Optic Neuropathy and Macular Ischemia Associated with Neurosarcoidosis: A Case Report

In this study, we present a case of bilateral optic neuropathy and macular ischemia in the right eye associated with neurosarcoidosis. A 26-year-old woman presented to our clinic with complaints of bilateral blurred vision. Bilateral granulomatous anterior uveitis, vitritis, optic neuropathy, and macular ischemia were detected in the right eye in slit-lamp examination. She also reported complaints of fever, weakness, sweating, arthralgia, and headache for 2 months. She was referred to the pulmonary diseases unit of our hospital due to hilar lymphadenopathy seen in her chest x-ray, and biopsies were taken for diagnostic purposes. Histological analysis of the mediastinal lymph node biopsies revealed chronic, non-caseating, granulomatous inflammation. Furthermore, the patient was referred to a neurologist due to concomitant complaint of intense headaches. She was diagnosed with neurosarcoidosis supported by findings on cranial magnetic resonance imaging and lumbar puncture. She received a 3-day course of high-dose (1 g/day) intravenous steroid treatment (methylprednisolone) followed by a tapering dose of oral prednisone. The patient began receiving oral methotrexate 15 mg/week as a steroid-sparing agent. Significant improvement in neurological and ophthalmological symptoms occurred in the first week of treatment. In this case report, we emphasized that neurosarcoidosis should be included in the differential diagnosis of patients with both bilateral optic neuropathy and macular ischemia. Furthermore, early diagnosis and timely treatment of neurosarcoidosis are important for favorable visual outcomes

Vaccination in Individuals with Multiple Sclerosis – Part I

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections

Brait-fahn-schwarz disease: Parkinson's disease and amyotrophic lateral sclerosis complex

WOS: 000381980000033PubMed: 26319125Neurodegenerative diseases such as Parkinson’s disease (PD) and amyotrophic lateral sclerosis (ALS) are sometimes present together, as in the Parkinsonism-dementia complex of Guam. Outside the specific geographical regions, the combination of ALS and PD is rare [1]. This neurodegenerative complex was first described by Brait et al. [2] and clinically presents with levodopa responsive parkinsonism followed by AL

Use of Mitoxantrone in Early Secondary Progressive Multiple Sclerosis: An Observational Study of 48 Patients with Clinical and MRI Outcomes

OBJECTIVE: To report the clinical follow-up, side effects, and magnetic resonance imaging (MRI) findings of mitoxantrone treatment in patients in the early phase of secondary progressive and exacerbating relapsing-remitting multiple sclerosis. METHODS: Patients that completed and/or were undergoing treatment between 2001 and 2008 were included in the study. All patients were definitive progressive multiple sclerosis patients and met ‘non-responder’ criteria for immunomodulatory the- rapy. They did not have active infection, cardiac disease, or any contraindication for immunosuppressive treatment. Baseline comp- lete blood count, liver function tests, and transthoracic echocardiography were performed. Mitoxantrone was given as induction the- rapy (1 dose per month for 3 months) and then as maintenance therapy (with 3 month periods, 12 mg/m2 until to the cumulative dose was reached). Patients were followed-up regularly for the appearance of any side effects. RESULTS: The study included 33 female and 15 male patients. Mean age was 36.6 ± 7.8 years, mean disease duration was 9.38 ± 4.8 years, mean expanded disease severity scale (EDSS) score was 5.8, and mean treatment duration was 11.16 ± 7.4 months. Fol- lowing the end of treatment, 17 patients were stabilized, 10 improved, and 14 progressed. There were no side effects observed du- ring or after treatment in 16 patients. Among the other 32 patients, the observed side effects were as follows: nausea (n= 18), per- manent leucopenia (n= 1), transient thrombocytopenia (n= 4), alopecia (n= 13), neutropenic fever (n= 1), and amenorrhea (n= 18). MRI follow-up was performed in a subgroup of patients and showed that the lesion loads were stabilized. CONCLUSION: We reported the efficacy, and clinical and MRI follow-up results of multiple sclerosis patients treated with mitoxantro- ne. Patient selection and therapy timing was very important for maximum efficacy. Patients that responded to mitoxantrone treat- ment benefited beginning with the induction phase and their disability was limited or improve

Vaccination in Individuals with Multiple Sclerosis – Part II Multipl Skleroz Tanılı Bireylerde Aşılama – Bölüm II

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions about vaccination should be made considering the disease process and the medications used by the patient. Since vaccination can be performed at any stage of life, immune system activity should be reviewed in patients with MS except where it is characteristic of the vaccine. In this review, the applications of different vaccines in patients with MS are discussed in two separate sections (part 1 was published in the previous issue)