1/15. Neuro-ophthalmic sarcoidosis.sarcoidosis is a multisystem disorder in which ocular involvement occurs in about one-quarter and neurosarcoidosis in 7 per cent of patients. When the retina is involved, the reported incidence of central nervous system sarcoidosis is 37 per cent. The patient described had a transient papular eruption of the legs, bilateral hilar lymphadenopathy, polyarthralgia with knee effusions, and bilateral facial and peripheral neuropathy. Ocular involvement was characterized by anterior uveitis (in the initial stages), vitreous flare, bilateral disc oedema, macular oedema, streak haemorrhages, peripheral periphlebitis, nerve fibre bundle defects, and candle-wax spots. fluorescein angiography showed no fluorescence of the candle-wax spots nor of the adjacent vessels. However, there was hyperfluorescence of two retinal lesions. This patient had unilateral internal ophthalmoplegia, only three cases of which have been reported in the literature. Her health was restored by heavy, prolonged corticosteroid therapy. Her family history revealed that an uncle died of sarcoidosis complicated by cryptococcal meningitis. The literature on retinopathy in sarcoidosis is reviewed and the lesions noted in the posterior segment are listed.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
2/15. Pseudouveitis: a clue to the diagnosis of primary central nervous system lymphoma in immunocompetent patients.Primary oculocerebral non-Hodgkin lymphoma (NHL) of the immunocompetent patient is associated with significant morbidity and mortality, but early diagnosis and follow-up may improve prognosis. The eye, anatomically and embryologically part of the central nervous system (CNS), can be the primary site of the lymphomatous process. In patients with symptoms of atypical uveitis, vitrectomy can be of great help for early diagnosis of primary central nervous system lymphoma. We retrospectively reviewed the diagnostic features, treatment, and evolution of 10 patients with primary central nervous system lymphoma who presented with symptoms of pseudouveitis. The patients complained of chronic vitreal opacities, increasing with time. These symptoms contrasted with the absence of the usual signs of inflammation of the anterior segment or of the retina, which characterize true uveitis. vitrectomy was proposed after lumbar puncture and cerebral magnetic resonance imaging. Six vitrectomies were carried out, 3 patients had a stereotaxic biopsy, and 1 patient had a cardiac biopsy. A pathologic diagnosis of large B-cell lymphoma was made on vitrectomy specimens in 100% of the patients who had this procedure. The mean time from onset of ocular symptoms to diagnosis was 24 months. This series was characterized by a rare systemic dissemination of the NHL (negative in 80%), a strong preponderance of B-cell NHL, and the absence of association with Epstein-Barr virus (EBV) among these immunocompetent patients. To our knowledge, this series includes the only reported case of oculocardiac lymphoma. Meningeal dissemination appeared to be associated with a poor prognosis. Neurologic complications of treatment combining radiotherapy and methotrexate were significant among patients older than 60 years of age. The current study suggests that primary central nervous system lymphoma should be suspected in patients with pseudouveitis, and that the diagnosis can be established quickly and without side effects by vitrectomy. These patients should be followed carefully in order to detect meningeal dissemination.- - - - - - - - - - ranking = 8keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/15. Extranodal B-cell lymphoma of the uvea: a case report.CASE REPORT: Ocular involvement by non-Hodgkin's lymphoma is a rare condition that can result from a primary intraocular lymphoma of the retina or an intraocular manifestation of systemic lymphoma. Uveal involvement is seldom the initial manifestation of extranodal lymphoma. We describe an 80-year-old patient with a blind and painful left eye and a history of recurrent uveitis. After ultrasound evaluation, the eye was enucleated and histopathologic examination revealed a malignant B-cell lymphoma of the uveal tract. The patient has been followed for 8 years after surgery, but she has had no further systemic manifestations of lymphoma and has not required subsequent treatment. COMMENTS: Primary extranodal lymphoma can be easily mistaken for recurrent uveitis or primary intraocular lymphoma of the retina and central nervous system; it is a differential diagnosis to be considered in cases of recurrent uveitis-like symptoms evolving to blind painful eye.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
4/15. Concurrent intermediate uveitis and an enhancing intracranial lesion as the initial manifestation of sarcoidosis.INTRODUCTION: Posterior segment involvement has been described to be associated with central nervous system involvement in sarcoidosis as a result of direct sarcoid tissue infiltration or mass effect of a cerebral lesion. However, isolated intermediate uveitis occurring concurrently with central nervous system involvement prior to extensive systemic disease is rare. CLINICAL PICTURE: We describe a patient with neuro-ophthalmic manifestations of intermediate uveitis and an enhancing basal ganglia lesion at initial presentation, in the absence of extensive systemic disease. TREATMENT: He was treated with high-dose systemic steroids which was progressively tailed down over 6 months. OUTCOME: There was prompt resolution of vitritis with good preservation of visual acuity. CONCLUSION: The difficulties of the initial diagnosis of sarcoidosis and the indications for initiation of steroid therapy are illustrated. We use this case to emphasise the need for a high clinical suspicion of sarcoidosis in the presence of similar unusual and seemingly unrelated combinations of neurological manifestations so as to facilitate the prompt institution of appropriate treatment when indicated.- - - - - - - - - - ranking = 2keywords = central nervous system, nervous system (Clic here for more details about this article) |
