1
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Cohen DC, Naeem F, Will D, Egan RA, Tamhankar MA. Appearance and resolution of numerous bilateral gass plaques in probable Susac syndrome. Am J Ophthalmol Case Rep 2024; 36:102088. [PMID: 39036655 PMCID: PMC11260388 DOI: 10.1016/j.ajoc.2024.102088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/27/2024] [Accepted: 05/26/2024] [Indexed: 07/23/2024] Open
Abstract
Purpose To describe a patient with a unique retinal phenotype of probable Susac syndrome. Observations A 47-year-old female who presented with bilateral tinnitus and vision changes was found to have bilateral sensorineural hearing loss and many bilateral retinal arteriolar Gass plaques. She had bilateral scotomas corresponding with temporal thinning and atrophy of the inner nuclear layer (INL) on OCT. Retinal examination and fluorescein angiography demonstrated minimal arteriolar wall hyperfluorescence with no evidence of acute branch retinal artery occlusion. She developed daily headaches. MRI of the brain was normal with no corpus callosal lesions. She was diagnosed with probable Susac syndrome based on the above findings. Conclusions and importance Our patient's bilateral high frequency sensorineural hearing loss, numerous bilateral Gass plaques, and headaches are most likely attributable to Susac syndrome. While BRAO is considered a cornerstone of retinal involvement in Susac syndrome, it may only be appreciable angiographically in the acute setting, and it is important to recognize Gass plaques as a significant diagnostic marker of disease.
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Affiliation(s)
- Devin C. Cohen
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Fawaz Naeem
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Daniel Will
- Department of Ophthalmology, Abington Jefferson Hospital, Abington, PA, United States
| | - Robert A. Egan
- Department of Neurology, Providence Medford Medical Center, Medford, OR, United States
| | - Madhura A. Tamhankar
- Scheie Eye Institute, Department of Ophthalmology, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
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Piura Y, Bregman N, Kavé G, Karni A, Kolb H, Vigiser I, Day GS, Lopez-Chiriboga S, Shiner T, Regev K. Long-term cognitive outcomes in Susac syndrome: A case series. J Neuroimmunol 2024; 393:578396. [PMID: 38908330 DOI: 10.1016/j.jneuroim.2024.578396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/17/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Susac syndrome (SuS) presents with encephalopathy, visual disturbances, and hearing loss from immune-mediated microvascular occlusion. While acute SuS is well-described, long-term cognitive outcomes with current treatments are underknown. We assessed ten SuS patients treated in accordance with evidence-based guidelines using immunotherapies targeting humoral and cell-mediated pathways. Patients were followed for a median 3.6 years. Initially, cognition inversely correlated with corpus callosum lesions on MRI. All reported cognitive improvement; 5/10 patients had residual deficits in visual attention and executive function. Early, aggressive treatment was associated with good outcomes; extensive early corpus callosum lesions may identify patients at-risk of persistent cognitive deficits.
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Affiliation(s)
- Yoav Piura
- Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; The Neuroimmunology and Multiple Sclerosis Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel.
| | - Noa Bregman
- Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Gitit Kavé
- Department of Education and Psychology, The Open University of Israel, Ra'anana, Israel; Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Arnon Karni
- Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; The Neuroimmunology and Multiple Sclerosis Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Hadar Kolb
- Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; The Neuroimmunology and Multiple Sclerosis Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ifat Vigiser
- Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Neuroimmunology and Multiple Sclerosis Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Gregory S Day
- Department of Neurology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | | | - Tamara Shiner
- Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Cognitive Neurology Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Keren Regev
- Department of Neurology, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel; The Neuroimmunology and Multiple Sclerosis Unit, Neurological Institute, Tel Aviv Medical Center, Tel Aviv, Israel
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3
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Kashipazha D, Bahramy MA, Razaghi M, Rahimi Z. Successful treatment of a complete Susac syndrome in a 16-year-old boy: A case report. Clin Case Rep 2024; 12:e9027. [PMID: 39055087 PMCID: PMC11268951 DOI: 10.1002/ccr3.9027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 09/18/2023] [Accepted: 01/19/2024] [Indexed: 07/27/2024] Open
Abstract
Key Clinical Message We reported a pediatric case of SuS with a complete diagnosis triad. Although the optimal treatment of SS is unclear, prompt diagnosis and treatment can result in almost a complete recovery. Abstract Susac's syndrome (SuS) is a rare, autoimmune disorder known as a typical triad of sensorineural hearing impairment, central nervous system involvement, and multiple branch retinal artery occlusions (BRAOs). It is usually misdiagnosed or underdiagnosed because its symptoms may vary at the presentation time. Diagnosis can be established based on neuroimaging, ophthalmic examination, and audiometry, which match the clinical symptoms. SuS is very limited and rare in childhood and can be easily misdiagnosed with multiple sclerosis or acute disseminated encephalomyelitis. We report a 16-year-old boy patient with a completed SuS triad including BRAO in fluorescent angiography (FA), mild to moderate sensory neural hearing loss (SNHL), "Snowball lesions," and "pearl of string" signs in magnetic resonance imaging (MRI). Successful treatment was achieved with methylprednisolone, rituximab, azathioprine, cyclophosphamide, and plasmapheresis. SuS is a rare disorder, which rarely presents with a full triad and all the manifestations may not be present at the onset of the disease, leading to misdiagnosis or underdiagnosis. Our case is exceptional because he was in a pediatric age and presented with a complete triad of SuS which adds to the rarity of this disease. Although optimal treatment of SuS is unclear, our treatment regimen resulted in almost a complete recovery.
