Single demyelinating lesion in the cervical spine due to dystonic and athetoid hands movements

Dystonic and athetoid movements are usually caused by lesion of the basal ganglia, however the etiopathogenesis of involuntary movements could be also different. The 27-year-old female was admitted to the Neurological Department of the Kopernik Hospital in Łódź, because of developing in two days writhing dystonic and athetoid movements of the hands and weakness with paresthesias of upper and lower limbs. The neurological examination also revealed the loss of abdominal reflexes, which could suggest demyelinating process. The laboratory tests of blood and composition of CSF were normal. No demyelinating lesions were disclosed in the brain MRI. The only one lesion was noticed in posterior cervical spine in the cervical MRI. The results of EVP and BEARs were normal. The involuntary movements diminished after treatment with intravenous infusions of amantadine, but the patient decided to discharge from the hospital before the end of therapy. In one week the patient was admitted to the hospital again because of the same complaints and appearance of pathological symptoms and Lhermitte’s sign. Repeated MRI of the brain and cervical spine showed only the lesion found earlier. The amplitude of F wave was extremely high in EMG examination. The involuntary movements as a clinical manifestation of the single cervical demyelinating lesion are described in literature rarely.Dystoniczne i atetotyczne ruchy rąk związane są przeważnie z dysfunkcją jąder podstawy, jednakże etiopa-togeneza ruchów mimowolnych może być również inna. Dwudziestosiedmioletnia kobieta została przyjęta na Oddział Neurologii Szpitala im. M. Kopernika w Łodzi z powodu występujących od dwóch dni wykręcających ruchów dystonicznych i atetotycznych rąk oraz osłabienia kończyn górnych i dolnych z towarzyszącymi parestezjami. W badaniu neurologicznym stwierdzono ponadto brak odruchów brzusznych, co mogło sugerować proces demielinizacyjny. Wyniki badań laboratoryjnych krwi i skład płynu mózgowo-rdzeniowego były prawidłowe. W badaniu MRI głowy nie uwidoczniono zmian demielinizacyjnych, zaś w szyjnym odcinku rdzenia kręgowego zobrazowano pojedynczą zmianę w tylnej części. Wyniki badań WPW i SPPM były w normie. Po zastosowanym leczeniu dożylnymi infuzjami amantadyny ruchy mimowolne zmniejszyły się, jednak pacjentka wypisała się ze szpitala przed zakończeniem terapii. Po tygodniu chora została ponownie przyjęta na Oddział z powodu nawrotu dolegliwości oraz pojawienia się objawów patologicznych i objawu Lhermitte’a. Powtórzone badania MRI potwierdziły opisywaną wcześniej zmianę. W badaniu EMG zaobserwowano bardzo wysoką amplitudę fali F. W literaturze sporadycznie opisywano ruchy mimowolne rąk jako kliniczną manifestację uszkodzenia szyjnego rdzenia kręgowego o charakterze demielinizacji

High- and low-dose oral delayed-release mesalamine in children with mild-to-moderately active ulcerative colitis

Copyright © 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.Objective: The aim of the study was to assess the safety and efficacy of hi

European Crohn's and Colitis Organisation topical review on transitional care in inflammatory bowel disease

Background: This European Crohn's and Colitis Organisation [ECCO] topical review focuses on the transition of adolescents with inflammatory bowel disease [IBD] from child-centred to adult-oriented care. The aim was to provide evidence-supported, expert consensus for health professionals taking part in the transition. Methods: An online survey determined the areas of importance for health professionals involved in the transition of adolescents with IBD. Thereafter an expert panel of nine paediatric and five adult gastroenterologists was formed to identify the critical elements of the transition programme, and to prepare core messages defined as 'current practice points'. There is limited literature about transition, therefore this review is mainly based on expert opinion and consensus, rather than on specific evidence. Results: A total of 21 practice points were generated before the first [online] voting round. Practice points that reached > 80% agreement were accepted, while those that did not reach 80% agreement were refined during a consensus meeting and subjected to voting. Ultimately, 14 practice points were retained by this review. Conclusion: We present a consensus-based framework for transitional care in IBD that provides a guidance for clinical practice. © 2017 European Crohn's and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved