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Neurologic disorders in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Robert Burger, Terry Rolan, David Lardizabal, Upinder Dhand, Aarti Sarwal, Pradeep Sahota
CSF: CSF analysis provides important information in MS and should be considered to help confirm a diagnosis of MS. The CSF may be abnormal in up to at least 80% of MS patients, although a normal CSF examination does not rule out the disease. Immunoglobulin G (IgG) in the CSF can be compared with levels in the serum and may be elevated in the CSF of patients with MS (IgG index and IgG synthesis rate). CSF electrophoresis may also reveal the presence of oligoclonal bands, which are due to IgG synthesis in the CNS. Elevated levels of myelin basic protein indicating myelin damage may also be seen in MS. None of the above CSF abnormalities are specific for MS although their presence in the setting of a typical clinical history can aid in making a diagnosis.
Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
Because of spirochetemia and dissemination, the CNS becomes involved in up to 40% of patients with secondary syphilis.5 Symptoms of meningitis, such as headache, nuchal rigidity, and photophobia, are common. If an LP is performed, an elevated protein (100–200 mg/dL) and lymphocytic pleocytosis (200–400 cells/μL) are the norm, and falls under the broad classification of aseptic meningitis.6 Oligoclonal bands are frequently present. Other signs and symptoms include cranial neuropathies, visual disturbances, hearing loss, tinnitus, syphilitic paraplegia (Erb's paralysis), and myelitis with lower motor neuron manifestations. Signs of encephalitis are rarely present. Meningeal inflammation can be either diffuse (leptomeningitis) or can present as more focal inflammatory areas called syphilitic gummas. In some cases, early meningovascular disease can result in ischemia, infarction, or seizures.
Intense Immunosuppression Followed by Autologous Stem Cell Transplantation in Severe Multiple Sclerosis Cases
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
G.L. Mancardi, R. Saccardi, A. Murialdo, F. Pagliai, F. Gualandi, A. Marmont, M. Inglese, P. Bruzzi, M.P. Sormani, M.G. Marrosu, G. Meucci, L. Massacesi, A. Bertolotto, A. Lugaresi, E. Merelli, M. Filippi
Case 2 is a 16 year old male who experienced a right hemiparesis of sudden onset when he was 15 years old. MRI showed a large T2 positive lesion in the left pons and midbrain and a number of hyperintense lesions in the hemispheric white matter. CSF examination showed oligoclonal bands in the CSF and not in the serum. At that time he was treated with steroids, followed by a severe relapse with cerebellar signs 2 months later. The patient then started therapy with interferon beta la but within the next 5 months he had 3 relapses with right hemianopsia, left hemiparesis and diplopia, and beta interferon was interrupted. He was treated with plasma-exchange without results and subsequently with CY (1 gram every month for 2 months). At the end of the second cycle, the patient relapsed again. MRI showed dramatic enlargement of the previous lesions and the appearance of new lesions after the administration of a single dose of Gd. At that time, partial epileptic seizures with secondary generalization occurred, and the patient was treated successfully with phenobarbital. When he reached an EDSS of 7.5, one year after the onset of symptoms, and following informed consent of the parents, the patient was treated with the same previously described regimen. He was not included in the frequent MRI study due to the age requirement.
Paracentral Acute Middle Maculopathy Associated with Severe Anti-Mog (Myelin Oligodendrocyte Glycoprotein)-Positive Optic Neuritis
Published in Neuro-Ophthalmology, 2023
Rodrigo Dahia Fernandes, Thais de Souza Andrade, Rony C. Preti, Leandro C. Zacharias, Guilherme Diogo Silva, Leandro Tavares Lucato, Samira L. Apóstolos-Pereira, Dagoberto Callegaro, Mário Luiz R. Monteiro
Orbital magnetic resonance imaging (MRI) disclosed long bilateral optic neuritis lesions (characterised by T2-hyperintensity and contrast enhancement) together with bilateral perineural gadolinium enhancement suggestive of perineuritis (Figure 3). Brain and spinal cord MRI was unrevealing. Initial laboratory findings were negative, including complete blood count, C-reactive protein, electrolytes, renal function analysis, sedimentation rate, antinuclear antibody testing, anti-cardiolipin, anti-native deoxyribonucleic acid, rheumatoid factor, complement, anti-SSA, anti-SSB, hepatitis, human immunodeficiency virus and syphilis serology. Oral and nasal swabs were negative for COVID-19 on polymerase chain reaction testing, as was testing for AQP4 antibodies. A lumbar puncture showed clear and colourless cerebrospinal fluid (CSF) with five cells (98% lymphocytes), a protein level of 6 mg/dL and a normal biochemical analysis except for a slight increase in lactate levels to 27.0 mg/dL (normal range: 10–22). Serology and cultures for mycobacteria, fungi and syphilis were negative. Oligoclonal bands were absent.
Neurological manifestations in COVID-19: a systematic review and meta-analysis
Published in Brain Injury, 2020
Tzy Harn Chua, Zheyu Xu, Nicolas Kon Kam King
Of 15 patients with CSF tested, eight (53.3%) were abnormal (27,28,34,35,37). 25.0% (two out of eight) of the abnormal CSFs had elevated protein levels with normal cell count (27,37). Four (50.0%) out of eight had elevated cell count (28,34,35). One (8.3%) out of 12 CSFs was positive for COVID-19 (28). Four (26.7%) CSFs were sent for bacterial culture and were all negative (30,32,34). CSFs were sent for herpes simplex virus testing in four (26.7%) patients (27,28,30,35) and were all negative. CSF was sent for varicella zoster virus testing in two (13.3%) patients (28,30) and both were negative. One patient (6.7%) (30) was tested for West Nile virus while another patient (6.7%) (27) was tested for cytomegalovirus and respiratory syncytial virus; the CSFs were negative. Two (13.3%) patients were negative for unspecified viral pathogens (34). Oligoclonal bands with the same pattern in serum were reported in two (13.3%) patients (37). Investigation for other sources of pathogen in the CSF was not reported in three studies (29,31,33).
Novel uses of retinal imaging with optical coherence tomography in multiple sclerosis
Published in Expert Review of Neurotherapeutics, 2019
Frederike C. Oertel, Hanna G. Zimmermann, Alexander U. Brandt, Friedemann Paul
Over the last decades, several clinical and paraclinical measures have found their way into the diagnostic work-up of MS. Whereas, oligoclonal bands in the cerebrospinal fluid are an important indicator of immune reaction in the CNS, magnetic resonance imaging (MRI) is widely used for the detection of characteristic inflammatory lesions and of tissue atrophy in brain and spinal cord and for exclusion of relevant differential diagnoses [13–22]. Recently, diagnostic procedures are increasingly complemented by retinal imaging with optical coherence tomography (OCT). Application of OCT in MS was first described by Parisi et al. [23] for the evaluation of ON-related retinal nerve fiber layer thinning. OCT has since undergone a rapid development for the application in neurology, especially for patients with MS, and is now evolving into an inherent part of the diagnostic process and monitoring in specialized neuroimmunology services [24–27]. This article reviews OCT techniques and discusses associations between structural retinal damage and function in MS, as well as describes the application and future relevance of OCT for differential diagnosis, individual monitoring and prognosis of disease course, and for clinical trials.