Neuro clinic 82
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Neuro-Clinic 82Acute hemorrhagic conjunctivitis and
neurologic disorder.
Dr Pratyuh Chaudhuri
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• Dedicated to
A study of the neurological disorder associated with acute haemorrhagic conjunctivitis due to enterovirus 70.
N H Wadia, P N Wadia, S M Katrak, and V P Misra
• J Neurol Neurosurg Psychiatry. 1983 July; 46(7): 599–610
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Historical apect
• First pandemic [1969- 71]• Second pandemic [1980-1982]
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Epidemiology
• Highly contagious conjunctivitis• Transmission through crowd.• 20-40yrs of age group most commonly
affected {extremes of age also affected}
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The neurological illness
• First identified by Prof Wadia
• Conjunctivitis followed by acute hypotonic, areflexic paralytic disease of the lower limb.
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stages
• Conjunctivitis• Latent phase
• Pre-paralysis stage• Paralysis
• Types– Spinal form– Cranial nerve form– Combined form
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• Severe necrotic and inflammatory reaction in the grey matter at different levels of the spinal cord
• Anterior nerve root showed demyelination due to neuronal damage.
• Virus has never been isolated from the CSF/CN
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Investigation
• Virus [E70] culture – not practical• Serologic tests– Neutralization test { 4 fold rise is considered +ve in
paired sera or 1:16 titre }– Haemagglutination test– ELISA– Compliment fixation test
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CSF
• Pleocytosis is early finding
• Delayed rise in protein levels.
• CSF may be normal in cranial type.
• Useful in early stage because in later stage due to the albuminocytologic dissociation, may be confused with GBS.
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• CF study (criteria established in Mumbai)• E70 antibody titre [1:2 titre]
• Serum/CSF NAT <20
• Serological test for CA24v , polio virus and adenovirus (which are known to cause AHC) should be done to r/o co-infection.
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Differential diagnosis
• GBS• Devics disease• Bells palsy• Encephalitis• Inflammatory radiculopathies
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Treatment
• Supportive• No role of steroids• Rehabilitation measures
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Thank You