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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(08): 867-868
DOI: 10.1055/s-0042-1755280
Images in Neurology

Conus medullaris syndrome in Vogt-Koyanagi-Harada disease: an unusual presentation

Síndrome de cone medular na doença de Vogt-Koyanagi-Harada: uma apresentação não usual
Fabiano Ferreira de Abrantes 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Nerurocirgia, São Paulo SP, Brazil.
,
Marianna Pinheiro Moraes de Moraes 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Nerurocirgia, São Paulo SP, Brazil.
,
Wardislau Ferreira 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Nerurocirgia, São Paulo SP, Brazil.
,
Flávio Moura Rezende Filho 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Nerurocirgia, São Paulo SP, Brazil.
,
José Luiz Pedroso 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Nerurocirgia, São Paulo SP, Brazil.
,
Orlando Graziani Povoas Barsottini 
1   Universidade Federal de São Paulo, Departamento de Neurologia e Nerurocirgia, São Paulo SP, Brazil.
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A 25-year-old woman presented over one week with subacute flaccid paraparesis, saddle anesthesia and sphincter dysfunction, compatible with conus medullaris syndrome. Lumbar magnetic resonance imaging (MRI) ([Figure 1]) showed spinal cord edema and intense leptomeningeal enhancement. Six months after, she presented with aseptic meningitis and bilateral vision loss. Optical coherence tomography (OCT) showed bilateral exudative retinal detachments ([Figure 2]). Incomplete Vogt-Koyanagi-Harada disease (VKHD) was diagnosed based on the combination of bilateral granulomatous panuveitis and aseptic meningitis.[1] Spinal cord involvement is a frequent manifestation of neurological inflammatory diseases, and VKHD should be considered when typical eye, ear, and skin symptoms are present.[2] [3]

Zoom Image
Figure 1 Axial T2-weighted (A) and sagittal (C) short-TI inversion recovery (STIR) magnetic resonance imaging with central hyperintense signal associated with lumbosacral intumescence and conus medullaris edema. Axial (B) and sagittal (D) contrast-enhanced T1-weighted magnetic resonance imaging with leptomeningeal enhancement.
Zoom Image
Figure 2 Right (A) and left (C) eyes retinography depicting hyperemic optic discs and areas of retinal detachment (white arrows). Macular horizontal B-scans reveal bilateral serous retinal detachment, located in the foveal and parafoveal regions in the right eye (B) and in the nasal retina in the left eye (D) (white arrows).

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Conflict of Interest

The authors have no conflict of interests to declare.

Authors' Contributions

FFA: conceptualization, visualization, writing – original draft, and writing – review & editing; MPMM: conceptualization, visualization, writing – original draft, and writing – review & editing; WF: conceptualization, visualization, writing – original draft; FMRF: visualization, writing – original draft; JLP: conceptualization and writing – review & editing; OGPB: conceptualization, visualization, writing – original draft, and writing – review & editing.


  • References

  • 1 Read RW, Holland GN, Rao NA. et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol 2001; 131 (05) 647-652
    CrossrefPubMedSearch in Google Scholar
  • 2 Triplett JD, Buzzard KA, Lubomski M. et al. Immune-mediated conditions affecting the brain, eye and ear (BEE syndromes). J Neurol Neurosurg Psychiatry 2019; 90 (08) 882-894
    CrossrefPubMedSearch in Google Scholar
  • 3 Gu S, Liu Y, Song Z, Zi X, Deng H. Acute myelitis in a patient with vogt-koyanagi-harada disease: case report and review of the literature. J Clin Neurol 2013; 9 (01) 61-64
    CrossrefPubMedSearch in Google Scholar

Address for correspondence

Fabiano Ferreira de Abrantes

Publication History

Received: 26 January 2022

Accepted: 11 February 2022

Article published online:
17 October 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Read RW, Holland GN, Rao NA. et al. Revised diagnostic criteria for Vogt-Koyanagi-Harada disease: report of an international committee on nomenclature. Am J Ophthalmol 2001; 131 (05) 647-652
    CrossrefPubMedSearch in Google Scholar
  • 2 Triplett JD, Buzzard KA, Lubomski M. et al. Immune-mediated conditions affecting the brain, eye and ear (BEE syndromes). J Neurol Neurosurg Psychiatry 2019; 90 (08) 882-894
    CrossrefPubMedSearch in Google Scholar
  • 3 Gu S, Liu Y, Song Z, Zi X, Deng H. Acute myelitis in a patient with vogt-koyanagi-harada disease: case report and review of the literature. J Clin Neurol 2013; 9 (01) 61-64
    CrossrefPubMedSearch in Google Scholar

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Zoom Image
Figure 1 Axial T2-weighted (A) and sagittal (C) short-TI inversion recovery (STIR) magnetic resonance imaging with central hyperintense signal associated with lumbosacral intumescence and conus medullaris edema. Axial (B) and sagittal (D) contrast-enhanced T1-weighted magnetic resonance imaging with leptomeningeal enhancement.
Zoom Image
Figure 2 Right (A) and left (C) eyes retinography depicting hyperemic optic discs and areas of retinal detachment (white arrows). Macular horizontal B-scans reveal bilateral serous retinal detachment, located in the foveal and parafoveal regions in the right eye (B) and in the nasal retina in the left eye (D) (white arrows).