Autonomic dysreflexia following acute myelitis due to neuromyelitis optica

Furlan, Julio C.

doi:10.1016/j.msard.2018.04.007

Cited by 18 publications

(7 citation statements)

References 9 publications

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“…She also described sensory changes in her legs which likely represented early myelopathy. As an aside, although not described in our case, autonomic dysreflexia and area postrema syndrome, both well reported in longitudinally extensive transverse myelitis due to NMOSD, [10][11] may further distract from a neurological pathology if present, with the former mimicking the haemodynamic abnormalities of systemic sepsis and the latter characterised by refractory nausea, vomiting and/or hiccups which may further anchor clinicians to the abdomen.…”

Section: Neurological Causes Of Abdominal Painmentioning

confidence: 84%

Acute abdominal pain: chameleon presentations of acute myelitis

Mackrill¹,

Reschen²

2022

Acute Med

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Patients with acute abdominal pain typically undergo urgent clinical assessment to exclude serious underlying surgical diagnoses. However, a diverse range of less common medical conditions may also present with abdominal pain and their severity can range from benign to life threatening. Here we present a case of myelitis (inflammation of the spinal cord) presenting with acute abdominal pain that was initially diagnosed clinically as biliary pathology. We review the canonical differential diagnosis for medical causes of acute abdominal pain and highlight the clinical features that raise the suspicion of spinal pathology. We argue that awareness of the basic clinical features of structural and inflammatory spinal lesions could improve early recognition of these potentially overlooked diseases.

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Section: Neurological Causes Of Abdominal Painmentioning

confidence: 84%

Acute abdominal pain: chameleon presentations of acute myelitis

Mackrill¹,

Reschen²

2022

Acute Med

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“…Available studies investigating autonomic dysfunction in pwN-MOSD are limited to case reports and are mainly related to cardiovascular autonomic disturbances [15][16][17][18][19][20]. Only two studies systematically investigated autonomic dysfunction in pwNMOSD.…”

Section: Discussionmentioning

confidence: 99%

Sudomotor dysfunction in people with neuromyelitis optica spectrum disorders

Habek

Andabaka

Fanciulli

et al. 2022

Euro J of Neurology

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Background and purpose The aim was to determine the extent of sudomotor dysfunction in people with neuromyelitis optica spectrum disorder (pwNMOSD) and to compare findings with a historical cohort of people with relapsing–remitting multiple sclerosis (pwRRMS). Methods Forty‐eight pwNMOSD were enrolled from four clinical centers. All participants completed the Composite Autonomic Symptom Score 31 to screen for symptoms of sudomotor dysfunction. Sudomotor function was assessed using the quantitative sudomotor axon reflex test. The results were compared with a historical cohort of 35 pwRRMS matched for age, sex and disease duration. Results Symptoms of sudomotor dysfunction, defined by a score in the Composite Autonomic Symptom Score 31 secretomotor domain >0, were present in 26 (54%) of pwNMOSD. The quantitative sudomotor axon reflex test confirmed a sudomotor dysfunction in 25 (52.1%) of pwNMOSD; in 14 of them (29.2%) sudomotor dysfunction was moderate or severe. No difference was observed between pwNMOSD and pwRRMS in any of the studied parameters. However, symptomatic sudomotor dysfunction was more frequent in pwNMOSD (n = 8, 22.9%) compared to pwRRMS (n = 1, 3%; p = 0.028). In a multivariable logistic regression analysis, statistically significant predictors for symptomatic sudomotor failure were age and diagnosis of neuromyelitis optica spectrum disorder. Conclusions Sudomotor dysfunction is common in pwNMOSD and more often symptomatic compared to pwRRMS.

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“…16 One of the devastating consequences of spinal cord involvement at Th6 or above, which has recently been described in pwNMOSD, is a so-called autonomic dysreflexia, a condition characterized with a low baseline systemic arterial blood pressure and OH that can be interposed by sudden-onset hypertensive episodes. 17…”

Section: Discussionmentioning

confidence: 99%

Autonomic dysfunction in people with neuromyelitis optica spectrum disorders

et al. 2019

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Aims: To determine the difference in autonomic symptom burden measured with the Composite Autonomic System Score-31 (COMPASS-31) and presence of objective dysautonomia in people with neuromyelitis optica spectrum disorders (pwNMOSD) compared to people with multiple sclerosis (pwMS). Design/Methods: Twenty pwNMOSD and 20 pwMS, matched for age, sex, and disease duration, were enrolled. All patients completed the COMPASS-31. The quantification of cardiovascular autonomic dysfunction (CAD) was made using the two indices of the Composite Autonomic Scoring Scale (CASS): adrenergic index (AI) and cardiovagal index (CI). Results: In all pwNMOSD, COMPASS-31 was >0. Sympathetic dysfunction was present in 8 (40%), parasympathetic dysfunction in 10 (50%), and orthostatic hypotension in 6 (30%) pwNMOSD. This group of patients had higher frequency and level on the pupillomotor domain of the COMPASS-31 compared to pwMS ( p = 0.048 and p = 0.006, respectively). A binary logistic regression model showed that drop in diastolic blood pressure (dBP) during tilt-table test and normal function of autonomic nervous system, defined as AI = 0 and CI = 0, were independent predictors of pwNMOSD ( p = 0.042 and p = 0.029, respectively). If CAD was present, it was significantly worse in pwNMOSD compared to pwMS ( p = 0.003). Conclusion: Significant proportion of pwNMOSD experience dysautonomia, which seems to be different from dysautonomia observed in pwMS.

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Autonomic dysreflexia following acute myelitis due to neuromyelitis optica

Cited by 18 publications

References 9 publications

Acute abdominal pain: chameleon presentations of acute myelitis

Acute abdominal pain: chameleon presentations of acute myelitis

Sudomotor dysfunction in people with neuromyelitis optica spectrum disorders

Autonomic dysfunction in people with neuromyelitis optica spectrum disorders

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