5/15. South American blastomycosis: ophthalmic and oculomotor nerve lesions.A case of South American blastomycosis began with an oropharyngeal lesion which was followed by a granulomatous uveitis. The patient was treated with amphotericin b and showed a clinical regression. Four months later, he developed a right 3rd cranial nerve palsy, aggravating the clinical aspect with a severe generalized involvement of the central nervous system and death. Necropsy showed blastomycotic meningoencephalitis.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
6/15. Vogt-Koyanagi-Harada syndrome--isolation of cloned T cells with specificity for melanocytes and melanoma cells.The pathogenesis of Vogt-Koyanagi-Harada syndrome is poorly understood. A unifying mechanism for its diverse clinical manifestations affecting central nervous system, eye, integument and auditory system has not been found, although many authors have suggested that the features of the disease are the result of autoimmune responses. We performed immunological studies on two patients with Vogt-Koyanagi-Harada syndrome. In one case antibodies to melanoma cells in cytotoxic assay were detected, which it was thought may indicate the presence of antibodies to melanocytes. In the second patient three clones of interleukin-2-dependent T cells were isolated which appeared to have specificity in both cytotoxic and proliferative assays to cultured normal melanocytes and to three allogeneic melanoma cells. These findings further support a role for autoimmunity to pigmented cells in the pathogenesis of Vogt-Koyanagi-Harada syndrome. However, the precise role of autoimmunity in this disease is yet to be established.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
7/15. Anterior uveitis and multiple sclerosis.Three patients with clinically definite multiple sclerosis and uveitis were studied. The uveitis presented as inflammation of the anterior segment of the eye (iridocyclitis) and was characterized by large keratic precipitates and posterior synechiae, consistent with a granulomatous iridocyclitis. Clinical and laboratory evidence militated against other central nervous system diseases often associated with uveitis including neurosarcoidosis, Behcet's syndrome, Vogt-Koyanagi-Harada disease, neurosyphilis, and tuberculosis. Further attention should be directed to the possibility of granulomatous anterior uveitis in patients with multiple sclerosis.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
8/15. Ocular syphilis in patients with human immunodeficiency virus infection.We diagnosed ocular syphilis in three homosexual men infected with human immunodeficiency virus (hiv). Ocular inflammation included uveitis, optic neuritis, and retinitis. Dermatologic and central nervous system manifestations of secondary syphilis were also present. The history of homosexuality was difficult to obtain. Concomitant infection with hiv may alter the course of syphilis, obscure the diagnosis, and impair the response to therapy.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
9/15. lymphomatoid granulomatosis with ocular involvement.lymphomatoid granulomatosis is an angiocentric and angiodestructive lymphoproliferative disorder that involves multiple organs including the lung, skin, kidney and central nervous system. A case of lymphomatoid granulomatosis with ocular involvement is reported herein. Bilateral peripheral retinal vasculitis involving both arterioles and veins, with posterior uveitis, is the prominent clinical finding.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
10/15. Conjunctival biopsy in the diagnosis of sarcoidosis.The diagnosis of sarcoidosis with ocular involvement is often difficult and accompanied by a certain measure of uncertainty due to a paucity of additional physical signs. In the ophthalmic literature, it is controversial as to whether biopsy of a clinically normal conjuctiva should be done if sarcoidosis is suspected. Many authors advocate biopsy only in the presence of conjunctival follicles or nodules. However, a positive biopsy from a clinically normal-appearing conjunctiva has been reported. Recently, we saw a patient with bilateral uveitis, evanescent cranial nerve palsies, and other clinical manifestations suggesting central nervous system and ocular sarcoidosis. Random biopsy of a normal-appearing conjunctiva revealed a noncaseating granuloma consistent with sarcoidosis. Since conjunctival biopsy is a simple office procedure with minimal morbidity, this diagnostic tool should be considered for patients with clinically suspected sarcoidosis, even in the absence of conjunctival follicles or nodules.- - - - - - - - - - ranking = 1keywords = central nervous system, nervous system (Clic here for more details about this article) |
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