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Optic Neuropathies Associated with Systemic Disorders And Radiation-Induced Optic Neuropathy
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
CNS involvement occurs in the minority (2–25%) Sjogren's cases and is much less common than peripheral nerve involvement in this condition (24, 26). The optic neuropathy may be related to immune-mediated small vessel vasculitis or demyelinating disease (24). Sjogren's related optic neuropathy may be more likely to recur than optic neuritis associated with MS (25).
Non-traumatic neurological conditions in medico-legal work
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
This is the most common form of demyelinating disease. It is a relapsing-remitting disorder in which plaques of demyelination can be widely distributed throughout the CNS. In general, the forensic pathologist will encounter multiple sclerosis (MS) as an incidental finding rather than a direct cause of death, although death may occur if there is acute demyelination in the brainstem. In chronic MS, the plaques have a predilection for subependymal (periventricular) and subpial sites, and for the cortical grey-white matter junction. Chronic plaques are sunken and grey and generally sharply defined. Acute plaques have a rather more granular appearance (Figure 18.11). The optic nerves should be examined if possible.
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
Potential chronic neurologic complications of COVID-19Cognitive function. Approximately one-third of hospitalized COVID-19 patients with severe clinical features who are subsequently discharged have deficits in executive function.4 The long-term outcomes for these patients are not clear. It also is unknown whether these patients are at risk for the development of a progressive dementia similar to that observed in HIV/AIDS.29Demyelinating disease. In experimental animal models, coronaviruses initiate the formation of CNS demyelinating lesions similar to those seen in multiple sclerosis.30 At this point in time, there has not been a reported increase in MS-like diseases in patients who have recovered from COVID-19. However, assessment of the long-term impact of COVID-19 on the development of neurologic and autoimmune diseases will require clinical monitoring over several years.
Spinal cord involvement in COVID-19: A review
Published in The Journal of Spinal Cord Medicine, 2023
Ravindra Kumar Garg, Vimal Kumar Paliwal, Ankit Gupta
Acute transverse myelitis is clinically characterized by sensorimotor disturbances, bladder/bowel dysfunction, and/or autonomic dysfunction attributable to the spinal cord. Typically, it manifests as a rapid disease progression within a few hours to up to 21 days, with a sharp sensory affection level, bilateral pyramidal signs, and bladder/bowel dysfunction. While neuroimaging is not usually suggestive of compressive myelopathy, cerebrospinal fluid (CSF) examination may reveal inflammatory changes.1,2 Acute demyelinating diseases of the central nervous system, such as multiple sclerosis, neuromyelitis optica spectrum disorder, and acute disseminated encephalomyelitis are other frequently encountered causes of acute myelitis. Moreover, many viruses can be directly implicated in the etiopathogenesis of acute transverse myelitis, including varicella-zoster, herpes simplex, Epstein–Barr, West Nile, Dengue, Japanese encephalitis, Zika, influenza, echovirus & hepatitis B, mumps, measles, and rubella viruses. However, most often, it is difficult to differentiate between a viral-induced and immune-mediated transverse myelitis.2,3 Furthermore, there is an increasing number of reports that have linked the SARS-CoV-2 virus to the pathogenesis of acute transverse myelitis.4–6 The spinal cord involvement can result either from the direct invasion of the spinal cord, cytokine storm, or an autoimmune response.
An Atypical Case of Enterovirus Meningitis Presenting with Unilateral Optic Disc Swelling and Minimal Optical Symptoms
Published in Ocular Immunology and Inflammation, 2023
Efthymios Karmiris, Georgios Vasilakos, Konstantinos Tsiripidis, Evangelia Chalkiadaki
Οur patient had no clinical symptoms and signs except from a reduction in visual quality, therefore, we had to exclude a broad range of diseases causing optic disc swelling, both typical and atypical. There are various possible causes of spontaneous optic neuritis. First, optic neuritis is often a symptom of demyelinating diseases such as multiple sclerosis or neuromyelitis optica spectrum disorders.4 In our case no spinal cord and brain abnormalities were found on brain and spine MRI. In addition, tests for anti-MOG and AQP-4-IgG antibodies showed negative results. Second, the possibility of other autoimmune or systemic diseases were considered. This required comprehensive patient evaluation, including hematologic, spinal and neuroimaging studies, which were all unremarkable in our case. Third we considered optic neuritis due to infectious disease or inflammatory reaction. Optic disc swelling on fundoscopy can be caused by almost all infections.3 When considering the CSF findings of our patient, it was most likely that the diagnosis was enterovirus optic papillitis accompanying aseptic meningitis, even if, surprisingly, the patient had no neurological symptoms.
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
Definitions for neuropsychiatric manifestations, including a minimal set of investigation and attribution criteria, are the first step toward a standardization. Positive experience has been made in other autoimmune diseases, such as systemic lupus erythematosus. Therefore, we consider that an international, multidisciplinary study could significantly contribute and make an important step toward diagnostic and/or classification criteria for neuropsychiatric manifestations in pSS. So far, these have been classified as PNS, CNS (Diffuse, focal, and spinal cord involvement), and ANS. Some manifestations, such as demyelinating disease, have to be differentiated from multiple sclerosis and neuromyelitis optica. Definition criteria and attribution could significantly impact future studies allowing comparisons of different cohorts and validation of biomarkers.