JNNP: Radiological diagnosis of spinal nod disease.

More than half of patients with spinal nods are mainly neurosynamics, which often delay diagnosis due to the different manifestations of this granuloma multisyscing inflammatory disease.
authors reported two cases of spinal nodding disease, indicating a lack of understanding between clinical and radiological characteristics in patients with spinal nodding.
70-year-old experienced acute left eye pain 12 months after suffering from mild abnormalities in his distant limbs.
ophthalmology assessment showed pre-vine membraneitis.
electrophysiological assessment showed that the sensory response of the upper and lower extremities was significantly reduced, while the retained motor response was consistent with the general axon sensory disease.
MRI of the brain and spinal cord showed a significant increase in the intensity of T2 at C2-5 and an increase in the signaling of the central tube of the spinal cord at C4-5 (Figure 1A, B) without intracranial lesions.
the patient's nervous system is considered to be secondary to peripheral sensory neuropathy rather than spinal cord abnormalities due to a clinical lack of spinal nods.
laboratory tests showed that the serum ACE was raised to 161U/L (n -lt;55).
antibodies to myelitis and myelin-less protrusion glial cell glycoprotein were negative.
CT chests show extensive vertical lymph node swelling, which is also confirmed in PET scans (positive electron emission fault scans), where the area above the lung door and collarbone, as well as the abdominal shaft, is accompanied by multiple fluorodesulated glucose lymph nodes swelling (Figure 1C).
ingestion was not shown in the spinal lesions area on PET.
subsequent tissue pathology of the biopsy of the lymph nodes showed that non-cheese granuloma had significant lymphocyte immersion (Figure 1D), confirming the diagnosis of nodding disease.
patient received a high dose of oral steroid hormone therapy, and the sensational symptoms of the far end of the limb slowly improved.
3 months after the initial study continued to show a sustained increase in spinal cord lesions.
61-year-old male, who had previously been diagnosed with pulmonary nodding, had a history of numbness at the far end of his upper right upper limb for six weeks.
a neurological examination found that the right biceps on the outside of his right forearm and hand were unsteady, he could not feel the plaques, his strength was normal, and there were no lower limb abnormalities.
study of the upper right limb shows normal sensation and motion conduction values.
MRI of the cervical vertebrae showed extensive C4-6 enhanced lesions in the right hemisphere (Figure 1E, F) without intracranial lesions.
PET scans showed a variety of FDG-avid abnormalities, including in areas of cervical lesions, as well as a wide aorta side, lung doors and vertical lymph nodes.
antibodies to myelitis and myelin-less protrusion glial cell glycoprotein were negative.
the patient was treated with a large dose of oral steroids, and during the 12-month follow-up period, the numbness of his right upper limb almost completely disappeared.
spinal nod disease is rare (5 per cent of patients with nodding), and diagnosis is often challenging given its different clinical manifestations and nonse specific abnormalities that occur after radiology, laboratory and electrophysiological examinations.
Neuroimaging features previously exhibited in spinal neurotic nod disease include individual central tube signal enhancement (as observed in the first patient) (11%) or combined with back-to-top burst signal enhancement (89%) that is usually similar to trident head in axial sequences.
, however, imaging characteristics such as optic neuroscolonitis spectral disease (NMOSD) are more specific to neurotic nod disease in a few years than other inflammatory diseases.
diagnosis depends on the display of typical histopathological characteristics after biopsies of affected tissues (Figure 1D).
because tissue diagnosis is not obtained directly from spinal cord lesions, both cases presented may be spinal neurotic nod nod tissue derived from pathological confirmation of lymphatics.
diagnosis usually leads to higher morbidity and mortality.
spinal nodule disease includes a variety of manifestations that may involve the central nervous system and peripheral nervous system, of which aseptic meningitis is secondary to cranial neuropathy up to 80%.
of spinal cord lesions, with reports of about 15 per cent of cases of spinal nods suggesting "asymptomatic" symptoms.
this observation is further supported by the two cases described in this report, where significant abnormalities in spinal neuroimaging are associated with clinical symptoms and signs.
recognizes that this clinical radiological separation in patients with spinal nodding lesions can facilitate early diagnosis, especially in patients without a history of nocculosis, and thus can be treated in a timely manner and prevent subsequent severe disabilities.
Dhanapalaratnam R, Huynh W Clinicoradiological dissociation in sarcoid myelopathy Journal of Neurology, Neurosurgery and Psygy Published Online First: 27 August 2020. doi: 10.1136/jnnp-2020-323788MedSci Original Source: MedSci Original !-- Content Presentation End -- !-- Judge Whether to Log In End.