Coexistence of longitudinally extensive transverse myelitis and diffuse midline glioma in the brainstem in an adolescent boy with acute flaccid paralysis.
Emine ÇalışkanSafiye Gunes SagerUfuk YukselmisAhmet Kasim KilicHediye Pınar GunbeyPublished in: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (2023)
We present the case of a previously healthy 13-year-old boy who was admitted to the emergency department with acute flaccid paralysis. Magnetic resonance imaging revealed radiological evidence of longitudinally extensive transverse myelitis. Additionally, homogeneous T2 signal increase was observed in the pons and medulla oblongata, initially indicating brainstem encephalitis. Subsequent evaluations confirmed a coexistence of diffuse midline glioma (DMG) in the brain stem alongside acute transverse myelitis (ATM). Children with ATM generally have a more favorable prognosis than adults. However, despite the implementation of advanced treatment methods, the patient's quadriplegia did not improve and resulted in spinal cord sequela atrophy. DMG exhibits an aggressive growth pattern and lacks a known curative treatment. This case represents an exceedingly rare synchronous occurrence of aggressive conditions, underscoring the importance of raising awareness among physicians. Furthermore, we aim to discuss the radiologic differential diagnosis, as this is the first documented instance in the literature.
Keyphrases
- liver failure
- emergency department
- magnetic resonance imaging
- respiratory failure
- spinal cord
- primary care
- young adults
- drug induced
- healthcare
- dna damage
- aortic dissection
- risk assessment
- magnetic resonance
- mental health
- systematic review
- dna repair
- computed tomography
- hepatitis b virus
- low grade
- dna damage response
- rectal cancer
- single cell
- combination therapy
- intensive care unit
- brain injury
- contrast enhanced
- functional connectivity
- mechanical ventilation
- resting state
- adverse drug
- prognostic factors