1/45. Postpartum optic neuritis: etiologic and pathophysiologic considerations.The clinical course of four patients with visual loss in the postpartum period due to acute optic neuritis is described. Factors that disclosed the underlying etiology and expression of disease are discussed. The clinical records of four women examined and managed for visual loss after uncomplicated pregnancies and term deliveries were reviewed. Neurodiagnostic examination, treatment modalities, and outcomes were assessed. These four women with varied and confounding medical histories, all with optic neuropathy, eventually were demonstrated to harbor demyelinating disease. Although visual loss in the postpartum period evokes differential diagnostic considerations, the authors' experience suggests that puerperal immune-mediated changes are responsible for activation of optic neuritis associated with relapsing multiple sclerosis.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
2/45. Cutaneous ulceration after injection of polyethylene-glycol-modified interferon alpha associated with visual disturbances in a melanoma patient.interferons are used in the therapy of multiple sclerosis, Kaposi's sarcoma, hepatitis and melanoma. Their short half-life that requires frequent injections can be increased by polyethylene glycol (PEG) modification. A 50-year-old patient was diagnosed as having an acrolentiginous melanoma (Breslow >5 mm, Clark level IV) and inguinal lymph node metastases. After surgical excision and lymphadenectomy, immune therapy with 6.0 microg pegylated interferon alpha(2b)/kg body weight, s.c., was started. Cutaneous ulcerations at the injection sites developed 9 months after treatment initiation. The patient also developed blurred vision and presented with binasal scotomas and pathological visually evoked potentials and electroretinogram. The cutaneous ulcerations slowly healed under local therapy and reduction of the concentration of the PEG-modified interferon from 0.86 to 0.43 mg/ml. The dosage was maintained. Two months later, the therapy was stopped due to disease progression. Vision subsequently recovered. Cutaneous reactions evolved at the sites of subcutaneous injections of PEG-modified interferon alpha(2b). Changes in vision can probably be attributed to immunotherapy.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
3/45. Acute asymmetric upper nasal quandrantanopsia caused by a chiasmal colloid cyst in a patient with multiple sclerosis and bilateral retrobulbar neuritis.PURPOSE: To report a patient with multiple sclerosis and a history of sequential bilateral retrobulbar neuritis, who developed new onset of highly asymmetric upper quadrantanopsia. DESIGN: Interventional case report. METHOD: A 36-year-old woman with multiple sclerosis and bilateral retrobulbar neuritis developed an acute asymmetric upper nasal quadrantanopsia. RESULTS: magnetic resonance imaging of the brain revealed a cyst that caused chiasmal compression and bilateral visual field defects. CONCLUSION: New onset of bilateral visual field defects in a patient with diagnosed multiple sclerosis is likely to be caused by a new attack of the demyelinating disease. In this case, a newly diagnosed chiasmal colloid cyst was the cause of visual field defects.- - - - - - - - - - ranking = 7keywords = sclerosis (Clic here for more details about this article) |
4/45. A pilot study of gabapentin as treatment for acquired nystagmus.The effects of the anticonvulsant gabapentin were measured on vision and eve movements in three patients with acquired pendular nystagmus. In two patients, the nystagmus was associated with multiple sclerosis and, in the other, it followed brainstem stroke. A single oral 600 mg dose of gabapentin produced improvement of vision due to changes in ocular oscillations in all three patients. The effect was sustained after five weeks of treatment in two patients who elected to continue taking gabapentin 900-1500 mg/day. The results of this pilot study suggest that a controlled trial of gabapentin should be conducted to evaluate its role in the treatment of acquired forms of nystagmus.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
5/45. Leber hereditary optic neuropathy, progressive visual loss, and multiple-sclerosis-like symptoms.PURPOSE: To report a case of Leber hereditary optic neuropathy with multiple-sclerosis-like symptoms. methods: Observational case report. A 34-year-old man was found to have Leber hereditary optic neuropathy and a mutation at position 11778 of the mitochondrial genome. The progression of vision loss and onset of weakness in the right leg warranted neuroimaging. RESULTS: magnetic resonance imaging documented multiple lesions in the brain and spinal cord. CONCLUSION: Although rarely reported, progression of optic neuropathy over months has been previously documented in Leber hereditary optic neuropathy. The emergence of multiple sclerosis-like symptoms and signs in our patient may be part of the spectrum of Leber hereditary optic neuropathy or a coincidental occurrence.- - - - - - - - - - ranking = 6keywords = sclerosis (Clic here for more details about this article) |
