acute motor-sensory axonal neuropathy (AMSAN) or critical illness polyneuropathy and myopathy (CIPNM). These cases emphasize the need for nerve and muscle biopsies to make the differential diagnosis between AMSAN and CIPNM in patients with ATM complicated with axonal polyneuropathy.

Keyword

Acute transverse myelitis; Acute motor-sensory axonal polyneuropathy; Critical illness polyneuropathy; Critical illness myopathy

MeSH Terms

Axons*
Biopsy
Child*
Diagnosis, Differential
Humans
Motor Neuron Disease
Muscular Diseases
Myelitis, Transverse*
Polyneuropathies*
Spinal Cord

Figure

• 

  Fig. 1 Magnetic resonance images (MRI) of the cervical spine in case 1. (A) Sagittal section spinal MRI (post-gadolinium) reveals a high signal between C2 and the upper thoracic cord. (B) Transverse T2-weighted MRI at the C4 cord level indicates cord edema.

• 

  Fig. 2 Magnetic resonance images (MRI) of the cervical spine in case 2. (A) Sagittal section of spinal MRI (post-gadolinium) reveals a high signal between C5 and C7. (B) Transverse T2-weighted MRI at C6 indicates cord edema.

Reference

1. Berman M, Feldman S, Alter M, Zilber N, Kahana E. Acute transverse myelitis: incidence and etiologic considerations. Neurology. 1981; 31:966–971. PMID: 7196523.

2. Kaplin AI, Krishnan C, Deshpande DM, Pardo CA, Kerr DA. Diagnosis and management of acute myelopathies. Neurologist. 2005; 11:2–18. PMID: 15631640.

3. Griffin JW, Li CY, Ho TW, Xue P, Macko C, Gao CY, et al. Guillain-Barre syndrome in northern China: the spectrum of neuropathological changes in clinically defined cases. Brain. 1995; 118(Pt 3):577–595. PMID: 7600080.

4. Howell KB, Wanigasinghe J, Leventer RJ, Ryan MM. Concomitant transverse myelitis and acute motor axonal neuropathy in an adolescent. Pediatr Neurol. 2007; 37:378–381. PMID: 17950429.

5. Yuki N, Ang CW, Koga M, Jacobs BC, van Doorn PA, Hirata K, et al. Clinical features and response to treatment in Guillain-Barre syndrome associated with antibodies to GM1b ganglioside. Ann Neurol. 2000; 47:314–321. PMID: 10716250.

6. Adamovic T, Willems A, Vanasse M, D'Anjou G, Robitaille Y, Litalien C, et al. Critical illness polyneuromyopathy in a child with severe demyelinating myelitis. J Child Neurol. 2009; 24:758–762. PMID: 19264734.

7. de Letter MA, Visser LH, van der Meche FG, Ang W, Savelkoul HF. Distinctions between critical illness polyneuropathy and axonal Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 2000; 68:397–398. PMID: 10787316.

8. Yuki N, Hirata K. Relation between critical illness polyneuropathy and axonal Guillain-Barre syndrome. J Neurol Neurosurg Psychiatry. 1999; 67:128–129. PMID: 10454879.

9. de Seze J, Lanctin C, Lebrun C, Malikova I, Papeix C, Wiertlewski S, et al. Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology. 2005; 65:1950–1953. PMID: 16380618.

10. Visser LH. Critical illness polyneuropathy and myopathy: clinical features, risk factors and prognosis. Eur J Neurol. 2006; 13:1203–1212. PMID: 17038033.