Whole-genome analysis of a rare G15P[21] group A rotavirus detected at a dairy cattle farm.

Group A rotaviruses (RVAs) are a major cause of severe enteritis in humans and animals. RVAs have been identified in several animal species and their genetic diversity, the segmented nature of their RNA genome and the ability to spill over from one species to another can generate new RVA strains. In this study, we investigated the genome constellations of an unusual, rare, bovine RVA strain, G15P[21], identified from a farm with neonatal diarrhoea of calves in 2006. In parallel, the genome constellations of other RVA strains with different G/P types identified from the same farm in the same time span (2006-2008) were analysed. The genome constellation of strain K53 was G15-P[21]-I2-R2-C2-M2-A13-N2-T9-E2-H3 and was similar, overall, to that of the other bovine RVA strains (G6/10-P[11]-I2-R2-C2-M2-A13-N2-T6-E2-H3) with the exception of the NSP3 segment (T9 vs T6). This study describes RVA genomes with different genotype combinations isolated at a farm and also contributes to the understanding of the diversity and evaluation of rotavirus in a global context.

Should "Retro-ocular Pain, Photophobia and Visual Acuity Loss" Be Recognised as a Distinct Entity? The ROPPVAL Syndrome.

Unilateral retro-ocular pain, photophobia and visual disturbance in patients suspected as having acute optic neuritis was described as a distinct clinical entity by Jefferis et al. in 2018. We hereby report a further four patients with the same clinical phenotype and propose the term ROPPVAL syndrome (Retro-Ocular Pain, Photophobia and Visual Acuity Loss). All of them had a previous (mis)diagnosis of optic neuritis. All of the patients had normal ocular and neurological examinations, no relative afferent pupillary defect and no objective structural abnormality was identified. We also discuss possible mechanisms, the role of cycloplegics that we found to be useful in reducing symptoms, and the importance of distinguishing this syndrome from optic neuritis.

Retrogeniculate Lesion of the Visual Pathways: Retinal Optical Coherence Tomography Angiography Shows Evidence of Transsynaptic Retrograde Degeneration.

Transsynaptic retrograde degeneration (TSRD) of the visual pathways is the loss of retinal ganglion cells occurring upstream from a posterior visual pathway lesion. We present a case of a 54-year-old woman with an epidermoid cyst at the right temporo-occipital junction, in whom retinal optical coherence tomography angiography showed a reduction of the superficial retinal capillary density consistent with TSRD. While this reduction has been described in chronic optic neuropathies and pregeniculate lesions, to our knowledge, this is the first case report showing how a reduction in the superficial retinal capillary density occurs also for a postgeniculate lesion.

Corneal Involvement in Wallenberg Syndrome: Case Report and Literature Review.

A 47-year-old man with Wallenberg syndrome after a stroke in the territory of the left vertebrobasilar artery and posterior inferior cerebellar artery, presented a week later complaining of visual loss in the left eye. Examination showed corneal anaesthesia associated with a neurotrophic corneal epithelial defect. Corneal involvement secondary to trigeminal neuropathy in Wallenberg syndrome is not frequently reported and may lead to epithelial erosion and neurotrophic keratopathy. Clinicians should be aware that visual loss can occur from a neurogenic basis (e.g., Wallenberg syndrome) due to neurotrophic keratopathy. The use of cocaine, a potential cause of neurotrophic keratopathy, should also be suspected in the appropriate clinical scenario.

Photophobia as the Presenting Symptom of Internal Carotid Artery Dissection.

A 53-year-old man developed right eye photophobia after a hypertensive crisis, followed by right-sided headache and retro-orbital pain. On examination, a right Horner syndrome was evident and an urgent brain and neck Computed Tomography confirmed the suspicion of an internal carotid artery (ICA) dissection. While photophobia may occur in many neurological disorders, to our knowledge, it has never been described when the ICA is involved. Possible hypotheses of photophobia caused by carotid artery dissection are discussed.

Optical Coherence Tomography Angiography Findings in Deficiency Optic Neuropathy.

A 44-year-old man was evaluated for bilateral progressive visual loss and diagnosed with vitamin B12 deficiency optic neuropathy. Optical Coherence Tomography Angiography features of optic nerve and macula showed a decrease in peripapillary and macular vessel density that correlated well with the areas of retinal nerve fibre layer thinning seen on OCT. Further studies are needed to evaluate the role of this new technology in the evaluation of toxic and metabolic optic neuropathy.

