Retrobulbar optic neuritis and cystoid macular edema as a first manifestation of lyme disease

Lyme disease is a multi-system disorder caused by the spirochete Borrelia burgdoferi. Eye manifestations are a rare involvement. We report two cases of patients who developed a retrobulbar optic neuritis and a cystoid macular edema as a sole clinical presenting in Lyme disease.A 42-year-old female presented with left eye decreased visual acuity and painful ocular movement. Dilated funduscopy and neurological examination were normal. A diagnosis of left eye retrobulbar optic neuritis was made. The brain and spinal cord MRI showed typical lesions characteristic of MS. Serological tests for Lyme disease revealed positive results for IgM ELISA and Western blot. The possible serologically proven Lyme disease was diagnosed. Visual acuity returned to normal following a course of high-dose steroids and intravenous antibiotic, after by oral antibiotic. A 28-year-old male presented with left eye blurred vision and intermittent blurring vision in his right eye. Dilated funduscopy revealed bilateral cystoid macular edema (left more than right). He was positive for Lyme serology, IgM ELISA and Western blot, and intravenous antibiotic therapy was commenced, followed by oral antibiotic. Visual acuity was restored and fuduscopy was normal.In summary, although Lyme disease is an uncommon cause of these neuro-ophthalmic complications, our two patients highlight the importance of considering this disorder as a differential diagnosis and to initiate an early adequate therapy

Unilateral proptosis: a diagnostic clinical and neuroimaging challenge

INTRODUCTION: The differential diagnosis of unilateral proptosis includes tumors, infections often related with immunological process, trauma, vascular diseases or axial myopia.CASE REPORTS: We present two patients with unilateral proptosis. A 34-yeard old caucasian man with a 3-months history of proptosis of the left eye with diplopia and normal visual acuity; initial CT scan examination showed highly suggestive finding for orbital apex tumor or glioma of the optic nerve, but a second CT scan with complementary projections was performed and a highly swollen inferior rectus muscle simulating an orbital apex tumor was visible. A diagnosis of unilateral thyroid ophthalmopathy was made. A 56-year old caucasian woman with unilateral exophthalmus and medical history of Graves’ hyperthyroidism; previously Graves’ ophthalmopathy was suggested. Fundoscopy showed myopic fundus. The CT scan revealed normal extraocular muscles without swollen.CONCLUSION: These two cases of unilateral proptosis are described because of their clinical and radiological differential diagnosis. We suggest that the accurate diagnosis of a unilateral proptosis remains a big challenge to the neuroophthalmologist, endocrinologist, immunologist, neurosurgeon and radiologist

(18F)-FDG pet imaging and Neuro-ophthalmological findings in diagnosis of progressive Supranuclear palsy: Case report

Introduction: Progressive supranuclear palsy is a neurodegenerative disorder, described as a tauopathy. The neuroimaging and visual symptoms are among the most important in the diagnosis of this disease. The ophthalmoparesis mainly concerns voluntary eye movements. Patients mostly present with vertical palsy, involuntary eye movements, convergence insufficiency, and diplopia.Case report: A 62-year-old female patient was admitted to the hospital because of the gait disturbance and frequent falls. She had impaired memory, handwriting and speech for one year. On neurological and neuro-ophthalmological examinations, the patient presented with vertical gaze palsy, involuntary eye movements, dysarthria, tremor in the right hand, and cerebellar ataxia. Blood tests were normal. (18F)-FDG PET revealed bilateral zones of moderate hipometabolism in the regions of posterior frontal cortex, anterior cingulum, left thalamus, head of left striatum, and left temporal lobe. Neuropsychological tests revealed cognitive impairment (MMSE-26; IADL-1).Conclusion: Based on the literature review and our own notices, we suggest that (18F)-FDG PET scanning and neuro-ophthalmological examination in addition to structural neuroimaging and clinical findings play a crucial role in the differential diagnosis of PSP and other parkinsonian syndromes