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Affiliation(s)
- Davood Kashipazha
- Department of NeurologyAhvaz Jundishapur University of Medical SciencesAhvazIran
| | | | - Mahshad Razaghi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
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4
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Marrodan M, Calandri IL, Bocancea DI, Ysrraelit MC, Gomez Figueroa E, Massó Páez M, Flores JDJ, Rojas JI, Ciampi E, Ioli P, Zanga G, Ardohain C, Fracaro ME, Amaya M, Tkachuk V, Fernandez VC, José G, Silva E, Luetic G, Carnero Contentti E, Köhler E, Pagani Cassara F, Moran D, Seimandi C, Paviolo JP, D'elio B, Da Prat G, Gatto E, Cristiano E, Pujol Lereis V, Ameriso SF, Fiol MP, Correale J. Diagnostic MRI Score to Differentiate Susac Syndrome from Primary Angiitis of the Central Nervous System and Multiple Sclerosis. Ann Neurol 2024. [PMID: 39056308 DOI: 10.1002/ana.27043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 06/24/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE Susac syndrome (SuS), multiple sclerosis (MS), and primary angiitis of the central nervous system (PACNS) present diagnostic challenges due to overlapping clinical features. We aimed to enhance diagnostic precision by developing the SPAMS (SuS, PACNS, MS) score, a practical radiological tool. METHODS This multicenter study included 99 patients (43 SuS, 37 MS, 19 PACNS) from South American countries. Relevant MRI features were identified through an elastic-net model determined key variables. RESULTS The SPAMS score assigned 2 points for snowball lesions, 1 point for spokes-like lesions, or if there are more than 4 lesions in the corpus callosum, corpus callosum involvement, or cerebellar involvement. It subtracted 1 point if gadolinium-enhancing lesions or 4 points if Dawson's fingers are present. Bootstrapping validated the optimal cutoff at 2 points, exhibiting a diagnostic performance of area under the curve = 0.931, sensitivity = 88%, specificity = 89%, positive predictive value = 88%, negative predictive value = 89%, and accuracy = 88%. INTERPRETATION When specific MRI findings coexisted, the SPAMS score differentiated SuS from MS and PACNS. Access to MRI and standard protocol sequences makes it a valuable tool for timely diagnosis and treatment, potentially preventing disability progression and severe clinical outcomes. ANN NEUROL 2024.
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Affiliation(s)
| | - Ismael L Calandri
- Departamento de Neurología Cognitiva, Fleni, Buenos Aires, Argentina
- Alzheimer Center, VU University, Amsterdam, The Netherlands
| | | | | | - Enrique Gomez Figueroa
- Departamento de Neurología, Hospital Civil de Guadalajara, Universidad de Guadalajara, Guadalajara, Mexico
| | - Montserrat Massó Páez
- Departamento de Neurología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
- Departamento de Neurología, Hospital Médica Sur, Ciudad de México, Mexico
| | - José D J Flores
- Departamento de Neurología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, Mexico
| | - Juan I Rojas
- Departamento de Neurología, Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina, Buenos Aires, Argentina
- Departamento de Neurología, CEMIC, Buenos Aires, Argentina
| | - Ethel Ciampi
- Departamento de Neurología, Hospital Dr. Sótero del Río, Santiago, Chile
- Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Ioli
- Departamento de Neurología, Hospital Privado de la Comunidad, Mar del Plata, Argentina
| | - Gisela Zanga
- Departamento de Neurología, ENERI Dr. Pedro Lylyk, Buenos Aires, Argentina, Buenos Aires, Argentina
| | - Carolina Ardohain
- Departamento de Neurología, ENERI Dr. Pedro Lylyk, Buenos Aires, Argentina, Buenos Aires, Argentina
| | - Maria E Fracaro
- Departamento de Neurología, Clínica El Castaño, San Juan, Argentina
| | - Mariela Amaya
- Departamento de Neurología, Hospital Marcial Quiroga, San Juan, Argentina
| | - Verónica Tkachuk
- Departamento de Neurología, Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | | | - Gustavo José
- Departamento de Neurología, Hospital Padilla, Tucumán, Argentina
| | - Emanuel Silva
- Departamento de Neurología, Predigma, Posadas, Argentina
| | - Geraldine Luetic
- Departamento de Neurología, Instituto de Neurociencias de Rosario, Santa Fe, Argentina
| | | | - Eduardo Köhler
- Departamento de Neurología, Fundación Sinapsis, Rosario, Argentina
| | | | - Dolores Moran
- Departamento de Neurología, HZE/Cons. Cruz Blanca, Chubut, Argentina
| | - Carla Seimandi
- Departamento de Neurología, Hospital Privado de Córdoba, Córdoba, Argentina
| | - Juan P Paviolo
- Departamento de Neurología, Hospital SAMIC El Dorado, El Dorado, Argentina
| | - Brenda D'elio
- Departamento de Neurología, Clínica Los Alerces, Esquel, Argentina
| | - Gustavo Da Prat
- Departamento de Neurología, Sanatorio Anchorena de San Martin, Buenos Aires
- Departamento de Neurología, INEBA, Buenos Aires, Argentina
- Departamento de Neurología, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
| | - Emilia Gatto
- Departamento de Neurología, Sanatorio Anchorena de San Martin, Buenos Aires
- Departamento de Neurología, INEBA, Buenos Aires, Argentina
- Departamento de Neurología, Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Departamento de Neurología, Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina, Buenos Aires, Argentina
| | | | | | - Marcela P Fiol
- Departamento de Neurología, Fleni, Buenos Aires, Argentina
| | - Jorge Correale
- Departamento de Neurología, Fleni, Buenos Aires, Argentina
- Departamento de Química Biológica e Instituto de Química y Fisicoquímica Biológicas (IQUIFIB), Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires. CONICET, Buenos Aires, Argentina
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Koncz R, Say MJ, Gleason A, Hardy TA. The neurocognitive and neuropsychiatric manifestations of Susac syndrome: a brief review of the literature and future directions. Neurol Sci 2024:10.1007/s10072-024-07672-9. [PMID: 38954275 DOI: 10.1007/s10072-024-07672-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
Encephalopathy is part of the clinical triad of Susac syndrome, but a detailed understanding of the neurocognitive and neuropsychiatric profile of this condition is lacking. Existing literature indicates that cognitive deficits range in severity from subtle to profound. Executive function and short-term recall are affected frequently. Psychiatric manifestations may be absent or may include anxiety, mood disorders or psychosis. If psychiatric phenomena develop during the disease course, it can be hard to disentangle whether symptoms directly relate to the pathology of Susac syndrome or are secondary to treatment-related side effects. In this article, we review what is known about the cognitive and psychiatric morbidity of Susac syndrome and identify areas where knowledge is deficient. Importantly, we also provide a framework for future research, arguing that better phenotyping, understanding of pathophysiology, evaluation of treatments on cognitive and psychiatric outcomes, and longitudinal data capture are vital to improving patient outcomes.
