ABSTRACT
BACKGROUND: To evaluate the population-based frequency and severity of multiple sclerosis (MS)-related ocular diseases. METHODS: Retrospective, population-based study examining patients with MS between January 1, 1998 and December 31, 2011. Patients were identified using the Rochester Epidemiology Project, which is a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota residents. Diagnosis of MS was confirmed based on neuroimaging, cerebrospinal fluid studies, and serum studies for each patient according to the 2017 McDonald criteria. Patient data were obtained using the medical records and followed through April 1, 2018. RESULTS: Of the 116 patients with MS, 66% were female and the median age of onset was 36 years (interquartile range 27.5-43.5 years). About half (61/116, 53%) had MS-related neuro-ophthalmic manifestations during their disease course, and about one-fourth (33/116, 28%) had visual symptoms as their presenting symptom of MS, most commonly as optic neuritis (26/116, 22%). Optic neuritis was the leading MS-related ocular condition (37%), followed by internuclear ophthalmoplegia (16%) and nystagmus (13%). Optic neuritis was mostly unilateral (40/43, 93%), with 16% (6/43) having a visual acuity of 20/200 or worse at nadir but ultimately 95% (35/37) improving to a visual acuity of 20/40 or better. CONCLUSIONS: This study provides the population-based frequency of MS-related ocular disease, which demonstrates a high frequency of ocular manifestations in MS both at disease onset and during the disease course, emphasizing the utility of neuro-ophthalmologists, or collaboration between neurologists and ophthalmologists, in the care of patients with MS.
Subject(s)
Multiple Sclerosis , Humans , Female , Male , Adult , Retrospective Studies , Multiple Sclerosis/epidemiology , Multiple Sclerosis/diagnosis , Multiple Sclerosis/complications , Minnesota/epidemiology , Middle Aged , Eye Diseases/epidemiology , Eye Diseases/etiology , Eye Diseases/diagnosis , Optic Neuritis/epidemiology , Optic Neuritis/diagnosis , Optic Neuritis/etiology , Young AdultABSTRACT
OBJECTIVE: To explore sensitivity of optical coherence tomography (OCT) in detecting prior unilateral optic neuritis. METHODS: This is a retrospective, observational clinical study of all patients who presented from January 1, 2014, to January 6, 2017, with unilateral optic neuritis and OCT available at least 3 months after the attack. We compared OCT retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thicknesses between affected and unaffected contralateral eyes. We excluded patients with concomitant glaucoma or other optic neuropathies. Based on analysis of normal controls, thinning was considered significant if RNFL was at least 9 µm or GCIPL was at least 6 µm less in the affected eye compared to the unaffected eye. RESULTS: Fifty-one patients (18 male and 33 female) were included in the study. RNFL and GCIPL thicknesses were significantly lower in eyes with optic neuritis compared to unaffected eyes (p < 0.001). RNFL was thinner by ≥9 µm in 73% of optic neuritis eyes compared to the unaffected eye. GCIPL was thinner by ≥6 µm in 96% of optic neuritis eyes, which was more sensitive than using RNFL (p < 0.001). When using a threshold ≤1st percentile of age-matched controls, sensitivities were 37% for RNFL and 76% for GCIPL, each of which was lower than those calculated using the intereye difference as the threshold (p < 0.01). CONCLUSIONS: OCT, especially with GCIPL analysis, is a highly sensitive modality in detecting prior optic neuritis, which is made more robust by using intereye differences to approximate change. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that OCT accurately identifies patients with prior unilateral optic neuritis.
Subject(s)
Optic Neuritis/diagnostic imaging , Tomography, Optical Coherence , Adult , Demyelinating Diseases/diagnostic imaging , Demyelinating Diseases/pathology , Female , Humans , Male , Middle Aged , Multiple Sclerosis/diagnostic imaging , Nerve Fibers/pathology , Neuromyelitis Optica/diagnostic imaging , Neuromyelitis Optica/pathology , Optic Neuritis/pathology , Retinal Ganglion Cells/pathology , Retrospective Studies , Sensitivity and Specificity , Young AdultSubject(s)
Blood Pressure/physiology , Brain/diagnostic imaging , Hypertension, Malignant/complications , Magnetic Resonance Imaging/methods , Papilledema/diagnosis , Retinal Hemorrhage/diagnosis , Vision, Low/diagnosis , Adult , Female , Humans , Hypertension, Malignant/diagnosis , Hypertension, Malignant/physiopathology , Papilledema/etiology , Retinal Hemorrhage/etiology , Vision, Low/etiologyABSTRACT
The association of severe calcific aortic stenosis with clinically significant stroke has not been well established. This case vividly describes the relationship with clinical and pathological (gross and microscopic) findings in a 62-year-old man with a severely calcified bicuspid aortic valve. Eleven months prior to aortic valve surgery, the patient had stigmata of cerebral embolic events in the absence of any other embolic source. During the aortic valve replacement surgery for aortic stenosis, he was found to have a large atheroma on the aortic valve cusp with a crater containing friable debris in its center. These findings support the potential for embolic stroke in patients with severe calcific aortic stenosis. We recommend that the aortic valve be considered as an embolic source in patients with an otherwise cryptogenic cerebrovascular accident.
