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Cureus Mar 2024Optic neuritis (ON) is a debilitating condition that through various mechanisms, including inflammation or demyelination of the optic nerve, can result in partial or... (Review)
Review
Optic neuritis (ON) is a debilitating condition that through various mechanisms, including inflammation or demyelination of the optic nerve, can result in partial or total permanent vision loss if left untreated. Accurate diagnosis and promptly initiated treatment are imperative related to the potential of permanent loss of vision if left untreated, which can lead to a significant reduction in the quality of life in affected patients. ON is subtyped as "typical" or "atypical" based on underlying causative etiology. The etiology of ON can be differentiated when appropriate diagnostic testing is performed. Using history taking, neuroimaging, and visual testing to localize the underlying pathology of ON in a time-sensitive manner is critical in mitigating these unsatisfactory outcomes. Herein, we examine the differences in presentation, pathophysiology, and treatments of typical ON causes, like multiple sclerosis (MS), and atypical causes such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) ON. The present investigation places focus on both neuroimaging and visual imaging in the differentiation of ON. Additionally, this review presents physicians with a better understanding of different presentations, treatments, and prognoses of ON.
PubMed: 38618469
DOI: 10.7759/cureus.56094 -
Antibodies (Basel, Switzerland) May 2024Clinical syndromes associated with antibodies against myelin oligodendrocyte glycoprotein (MOG) are now recognized as a distinct neurological disease entity, and are... (Review)
Review
Clinical syndromes associated with antibodies against myelin oligodendrocyte glycoprotein (MOG) are now recognized as a distinct neurological disease entity, and are gaining increasing attention. The pathogenic mechanisms underlying MOG-antibody disease (MOGAD) remain incompletely understood. Case series, facilitated by registries, and observational studies over the past few years have shed increasing light on the clinical aspects and therapeutic approaches of MOGAD. MOGAD may manifest with a variety of clinical syndromes, including acute disseminated encephalomyelitis (ADEM), autoimmune encephalitis, optic neuritis (ON) and transverse myelitis (TM). MOGAD can be either monophasic or relapsing. This review aims to provide a comprehensive updated description of the clinical spectrum, paraclinical features, and prognosis of MOG-antibody disease, as well as summarize its therapeutic considerations. Randomized clinical trials, standardized diagnostic criteria and treatment guidelines are the steps forward.
PubMed: 38804311
DOI: 10.3390/antib13020043 -
Journal of Clinical Medicine Aug 2023The aim of this study is to access the perifoveolar and peripapillary vascular density (VD) using optical coherence tomography-angiography (OCT-A) in eyes with optic...
UNLABELLED
The aim of this study is to access the perifoveolar and peripapillary vascular density (VD) using optical coherence tomography-angiography (OCT-A) in eyes with optic neuritis (ON) and in fellow eyes, then compare that to healthy controls.
METHOD
This is a cross-sectional study including 22 patients with unilateral ON and 20 control eyes of healthy subjects. A complete clinical examination and OCT-A were performed at least 6 months after the acute episode of optic neuritis. Vascular plexuses of the peripapillary and perifoveolar images obtained from OCT-A were used to calculate the VD in each plexus: superficial, deep, and peripapillary capillaries for each group (ON eyes, fellow eyes, healthy eyes).
RESULTS
Compared to healthy control eyes, in the peripapillary area, we found a significant decrease in VD not only in ON eyes but also in fellow eyes in average ( ≤ 0.05) and in the temporal sector ( 0.001). In the perifoveolar area, the VD of the superficial capillary plexus is decreased in all sectors ( < 0.001) in ON eyes and only in the upper sector ( = 0.037) of fellow eyes compared to control eyes. VD correlates with ganglion cell layer (GCL) thickness in ON and in fellow eyes.
CONCLUSION
Peripapillary vascular density is decreased in both affected eyes and fellow eyes after a unilateral episode of optic neuritis, suggesting a subclinical involvement of the disease. Further studies are needed to clarify the mechanism and clinical implications of these data.
PubMed: 37629445
DOI: 10.3390/jcm12165403 -
Eye (London, England) Oct 2023To search for and critically appraise the psychometric quality of patient-reported outcome measures (PROMs) developed or validated in optic neuritis, in order to support... (Review)
Review
OBJECTIVE
To search for and critically appraise the psychometric quality of patient-reported outcome measures (PROMs) developed or validated in optic neuritis, in order to support high-quality research and care.
