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1.
J Neuroophthalmol ; 2023 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-37976151

RESUMO

BACKGROUND: Over a century ago, German ophthalmologist Hermann Wilbrand reported inferonasal crossing fibers within the chiasm curve anteriorly into the contralateral optic nerve. This anatomic bend, "Wilbrand knee," is classically cited as the explanation for the "junctional scotoma," a contralateral superotemporal visual field defect associated with lesions affecting the optic nerve at its junction with the chiasm. More recent reports have called into question the existence of Wilbrand knee or suggested that it may simply be an artifact. METHODS: Four human optic chiasms (obtained from cadaver donors with no reported premortem visual pathology) and 2 monkey chiasms were fixed and thin sectioned (40 µm), then examined using anisotropic scattering imaging, a novel technique that takes advantage of the fact that light reflects off well-defined linear structures (i.e., axonal tracts) in a predictable manner based on their orientation. Using this technique, tissue structures oriented in different directions can be distinguished at high resolution without the need for tissue staining. RESULTS: In all 4 human optic chiasms, thin fiber tracts consistent with, but less prominent than, those Wilbrand had described were observed. No such tracts were found in the monkey chiasms. CONCLUSIONS: Wilbrand knee exists in humans but is modest in its anterior projection. Wilbrand knee does not seem to be present in monkeys, however, which may explain conflicting reports in the literature regarding its existence.

2.
J Neuroophthalmol ; 44(1): 125-128, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38170604
3.
BMC Neurol ; 16: 72, 2016 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-27206499

RESUMO

BACKGROUND: Primary central nervous system lymphoma (PCNSL) may rarely be preceded by "sentinel demyelination," a pathologic entity characterized by histologically confirmed demyelinating inflammatory brain lesions that mimic multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM). Interpreting the overlapping radiologic and clinical characteristics associated with each of these conditions-contrast-enhancing demyelination of white matter and relapsing and remitting steroid-responsive symptoms respectively-can be a significant diagnostic challenge. CASE PRESENTATION: We describe a 57-year-old woman with an unusual clinical course who presented with multi-focal enhancing white matter lesions demonstrated to be inflammatory demyelination by brain biopsy. Despite a good initial response to steroids and rituximab for treatment of presumed tumefactive multiple sclerosis, the patient's condition rapidly deteriorated, and a repeat brain biopsy six months later was consistent with a diagnosis of diffuse large B-cell lymphoma. CONCLUSIONS: Early clinical suspicion for PCNSL and awareness that biopsied lesions may initially show sentinel demyelination suggestive of alternate diagnoses may be essential for early initiation of appropriate therapies and mitigation of disease progression. Clinical, pathophysiological, and diagnostic aspects of sentinel demyelination and PCNSL are discussed.


Assuntos
Neoplasias do Sistema Nervoso Central/patologia , Doenças Desmielinizantes/patologia , Linfoma de Células B/patologia , Corticosteroides/uso terapêutico , Neoplasias do Sistema Nervoso Central/complicações , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico por imagem , Doenças Desmielinizantes/tratamento farmacológico , Progressão da Doença , Feminino , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/diagnóstico por imagem , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Rituximab/uso terapêutico , Substância Branca/patologia
4.
J Neuroophthalmol ; 35(2): 139-43, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25742198

RESUMO

BACKGROUND: Cranial nerve schwannomas are radiologically characterized by nodular cranial nerve enhancement on magnetic resonance imaging (MRI). Schwannomas typically present with gradually progressive symptoms, but isolated reports have suggested that schwannomas may cause fluctuating symptoms as well. METHODS: This is a report of ten cases of presumed cranial nerve schwannoma that presented with transient or recurring ocular motor nerve deficits. RESULTS: Schwannomas of the third, fourth, and fifth nerves resulted in fluctuating deficits of all 3 ocular motor nerves. Persistent nodular cranial nerve enhancement was present on sequential MRI studies. Several episodes of transient oculomotor (III) deficts were associated with headaches, mimicking ophthalmoplegic migraine. CONCLUSIONS: Cranial nerve schwannomas may result in relapsing and remitting cranial nerve symptoms.


