Brain MRI, CSF examination, and evoked potentials in patients affected by optic neuritis: their diagnostic and prognostic role

1995 ◽  
Vol 56-63 ◽  
pp. 55-55
Author(s):  
A. Ghezzi ◽  
V. Torn ◽  
A. Zibetti ◽  
S. Baldini ◽  
M. Zaffaroni
Keyword(s):  
Optic Neuritis ◽  
Evoked Potentials ◽  
Brain Mri ◽  
Prognostic Role ◽  
Csf Examination

scholarly journals Seronegative Neuromyelitis Optica: A Case Report of a Hispanic Male

2016 ◽  
Vol 8 (2) ◽  
pp. 102-107 ◽  
Author(s):  
Nabeel Badri ◽  
Mohamed Teleb ◽  
Saad Syed ◽  
Miraie Wardi ◽  
Mateo Porres-Aguilar ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Neuromyelitis Optica ◽  
Brain Mri ◽  
Sudden Onset ◽  
Interesting Case ◽  
Imaging Studies ◽  
Thoracic Spinal Cord ◽  
Lower Extremity Weakness ◽  
Thoracic Spinal ◽  
Hispanic Male

Neuromyelitis optica (NMO) is a rare disease, common in white females and rarely reported in Hispanic males. It is usually associated with recurrent demyelinating spectrum that is autoimmune in nature. The diagnosis is usually confirmed by antibody biomarkers; however, they can be negative and lead to more dilemma in diagnosis. Furthermore, the course of disease and prognosis are different in seronegative as compared to seropositive NMO. Treatment is similar in both subgroups with new approaches under investigation for seronegative NMO patients. We present an interesting case of a 37-year-old Hispanic male who presented with sudden onset of lower extremity weakness, numbness, blurry vision, and urinary retention. Magnetic resonance imaging (MRI) of the thoracic spine showed multiphasic demyelinating process involving the thoracic spinal cord. His brain MRI also revealed changes suggesting optic neuritis. The patient met the criteria for diagnosis of NMO by having optic neuritis and myelitis by imaging studies despite having negative aquaporin-4 antibodies (AQP4-Ab). His condition improved after plasma exchange. NMO can be difficult to distinguish from acute multiple sclerosis in the early stages of the disease. Having AQP4-Ab testing is important for diagnosis with imaging studies; however, negative antibody results cannot exclude the diagnosis, but rather group it in seronegative subtype. Ongoing studies and research suggest that seronegative NMO might have a different pathophysiology, manifestation, and prognosis.

Blink-associated contralateral eccentric saccades as a rare sign of unilateral brain injury

Neurology ◽  
2016 ◽  
Vol 88 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Ilaria Zivi ◽  
Eugenio Bertelli ◽  
Giacinta Bilotti ◽  
Ignazio Alessandro Clemente ◽  
Leopold Saltuari ◽  
...  
Keyword(s):  
Brain Injury ◽  
Evoked Potentials ◽  
Brain Mri ◽  
Neural Pathways ◽  
Cerebral Lesions ◽  
Infrared Video ◽  
Corrective Movement ◽  
The Right ◽  
Mri Study ◽  
Unilateral Brain

Objective:To describe a rare sign of unilateral brain injury as a form of unwanted blink-associated contralateral eccentric saccades.Methods:A 62-year-old patient who underwent an ischemic stroke affecting the entire right middle cerebral artery territory came to our attention 1 year after stroke, manifesting with transient contralateral conjugate gaze deviations associated with spontaneous blinking. We complemented the regular neurologic evaluation with brain MRI, study of evoked potentials, electroneurography of the facial nerve, and infrared video-oculoscopy.Results:The patient had left-sided hemiparesis, hypoesthesia, hemianopia, and hemispatial neglect. He also showed the occurrence of a rapid leftward conjugate deviation of the eyes, followed by a corrective movement to the primary ocular position. MRI showed a wide malacic area spanning the right frontal, temporal, and parietal cortical and subcortical regions, with signs of wallerian degeneration of the descending right corticospinal tract. Motor and somatosensory evoked potentials were centrally altered on the right side. Electroneurography of the facial nerves was normal. Infrared video-oculoscopy indicated persistence of the same blink-related saccades even in darkness.Conclusions:It is known that unilateral cerebral lesions may manifest with a contralateral conjugate gaze deviation evoked by closure of the lids. This sign, known as spasticity of conjugate gaze, may be due to the suppression of the fixation reflex. In our case, the persistence of this sign in the darkness allowed us to exclude this diagnosis. We hypothesized that the blink-related neural pathways may improperly activate the oculomotor circuitry at both the cortical and subcortical levels.

