Presumptive isolated neurosarcoidosis involving eloquent structures: An argument for empirical TNF-α inhibition.

There are clinical and radiological phenotypes characteristic of neurosarcoidosis. Histopathologic confirmation is preferred, however, biopsy is associated with a significant risk of morbidity when only eloquent neural structures are involved and where there is no systemic disease. We present a series of patients with isolated neurosarcoidosis and suggest circumstances where an empirical, closely monitored, trial of tumour-necrosis-factor-alpha inhibitor therapy can improve outcome and diagnostic confidence.

The spectrum of immune-mediated and inflammatory lesions of the brainstem: Clues to diagnosis.

The presentation of a patient with brainstem symptoms and signs invokes a number of common and less common differential diagnoses, and accurate diagnosis can be challenging. We review the major immune-mediated and inflammatory syndromes that can affect the brainstem including multiple sclerosis, neuromyelitis optica spectrum disorder, neuro-Behçet disease, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids, neurosarcoidosis, Susac syndrome, and the histiocytic disorders. We focus on clinical features and MRI clues that help to distinguish among the different brainstem conditions. Accurate diagnosis is important to guide appropriate treatment and limit neurologic disability.

Progressive multifocal leukoencephalopathy in a patient with systemic lupus erythematosus: Clues to early diagnosis.

A case of progressive multifocal leukoencephalopathy (PML) occurring on low dose immunosuppression for systemic lupus erythematosus (SLE) and Sjogren's syndrome (SS) is presented. Neurologic changes in patients with SLE or SS should not be assumed to be a disease manifestation. Importantly, serious opportunistic infections such as PML can occur in minimally immunosuppressed rheumatic patients. Early diagnosis, facilitated by scrutiny of MRI findings, should trigger measures to reconstitute immunity in an otherwise fatal disease.

Paraneoplastic acute disseminated encephalomyelitis associated with multiple myeloma.

We describe a man recently diagnosed with multiple myeloma who presented with progressive spastic paraparesis, encephalopathy and multifocal MRI lesions with haemorrhage. Brain histopathology was consistent with acute disseminated encephalomyelitis (ADEM) with no new clinicoradiological findings on follow-up. This case emphasises the growing paraneoplastic spectrum, including non-classical but treatable disorders such as ADEM.

Current concepts in multiple sclerosis therapy.

Over the past 20 years, the available therapies for multiple sclerosis have expanded exponentially. With several more agents likely to be approved for public funding in Australia in the next 12 months on top of the existing multitude of Australian Pharmaceutical Benefits Scheme-subsidized therapies, the choice is becoming even more complex. This review summarizes the current state of available therapies and anticipates likely future directions, including an important focus on contemporary symptom management. For each agent, the major trials, side effects, and clinical utility are summarized, with a particular focus on the Australian experience of these therapies. It is hoped this review provides an up-to-date reference of the exciting current state of multiple sclerosis therapy.

Advances in endovascular therapy for ischemic stroke: A whole new ball game.

Purpose of review: The burden of disability from ischemic stroke continues to intensify. Any acute therapeutic option that reduces disability after ischemic stroke should be encouraged and further studied. In particular, the need for an effective treatment in patients with large vessel occlusion has been long overdue. Recent findings: Consistent trial evidence has answered this need in an emphatic fashion, demonstrating improved functional outcomes with endovascular therapy following better patient selection, new device technology, and reduced treatment times. The article discusses the current evidence and guidelines and highlights the inherent complexities of a specialized intervention whose demand will grow exponentially. The scope for future investigation especially using advanced imaging to expand patient selection will be considered. Summary: Endovascular thrombectomy is an established and highly efficacious acute treatment for ischemic stroke that we need to apply and implement to maximize benefit to the population.