METHODS
We systematically searched MEDLINE(Ovid), Embase(Ovid), PsycINFO(Ovid) and CINAHLPlus(EBSCO), and additional grey literature to November 2021, to identify PROM development or validation studies applicable to optic neuritis associated with any systemic or neurologic disease in adults. We included instruments developed using classic test theory or Rasch analysis approaches. We used established quality criteria to assess content development, validity, reliability, and responsiveness, grading multiple domains from A (high quality) to C (low quality).
RESULTS
From 3142 screened abstracts we identified five PROM instruments potentially applicable to optic neuritis: three differing versions of the National Eye Institute (NEI)-Visual Function Questionnaire (VFQ): the 51-item VFQ; the 25-item VFQ and a 10-item neuro-ophthalmology supplement; and the Impact of Visual Impairment Scale (IVIS), a constituent of the Multiple Sclerosis Quality of Life Inventory (MSQLI) handbook, derived from the Functional Assessment of Multiple Sclerosis (FAMS). Psychometric appraisal revealed the NEI-VFQ-51 and 10-item neuro module had some relevant content development but weak psychometric development, and the FAMS had stronger psychometric development using Rasch Analysis, but was only somewhat relevant to optic neuritis. We identified no content or psychometric development for IVIS.
CONCLUSION
There is unmet need for a PROM with strong content and psychometric development applicable to optic neuritis for use in virtual care pathways and clinical trials to support drug marketing authorisation.
Topics: Humans; Adult; Quality of Life; Reproducibility of Results; Optic Neuritis; Surveys and Questionnaires; Patient Reported Outcome Measures; Multiple Sclerosis
PubMed: 36932161
DOI: 10.1038/s41433-023-02478-z -
Association of retinal vessel pathology and brain atrophy in relapsing-remitting multiple sclerosis.Frontiers in Immunology 2023Optical coherence tomography angiography (OCTA) allows non-invasive assessment of retinal vessel structures. Thinning and loss of retinal vessels is evident in eyes of... (Observational Study)
Observational Study
BACKGROUND
Optical coherence tomography angiography (OCTA) allows non-invasive assessment of retinal vessel structures. Thinning and loss of retinal vessels is evident in eyes of patients with multiple sclerosis (MS) and might be associated with a proinflammatory disease phenotype and worse prognosis. We investigated whether changes of the retinal vasculature are linked to brain atrophy and disability in MS.
MATERIAL AND METHODS
This study includes one longitudinal observational cohort (n=79) of patients with relapsing-remitting MS. Patients underwent annual assessment of the expanded disability status scale (EDSS), timed 25-foot walk, symbol digit modalities test (SDMT), retinal optical coherence tomography (OCT), OCTA, and brain MRI during a follow-up duration of at least 20 months. We investigated intra-individual associations between changes in the retinal architecture, vasculature, brain atrophy and disability. Eyes with a history of optic neuritis (ON) were excluded.
RESULTS
We included 79 patients with a median disease duration of 12 (interquartile range 2 - 49) months and a median EDSS of 1.0 (0 - 2.0). Longitudinal retinal axonal and ganglion cell loss were linked to grey matter atrophy, cortical atrophy, and volume loss of the putamen. We observed an association between vessel loss of the superficial vascular complex (SVC) and both grey and white matter atrophy. Both observations were independent of retinal ganglion cell loss. Moreover, patients with worsening of the EDSS and SDMT revealed a pronounced longitudinal rarefication of the SVC and the deep vascular complex.
DISCUSSION
ON-independent narrowing of the retinal vasculature might be linked to brain atrophy and disability in MS. Our findings suggest that retinal OCTA might be a new tool for monitoring neurodegeneration during MS.
