Transorbital Sonography in Acute Optic Neuritis: A Case-Control Study

BACKGROUND AND PURPOSE: Acute unilateral optic neuritis is associated with a thickening of the retrobulbar portion of the optic nerve as revealed by transorbital sonography, but no comparison has been made between nerve sheath diameter and optic nerve diameter in patients with acute optic neuritis versus healthy controls. We evaluated optic nerve sheath diameter and optic nerve diameter in patients with acute optic neuritis and healthy controls and compared optic nerve sheath diameter and optic nerve diameter with visual-evoked potentials in patients. MATERIALS AND METHODS: A case-control study was performed in 2 centers. Twenty-one consecutive patients with onset of visual loss during the prior 10 days and established acute noncompressive unilateral optic neuritis were compared with 21 healthy controls, matched for sex and age (±5 years). Two experienced vascular sonographers performed the study by using B-mode transorbital sonography. Visual-evoked potentials were performed on the same day as the transorbital sonography and were evaluated by an expert neurophysiologist. Sonographers and the neurophysiologist were blinded to the status of the patient or control and to clinical information, including the side of the affected eye. RESULTS: The median optic nerve sheath diameter was thicker on the affected side (6.3 mm; interquartile range, 5.9–7.2 mm) compared with the nonaffected side (5.5 mm; interquartile range, 5.1–6.2 mm; P P P = not significant.). Both sides were thicker than those in controls (2.7 mm; interquartile range, 2.5–2.8 mm; P = .001 and .009). No correlation was found between optic nerve sheath diameter and optic nerve diameter and amplitude and latency of visual-evoked potentials in patients with optic neuritis. CONCLUSIONS: Transorbital sonography is a promising tool to support the clinical diagnosis of acute optic neuritis. Further studies are needed to define its specific role in the diagnosis and follow-up of optic neuritis

New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report

<p>Abstract</p> <p>Introduction</p> <p>Devic's neuromyelitis optica is an inflammatory demyelinating disease that targets the optic nerves and spinal cord. It has a worldwide distribution and distinctive features that distinguish it from multiple sclerosis. There has been no previous report of neuromyelitis optica from our practice environment, and we are not aware of any case associated with antiphospholipid syndrome in an African person.</p> <p>Case presentation</p> <p>We report the case of a 28-year-old Nigerian woman who presented with neck pain, paroxysmal tonic spasms, a positive Lhermitte's sign and spastic quadriplegia. She later developed bilateral optic neuritis and had clinical and biochemical features of antiphospholipid syndrome. Her initial magnetic resonance imaging showed a central linear hyperintense focus in the intramedullary portion of C2 to C4. Repeat magnetic resonance imaging after treatment revealed resolution of the signal intensity noticed earlier.</p> <p>Conclusion</p> <p>Neuromyelitis optica should be considered in the differential diagnoses of acute myelopathy in Africans. We also highlight the unusual association with antiphospholipid syndrome. Physicians should screen such patients for autoimmune disorders.</p

Late-onset seizures and risk of subsequent stroke: A systematic review

Otherwise unexplained late-onset seizures, conventionally defined as epileptic seizures occurring in subjects older than 60years and in the absence of disorders known to increase the risk of developing epilepsy, have been assumed to be, in most cases, of cerebrovascular origin. We systematically searched the literature to identify the evidence supporting the association between otherwise unexplained late-onset seizures/epilepsy and the risk of subsequent stroke. Most data from the literature indicate that cerebrovascular disease often underlies otherwise unexplained late-onset seizures/epilepsy. Patients presenting with seizures occurring for the very first time in late life and without clinically overt cerebrovascular disease should be considered as at increased risk of stroke. Consequently, these patients should be screened for the presence of vascular risk factors and treated accordingly. Such measures may greatly contribute to prevent strokes in these patients

When one plus one makes three: the quest for rational antiepileptic polytherapy with supraadditive anticonvulsant efficacy.

The experimental and clinical evidence in support of \u201crational polytherapy\u201d is sparse, and to date, no clear evidence-based indications can be made to help physicians in their choice of a specific drug combination against specific forms of epilepsy. This article briefly reviews the data available in the literature and obtained from studies conducted in humans to evaluate which main AED combinations might possess supraadditive, synergistic effects in terms of efficacy, with infraadditive toxicity. By far, the most documented association resulting in supraadditive anticonvulsant effects against focal seizures is that of VPA and LTG. There are some indications that combinations of drugs with different primary mechanisms of action may be more effective than combining drugs with the same mechanisms of action. However, further animal and human research studies that focus both on toxicity and anticonvulsant effects of various combinations of AEDs are required

Static analysis of shear flexible beams and frames in adhesive contact with an isotropic elastic half-plane using a coupled FE-BIE model

Shear deformable beams and frames in perfect adhesion with an isotropic elastic half-space are analysed in plane strain or plain stress states. By means of a mixed variational formulation, the beam elements are described in terms of nodal displacements and rotations using locking-free shape functions, whereas the soil substrate is represented in terms of surface tractions through a boundary integral equation that incorporates a suitable Green's function. The formulation ensures full continuity between structure and substrate in terms of displacements and rotations. A variety of numerical examples is presented to show the effectiveness of the proposed model. For very stiff beams subjected to a point force or moment, comparisons are made with available closed-form solutions to the contact problem of a rigid indenter. For foundation beams bonded to the substrate and loaded by a vertical point force the proposed model exhibits a superior convergence rate in comparison with other standard numerical models. Moreover, the shear deformations are shown to play a crucial role on both beam displacements and soil surface tractions. Finally, the soil-structure interaction analysis of a two-bay plane frame is presented