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Affiliation(s)
- Rebecca Koncz
- The University of Sydney Specialty of Psychiatry, Concord, NSW, Australia.
- Department of Psychiatry, Concord Repatriation General Hospital, Concord, NSW, Australia.
| | - Miranda J Say
- Department of Psychology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Andrew Gleason
- Department of Consultation-Liaison Psychiatry, Concord Repatriation General Hospital, Concord, NSW, Australia
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
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Koseki A, Suzuki Y, Uchida S, Morishita N, Hokazono Y, Kuriki K, Yamamura Y, Yoshida M, Sakai N. Primary Central Nervous System Vasculitis Mimicking Susac Syndrome and Multiple Sclerosis With Long-Term Remission and Spontaneous Resolution of Lesions: A Case Report. Cureus 2024; 16:e64358. [PMID: 39131025 PMCID: PMC11316671 DOI: 10.7759/cureus.64358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2024] [Indexed: 08/13/2024] Open
Abstract
Primary central nervous system vasculitis (PCNSV) is an angiitis localized to the central nervous system (CNS), with various manifestations and no specific biomarkers. Herein, we report a case of PCNSV that presented with an unusual course. A 40-year-old Japanese male developed inner ear symptoms and visual field disturbances. Later, at 42 years of age, the patient developed right hemiparesis and was diagnosed with multiple sclerosis (MS). He received methylprednisolone pulse therapy, which improved his symptoms and resolved most brain lesions. Subsequently, he did not visit the hospital for 13 years, during which time he experienced no relapse. At 55 years of age, he presented to our hospital with fatigue and dizziness. Susac syndrome was suspected because of sensorineural hearing loss and snowball lesions in the corpus callosum. Some of the brain lesions resolved spontaneously. A biopsy was performed on a right frontal lobe lesion, which revealed vasculitis with fibrinoid necrosis, no demyelinating lesions, no amyloid positivity, and no infiltration of atypical lymphocytes. With no evidence of vasculitis in other organs, the patient was diagnosed with PCNSV. The patient was treated with methylprednisolone pulse therapy, followed by oral prednisolone (1 mg/kg/day). The prednisolone was tapered off, and no relapse of symptoms or new lesions on magnetic resonance imaging (MRI) were noted. As observed in this case, even in a scenario suggestive of Susac syndrome or multiple sclerosis, PCNSV should be considered a differential diagnosis and confirmed via brain biopsy.
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Affiliation(s)
| | | | | | | | | | - Ken Kuriki
- Diagnostic Pathology, Yaizu City Hospital, Yaizu, JPN
| | | | - Mari Yoshida
- Pathology, Aichi Medical University, Nagakute, JPN
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7
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Richter JE, Rourk KS, Stewart MW, Raymond MJ. Fatal Presentation of Susac Syndrome in a Congenitally Deaf Patient With a Cochlear Implant. Otol Neurotol 2024; 45:e468-e471. [PMID: 38865723 DOI: 10.1097/mao.0000000000004201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To report a fatal case of Susac syndrome in a congenitally deaf patient with a cochlear implant and a history of migraines, emphasizing the diagnostic challenges in patients with preexisting conditions. PATIENT A 33-year-old male with congenital hearing loss, a cochlear implant, and chronic migraines who presented with mild subacute auditory disturbance and headaches that later progressed to severe encephalopathy. INTERVENTION Explantation of a non-magnetic resonance imaging (MRI) compatible cochlear implant followed by MRI, fundoscopy, and the administration of immunosuppressive medications. MAIN OUTCOME MEASURES Diagnosis was confirmed by characteristic MRI appearance and the presence of a hemi-retinal artery occlusion. RESULTS After weeks of immunosuppressive treatment, the patient died of a global cerebral ischemic event of unknown origin. CONCLUSIONS For patients with preexisting sensorineural hearing loss and cochlear implants, Susac syndrome poses a diagnostic challenge. Auditory disturbances in the absence of cochlear implant failure should prompt further evaluation for visual disturbances and encephalopathy. MRI and fundoscopy should be performed to detect other features of the disease.