Topics: Humans; Atrophy; Brain; Central Nervous System Diseases; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Neurodegenerative Diseases; Optic Neuritis; Retina; Retinal Vessels; Longitudinal Studies
PubMed: 38090586
DOI: 10.3389/fimmu.2023.1284986 -
Quantitative Imaging in Medicine and... Jan 2024Diffusion tensor imaging (DTI) has been implemented in a breadth of scientific investigations of optic neuropathies, though it has yet to be fully adopted for diagnosis... (Review)
Review
BACKGROUND AND OBJECTIVE
Diffusion tensor imaging (DTI) has been implemented in a breadth of scientific investigations of optic neuropathies, though it has yet to be fully adopted for diagnosis or prognosis. This is potentially due to a lack of standardization and weak replication of results. The aim of this investigation was to review DTI results from studies specific to three distinct optic neuropathies in order to probe its current clinical utility.
METHODS
We reviewed the DTI literature specific to primary open-angle glaucoma (POAG), optic neuritis (ON), and traumatic optic neuropathy (TON) by systematically searching the PubMed database on March 1, 2023. Four distinct DTI metrics are considered: fractional anisotropy (FA), along with mean diffusivity (MD, axial diffusivity (AD), and radial diffusivity (RD). Results from within-group, between-group, and correlational studies were thoroughly assessed.
KEY CONTENT AND FINDINGS
POAG studies most consistently report a decrease in FA, especially in the optic radiations, followed in prevalence by an increase in RD and then MD, whilst AD yields conflicting results between studies. It is notable that there is not an equal distribution of investigated DTI metrics, with FA utilized the most, followed by MD, RD, and AD. Studies of ON are similar in that the most consistent findings are specific to FA, RD, and MD. These results are specific to the optic nerve and radiation since only one study measured the intermediary regions. More studies are needed to assess the effect that ON has on the tracts of the visual system. Finally, only three studies assessing DTI of TON have been performed to date, displaying low to moderate replicability of results. To improve the level of agreement between studies assessing each optic neuropathy, an increased level of standardization is recommended.
CONCLUSIONS
Both POAG and ON studies have yielded some prevalent DTI findings, both for contrast and correlation-based assessments. Although the clinical need is high for TON, considering the limitations of the current diagnostic tools, too few studies exist to make confident conclusions. Future use of standardized and longitudinal DTI, along with the foreseen methodological and technical improvements, is warranted to effectively study optic neuropathies.
PubMed: 38223128
DOI: 10.21037/qims-23-779 -
Radiology Case Reports Aug 2023Neurological symptoms are prevalent in Coronavirus disease 2019 (COVID-19) cases, ranging from 30% to 80% depending on the severity of the disease caused by the severe...
Neurological symptoms are prevalent in Coronavirus disease 2019 (COVID-19) cases, ranging from 30% to 80% depending on the severity of the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We have documented a case of a 26-year-old woman who suffered from trigeminal neuritis caused by COVID-19, but responded well to corticotherapy. Two primary mechanisms may explain the neuroinvasive and neurovirulent properties of human coronaviruses. Neurological symptoms can persist long after recovery from COVID-19.
PubMed: 37250480
DOI: 10.1016/j.radcr.2023.04.051 -
World Journal of Clinical Cases Sep 2023The incidence and mortality rates of gastric cancer in China are the second-highest in the world, and most patients with gastric cancer lose their chance of surgery by...
BACKGROUND
The incidence and mortality rates of gastric cancer in China are the second-highest in the world, and most patients with gastric cancer lose their chance of surgery by the time of their diagnosis.
AIM
To explore the predictive potential of serum basic fibroblast growth factor and interleukin-1β levels for the effect of first-line chemotherapy in patients with advanced gastric cancer.
METHODS
From the gastric cancer patients admitted to our hospital from May 2019 to April 2023, 84 patients were selected and randomly and equally assigned to the experimental or control group. The FLOT group received the FLOT chemotherapy regimen (composed of oxaliplatin + calcium folinate + fluorouracil + paclitaxel), while the SOX group received the SOX chemotherapy regimen (composed of oxaliplatin + tiga capsules). The clinical efficacy, tumor marker levels, adverse reactions, and survival rates of the two groups were compared 7 days after the end of the relevant treatments.
