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Case reports.
Case 1.
A previously healthy 38-year-old man presented with acute urinary retention and constipation after 4 days of progressive weakness affecting all 4 limbs and patchy sensory disturbance over the trunk and upper arms. Ten days prior to the onset of symptoms, he had received H1N1 09 influenza (Panvax H1N1, CSL Biotherapies, Parkville, Australia) vaccination and had experienced a spontaneously resolving febrile reaction 24–48 hours following administration.
MRI of the brain, cervical, thoracic, and lumbar spine was performed (figure,A). Several areas of central cord T2 signal hyperintensity were demonstrated, extending from C3 to C6 and from T7 to L1, and a diagnosis of longitudinally extensive transverse myelitis was made. Serologic investigations for infective and autoimmune etiologies were unremarkable. CSF demonstrated an inflammatory pattern, with 80 × 106/L lymphocytes and 0.78 g/L total protein.
(A) MRI thoracic spine, demonstrating extensive longitudinal intramedullary T2 hyperintensity. (B) MRI cervical spine, demonstrating multilevel cord edema and hyperintensity of proximal thoracic segments.
The patient received IV methylprednisolone (1 g/d for 3 days), with resolution in power and sphincter function over the following 10 days.
Case 2.
A previously healthy 19-year-old …
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