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Optic Neuropathies Associated With Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorders (NMO-SD)
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Cerebrospinal fluid (CSF) is usually acellular but may reveal mild mononuclear pleocytosis. Proteins may be normal or mildly increased. Pleocytosis of >100 cells/mm3 or proteins of >100 mg/dl should alarm a clinician toward an alternative diagnosis. CSF total IgG levels and 24 hour intrathecal production of IgG are increased resulting in oligoclonal bands in 85% of MS patients (20, 21). As per the 2017 Mc Donald criteria (Annexure 5.1), the presence of CSF-specific OCBS can substitute for requirement of DIT in a patient with clinical evidence of a single attack.
Fetal and neonatal medicine
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Congenital rubella infection causes cataract and glaucoma. Cataract is the most characteristic ocular lesion of congenital rubella but may not be recognized until after the neonatal period. CNS involvement is frequent and may present with lethargy, irritability and bulging fontanelle. Spinal fluid shows pleocytosis. The retina is involved but the optic nerve is spared. Hearing loss may also manifest later in life, which may be as late as school age. Diabetes mellitus occurs many years later due to destruction of islet cells of the pancreas
Rocky Mountain Spotted Fever and Typhus Fever
Published in James H. S. Gear, CRC Handbook of Viral and Rickettsial Hemorrhagic Fevers, 2019
Neurologic signs — Headache is very common, severe in intensity, frontal or generalized in distribution. Patients are restless, irritable, and unable to sleep. Severe myalgia with muscle pains, even with nuchal rigidity, may involve muscles of the neck, back, legs, and abdominal wall. Severely ill patients develop athetoid movements, convulsions, coma, and hemiplegia (rarely). All are grave signs indicative of rickettsial encephalitis and/or vascular thromboses. Deafness may be noted during the acute illness and persist for a number of months. Most signs abate with defervescence; the electroencephalogram may show signs of diffuse involvement and gradually become normal. During the acute stages, the CSF is usually clear, under moderately elevated pressure and normal dynamics. There may be a mild pleocytosis and normal chemical values.
Ocular Syphilis: Experience over 11 Years at a German Ophthalmology Reference Centre
Published in Ocular Immunology and Inflammation, 2023
R. Yaici, A. Balasiu, C.R. MacKenzie, M. Roth, K. Beseoglu, C. Holtmann, G. Geerling, R. Guthoff
Cerebrospinal fluid (CSF) analysis was performed in 15 cases (46.9%). The median TPPA-titre was 1:128, range 1:8–1:4096. Lactate (median 1.8; normal range 1.1–2.4) and glucose (median 58; normal range 40–76) were within the normal range for all samples. Pleocytosis was found in 10/15 (31.3%) samples and increased protein in 7/15 (21.9%). Brain-blood barrier function was analysed by means of a Reiber-Diagram in the Institute of Clinical Chemistry, Heinrich-Heine University, Dusseldorf, for all CSF presenting abnormalities. The brain-blood barrier was intact in ten samples, three of which displayed intrathecal antibody production, one without pleocytosis but increased protein, one with pleocytosis but without increased protein and in the third lymphocytes and proteins were both within normal values. Among five CSF samples with impaired brain-blood barrier, three presented with neither intrathecal antibody production, nor increased protein, nor pleocytosis. The two samples with intrathecal antibody production showed concomitant pleocytosis and increased protein. Moreover, these two patients were HIV positive and thus difficult to diagnose as neurosyphilis. In addition, Epstein- Bar virus (EBV) was detected in two samples, one vitreous biopsy and one in the CSF.
Oligoclonal bands: clinical utility and interpretation cues
Published in Critical Reviews in Clinical Laboratory Sciences, 2022
Sara Carta, Diana Ferraro, Sergio Ferrari, Chiara Briani, Sara Mariotto
Oligoclonal immunoglobulin G (IgG) bands (OCBs) are composed of clonal immunoglobulins generated by plasmablasts/plasma cells that reflect an immunologic antigen response, usually associated with inflammatory or infectious nervous system disorders [1]. Different patterns of OCBs have been described based on the presence/absence of OCBs in the serum, cerebrospinal fluid (CSF), or both, with intrathecal synthesis being defined by the presence of at least two bands exclusively observed in the CSF (patterns 2 and 3). Isoelectric focusing (IEF) on agarose gels followed by immunoblotting is the electrophoretic technique recommended for OCB detection [1–3] that allows the identification of a central humoral response. With this technique, intrathecal IgG synthesis has been observed in >90% of subjects with multiple sclerosis (MS) [1,4] and in a variable percentage also in other inflammatory or infectious neurological disorders. Whether directed against an unknown (as in MS) or known (as in infectious disorders) antigen target, OCB detection has a potential role in informing the mechanisms of immune response and pathogenesis of nervous system disorders. In this review, we review the presence and significance of OCBs in different central and peripheral nervous system conditions and discuss possible pathogenetic mechanisms related to intrathecal IgG synthesis. OCB and pleocytosis prevalence in the neurological conditions described herein is presented in Table 1.
Vogt–Koyanagi–Harada-like Disease following Yellow Fever Vaccination
Published in Ocular Immunology and Inflammation, 2021
Wesley R. Campos, Sarah P. F. Cenachi, Matheus Schmidt Soares, Priscila Freitas Gonçalves, Daniel V. Vasconcelos-Santos
Magnetic resonance imaging of the head and chest X-ray were unremarkable. Tuberculin skin test, as well as serological tests for hepatitis B and C, herpes simplex virus, human T-lymphotropic virus, HIV, and syphilis (venereal diseases research laboratory and fluorescent treponemal antibody absorption tests), was negative. Positive results were only for anti-cytomegalovirus and anti-varicella zoster virus IgG antibodies, and not IgM, in the serum. Results of other investigations were unremarkable, including full blood count, C-reactive protein, erythrocyte sedimentation rate, serum rheumatoid factor, angiotensin-converting enzyme, antinuclear antibodies, and antineutrophilic cytoplasmic antibodies (p- and c-antineutrophilic cytoplasmic antibodies). Lumbar puncture was performed and disclosed mild cerebrospinal fluid (CSF) pleocytosis (cells/mm3, with predominance of neutrophilic granulocytes −60%) and increased protein level (55 mg%). RNA of yellow fever virus was not found in serum or CSF by reverse-transcriptase polymerase chain reaction, and no pathogens were detected in cerebrospinal fluid culture.