Recurrent longitudinally extensive transversal myelitis in a patient with Sjögren’s syndrome

Introduction. Longitudinally extensive transverse myelitis (LETM) is a transversal myelitis that extends through three or more vertebral segments in length. Case report. A 52- year-old woman was hospitalized due to pain in the lumbar region, difficulty in walking, hypoesthesia of the anogenital area and urinary retention. In the past medical history, two years earlier, the patient had been diagnosed with transversal myelitis confirmed by MRI of the cervical spine and six months earlier, the patient was diagnosed with primary Sjögren’s syndrome (SS). During the current hospitalization MRI of the spinal cord revealed extensive inflammatory lesions of almost the whole spinal cord. Lumbar puncture (LP) revealed mild pleocytosis and slightly increased protein level. Isoelectric focusing of cerebrospinal fluid (CSF) and serum proteins was normal. Visual evoked potentials were normal. Serological testing excluded acute viral infections. Corticosteroid therapy was applied with good therapeutic response. Control MRI revealed regression of pathological changes in the spinal cord. Conclusion. A wide range of disorders can cause LETM, but usually the first line diagnosis is neuromyelitis optica (NMO). Based on the detection of NMO immunoglobulin G in the serum of affected patients, a variety of allied disorders were grouped under the name of NMO spectrum disorders, including recurrent myelitis associated with LETM and myelitis associated with autoimmune disorders such as SS. There have been only a few cases reported in the literature with recurrent LETM associated with non-organ specific autoimmune disorder

Reokluzija bazilarne arterije u prvih 24 sata nakon mehaničke trombektomije, uspješno liječena ponovljenom intervencijom

Acute basilar artery occlusion (BAO) may cause ischemia in the region of brainstem, parts of the thalamus, occipital lobes, and cerebellum, resulting in severe disability or mortality rate above 70%. Recurrent BAO has been described in only a small number of cases. We present a case of repeated mechanical thrombectomy (MT) for the tip of basilar artery (BA) reocclusion within 24 hours. A previously healthy 37-year-old male presented with occipital headache, nausea, vomiting, right-sided hemiparesis, within 30 minutes from the onset and NIHSS 18. The patient was vaccinated against COVID-19 with Pfizer-BioNTech vaccine seven days before the onset. On initial computed tomography (CT) scan, the pc-ASPECTS was 10 and CT angiography (CTA) showed the tip of BA thrombosis. Intravenous thrombolytic therapy was administered, followed by MT, achieving mTICI 3 and NIHSS 5 after the procedure. Within 24 hours from the first MT, there was neurological deterioration followed by coma. Urgent CT/CTA was performed and rethrombosis of BA was confirmed with pc-ASPECTS 10. MT was repeated with mTICI 2b. Stroke etiology was undetermined. After 17 days, the patient was discharged and referred to continue rehabilitation treatment. After 90 days of stroke, his NIHSS was 2 and mRS 1. We can consider that early recurrent BAO can be successfully treated with repeated MT.Akutna okluzija bazilarne arterije može uzrokovati ishemiju u regiji moždanog stabla, dijelovima talamusa, potiljačnim režnjevima i malom mozgu, s posljedičnom teškom onesposobljenošću i stopom smrtnosti preko 70%. Ponovljena okluzija bazilarne arterije opisana je u literaturi u malom broju slučajeva. Prikazujemo slučaj ponovljene mehaničke trombektomije kod ponovljene okluzije vrha bazilarne arterije u prvih 24 sata. Prethodno zdrav muškarac u dobi od 37 godina javio se 30 minuta od nastanka tegoba s potiljačnom glavoboljom, mučninom, povraćanjem i desnostranom hemiparezom, NIHSS 18. Bolesnik je bio cijepljen protiv COVID-19 cjepivom Pfizer-BioNTech sedam dana prije nastanka tegoba. Na inicijalnom CT pregledu mozga pc-ASPECTS je opisan s 10, a CT angiografija (CTA) ukazala je na trombozu vrha bazilarne arterije. Ordinirana je intravenska trombolitička terapija, a potom načinjena i mehanička trombektomija s posljedičnim mTICI 3 i NIHSS 5 nakon provedenih postupaka. Tijekom prva 24 sata od prve mehaničke trombektomije dolazi do neurološkog pogoršanja praćenog razvojem kome. Provedena je hitna CT/CTA dijagnostika gdje je utvrđena ponovna tromboza bazilarne arterije s pc-ASPECTS 10. Ponovljena je mehanička trombektomija s posljedičnim mTICI 2b. Etiologija moždanog udara je ostala neutvrđena. Nakon 17 dana bolesnik je otpušten i upućen na daljnji nastavak rehabilitacijskog tretmana. Nakon 90 dana od moždanog udara, NIHSS bio je 2, a mRS 1. Možemo smatrati da se rana ponovljena okluzija bazilarne arterije može uspješno liječiti ponovljenom mehaničkom trombektomijom