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Coexistence of longitudinally extensive transverse myelitis and diffuse midline glioma in the brainstem in an adolescent boy with acute flaccid paralysis

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Abstract

We present the case of a previously healthy 13-year-old boy who was admitted to the emergency department with acute flaccid paralysis. Magnetic resonance imaging revealed radiological evidence of longitudinally extensive transverse myelitis. Additionally, homogeneous T2 signal increase was observed in the pons and medulla oblongata, initially indicating brainstem encephalitis. Subsequent evaluations confirmed a coexistence of diffuse midline glioma (DMG) in the brain stem alongside acute transverse myelitis (ATM). Children with ATM generally have a more favorable prognosis than adults. However, despite the implementation of advanced treatment methods, the patient’s quadriplegia did not improve and resulted in spinal cord sequela atrophy. DMG exhibits an aggressive growth pattern and lacks a known curative treatment. This case represents an exceedingly rare synchronous occurrence of aggressive conditions, underscoring the importance of raising awareness among physicians. Furthermore, we aim to discuss the radiologic differential diagnosis, as this is the first documented instance in the literature.

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Funding

No external funding was secured for this study.

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Authors and Affiliations

  1. Department of Pediatric Radiology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey

    Emine Caliskan

  2. Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey

    Safiye Gunes Sager

  3. Department of Pediatric Intensive Care, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey

    Ufuk Yukselmis

  4. Department of Neurology, Kartal Dr. Lutfi Kirdar City Hospital, University of Health Sciences, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal, Istanbul, Turkey

    Ahmet Kasim Kilic

  5. Department Radiology, University of Health Sciences, Kartal Dr. Lutfi Kirdar City Hospital, D-100 Güney Yanyol, Cevizli Mevkii, No:47, 34865, Kartal Istanbul, Turkey

    Hediye Pınar Gunbey

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  1. Emine Caliskan
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  2. Safiye Gunes Sager
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  3. Ufuk Yukselmis
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  4. Ahmet Kasim Kilic
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  5. Hediye Pınar Gunbey
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Contributions

Emine Caliskan and Safiye Gunes Sager wrote the main manuscript text. Ufuk Yukselmis and Ahmet Kasim Kilic reviewed the manuscript. Hediye Pinar Gunbey prepared figures.

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Correspondence to Emine Caliskan.

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Caliskan, E., Sager, S.G., Yukselmis, U. et al. Coexistence of longitudinally extensive transverse myelitis and diffuse midline glioma in the brainstem in an adolescent boy with acute flaccid paralysis. Childs Nerv Syst 40, 227–232 (2024). https://doi.org/10.1007/s00381-023-06163-0

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  • DOI: https://doi.org/10.1007/s00381-023-06163-0

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