Assuntos
Neoplasias dos Nervos Cranianos/complicações , Neurilemoma/complicações , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/etiologia , Adulto , Idoso , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
J Neuroophthalmol ; 33(2): 128-33, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23528798

RESUMO

BACKGROUND: Using diffusion tensor imaging, we evaluated the directional diffusivities of the optic nerve in patients with traumatic optic neuropathy (TON). METHODS: Our study consisted of 12 patients with unilateral TON, 6 patients with severe traumatic brain injury (comparison group A), and 6 patients with normal conventional brain magnetic resonance imaging (comparison group B). The contralateral optic nerve in patients with TON also was evaluated (comparison group C). Two trauma radiologists, blinded to the clinical diagnosis, independently obtained the directional diffusivities. The intraorbital optic nerve was divided into anterior and posterior segments to evaluate intersegmental differences in directional diffusivities. RESULTS: The mean axial diffusivity (AD) in both optic nerve segments and the mean diffusivity (ADC) in the posterior segment on the affected side were significantly lower and differentiated subjects with TON from those in comparison groups A and B. Area under the receiver operating characteristic curve was 0.762, 0.746, and 0.737 for posterior AD, anterior AD, and posterior ADC, respectively. The mean AD, mean diffusivity, and radial diffusivity were lower in the affected nerves in comparison to the contralateral nerve (comparison group C), but the values did not reach statistical significance. CONCLUSION: Decreased AD and mean diffusivity in the posterior segment of the optic nerve may serve as a biomarker of axonal damage in patients with TON and merits further investigation as a predictor of initial visual acuity and potential visual recovery.


Assuntos
Imagem de Difusão por Ressonância Magnética , Traumatismos do Nervo Óptico/diagnóstico , Adulto , Idoso , Anisotropia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-37673687

RESUMO

A 28-year-old woman presented with subacute relapsing left-sided weakness. MRI demonstrated both enhancing C3-C6 and nonenhancing T2-T4 lesions. Initial provisional diagnosis was inflammatory/autoimmune. Her left-sided weakness progressed despite immunosuppressive therapies. We reassessed our original suspected diagnosis because of an atypical clinicoradiologic course, leading to biopsy and a definitive diagnosis.


Assuntos
Esclerose Múltipla , Humanos , Feminino , Adulto , Esclerose Múltipla/diagnóstico por imagem , Biópsia , Terapia de Imunossupressão , Imageamento por Ressonância Magnética
7.
Pract Neurol ; 12(6): 390-1, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23144306

RESUMO

Aberrant regeneration of a third nerve palsy (oculomotor synkinesis) excludes an ischaemic cause and in the absence of relevant trauma strongly suggests a compressive aetiology. A scan is mandatory in such cases. We describe the case of a 52-year-old woman who presented with complete pupil-involving third nerve palsy from a posterior communicating artery aneurysm, who later developed widespread aberrant regeneration of pupil, eyelid and third nerve territory rectus muscles.


Assuntos
Regeneração Nervosa , Doenças do Nervo Oculomotor/fisiopatologia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/diagnóstico por imagem , Doenças do Nervo Oculomotor/etiologia , Tomografia Computadorizada por Raios X
8.
Neurol Ther ; 11(2): 515-524, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35066816

RESUMO

The ongoing coronavirus disease 2019 (COVID-19) pandemic continues to raise questions for people living with multiple sclerosis (MS) and their healthcare providers. Common questions have included whether people living with MS are at higher risk of COVID-19 or of severe disease, whether certain disease-modifying therapies (DMTs) for MS heighten COVID-19 risk, and if/how COVID-19 vaccinations should be administered in relation to MS treatments. Anti-CD20 therapies, which target B cells, have been of particular interest given the role B cells play in the response to both the virus that causes COVID-19 (SARS-CoV-2) and vaccines. As more data surfaces and the pandemic evolves, additional questions have emerged regarding the administration of booster shots and differences between B cell-targeting therapies and other DMTs in terms of their immunomodulatory effects. In this podcast article, MS specialists discuss these challenges to MS care during the COVID-19 pandemic and the recent data which are currently informing their clinical decision-making. As the pandemic evolves, providers should continually partner with people living with MS to achieve MS treatment goals informed by the latest developments in COVID-19. Video: Podcast Video (MP4 388175 KB).

10.
Brain Sci ; 11(9)2021 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-34573267

RESUMO

There is increasing interest in the development and deployment of digital solutions to improve patient care and facilitate monitoring in medical practice, e.g., by remote observation of disease symptoms in the patients' home environment. Digital health solutions today range from non-regulated wellness applications and research-grade exploratory instruments to regulated software as a medical device (SaMD). This paper discusses the considerations and complexities in developing innovative, effective, and validated SaMD for multiple sclerosis (MS). The development of SaMD requires a formalised approach (design control), inclusive of technical verification and analytical validation to ensure reliability. SaMD must be clinically evaluated, characterised for benefit and risk, and must conform to regulatory requirements associated with device classification. Cybersecurity and data privacy are also critical. Careful consideration of patient and provider needs throughout the design and testing process help developers overcome challenges of adoption in medical practice. Here, we explore the development pathway for SaMD in MS, leveraging experiences from the development of Floodlight™ MS, a continually evolving bundled solution of SaMD for remote functional assessment of MS. The development process will be charted while reflecting on common challenges in the digital space, with a view to providing insights for future developers.

11.
Ann Neurol ; 63(3): 355-65, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17696176

RESUMO

OBJECTIVE: To characterize the syndrome of saccadic palsy that may follow cardiac surgery, and to interpret the findings using current concepts of the neurobiology of fast eye movements. METHODS: Using the magnetic search coil technique, we measured eye, eyelid, and head movements of 10 patients who developed selective palsy of saccades after cardiac surgery. RESULTS: Patients showed varying degrees of slowing and hypometria of saccades in the vertical plane or both horizontal and vertical planes, with complete loss of all saccades in one patient. Quick phases of nystagmus were also affected, but smooth pursuit, vergence, and the vestibuloocular reflex were usually spared. The smallest saccades were less slowed than larger saccades. Affected patients were visually disabled by loss of ability to voluntarily shift their direction of gaze. Blinks and head thrusts modestly improved the range and speed of voluntary movement. The syndrome usually followed aortic valve replacement. Common accompanying features included dysarthria, labile emotions, and unsteady gait. The saccadic palsy either improved during the early part of the course or remained static. INTERPRETATION: Selective loss of all forms of saccades, with sparing of other eye movements, indicates malfunction of the brainstem machinery that generates saccades. A current model of brainstem circuits could account for both hypometria and slowing. This syndrome and the visual disability it causes often go unrecognized unless saccades are systematically tested at the bedside.


Assuntos
Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Nistagmo Patológico/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Movimentos Sacádicos/fisiologia , Adulto , Idoso , Feminino , Movimentos da Cabeça/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/etiologia , Doenças do Nervo Oculomotor/etiologia , Complicações Pós-Operatórias/etiologia
12.
Neurol Ther ; 10(2): 415-425, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34347280

RESUMO

COVID-19 vaccines are safe for people living with MS on or off disease-modifying therapies and are important for the prevention of COVID-19. Antibody responses for individuals on certain DMTs may be diminished, however, T-cell responses may be preserved in those individuals. Data are lacking regarding optimal timing of vaccinations, and delaying disease-modifying therapies may increase the risk of disease activity and progression. In this perspective podcast, the authors recommend COVID-19 vaccination as soon as possible, regardless of timing considerations, in most cases.

14.
J Neuroimaging ; 12(3): 270-2, 2002 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-12116747

RESUMO

The authors describe a 36-year-old man with Sturge-Weber syndrome who presented with focal seizures and subsequently developed a temporary post-ictal hemianopia. Magnetic resonance imaging of the brain demonstrated focal leptomeningeal enhancement, which subsequently resolved.


