Table-II.
Cerebrospinal fluid and radiological findings, and complications of included patients with the clinical diagnosis of Elsberg syndrome.
| Study By | Parameters | |||
|---|---|---|---|---|
| CSF Findings | Radiological Investigations | Main Treatment | Response | |
| Lucie et al.9 | WBC 87 M/l with 98% mono lymphocytes and 1% PMN, Proteins 0.66 g/L, Positive CSF/serum albumin ratio | Brain and spinal cord MRI – normal, Dysfunction of sensitive fibers of S1 left root was observed on electroneurography | IV Acyclovir 750 mg three times a day, IV Ampicillin 2 g six times a day, IV Ceftriaxone 2 g two times a day, Doxycycline 100 mg two times a day, Dexamethasone 11 mg four times a day, IV Vancomycin 1.75 g once a day, Tenofovir-emtricitabine-alafenamide) 50-200-25 mg once a day | Rash resolved, Muscle strength in lower extremities improved to 5/5, Fecal and urinary incontinence partially rectified. |
| Yang et al.10 | Nil | Lumbar MRI - no compression or lesion, Urodynamic tests - detrusor areflexia | IV Sulperazone 3 g twice a day for 7 days, Pregabalin 75 mg once daily per oral, Tramadol 50 mg twice a day per oral, Lactulose 10 ml thrice day per oral | Symptoms of constipation gradually improved but the attempt to remove the bladder catheter failed |
| Nsoga et al.11 | WBC 58 M/L, lymphocytes 94%, Proteinorachia at 0.76 g/L, Hypoglycorrhachia 2.6 mmol/L | MRI spine - medullary cone myelitis, with possible inflammation at the level of the cauda equina, especially at sacral roots 1 and 2 and thoracic roots 11 and 12 | IV Acyclovir was started for the VZV infection with a dose of 500 mg three times daily | Improved |
| Shah et al.12 | Elevated glucose (4.76mmol/l) and protein (2.00g/l), WBC 276, with 95% lymphocytes, RBC 910, CSF PCR - positive for varicella zoster virus (VZV) | MRI spine – normal | Intravenous methylprednisolone (IVMP) 1,000 mg daily for 5-days then, Intravenous immunoglobulin (IVIG); 0.4 mg/kg/day for 5-days | Subjective improvement in both weakness and numbness after IV steroid but no further progress after IVIG |
| Abati et al.13 | WBC 250 cells/mm3, PCR positive for HSV-2 DNA | Spine MRI with gadolinium - linear enhancement of cauda equina roots and of conus terminalis profile, in association with caudal roots enlargement | IV Acyclovir | Improved. |
| Abrams et al.14 | RBCs - 10/µL, WBCs - 0/µL, Glucose - 62 mg/dL, Protein - 38 mg/dL | Contrast MRIs of the spine - a potential subtle hyperintense signal in the dorsal cord at T10 | Six electroacupuncture treatments | Improved. |
| Suarez Calvet et al.15 | WBC - 189 cells/mm3, CSF/ blood glucose ratio - 1.18, Protein concentration - 5.120 g/L, Adenosine deaminase (ADA) - 18 U/L, Polymerase chain reaction (PCR) - positive for HHV-2 | Medullary MRI - no relevant abnormality | IV Ganciclovir and Acyclovir | No improvement. |
| Abdullah et al.16 | High protein 2.43g/L, WBC 256 x 106 /L; 10% polymorphs and 90% lymphocytes, PCR CSF – positive for HSV-2 | MRI spine – normal | Empirical treatment with ganciclovir Treatment changed to acyclovir after HHV-2 detection | No improvement. |
| Whalen et al.17 | WBC - 208 per mm3 with 92% lymphocyte, Protein - 79 mg/Dl, Glucose - 52 mg/dL, HSV PCR - negative | MRI spine with and without contrast: abnormal T2 prolongation, abnormal T1 post-contrast enhancement, mild expansion within the distal spinal cord and conus, faint smooth enhancement within scattered cauda equine nerve roots | IV aciclovir, amoxicillin and cefotaxime Nursing care in isolation | Death |
| Shields et al.18 | HCV-2 PCR – positive, Glucose - 90 mg/dL, Protein - 55 mg/dL, WBC 434/μL, RBC 9/μL | MRI spine - normal | IV Ceftriaxone, IV Acyclovir | Symptoms resolved except sacral pain and numbness in the soles of the feet with occasional incontinence. |
| Rohan et al.19 | WBC 59/mm3, Protein 193 mg/dL, IgG monoclonal immune globulin 3770mg/dl | MRI lumbar spine with and without contrast - peripherally enhancing region in the conus medullaris | Methylprednisolone, hydromorphone, Acyclovir 650 mg infused every 8 h for 3 weeks, Subsequently prescribed valacyclovir | No improvement of the lower extremity pain at 8 months follow-up, Significant improvement in the range of motion in lower extremities at 17 months follow-up |
| Dimitrios et al.20 | WBC 640/mm3, Glucose 45 mg/dL, Protein 1.8 g/L | MRI normal | IV Acyclovir, IV Valacyclovir, Dexamethasone | Improvement in skin and lower limb sensations, Improved bowel and bladder control |
| Saito et al.6 | WBC 69/Μl mono- nuclear cells 98.6%, Protein 46 mg/dL, Glucose 104 mg/dL | MRI spine - normal | IV hydrocortisone, Tamsulosin 0.4 mg daily, Distigmine 5 mg twice daily | Improved |
| Furugen et al.21 | WBC eosino-philia 23/mm3 9.7% | MRI spine - normal | IV Acyclovir treatment 10 mg/kg TDS, IV Ganciclovir 5 mg/kg BD for 2 days, Valganciclovir 900 mg BD for 9 days | Improved |
| Hsu et al.8 | WBCs 198 (59% eosinophils), Protein 163 mg/dL, Glucose 36 mg/dL | MRI spine - normal | IV Acyclovir 1.5 mg every 8 hours for 14 days, Methylprednisolone pulse therapy for 3 days | Improved |
| Krishna et al.22 | WBC 700, predominantly lymphocytes, Glucose of 50 mg/dl, Protein 150 mg/dl, CSF-PCR positive HSV-2 infection | MRI spine - normal | Oral prednisolone (40 mg/day) | Improved |
| Matsumoto et al.23 | Pleocytosis Cells 130/mm3, Protein 53 mg/dL, Positive VZV-IgG | MRI spine with gadolinium enhancement revealed left sacral nerve root swelling | Mebendazole at a dose of 100 mg twice daily for 5 days, Glucocorticosteroid at a dose of 60 mg/day for 5 days | Headache and fever subsided. Bladder dysfunction required placement of an indwelling urinary catheter |
| Abe et al.24 | WBC 341/mm3, mononuclear cells: 98%, Protein level of 168 mg/dL, Glucose level of 47 mg/dL, CSF PCR positivity for VZV | MRI spine - normal | IV Acyclovir at 10 mg/kg three times a day, Bethanechol and Tamsulosin | Improved |