Cauda equina nerve root enhancement in adult intestinal toxemia botulism.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY
Ruiji Jiang, Benjamin Beland, Vinil Shah, Min Kang, Douglas B Pet
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Abstract

Background: Adult botulism is a rare, life-threatening condition typically caused by exposure to preformed botulinum neurotoxin (BoNT). Acute intestinal toxemia botulism (AITB) is an uncommon subtype resulting from colonization of Clostridium botulinum in the intestines. Diagnosis is made by detecting BoNT in the patient's blood, stool, or gastric fluid. AITB is confirmed when C. botulinum is isolated in culture. Electrodiagnostic studies may support the diagnosis, while imaging-when performed-is generally used to exclude alternative conditions.

Case presentation: A 74-year-old man presented with acute dysarthria and ophthalmoparesis, which rapidly progressed to quadriparesis and respiratory failure requiring intubation. Magnetic resonance imaging (MRI) revealed thickening and enhancement of the cauda equina nerve roots. Due to high clinical suspicion for botulism, heptavalent botulinum antitoxin was administered. Intravenous immunoglobulin was also given, as the imaging findings raised concern for an alternative diagnosis of Guillain-Barré syndrome (GBS). Blood and stool samples later tested positive for BoNT type A, and C. botulinum was isolated from the stool, confirming AITB. The patient experienced a gradual but prolonged recovery of motor function following treatment.

Conclusions: Botulism in both infants and adults is not typically associated with abnormal neuroimaging findings. To our knowledge, this is the first reported case of cauda equina nerve root thickening and enhancement on MRI in AITB-or in adult botulism more broadly. We outline the differential diagnosis, pathophysiology, and treatment of botulism. This case underscores that abnormal neuroimaging should not delay prompt empiric treatment for botulism when clinical suspicion is high.

Abstract Image

成人肠毒血症肉毒中毒的马尾神经根增强。
背景:成人肉毒杆菌中毒是一种罕见的、危及生命的疾病,通常由暴露于预先形成的肉毒杆菌神经毒素(BoNT)引起。急性肠毒血症肉毒杆菌中毒(AITB)是一种罕见的亚型,由肉毒梭菌在肠内定植引起。诊断是通过检测患者血液、粪便或胃液中的BoNT。当培养中分离出肉毒杆菌时,就可以确诊AITB。电诊断研究可能支持诊断,而成像-当执行-通常用于排除其他条件。病例介绍:一名74岁男性患者表现为急性构音障碍和眼麻痹,并迅速发展为四肢瘫和呼吸衰竭,需要插管。磁共振成像显示马尾神经根增厚和增强。由于临床高度怀疑肉毒杆菌中毒,给予七价肉毒杆菌抗毒素。静脉注射免疫球蛋白,因为影像学结果引起了对格林-巴-罗综合征(GBS)的另一种诊断的关注。血液和粪便样本后来检测出A型BoNT阳性,并从粪便中分离出肉毒杆菌,证实患有aith。患者在治疗后运动功能逐渐恢复,但恢复时间较长。结论:婴儿和成人肉毒杆菌中毒通常与异常神经影像学表现无关。据我们所知,这是第一例报道的马尾神经根增厚和增强的MRI在aitb -或成人肉毒杆菌中毒更广泛。我们概述了肉毒杆菌中毒的鉴别诊断、病理生理和治疗。本病例强调,当临床怀疑肉毒杆菌中毒时,异常神经影像学不应延误及时的经验治疗。
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来源期刊
BMC Neurology
BMC Neurology 医学-临床神经学
CiteScore
4.20
自引率
0.00%
发文量
428
审稿时长
3-8 weeks
期刊介绍: BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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