Description of six cases of child cauda equina leptomeningitis: an emerging disease.
Child cauda equina leptomeningitis (CCEL) is a typical clinical example of aseptic meningitis with patterns of an emerging disease, and it affects children aged 2-9. Here we will describe six cases of CCEL. After the prodromes, all children underwent an acute phase with hypoasthenia of the lower limbs, hyporeflexia, staggering and ataxia with steppage. Only in one case there were generalized fits and coma of grade 1-2 too. All children underwent a spinal magnetic resonance imaging (MRI), proving pathologic enhancement of cauda equina and conus medullaris leptomeningitis. At the same time, MRI made possible the differential diagnosis between cauda equina leptomeningitis and isolated minor forms of Guillain-Barre syndrome involving the lower limbs. Three hypotheses will be formulated for understanding the pathogen mechanism(s) of CCEL. The first one is based on the presence of an immediate viral damage on the meninges, the second one, the more likely, contemplates the occurrence of an immunomediated mechanism in a host genetically prone to react in an abnormal way from an immune viewpoint. The third hyphotesis consists in a two-time damage: an early immediate damage from the virus, and a later immunomediated reaction.
Dicuonzo
Franca
F
Department of Neuroradiology, University of Bari, Bari, Italy. f.dic@neurorad.uniba.it
Palma
Michele
M
Tangari
Michele
M
De Nicolo
Roberta
R
Maghenzani
Marilena
M
Andresciani
Stefano
S
Sesta
Michela
M
Aristide
Carella
C
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002420:Cauda Equina / Q000276:immunology / Q000473:pathology / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000276:immunology / Q000473:pathology / Q000628:therapy / Q000821:virology*; D003937:Diagnosis, Differential; D005260:Female; D020275:Guillain-Barre Syndrome / Q000473:pathology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008582:Meningitis, Aseptic / Q000150:complications* / Q000276:immunology / Q000473:pathology / Q000628:therapy / Q000821:virology; D010523:Peripheral Nervous System Diseases / Q000276:immunology / Q000473:pathology / Q000628:therapy / Q000821:virology*; D010956:Plasmapheresis; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous