RESUMO
Optic neuritis (ON) often occurs at the presentation of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). The recommended treatment of high-dose corticosteroids for ON is based on a North American study population, which did not address treatment timing or antibody serostatus. The Acute Optic Neuritis Network (ACON) presents a global, prospective, observational study protocol primarily designed to investigate the effect of time to high-dose corticosteroid treatment on 6-month visual outcomes in ON. Patients presenting within 30 days of the inaugural ON will be enrolled. For the primary analysis, patients will subsequently be assigned into the MS-ON group, the aquapotin-4-IgG positive ON (AQP4-IgG+ON) group or the MOG-IgG positive ON (MOG-IgG+ON) group and then further sub-stratified according to the number of days from the onset of visual loss to high-dose corticosteroids (days-to-Rx). The primary outcome measure will be high-contrast best-corrected visual acuity (HC-BCVA) at 6 months. In addition, multimodal data will be collected in subjects with any ON (CIS-ON, MS-ON, AQP4-IgG+ON or MOG-IgG+ON, and seronegative non-MS-ON), excluding infectious and granulomatous ON. Secondary outcomes include low-contrast best-corrected visual acuity (LC-BCVA), optical coherence tomography (OCT), magnetic resonance imaging (MRI) measurements, serum and cerebrospinal fluid (CSF) biomarkers (AQP4-IgG and MOG-IgG levels, neurofilament, and glial fibrillary protein), and patient reported outcome measures (headache, visual function in daily routine, depression, and quality of life questionnaires) at presentation at 6-month and 12-month follow-up visits. Data will be collected from 28 academic hospitals from Africa, Asia, the Middle East, Europe, North America, South America, and Australia. Planned recruitment consists of 100 MS-ON, 50 AQP4-IgG+ON, and 50 MOG-IgG+ON. This prospective, multimodal data collection will assess the potential value of early high-dose corticosteroid treatment, investigate the interrelations between functional impairments and structural changes, and evaluate the diagnostic yield of laboratory biomarkers. This analysis has the ability to substantially improve treatment strategies and the accuracy of diagnostic stratification in acute demyelinating ON. Trial registration: ClinicalTrials.gov, identifier: NCT05605951.
RESUMO
RESUMEN La parálisis pseudoperiférica es una presentación infrecuente del ataque cerebrovascular (ACV) isquémico, que suele llevar a un diagnóstico erróneo de patología de nervio periférico. Se caracteriza por una presentación clínica consistente en paresia de la mano o de un grupo de dedos y alteración de la sensibilidad que puede simular el compromiso de un nervio periférico. Se reporta el caso clínico de un paciente que cursó con parálisis pseudoperiférica, con compromiso motor predominantemente cubital asociado a hipoestesia multimodal en la región hipotenar, lo cual ilustrando la dificultad de la localización topográfica para explicar el compromiso motor y sensitivo por un síndrome mononeuropático, troncular, radicular o medular. Se resalta la importancia de una adecuada evaluación semiológica, que permita hacer aproximaciones diagnósticas acertadas para dar un manejo adecuado de acuerdo con el estudio topográfico en las patologías neurológicas.
SUMMARY Pseudo-peripheral palsy is an infrequent presentation of ischemic stroke, which often leads to a misdiagnosis of peripheral nerve pathology. It is characterized by palsy of the hand or a group of fingers and altered sensitivity which can simulate peripheral nerve damage. We report a case of a patient who had pseudo-peripheral palsy with predominantly ulnar motor involvement, associated with multimodal hypoesthesia in the hypothenar region; illustrating the difficulty of topographic localization to explain motor and sensory involvement by a mononeuropathic, radicular or spinal syndrome. We highlight the importance of an adequate semiological evaluation to accurately diagnose and manage these pathologies.