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Affiliation(s)
- John E Richter
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | | | - Michael W Stewart
- Mayo Clinic Florida, Department of Ophthalmology, Jacksonville, Florida
| | - Mallory J Raymond
- Mayo Clinic Florida, Department of Otolaryngology-Head and Neck Surgery, Jacksonville, Florida
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8
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Zur Bonsen L, Rübsam A, Knecht V, Pleyer U. [Vasculitis of the retina : Clinical aspects, diagnostics, management and treatment]. DIE OPHTHALMOLOGIE 2024; 121:509-524. [PMID: 38806792 DOI: 10.1007/s00347-024-02050-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/30/2024]
Abstract
Inflammatory changes in the retinal vessels can be attributed to a wide range of etiologies. These include infections, intraocular and systemic autoimmune processes, general diseases and iatrogenic factors. As the endothelium of the retinal capillaries forms the inner blood-retinal barrier, a disruption of this structure is directly associated with consequences for the fluid electrolyte balance of the retina. Clinical sequelae can include leakage of the retinal vessels and macular edema, which are often functionally threatening and significantly reduce the quality of life of patients. As the eye can be affected as an "index organ", a work-up of the patient by the ophthalmologist is of great importance. In the age of "precision medicine", efforts are being made to gain new insights into the pathogenetic mechanisms of vasculitis through "omics" in order to develop innovative treatment concepts.
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Affiliation(s)
- Lynn Zur Bonsen
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Anne Rübsam
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Vitus Knecht
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Uwe Pleyer
- Universitäts-Augenklinik, Charité, Campus CBF - Universitätsmedizin Berlin Charité, Campus Virchow Klinikum - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität zu Berlin, Berlin, Deutschland.
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Wilf-Yarkoni A, Zmira O, Tolkovsky A, Pflantzer B, Gofrit SG, Kleffner I, Paul F, Dörr J. Clinical Characterization and Ancillary Tests in Susac Syndrome: A Systematic Review. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200209. [PMID: 38364193 PMCID: PMC11073882 DOI: 10.1212/nxi.0000000000200209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/02/2024] [Indexed: 02/18/2024]
Abstract
Susac syndrome (SuS) is an orphan microangiopathic disease characterized by a triad of encephalopathy, visual disturbances due to branch retinal artery occlusions, and sensorineuronal hearing loss. Our previous systematic review on all cases of SuS reported until 2012 allowed for a better understanding of clinical presentation and diagnostic findings. Based on these data, we suggested diagnostic criteria in 2016 to allow early diagnosis and treatment of SuS. In view of the accumulation of new SuS cases reported in the last 10 years and improved diagnostic tools, we here aimed at updating the demographic and clinical features of SuS and to review the updated ancillary tests being used for SuS diagnosis. Therefore, based on the 2016 criteria, we systematically collected and evaluated data on SuS published from January 2013 to March 2022.
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Affiliation(s)
- Adi Wilf-Yarkoni
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Ofir Zmira
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Assaf Tolkovsky
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Barak Pflantzer
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Shany G Gofrit
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Ilka Kleffner
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Friedemann Paul
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
| | - Jan Dörr
- From the Departmet of Neurology (A.W.-Y., A.T.), Rabin Medical Center, Petah Tikva; Department of Neurology and Neurosurgery (A.W.-Y., A.T., B.P., S.G.G.), Sackler Faculty of Medicine, Tel Aviv University; Department of Neurology (O.Z.), Hillel Yaffe Medical Center, Hadera; Department of Neurology (O.Z.), Ruth and Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa; Department of Neurology (B.P., S.G.G.), Sheba Medical Center, Ramat Gan, Israel; Department of Neurology (I.K.), University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum; Experimental and Clinical Research Center (F.P., J.D.), Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin; and Multiple Sclerosis Center (J.D.), Neurology Department, Oberhavel Kliniken, Hennigsdorf, Germany
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10
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Nociti V, Romozzi M, Mirabella M. Challenges in Diagnosis and Therapeutic Strategies in Late-Onset Multiple Sclerosis. J Pers Med 2024; 14:400. [PMID: 38673027 PMCID: PMC11051411 DOI: 10.3390/jpm14040400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory and degenerative demyelinating disease of the central nervous system of unknown etiology, which affects individuals in their early adulthood. However, nearly 5-10% of people with MS can be diagnosed at ages above 50 years old, referred to as late-onset multiple sclerosis (LOMS). Some studies have reported a distinctive presentation, clinical course, and prognosis for LOMS, implicating a different diagnostic and therapeutic approach for this population. Furthermore, similar manifestations between LOMS and other age-related conditions may lead to potential misdiagnosis and diagnostic delays, and a higher burden of multimorbidity associated with aging can further complicate the clinical picture. This review aims to explore the clinical characteristics, the disease course, and the differential diagnosis of LOMS and addresses therapeutic considerations for this population.
