title: Description of six cases of child cauda equina leptomeningitis: an emerging disease.
abstract: 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.
authors.affiliation: Department of Neuroradiology, University of Bari, Bari, Italy. f.dic@neurorad.uniba.it
authors.forename: Franca
authors.initials: F
authors.lastname: Dicuonzo
authors.forename: Michele
authors.initials: M
authors.lastname: Palma
authors.forename: Michele
authors.initials: M
authors.lastname: Tangari
authors.forename: Roberta
authors.initials: R
authors.lastname: De Nicolo
authors.forename: Marilena
authors.initials: M
authors.lastname: Maghenzani
authors.forename: Stefano
authors.initials: S
authors.lastname: Andresciani
authors.forename: Michela
authors.initials: M
authors.lastname: Sesta
authors.forename: Carella
authors.initials: C
authors.lastname: Aristide
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D016756:Immunoglobulins, Intravenous