Optic disc melanocytoma associated with macular cyst

BACKGROUND: Optic disc melanocytoma (ODM) is a benign tumor, most often asymptomatic and stationary. However occasionally it can grow slowly, cause visual loss or extremely rarely undergoes into malignant melanoma. Here lies the importance of periodic ocular examination and reliable documentation.AIM: to report a rare case of growing ODM, associated with macular cyst with related visual loss, 25-years follow-up, and documentation by color photography, optical coherence tomography (OCT) and fluorescein angiography (FAG).METHODS: Full ophthalmic examination, fundus color photography, FAG and OCT.CASE REPORT: An asymptomatic 40-year-old Caucasian female with normal visual acuity at routine ocular examination had a pigmented elevated lesion on the left optic disc, occupying the inferotemporal half. The diagnosis of ODM was based on clinical assessment, FAG, fundus photographies, and observation was recommended. Ten years later she complained of gradually decreasing visual acuity in the left eye. Dilated ophthalmoscopy showed an evidence of slow growth of ODM and initial macular degeneration. After 25 years fundus color photography, FAG, and OCT documented mild progressive growth of ODM and macular cyst in the same eye.CONCLUSION: According to the literature, optic disc melanocytoma is generally recognized to be a stationary lesion with excellent prognosis and no treatment is usually necessary. In our case fundus color photography, FAG and OCT data reveal persisting ODM. Despite the progressive growth of ODM and moderate to significant visual loss, the malignant transformation is not proved. We suggest that loss of vision is related with macular lesion. To our knowledge we report a rare case of 25 years follow-up of growing ODM with visual loss, associated with macula degeneration/cyst.

A comparison of (18)F FDG-PET, morphological neuroimaging and EEG findings in epilepsy

Although, EEG is accepted as a gold standard only 50% of the patients are safely diagnosed. MRI demonstrates morphologic changes in approximately 80% of patients with epilepsy. Interictal 18F-FDG PET studies show focus-localizing sensitivity ranging from 80 to 85%. Accordingly, we studied the usefulness of interictal FDG PET for detecting epileptic foci compared to structural neuroimaging and EEG findings. A total of 18 patients (7 M and 11 F; mean age 37.8±18.4 years, range 16-77 years) with epilepsy were included in the study. Neurological, FDG-PET/CT, MRI, and EEG examinations were performed. Interictal PET/CT images were acquired starting at 60 min after the intravenous injection of 5.0 mCi of (18) F-fluorodeoxyglucose. Neuroimaging showed abnormal findings in 9 patients. 15 patients had a predominantly unilateral epileptiform focus on EEG. Focal hypometabolism was found in 13 cases. 4p presented with larger hypometabolic areas and 2 had normal brain metabolism despite the epileptic focus on EEG. In 3p the zones of hypermetabolism corresponded to the tumor location. Additional hypometabolic areas were observed in the surrounding regions, which were concordant with the neuroimaging findings of perifocal edema. Based on our own findings and literature review, we suggest that interictal FDG-PET may be an important tool to better understand the neurobiology of seizures and to better define the ictal onset in epilepsy

PET-CT visualization of intracranial lipomas

Intracranial lipomas are rare lesions, infrequently indicated for neurosurgical treatment due to their benign course and significant surgery-related complications rate. The aim of this study was to collect, describe and analyze the patients with intracranial lipomas verified by PET-CT and reported in the literature up to date. The literature search was performed through Pub Med using the combination of the terms intracranial lipomas, CT, MRI and PET-CT. The thorough review of the relevant papers did not find even one case with PET-CT images of intracranial lipomas. The first two personal illustrative cases were demonstrated by our report. The value of PET-CT in the primary and differential diagnosis of intracranial lipomas was analyzed, in comparison with CT, MRI and PET-MRI

Comorbidity of Structural Epilepsy and Multiple Sclerosis: MRI, 18FFDG PET/CT and EEG Investigations