Neuro-Ophthalmic Sarcoidosis.

Background: In the absence of confirmatory biopsy, the criteria for diagnosis of neuro-ophthalmic sarcoidosis are not well established. Diagnostic criteria for both intraocular sarcoidosis and neurosarcoidosis have been proposed, but the diagnosis of neuro-ophthalmic sarcoidosis remains challenging. It is our intention to augment what is currently known about the diagnosis of neuro-ophthalmic sarcoidosis by providing a series of biopsy-proven cases that contribute to the continued development of diagnostic criteria for this enigmatic condition. Methods: Case series of four Caucasian women with biopsy-proven neuro-ophthalmic sarcoidosis. Results: The first patient was initially diagnosed with traumatic optic neuropathy following a fall. Years later, the presence of pathologic submandibular lymphadenopathy was identified and biopsied, revealing non-caseating granulomas. The second and third cases involved sarcoidosis of the extraocular muscles without clear or common systemic features of sarcoidosis. In the fourth and final case, the patient presented with a Horner syndrome attributed to sarcoid infiltration of the ipsilateral sympathetic chain. Bronchoscopy with biopsy showed non-caseating granulomas consistent with sarcoidosis. Conclusions: We describe four cases of neuro-ophthalmic sarcoidosis and propose possible neuro-orbital and neuro-ophthalmic criteria both with and without diagnostic biopsy.

Multicentric Glioblastoma Multiforme Mimicking Optic Neuritis.

A 49-year-old previously healthy woman presented with acute painless visual loss in the right eye, a right relative afferent pupillary defect, and a normal fundus examination. She was diagnosed with retrobulbar "optic neuritis" and given a course of intravenous steroids. Despite treatment, however, she continued to lose vision and serial visual field testing confirmed a junctional scotoma in the fellow eye. Cranial magnetic resonance imaging (MRI) showed a mass at the junction between the right optic nerve and the anterior aspect of the chiasm and a right frontal lesion that proved to be multicentric glioblastoma multiforme. Clinicians should be aware of the possibility of aggressive neoplasm in the differential diagnosis of retrobulbar optic neuritis.

Vogt-Koyanagi-Harada Disease Presenting as Unilateral Neuroretinits.

A 42-year-old female presented with unilateral visual loss associated with systemic symptoms of fever and headache. Although initial ophthalmic examination revealed a unilateral neuroretinitis, investigation for infectious and non-infectious causes of neuroretinitis were negative. At our examination, retinal imaging (suggestive of bilateral involvement) along with the results of lumbar puncture (pleocytosis) and clinical findings was consistent with a diagnosis of Vogt-Koyanagi-Harada disease. The patient was treated with intravenous steroids with prompt resolution of her symptoms. Vogt-Koyanagi-Harada disease may present atypically and should be considered in the differential diagnosis of neuroretinitis.

Bilateral Sixth Nerve Palsy and Nasal Voice in Two Sisters as a Variant of Guillan-Barré Syndrome.

A 6-year-old girl with acute pharyngitis presented with complaints of hypernasal speech and double vision. Examination revealed a bilateral abduction deficit associated with soft palate palsy causing rhinolalia aperta. Cerebrospinal fluid analysis showed albuminocytologic dissociation. Her sister also suffered from the same disorder, albeit milder, 1 month before. After treatment with intravenous immunoglobulin and steroids, the patient made a full recovery. After the case report, a brief discussion of Miller Fisher syndrome, Guillan-Barré syndrome, and their variants is made. This case highlights that bilateral sixth nerve palsy and rhinolalia aperta in the absence of ataxia should still raise suspicion for these autoimmune conditions that may rarely and atypically present in siblings.

From A to Z(OOR): The Clinical Spectrum of Acute Zonal Occult Outer Retinopathy.

Acute idiopathic blind spot enlargement (AIBSE) is often caused by Acute Zonal Occult Outer Retinopathy (AZOOR), an outer retinal disease. We report two illustrative cases of AZOOR. The first one was a 21-year-old white female who presented with a scotoma and "shimmering lights" in her left eye. In the second case, a 73-year-old white female was referred for evaluation of a "bitemporal hemianopsia" that started years prior, with no clinical significant photopsias. To our knowledge, case two is the longest documented duration of bilateral, progressive, and chronic, idiopathic, enlargement of the blind spot (CIBSE) documented in the English language ophthalmic literature.

Homonymous Hemianopsia Due to Posterior Cortical Atrophy.

