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Hopkins syndrome following the first episode of bronchial asthma associated with
enterovirus D68: a case report
#MMPMID29792179
Hayashi F
; Hayashi S
; Matsuse D
; Yamasaki R
; Yonekura K
; Kira JI
BMC Neurol
2018[May]; 18
(1
): 71
PMID29792179
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BACKGROUND: Hopkins syndrome (HS) is a rare disorder presenting with acute
flaccid paralysis of the limbs following an asthma attack. Neurologists encounter
a diagnostic challenge if patients without a history of bronchial asthma develop
neurologic features mimicking HS following acute respiratory distress. We report
a case of HS occurring after a first episode of bronchial asthma associated with
enterovirus D68 infection. CASE PRESENTATION: A 5-year-old girl developed acute
respiratory distress. On the fourth hospital day, both her legs became paralyzed
except for slight muscle contraction in the right lower limb. Tendon reflexes in
the lower limbs were diminished and there was a positive Babinski sign on the
right. Sensation was normal in all modalities, and there was no uro-rectal
disturbance. Spinal magnetic resonance imaging identified T2-hyperintense lesions
with spinal cord edema, mainly involving the bilateral T11 to L1 anterior horns,
with left side dominance extending to the left posterior horn. The neurological
and neuro-radiological findings of our case were suggestive of HS; however, she
had no history of bronchial asthma. An acetylcholine inhalation challenge
eventually proved the presence of reversible airway hyper-responsiveness,
allowing us to diagnose HS. We identified enterovirus D68 in the patient's
intratracheal aspirates using a sensitive polymerase chain reaction assay.
Intravenous immunoglobulin administrations at 2 g/kg(2) for 5 consecutive days
were repeated every month up to four times. After these treatments, the muscle
strength of her right lower limb slightly improved while her left lower leg
remained completely paralyzed. CONCLUSION: This case emphasizes the importance of
provocation tests to reveal the presence of airway hyper-responsiveness when a
child shows neurological signs mimicking HS following acute respiratory distress.
Furthermore, the present case suggests a possible link between HS and acute
flaccid paralysis following lower respiratory tract infection by enterovirus D68.
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