title: Postinfectious neurologic syndromes: a prospective cohort study.
abstract: OBJECTIVE
  Postinfectious neurologic syndromes (PINSs) of the CNS include heterogeneous disorders, sometimes relapsing. In this study, we aimed to a) describe the spectrum of PINSs; b) define predictors of outcome in PINSs; and c) assess the clinical/paraclinical features that help differentiate PINSs from multiple sclerosis (MS).
  
  
  METHODS
  In this prospective cohort study, adult inpatients with PINSs underwent extensive diagnostic assessment and therapeutic protocols at inclusion and during a minimum 2-year follow-up. We compared them with newly diagnosed, treatment-naive patients with MS, also prospectively recruited.
  
  
  RESULTS
  The study sample comprised 176 patients with PINSs aged 59.9 ± 17.25 years (range: 18-80 years) divided into 2 groups: group 1 (CNS syndromes, 64%)-encephalitis, encephalomyelitis, or myelitis; and group 2 (CNS + peripheral nervous system [PNS] syndromes, 36%)-encephalomyeloradiculoneuritis or myeloradiculoneuritis. We observed the patients for 24 to 170 months (median 69 months). Relapses, almost invariably involving the spinal cord, occurred in 30.5%. PNS involvement was an independent risk factor for relapses (hazard ratio 2.8). The outcome was poor in 43% of patients; risk factors included older age, greater neurologic disability at onset, higher serum-CSF albumin percentage transfer, myelitis, and PNS involvement. Steroid resistance occurred in 30% of the patients, half of whom responded favorably to IV immunoglobulins. Compared with MS, PINSs were characterized by older age, lower tendency to relapse, and distinct CSF findings.
  
  
  CONCLUSIONS
  The category of PINSs should be revised: most of the clinical variants have a poor prognosis and are not readily classifiable on the basis of current knowledge. PNS involvement has a critical role in relapses, which seem to affect the spine only.
authors: C. Mondino National Institute of Neurology Foundation, IRCCS, Pavia, Italy. enrico.marchioni@mondino.it
authors: Enrico
authors: E
authors: Marchioni
authors: Sabrina
authors: S
authors: Ravaglia
authors: Cristina
authors: C
authors: Montomoli
authors: Eleonora
authors: E
authors: Tavazzi
authors: Lorenzo
authors: L
authors: Minoli
authors: Fausto
authors: F
authors: Baldanti
authors: Milena
authors: M
authors: Furione
authors: Enrico
authors: E
authors: Alfonsi
authors: Roberto
authors: R
authors: Bergamaschi
authors: Alfredo
authors: A
authors: Romani
authors: Laura
authors: L
authors: Piccolo
authors: Elisabetta
authors: E
authors: Zardini
authors: Stefano
authors: S
authors: Bastianello
authors: Anna
authors: A
authors: Pichiecchio
authors: Pasquale
authors: P
authors: Ferrante
authors: Serena
authors: S
authors: Delbue
authors: Diego
authors: D
authors: Franciotta
authors: Giorgio
authors: G
authors: Bono
authors: Mauro
authors: M
authors: Ceroni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis; D009188:Myelitis, Transverse / Q000175:diagnosis / Q000209:etiology; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology*; D013577:Syndrome; D014612:Vaccines / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014612:Vaccines