A 63-year-old woman presented to her ophthalmologist complaining of reading difficulties for two years. Ophthalmological examination revealed a homonymous hemianopsia. Brain magnetic resonance imaging (MRI) scan was interpreted as normal, but positron emission tomography (PET) showed areas of posterior brain hypometabolism. This case highlights the high diagnostic suspicion that ophthalmologists should have regarding posterior cortical atrophy (including the visual variant of Alzheimer disease) in patients complaining of reading difficulties in the setting of a normal ophthalmic examination.

Retinitis Pigmentosa Sine Pigmento Mimicking a Chiasm Disease.

A 75-year-old woman presented to her ophthalmologist complaining of visual loss for several years. The ophthalmic examination was remarkable for a bitemporal visual field defect. Magnetic resonance imaging (MRI) scan of the brain was normal without evidence of chiasm compression. Neuro-ophthalmic examination was consistent with a retinal rather than a chiasmal disease. Retinal multimodal imaging helped in the correct diagnosis of retinitis pigmentosa, later confirmed by genetic testing.

Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients: a single-cohort perspective study.

Chronic diseases are increasing worldwide. Association of two or more chronic conditions is related with poor health status and reduced life expectancy, particularly among elderly patients. Comorbidities represent a risk factor for adverse events in several critical illnesses. We aimed to evaluate if elderly patients are affected by multiple chronic pathologies, assessed by Charlson comorbidity index (CCI), showed a reduced in-hospital survival after ischemic stroke. In a 3-year period, we evaluated all the subjects admitted to our internal medicine department for ischemic stroke. Age, sex, NIHSS score and all the comorbidities were recorded. Days of hospitalization, hospital-related infections and in-hospital mortality were also assessed. For each patient, we evaluated CCI, obtaining four classes: group 1 (CCI: 2-3), group 2 (CCI: 4-5), group 3 (CCI: 6-7) and group 4 (CCI: ≥8). Survival was evaluated with Kaplan-Meier and Cox regression analyses. The complete model considered in-hospital death as the main outcome, days of hospitalization as the time variable and CCI as the main predictor, adjusting for NIHSS, sex and nosocomial infections. Patients in CCI group 3 and 4 had an increased risk of in-hospital mortality, independently of NIHSS, sex and nosocomial infections. Elderly patients with multiple comorbidities have higher risk of in-hospital death when affected by ischemic stroke.

The Short and Brave Life of Gaetano Perusini: A Tribute to His Role in Shaping Neuroscience.

Gaetano Perusini was an early enigma in neuroscience. In an age where myths and religion still held tightly to medical knowledge, Dr. Perusini was a trailblazer, inventor, and decorated forerunner. Born in Udine, worshiped in Italy, educated across Europe, published all over the western hemisphere, and taken away from us during a time of worldwide strife, his story continues to fascinate us today. This is a short chronicle of the major events in his life that also celebrates his widely acclaimed influence on understanding Alzheimer's disease.

Serous macular detachment in ocular toxoplasmosis: A review.

Ocular toxoplasmosis, a disease of the eye caused by the protozoan parasite Toxoplasma gondii, represents a common cause of posterior uveitis. The Authors review the current Literature regarding the uncommon presentation of ocular toxoplasmosis as macular serous retinal detachment (SRD). It is imperative to keep in mind that inflammatory SRD is a possible presentation of toxoplasmic retinochoroiditis. Underestimation of this clinical scenario and treatment with steroids alone without appropriate antiparasitic drugs, could lead to devastating consequences.

Dexamethasone Intravitreal Implant to Treat Persistent Full-Thickness Macular Hole.

Purpose: To describe a new technique for the secondary repair of persistent full-thickness macular holes (FTMHs). Methods: This series evaluated 3 cases of a persistent FTMH after pars plana vitrectomy, internal limiting membrane peeling, and 20% sulfur hexafluoride gas tamponade. After at least 4 weeks (mean, 36.3; range, 32-40) of unsuccessful topical treatment with nonsteroidal anti-inflammatory drugs, an intravitreal dexamethasone implant was injected. Results: The intravitreal dexamethasone implant led to anatomic closure and visual improvement in all 3 cases over a 3-month follow-up. Conclusions: An intravitreal dexamethasone implant could be considered in the management of selected cases of persistent FTMH. Further studies and a consistent number of cases are needed to fully understand the role of intravitreal dexamethasone implants in persistent FTMHs.