Assuntos
Encéfalo/patologia , Imageamento por Ressonância Magnética , Síndrome de Sturge-Weber/patologia , Adulto , Humanos , Masculino
15.
Neurology ; 82(5): 459-60, 2014 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-24491972

RESUMO

Wilbrand and Saenger(1) studied optic chiasms after unilateral enucleation, noting inferonasal crossing fibers curved anteriorly into the contralateral optic nerve (Wilbrand knee; figure, A). This explains contralateral superotemporal visual field defects (junctional scotomas) with optic nerve lesions at the chiasmal junction. However, Wilbrand knee may be an enucleation artifact.(2) The anisotropic light-reflecting properties of myelinated axons permitted imaging of normal human chiasms. Thin sections (25 µm) were illuminated and digitally imaged from 3 incident angles. Each of the images was pseudocolored (red, green, or blue) and merged, revealing an anomalously oriented fiber tract (appearing white) that reversed direction at the optic nerve-chiasm junction, found in inferior (figure, C) but not in superior sections (figure, B), consistent with Wilbrand and Saenger's original description.


Assuntos
Artefatos , Polarização de Fluorescência , Quiasma Óptico/patologia , Nervo Óptico/patologia , Polarização de Fluorescência/métodos , Humanos
16.
Neurology ; 83(19): 1761-6, 2014 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-25305155

RESUMO

OBJECTIVE: To survey all US medical school clerkship directors (CDs) in neurology and to compare results from a similar survey in 2005. METHODS: A survey was developed by a work group of the American Academy of Neurology Undergraduate Education Subcommittee, and sent to all neurology CDs listed in the American Academy of Neurology database. Comparisons were made to a similar 2005 survey. RESULTS: Survey response rate was 73%. Neurology was required in 93% of responding schools. Duration of clerkships was 4 weeks in 74% and 3 weeks in 11%. Clerkships were taken in the third year in 56%, third or fourth year in 19%, and fourth year in 12%. Clerkship duration in 2012 was slightly shorter than in 2005 (fewer clerkships of ≥4 weeks, p = 0.125), but more clerkships have moved into the third year (fewer neurology clerkships during the fourth year, p = 0.051). Simulation training in lumbar punctures was available at 44% of schools, but only 2% of students attempted lumbar punctures on patients. CDs averaged 20% protected time, but reported that they needed at least 32%. Secretarial full-time equivalent was 0.50 or less in 71% of clerkships. Eighty-five percent of CDs were "very satisfied" or "somewhat satisfied," but more than half experienced "burnout" and 35% had considered relinquishing their role. CONCLUSION: Trends in neurology undergraduate education since 2005 include shorter clerkships, migration into the third year, and increasing use of technology. CDs are generally satisfied, but report stressors, including inadequate protected time and departmental support.


Assuntos
Estágio Clínico , Educação Médica , Avaliação Educacional , Neurologia/educação , Coleta de Dados , Educação Médica/economia , Feminino , Humanos , Masculino , Neurologia/economia
17.
Neurologist ; 16(5): 319-21, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20827123

RESUMO

INTRODUCTION: Granulocytic sarcomas, or chloromas, are extramedullary collections of immature granulocytes. Central nervous system involvement is rare and of those cases described, most are complications of acute myelogenous leukemia. CASE REPORT: A 40-year-old man with chronic myelogenous leukemia presented with seizure and encephalopathy. Magnetic resonance imaging of the brain revealed temporal T2 hyperintensities with gyriform cortical enhancement. Cerebrospinal fluid showed mild pleocytosis and elevated protein. Electroencephalography demonstrated periodic lateralized epileptiform discharges. Acyclovir was initiated for herpes simplex encephalitis, however, follow-up MRI showed extension of the lesion. MR spectroscopy suggested tumor, confirmed by brain biopsy. Postradiation MRI showed a significant decrease in lesion size. CONCLUSION: Granulocytic sarcoma can present as intraparenchymal cerebral lesions in patients with chronic myelogenous leukemia and may mimic herpes simplex encephalitis.


Assuntos
Neoplasias Encefálicas/patologia , Encefalite por Herpes Simples/patologia , Sarcoma Mieloide/patologia , Aciclovir/uso terapêutico , Adulto , Antivirais/uso terapêutico , Biópsia , Encéfalo/patologia , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/radioterapia , Diagnóstico Diferencial , Eletroencefalografia , Encefalite por Herpes Simples/tratamento farmacológico , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Imageamento por Ressonância Magnética , Masculino , Sarcoma Mieloide/etiologia , Sarcoma Mieloide/radioterapia
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