There is accumulating evidence of a mutual relationship between multiple sclerosis and structural epilepsy. Comorbidity of these severe neurological disorders is reported in numerous recent publications in the available foreign literature. Modern diagnostic tools include comprehensive neurological examinations as well as computed tomography, electroencephalography and 18FFDG positron emission tomography. In this paper we report the case of a female patient with multiple sclerosis and structural epilepsy

Health-related quality of life in multiple sclerosis patients with accompanying diseases

Introduction: Multiple sclerosis (MS) is a progressive demyelinating neurologic disease characterized by a different extent of comorbidity. Everydaily life is challenging for these patients because of physical and psychological impairments. The purpose of this study was to comparatively analyze the relationships between several health-related quality of life aspects of MS patients` in case of accompanying diseases.Material and methods: Health-related uality of life of 80 MS patients, 56 females and 24 males, at a mean age of 49 years, was examined by means of Short Form-36 questionnaire. Forty patients presented with at least one accompanying chronic disease.Results: These patients presented with similar Expanded Disability Status Scale scores of 2.0 or 2.5. Most questionnaire scores differed between MS patients without and with comorbidity. Usually, comorbidity additionally worsened patients` quality of life. There were statistically significant differences between the patients with MS alone and those with MS and comorbidity concerning the depression (t=5.877; p<0.0001); the troubles with concentration/thinking (t=4.822; p<0.0001); the troubles with memory (t=4.020; p<0.0001); the feeling of fatigue (t=4.148; p<0.0001), and the feeling of happiness (t=-3.399; p<0.001).Conclusion: The hot topic of the health-related quality of life of the patients with MS and comorbidities necessitates further interdisciplinary research. Correct treatment and follow-up of MS patients and particularly of those with common accompanying cardiovascular and other neurological diseases could contribute to long-lasting preservation of acceptable individual quality of life

MULTIPLE SCLEROSIS ASSOCIATED WITH ANAEMIC SYNDROME: A RETROSPECTIVE ANALYSIS AND LITERATURE REVIEW

An association of MS with different anaemic syndromes, most often pernicious and Vit. B12 deficiency anaemia has been reported in the literature. Accordingly, the coincidence of anaemia with MS has been considered to impact seriously on clinical presentation, therapeutic strategy and patient´s quality of life. Objective: To perform a retrospective analysis of 18 cases with anaemic syndrome as a factor of comorbidity in patients with MS. Material and methods: 18 MS patients (15 women and 3 men) with RRMS (13), PPMS (2), and SPMS (3) diagnosed according to McDonald criteria were included in the present study. Average age was 36.4±8.5 (22-42) years, average disease duration 10.6±6.8 (4-18) years and means EDSS - 3.5±2.5 points (2-6). All individuals underwent clinical, MRI and hematological examinations. Results: The study group included patients with pernicious (n=8), Vitamin B12 (n=6), and iron (n=3) deficiency anaemia, as well as with β-thalassemia (n=1). In 12 patients anaemic syndrome proceeded MS and in 6 evolved during the course of the desease.Conclusion: Our own notices and literature review suggests a possible causative relation between MS and anaemic syndrome. The role of this coincidence on clinical presentation, necessity of additional treatment, and patient´s quality of life is discussed

SUBJECTIVE COGNITIVE COMPLAINTS IN A PATIENT WITH KERATOCONUS: COGNITIVE IMPAIRMENT OR

Keratoconus is a disorder affecting the cornea, characterized by its variably progressive central thinning, which results in conically shaped protrusion. Patients with keratoconus are sometimes described as having peculiar personality characteristics. We present the case of a patient with keratoconus, complaining of impairment of concentration and memory disturbances. He reported slow progression of the complaints but was fully capable of performing his professional and social activities. Neuropsychological assessment confirmed fluctuations of active attention and diminished concentration. Long term memory was within normal limits, but closer to the lower level). MMSE score was 27. No significant changes were observed one year after baseline assessment. No major psychiatric disorder was found. In this clinical case we are tempted to discuss the possible role of keratoconus, which, as it has been described in the literature, could lead to some slight changes of behavior, forming a "keratoconic personality"