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Affiliation(s)
- Viviana Nociti
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Marina Romozzi
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Massimiliano Mirabella
- Centro Sclerosi Multipla, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
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11
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Schuknecht A, Wiest MRJ, Said S, Bajka A, Hamann T, Muth DR, Fasler K, Blaser F, Barthelmes D, Zweifel S. Ophthalmological Outcomes in Patients with Susac Syndrome. Klin Monbl Augenheilkd 2024; 241:477-481. [PMID: 38653298 DOI: 10.1055/a-2243-4913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND To report ophthalmological outcomes and treatment regimen in patients with Susac syndrome. METHODS This is a retrospective analysis of patients with Susac syndrome treated between November 2015 and March 2023. Multimodal imaging findings, ophthalmic examination data, information on neurological and sensorineural involvement, and therapeutic regimen were reviewed. Visual acuity was recorded as the logarithm of the minimum angle of resolution (logMAR). Ophthalmological manifestations and disease severity were assessed using the previously described clinical activity score (CAS). RESULTS Ten patients with Susac syndrome m : f = 5 : 5 were identified. The mean follow-up time was 31.2 ± 23.3 months (range 1 to 78 months). The mean age was 41.4 ± 13.8 years (range 21 to 59 years). At baseline, corrected distance visual acuity (CDVA) was 0.03 ± 0.08 logMAR. At the last follow-up, CDVA improved to 0.00 ± 0.03 logMAR (p = 0.029). Three of 20 eyes showed an improvement of 5 letters, while no loss of visual acuity was recorded during the follow-up time. Baseline CAS was 10.65 ± 12.69, and CAS at the last follow-up was 5.15 ± 5.49 (p = 0.068). Except for one patient, all were initially treated with intravenous (i. v.) steroids and subsequent oral tapering. Depending on the treatment response, cyclophosphamide (n = 4), i. v. immunoglobulins (IVIGs) (n = 4), anti-CD20 antibodies (n = 3), or plasmapheresis (n = 1) were applied. All patients under treatment for more than 1 month (n = 9) showed improvement in CAS and CDVA. CONCLUSION Susac syndrome is a rare autoimmune vascular endotheliopathy. Treatment of Susac syndrome appears to result in improving CAS and CDVA. The majority of patients, in addition to the systemic steroids, required systemic immunosuppressive agents. Interdisciplinary communication is crucial to reduce the time to diagnosis and initiation of therapy in patients with Susac syndrome.
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Affiliation(s)
| | | | - Sadiq Said
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Anahita Bajka
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Timothy Hamann
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | | | - Katrin Fasler
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Frank Blaser
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
| | - Daniel Barthelmes
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
- Ophthalmology, The University of Sydney Save Sight Institute, Sydney, Australia
| | - Sandrine Zweifel
- Department of Ophthalmology, Universitätsspital Zürich, Switzerland
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12
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Cviková M, Štefela J, Všianský V, Dufek M, Doležalová I, Vinklárek J, Herzig R, Zemanová M, Červeňák V, Brichta J, Bárková V, Kouřil D, Aulický P, Filip P, Weiss V. Case report: Susac syndrome-two ends of the spectrum, single center case reports and review of the literature. Front Neurol 2024; 15:1339438. [PMID: 38434197 PMCID: PMC10904644 DOI: 10.3389/fneur.2024.1339438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Susac syndrome is a rare and enigmatic complex neurological disorder primarily affecting small blood vessels in the brain, retina, and inner ear. Diagnosing Susac syndrome may be extremely challenging not only due to its rarity, but also due to the variability of its clinical presentation. This paper describes two vastly different cases-one with mild symptoms and good response to therapy, the other with severe, complicated course, relapses and long-term sequelae despite multiple therapeutic interventions. Building upon the available guidelines, we highlight the utility of black blood MRI in this disease and provide a comprehensive review of available clinical experience in clinical presentation, diagnosis and therapy of this disease. Despite its rarity, the awareness of Susac syndrome may be of uttermost importance since it ultimately is a treatable condition. If diagnosed in a timely manner, early intervention can substantially improve the outcomes of our patients.
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Affiliation(s)
- Martina Cviková
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Jakub Štefela
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Vít Všianský
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Michal Dufek
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Irena Doležalová
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Jan Vinklárek
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Roman Herzig
- Department of Neurology, Comprehensive Stroke Center, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czechia
| | - Markéta Zemanová
- Department of Ophthalmology and Optometry, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Vladimír Červeňák
- Department of Medical Imaging, St. Anne’s University Hospital and Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jaroslav Brichta
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
| | - Veronika Bárková
- Department of Clinical Pharmacology, St. Anne's University Hospital, Brno, Czechia
| | - David Kouřil
- Department of Neurology, Blansko Hospital, Blansko, Czechia
| | - Petr Aulický
- Department of Anesthesiology, Hospital of the Brothers of Charity Brno, Brno, Czechia
| | - Pavel Filip
- Department of Neurology, Charles University, First Faculty of Medicine and General University Hospital, Prague, Czechia
- Center for Magnetic Resonance Research (CMRR), University of Minnesota, Minneapolis, MN, United States
| | - Viktor Weiss
- Department of Neurology, St. Anne’s University Hospital in Brno and Faculty of Medicine at Masaryk University, Brno, Czechia
- Department of Neurology, Charles University Faculty of Medicine, Hradec Králové, Czechia
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13
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Tsikvadze M, Machado De Villafane B, Rose M, Peacock S, Peel JB, Ng L, Kramer C, Freeman WD. Diffuse Cerebral Edema With Uncal Herniation Leading to Brain Death in Patient With Fulminant Susac syndrome: Rare Complication of Rare Disease. Neurohospitalist 2024; 14:87-94. [PMID: 38235024 PMCID: PMC10790605 DOI: 10.1177/19418744231196625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Susac Syndrome was first described as an inflammatory microangiopathy of the brain and retina. Since then, multiple articles have been published in attempts to improve the understanding of this rare disease. Clinically Susac Syndrome is known to present with triad of encephalopathy, sensorineural hearing loss and branch of retinal artery occlusion (BRAO), along with characteristic "snowball" or "spoke" appearing white matter lesions of the corpus callosum. It has been characterized by vast heterogeneity in terms of its presenting symptoms, severity, and clinical course. Although subset of patients present with severe forms of Susac Syndrome and can develop prominent residual neurologic deficits, it has been reported to be mostly non-life-threatening and only few fatal cases have been described in the literature. Based on the available case reports with fatal outcome, mortality has been related to the systemic complications either during acute disease flare or during chronic-progressive phase. We describe a case of fulminant Susac Syndrome complicated by the sudden and rapid progression of diffuse cerebral edema leading to brain herniation and ultimate brain death, in order to increase awareness of this rare and catastrophic complication.