RESULTS
The target effective rate of the FLOT group was 54.76%, which was much higher than that of the SOX group (33.33%; < 0.05). After treatment, both the groups demonstrated lower levels of cancer antigen (CEA), carbohydrate antigen 199 (CA199), and peptide tissue antigen (TPS). For several patients before treatment ( < 0.05). Third and fourth grades. In terms of adverse reactions, the level of white blood cells in both the groups was lower. Moreover, the incidence of hand-foot skin reactions in these two study groups was lower ( < 0.05), while those of peripheral neuritis, vomiting, diarrhea, and abnormal liver function were significant ( < 0.05). No statistically significant difference was noted between the two groups ( < 0.05). The 1-year survival rate was higher in the FLOT group ( < 0.05).
CONCLUSION
The FLOT regimen was effective in reducing the serum CEA, CA199, and TPS levels as well as in improving the 1-year survival rate of patients with good tolerability, making it worthy of clinical promotion and application.
PubMed: 37731570
DOI: 10.12998/wjcc.v11.i26.6083 -
Frontiers in Endocrinology 2023Diabetic cheiroarthropathies limit hand mobility due to fibrosis and could be markers of a global profibrotic trajectory. Heterogeneity in definitions and lack of a...
AIMS
Diabetic cheiroarthropathies limit hand mobility due to fibrosis and could be markers of a global profibrotic trajectory. Heterogeneity in definitions and lack of a method to measure it complicate studying associations with organ involvement and treatment outcomes. We measured metacarpophalangeal (MCP) joint extension as a metric and describe magnetic resonance (MR) imaging determinants of MCP restriction.
METHODS
Adults with type 1 diabetes were screened for hand manifestations using a symptom questionnaire, clinical examination, and function [Duruoz hand index (DHI) and grip strength]. Patients were segregated by mean MCP extension (<20°, 20°-40°, 40°-60°, and >60°) for MR imaging (MRI) scanning. Patients in the four groups were compared using ANOVA for clinical features and MRI tissue measurements (tenosynovial, skin, and fascia thickness). We performed multiple linear regression for determinants of MCP extension.
RESULTS
Of the 237 patients (90 men), 79 (33.8%) with cheiroarthropathy had MCP extension limitation (39° versus 61°, p < 0.01). Groups with limited MCP extension had higher DHI (1.9 vs. 0.2) but few (7%) had pain. Height, systolic blood pressure, and nephropathy were associated with mean MCP extension. Hand MRI (n = 61) showed flexor tenosynovitis in four patients and median neuritis in one patient. Groups with MCP mobility restriction had the thickest palmar skin; tendon thickness or median nerve area did not differ. Only mean palmar skin thickness was associated with MCP extension angle on multiple linear regression.
CONCLUSION
Joint mobility limitation was quantified by restricted mean MCP extension and had structural correlates on MRI. These can serve as quantitative measures for future associative and interventional studies.
Topics: Male; Humans; Adult; Diabetes Mellitus, Type 1; Mobility Limitation; Joint Diseases; Diabetes Complications; Magnetic Resonance Imaging
PubMed: 38027132
DOI: 10.3389/fendo.2023.1238825 -
Frontiers in Neurology 2024Accurate and timely diagnosis of posterior circulation stroke in patients with acute dizziness is a challenge that can lead to misdiagnosis and significant harm. The... (Review)
Review
Accurate and timely diagnosis of posterior circulation stroke in patients with acute dizziness is a challenge that can lead to misdiagnosis and significant harm. The present review sought to identify and describe published research on the clinical application of vHIT in posterior circulation stroke. vHIT, a portable device, has gained prominence in evaluating peripheral vestibular disorders and offers potential applications in diagnosing neurological disorders, particularly posterior circulation stroke. Several studies have shown that vHIT can differentiate between stroke and vestibular neuritis based on VOR gain values, with high sensitivity and specificity. The manuscript also discusses vHIT's performance in differentiating between types of posterior circulation stroke, such as PICA, AICA, and SCA strokes. While vHIT has demonstrated promise, the review emphasizes the need for further research to validate its use as a tool to rule out stroke in acute dizziness patients in the emergency department. In conclusion, the manuscript underscores the potential of vHIT as a valuable addition to the diagnostic arsenal for acute dizziness, particularly in the context of posterior circulation stroke. It calls for further research and wider adoption of vHIT in clinical settings to improve patient care and reduce unnecessary costs associated with misdiagnoses.
PubMed: 38497038
DOI: 10.3389/fneur.2024.1339039