Neuro-Clinic 82Acute hemorrhagic conjunctivitis and

neurologic disorder.

Dr Pratyuh Chaudhuri

• 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

Historical apect

• First pandemic [1969- 71]• Second pandemic [1980-1982]

Epidemiology

• Highly contagious conjunctivitis• Transmission through crowd.• 20-40yrs of age group most commonly

affected {extremes of age also affected}

The neurological illness

• First identified by Prof Wadia

• Conjunctivitis followed by acute hypotonic, areflexic paralytic disease of the lower limb.

stages

• Conjunctivitis• Latent phase

• Pre-paralysis stage• Paralysis

• Types– Spinal form– Cranial nerve form– Combined form

• 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

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

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.

• 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.

Differential diagnosis

• GBS• Devics disease• Bells palsy• Encephalitis• Inflammatory radiculopathies

Treatment

• Supportive• No role of steroids• Rehabilitation measures

Thank You