6/45. Partial and significant reversal of progressive visual and neurological deficits in multiple sclerosis: a possible therapeutic effect.A 24-year-old woman developed over 18 months fluctuating and progressively increasing visual and cerebellar deficits, due to multiple sclerosis. The minimum visual acuities were 3/19 on the right and the perception of finger movement at 1 m on the left. She became able to walk only with a wide base and with support. Her condition deteriorated despite the use of methylprednisolone, prednisone and interferon beta-1b, so these were ceased. azathioprine, 25 mg daily increasing to 100 mg daily, reducing following abnormal liver function tests to 50 mg daily, and glatiramer acetate 20 mg daily were commenced. The visual acuities two months later were 3/7.5 on the right and 3/6 on the left and after 4 months 3/4.5 on the right and 3/3 on the left. She was able after 2 months to walk unaided on a narrow base and after 4 months to jog half a kilometre without difficulty. Progressive multiple sclerosis has been held to be irreversible. The response in the present case therefore raises the possibility of a drug effect. It indicates the need for trials of combined immunomodulatory and immunosuppressive therapies in progressive multiple sclerosis.- - - - - - - - - - ranking = 7keywords = sclerosis (Clic here for more details about this article) |
7/45. An unusual junctional scotoma.A 28-year-old woman presented with painful unilateral left visual loss, impaired color vision, left afferent pupillary defect, and normal ocular fundus. Although optic neuritis was first suspected, visual fields disclosed a junctional scotoma related to chiasmal demyelination, due to a probable multiple sclerosis.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
8/45. Nuclear sclerotic cataract in young patients in taiwan.PURPOSE: To document the clinical features of discrete nuclear sclerosis in young patients. SETTING: Chang-Gung Memorial Hospital, Taoyuan, taiwan, Republic of china. methods: The medical records of all patients younger than 45 years with nuclear sclerosis who had cataract surgery at 1 hospital were retrospectively reviewed. patients with congenital cataract, ocular trauma, ocular disease in addition to myopia, and systemic disease associated with cataract were excluded. The patients' age, sex, bilateral lens status, axial length, original and preoperative refractive status, and preoperative and postoperative best corrected visual acuities (BCVAs) were recorded. RESULTS: Fifty-five eyes of 35 patients aged 32 to 45 years met the study criteria. Nuclear sclerotic cataract was bilateral in 20 patients. The mean age at surgery was 40.64 years /- 3.63 (SD). The mean refraction before the development of cataract was -7.80 /- 3.57 diopters (D) and the mean preoperative refraction, -17.40 /- 6.05 D. The mean axial length was 28.09 /- 2.31 mm. The postoperative BCVA was 20/22 or better in 53 eyes (96.4%). CONCLUSIONS; In patients younger than 45 years with cataract in taiwan, nuclear sclerosis was not a rare cause of visual loss and axial myopia was strongly associated with the formation of nuclear sclerosis. Bilateral sclerosis was observed in most cases. patients with an axial length greater than 27.0 mm had the greatest risk. Surgical treatment was therapeutic.- - - - - - - - - - ranking = 5keywords = sclerosis (Clic here for more details about this article) |
9/45. multiple sclerosis.multiple sclerosis (MS) is the most common disabling neurologic disease of young people affecting between 350 and 450,000 individuals in the united states. Substantial advances have been made in the diagnostic assessment and treatment interventions over the last 10 years such that we are now able effectively to treat both the disease process and the associated symptomatic complaints associated with MS. Most patients consult with their primary care physician at the time when the first clinical manifestations of MS emerge. These physicians play a central role in the early identification and treatment of patients with MS. This article emphasizes the expanding diagnostic and therapeutic capabilities evolving for the MS patient and the crucial role played by primary care physicians in collaboration with neurologists in the coordination of the initial diagnostic and treatment plan.- - - - - - - - - - ranking = 5keywords = sclerosis (Clic here for more details about this article) |
10/45. Problems in diagnosing cranial base meningioma in patients with multiple sclerosis.A 49-year-old patient had been suffering from the relapsing-remitting form of multiple sclerosis since the age of 23. Attacks of the disease appeared every 2 years in the form of right-sided hemiparesis, vertigo, and problems in maintaining balance. The symptoms disappeared after treatment. At the age 32 retrobulbar inflammation of the second cranial nerve appeared with visual acuity weakness. The symptoms disappeared after treatment. At the age of 42, bilateral weakness of visual acuity appeared and then epileptic attacks occurred. After surgical treatment of meningioma the symptoms disappeared. Only the features of a psycho-organic syndrome remained. The following attack of MS appeared 2 years after surgical intervention. MRI of the head disclosed numerous demyelinating foci.- - - - - - - - - - ranking = 5keywords = sclerosis (Clic here for more details about this article) |
| | Next -> |