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Affiliation(s)
- Mariam Tsikvadze
- Department of Neurocritical Care, Mayo Clinic Florida, Jacksonville, FL, USA
| | | | - Mariah Rose
- Department of Neurocritical Care, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sarah Peacock
- Department of Neurocritical Care, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Jeffrey Brent Peel
- Department of Neurocritical Care, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Lauren Ng
- Department of Neurocritical Care, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Christopher Kramer
- Department of Neurocritical Care, Mayo Clinic Florida, Jacksonville, FL, USA
| | - William D. Freeman
- Department of Neurocritical Care, Mayo Clinic Florida, Jacksonville, FL, USA
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14
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Stinissen R, Tukanov E, Wyckmans M, Kerstens J, Willekens B. Clinical characteristics and treatment approaches in patients with Susac syndrome: a scoping review of cases. J Neurol 2023; 270:5719-5730. [PMID: 37668702 DOI: 10.1007/s00415-023-11936-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Susac syndrome (SuS) is a rare disease characterized by encephalopathy, hearing impairment and visual disturbances. Immunosuppressive treatments are used based on the hypothesis that an autoimmune endotheliopathy drives the disease. However, a solid evidence-based treatment approach is lacking. The aim of this review is to provide an overview of patient characteristics, disease course and treatment patterns related to successful outcome that have been reported in literature since 2013. METHODS Three reviewers conducted a systematic literature search in February 2022. The primary outcome was treatment used, derived from cases classified as probable or definite SuS, describing successful treatment outcome (i.e. no signs of disease activity for ≥ 1 month). Secondary outcomes were time-to-relapse and follow-up time. Published case reports and case series were included. Various clinical characteristics and treatment(s) were extracted and categorized into different phases of treatment. RESULTS A total of 810 records was identified. 120 articles met inclusion criteria and 161 cases were extracted. Of these, 151 cases were classified as probable or definite SuS and included in the final analysis. Number of combinations of treatments used per treatment phase were: 6 empirically, 35 after confirmed diagnosis, 43 for maintenance treatment, 22 after relapse, 18 during maintenance post-relapse. Median follow-up time was 12.3 months (0.5; 120) and median time to relapse was 4 months (1; 120). CONCLUSION This scoping review summarizes treatment approaches in patients with SuS, highlighting variability. International efforts to collect clinical, imaging and treatment data from patients with SuS in registries are needed, in order to provide less biased and long-term follow-up information on treatment response, predictors of relapse and patient outcomes. This may lead to more evidence-based therapeutic approaches.
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Affiliation(s)
- Robin Stinissen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Eldar Tukanov
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Martin Wyckmans
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Jeroen Kerstens
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
- Translational Neurosciences Research Group, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
- Laboratory of Experimental Hematology, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
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15
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Bose S, Papathanasiou A, Karkhanis S, Appleton JP, King D, Batra R, Mollan SP, Jacob S. Susac syndrome: neurological update (clinical features, long-term observational follow-up and management of sixteen patients). J Neurol 2023; 270:6193-6206. [PMID: 37608221 PMCID: PMC10632257 DOI: 10.1007/s00415-023-11891-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
Susac syndrome is a likely autoimmune microangiopathy affecting the brain, retina and inner ear. Due to the rarity of this condition, diagnosis and treatment can be challenging. Diagnosis is based on the presence of the clinical triad of central nervous system dysfunction, branch retinal artery occlusions and sensorineural hearing loss. Typical MRI findings of callosal and peri-callosal lesions may assist in diagnosis. Clinical course can be monophasic, polycyclic or chronic continuous. It is important to look out for red flags to attain an accurate diagnosis and follow a therapeutic algorithm based on severity of the disease and response to treatment. Patients are treated with steroids and immunosuppressive agents with a variable response. Early aggressive treatment especially in severe cases, may help in preventing relapses and morbidity/disability. This study highlights important diagnostic features and proposes a treatment algorithm based on clinical experience from management of 16 patients from 2 neuroscience centres in the UK since 2007, who were followed up over a long period of 3-15 years.
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Affiliation(s)
- Smriti Bose
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | | | - Sameep Karkhanis
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Jason P Appleton
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
- Institute of Applied Health Research, College of Dental and Medical Sciences, University of Birmingham, Birmingham, UK
| | - Dominic King
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
| | - Ruchika Batra
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Susan P Mollan
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saiju Jacob
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK.