The 5-year risk of MS after optic neuritis

Neurology ◽  
1997 ◽  
Vol 49 (5) ◽  
pp. 1404-1413 ◽  
Author(s):  
Keyword(s):  
Optic Neuritis ◽  
Strong Predictor ◽  
Brain Mri ◽  
Study Entry ◽  
Optic Disk ◽  
Cumulative Probability ◽  
Normal Brain ◽  
Neurologic Symptoms ◽  
Cohort Study Design ◽  
Optic Neuritis Treatment Trial

The objective of our study was to assess the 5-year risk of and prognostic factors for the development of clinically definite multiple sclerosis (CDMS) following optic neuritis. In a prospective cohort study design, 388 patients, who did not have probable or definite MS at study entry enrolled in the Optic Neuritis Treatment Trial between 1988 and 1991, and were followed for the development of CDMS. The 5-year cumulative probability of CDMS was 30% and did not differ by treatment group. Neurologic impairment in the patients who developed CDMS was generally mild. Brain MRI performed at study entry was strong predictor of CDMS, with the 5-year risk of CDMS ranging from 16% in the 202 patients with no MRI lesions to 51% in the 89 patients with three or more MRI lesions. Independent of brain MRI, the presence of prior nonspecific neurologic symptoms was also predictive of the development of CDMS. Lack of pain, the presence of optic disk swelling, and mild visual acuity loss were features of the optic neuritis associated with a low risk of CDMS among the 189 patients who had no brain MRI lesions and no history of neurologic symptoms or optic neuritis in the fellow eye. The 5-year risk of CDMS following optic neuritis is highly dependent on the number of lesions present on brain MRI. However, even a normal brain MRI does not preclude the development of CDMS. In these patients with no brain MRI lesions, certain clinical features identify a subgroup with a particularly low 5-year risk of CDMS.

The Early Diagnosis of Multiple Sclerosis

1980 ◽  
Vol 25 (1) ◽  
pp. 58-62
Author(s):  
B. Ashworth
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Early Diagnosis ◽  
Optic Neuritis ◽  
Evoked Potentials ◽  
Visual Evoked Potentials ◽  
Spastic Paraparesis ◽  
Psychological Disorder ◽  
Electrophysiological Tests ◽  
Visual Evoked

An outline of modern views on the aetiology of multiple sclerosis is followed by a discussion of diagnosis. Examination of the cerebrospinal fluid, visual evoked potentials, and other electrophysiological tests are considered. The special problems of optic neuritis, spastic paraparesis, and psychological disorder receive more detailed attention. It is concluded that while the supplementary tests are valuable the diagnosis remains essentially clinical.

Do multimodal evoked potentials add information to MRI in clinically isolated syndromes?

2009 ◽  
Vol 16 (1) ◽  
pp. 55-61 ◽  
Author(s):  
R. Pelayo ◽  
X. Montalban ◽  
T. Minoves ◽  
D. Moncho ◽  
J. Rio ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Auditory Evoked Potentials ◽  
Brain Mri ◽  
Expanded Disability Status Scale ◽  
Mri Findings ◽  
Diagnosis And Prognosis ◽  
Disability Status ◽  
Complete Study ◽  
Multimodal Evoked Potentials

The role of multimodal evoked potentials (MMEPs) in establishing multiple sclerosis (MS) diagnosis and prognosis has diminished nowadays. The objective of this article is to evaluate whether MMEPs add information to MRI in identifying patients with higher risk of relapse or development of disability after a clinically isolated syndrome (CIS). Patients who underwent visual, somato-sensory and brainstem auditory evoked potentials (EPs) were identified from a cohort of consecutive CIS. Patients also underwent brain MRI within 3 months of first attack. We analysed time to second attack and to Expanded Disability Status Scale (EDSS) score of 3.0 according to number of Barkhof criteria and number of abnormal MMEPs. A complete study was performed in 245 patients who were followed for a mean of 76.4 months (interquartile range: 61 to 96). Seventy-one patients (29%) had the three EPs normal, 115 patients (47%) had one abnormal EP; 40 patients (16%) had two; and 19 patients (8%) had three abnormal EPs. Baseline MRI determined the risk for converting to clinically definite MS and correlated with disability according to previous studies. EPs individually did not modify the risk of conversion or disability. However, the presence of three abnormal EPs increased the risk of reaching moderate disability (hazard ratio 7.0; 1.4—34.9) independently of baseline MRI. In conclusion, in the presence of three abnormal EPs could help identify CIS patients with a higher risk of developing disability, independently of MRI findings. However, the utility of MMEPs is limited by the low percentage of CIS patients having the three abnormal at baseline.

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