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
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16
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Bernardes C, Pires R, Farinha C, Lemos J, Lima C, Batista S. Clinical Reasoning: A 24-Year-Old Pregnant Woman With Headache and Behavioral Change Progressing to Coma. Neurology 2023; 101:e2331-e2337. [PMID: 37648530 PMCID: PMC10727214 DOI: 10.1212/wnl.0000000000207859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/26/2023] [Indexed: 09/01/2023] Open
Abstract
The broad differential diagnosis associated with progressive subacute encephalopathy can be intimidating, especially in a young, pregnant woman. In this case, a 24-year-old woman at 21 weeks of gestation presented with persistent, drug-resistant fronto-parietal headache, with subsequent progressive development of psychomotor lentification and inappropriate behavior. Physical examination was normal, as were routine laboratory parameters and CT findings, and these symptoms were initially interpreted in the context of chronic depression. Later, the patient developed generalized dystonia and fever, with rapid clinical deterioration, depression of consciousness and, eventually, progression to coma. This case emphasizes the complexity and challenges involved in the diagnostic approach to a patient with progressive subacute encephalopathy framed by worsening CNS symptoms. It highlights the clinical considerations and complementary investigation of various etiologies, in a step-by-step approach, ultimately leading to the final diagnosis. Early recognition and appropriate treatment of these conditions can lead to more favorable outcomes, particularly in gestating patients, where prompt intervention is crucial, and where critical decisions may have to be made regarding pregnancy and the safety of treatment options.
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Affiliation(s)
- Catarina Bernardes
- From the Neurology Department (C.B., J.L., C.L., S.B.); Functional Unit of Neurorradiology (R.P.), Department of Medical Imaging; and Ophthalmology Department (C.F.), Coimbra University Hospital Centre, Portugal.
| | - Ricardo Pires
- From the Neurology Department (C.B., J.L., C.L., S.B.); Functional Unit of Neurorradiology (R.P.), Department of Medical Imaging; and Ophthalmology Department (C.F.), Coimbra University Hospital Centre, Portugal
| | - Cláudia Farinha
- From the Neurology Department (C.B., J.L., C.L., S.B.); Functional Unit of Neurorradiology (R.P.), Department of Medical Imaging; and Ophthalmology Department (C.F.), Coimbra University Hospital Centre, Portugal
| | - João Lemos
- From the Neurology Department (C.B., J.L., C.L., S.B.); Functional Unit of Neurorradiology (R.P.), Department of Medical Imaging; and Ophthalmology Department (C.F.), Coimbra University Hospital Centre, Portugal
| | - Cláudia Lima
- From the Neurology Department (C.B., J.L., C.L., S.B.); Functional Unit of Neurorradiology (R.P.), Department of Medical Imaging; and Ophthalmology Department (C.F.), Coimbra University Hospital Centre, Portugal
| | - Sónia Batista
- From the Neurology Department (C.B., J.L., C.L., S.B.); Functional Unit of Neurorradiology (R.P.), Department of Medical Imaging; and Ophthalmology Department (C.F.), Coimbra University Hospital Centre, Portugal
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17
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Plantone D, Sabatelli E, Locci S, Marrodan M, Laakso SM, Mateen FJ, Feresiadou A, Buelens T, Bianco A, Fiol MP, Correale J, Tienari P, Calabresi P, De Stefano N, Iorio R. Clinically relevant increases in serum neurofilament light chain and glial fibrillary acidic protein in patients with Susac syndrome. Eur J Neurol 2023; 30:3256-3264. [PMID: 37335505 DOI: 10.1111/ene.15939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND AND PURPOSE Serum levels of neurofilament light chain (sNfL) and glial fibrillary acidic protein (sGFAP) are promising neuro-axonal damage and astrocytic activation biomarkers. Susac syndrome (SS) is an increasingly recognized neurological condition and biomarkers that can help assess and monitor disease evolution are highly needed for the adequate management of these patients. sNfL and sGFAP levels were evaluated in patients with SS and their clinical relevance in the relapse and remission phase of the disease was assessed. METHODS As part of a multicentre study that enrolled patients diagnosed with SS from six international centres, sNfL and sGFAP levels were assessed in 22 SS patients (nine during a relapse and 13 in remission) and 59 age- and sex-matched healthy controls using SimoaTM assay Neurology 2-Plex B Kit. RESULTS Serum NfL levels were higher than those of healthy controls (p < 0.001) in SS patients and in both subgroups of patients in relapse and in remission (p < 0.001 for both), with significantly higher levels in relapse than in remission (p = 0.008). sNfL levels showed a negative correlation with time from the last relapse (r = -0.663; p = 0.001). sGFAP levels were slightly higher in the whole group of patients than in healthy controls (p = 0.046) and were more pronounced in relapse than in remission (p = 0.013). CONCLUSION In SS patients, both sNFL and sGFAP levels increased compared with healthy controls. Both biomarkers had higher levels during clinical relapse and much lower levels in remission. sNFL was shown to be time sensitive to clinical changes and can be useful to monitor neuro-axonal damage in SS.
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Affiliation(s)
- Domenico Plantone
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Eleonora Sabatelli
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
| | - Sara Locci
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Sini M Laakso
- Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Translational Immunology Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amalia Feresiadou
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden
- Department of Medical Sciences, Section of Neurology, Uppsala University, Uppsala, Sweden
| | - Tom Buelens
- Department of Ophthalmology, CHU St Pierre and Brugmann, Brussels, Belgium
| | - Assunta Bianco
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
| | | | - Jorge Correale
- Neurology Department, Fleni, Buenos Aires, Argentina
- Institute of Biological Chemistry and Biophysics (IQUIFIB) CONICET, University of Buenos Aires, Buenos Aires, Argentina
| | - Pentti Tienari
- Department of Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland
- Research Program of Translational Immunology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Raffaele Iorio
- Neurology Unit, Fondazione Policlinico Universitario 'A.Gemelli' IRCCS, Rome, Italy
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Piura Y, Karni A, Kolb H, Vigiser I, Regev K. Olfactory function in Susac syndrome. Clin Neurol Neurosurg 2023; 233:107909. [PMID: 37524045 DOI: 10.1016/j.clineuro.2023.107909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Susac syndrome is a rare autoimmune endotheliopathy involving the brain, retina, and inner ear. Olfactory dysfunction is a common early manifestation of several central nervous system diseases, including neurodegenerative diseases and autoimmune-mediated diseases such as Multiple Sclerosis. While the literature is abundant about the Susac syndrome classic triad of encephalopathy, branch retinal artery occlusion, and low-frequency sensorineural hearing loss, little is known about the extent of olfactory sense involvement. METHODS Using the Sniffin' Sticks test, this study evaluated olfactory function (identification and threshold) in ten recovering Susac syndrome patients under our clinic surveillance with a median of 3.1 (SD=1.53) years post-disease onset. RESULTS olfactory assessment by threshold and odor identification were within the normal range. No differences between recovering Susac syndrome patients to standard norms of odor identification and threshold were found. CONCLUSIONS Our findings do not support olfactory dysfunction in Susac syndrome and thereby, do not support olfactory assessment as a reliable biomarker for this condition.
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Affiliation(s)
- Yoav Piura
- Department of Neurology, Assuta Medical Center, Ashdod, Israel; Neuroimmunology Clinic, Assuta Medical Center, Ashdod, Israel.
| | - Arnon Karni
- Department of Neurology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Neuroimmunology Unit, Neurological Institute Aviv Medical Center, Tel Aviv, Israel
| | - Hadar Kolb
- Department of Neurology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Neuroimmunology Unit, Neurological Institute Aviv Medical Center, Tel Aviv, Israel
| | - Ifat Vigiser
- Department of Neurology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Neuroimmunology Unit, Neurological Institute Aviv Medical Center, Tel Aviv, Israel
| | - Keren Regev
- Department of Neurology, Sourasky Tel Aviv Medical Center, Tel Aviv, Israel; Neuroimmunology Unit, Neurological Institute Aviv Medical Center, Tel Aviv, Israel
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19
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Hardy TA. Toward a serum biomarker of disease activity in Susac syndrome. Eur J Neurol 2023; 30:2953-2954. [PMID: 37435928 DOI: 10.1111/ene.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Todd A Hardy
- Multiple Sclerosis and Neuroimmunology Clinic, Concord Repatriation General Hospital, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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20
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Sun T, Qian Y, Wang Z, Xiao Y. Susac Syndrome With Retinal Vasculitis: A Rare Case Report and Brief Review. J Clin Neurol 2023; 19:495-497. [PMID: 37635426 PMCID: PMC10471549 DOI: 10.3988/jcn.2022.0477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/21/2023] [Accepted: 04/24/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Tingting Sun
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiwen Qian
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiqin Xiao
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, China.
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21
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Lotti A, Barilaro A, Mariottini A, Vannozzi L, Piergentili M, Fainardi E, Massacesi L. Case report: 3D intracranial vessel wall MRI in Susac syndrome: potential relevance for diagnosis and therapeutic management. Front Neurol 2023; 14:1201643. [PMID: 37638191 PMCID: PMC10456863 DOI: 10.3389/fneur.2023.1201643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/29/2023] [Indexed: 08/29/2023] Open
Abstract
Background Susac syndrome (SS) is a rare immune-mediated vasculitis affecting retina, inner ear and brain. Assessment of central nervous system (CNS) involvement is currently based on standard brain magnetic resonance imaging (MRI) sequences. Accuracy of three dimensional (3D)-vessel wall imaging (VWI) was compared to standard sequences and contrast-enhanced-3D T2-fluid attenuated inversion recovery (CE-FLAIR) to assess CNS disease activity in two cases of definite SS. Methods Brain MRI scan and retinal fluorescein angiogram (RFA) were performed at disease onset and at 1, 3, and 6 months after induction therapy start. CE-FLAIR and VWI based on 3D black-blood proton density weighted (PDW) with and without gadolinium were added to standard sequences on a 3 Tesla MRI scanner. Results Contrast enhanced-VWI (CE-VWI) detected an abnormal diffuse leptomeningeal enhancement (LME) in both cases at onset and during follow-up. Pathological enhancement on CE-VWI persisted at 6-month brain MRI, despite absence of new lesions and disappearance of LME on CE-FLAIR. Follow-up RFA revealed new arterial wall hyperfluorescence in both cases. Conclusions VWI may represent a useful tool for diagnosing and monitoring CNS disease activity in SS patients, as confirmed by concordance with RFA, leading treatment's choice and timing. Moreover, CE-VWI seemed at least as sensitive as CE-FLAIR in detecting LME, possibly being superior to the latter in posterior fossa. LME remission might be not accurate in predicting suppression of CNS inflammation in SS.
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Affiliation(s)
- Antonio Lotti
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | | | - Alice Mariottini
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - Lorenzo Vannozzi
- Department of Ophthalmology, Careggi University Hospital, Florence, Italy
| | - Marco Piergentili
- Department of Ophthalmology, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Careggi University Hospital, Florence, Italy
| | - Luca Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
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22
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Kurokawa R, Kurokawa M, Isshiki S, Harada T, Nakaya M, Baba A, Naganawa S, Kim J, Bapuraj J, Srinivasan A, Abe O, Moritani T. Dural and Leptomeningeal Diseases: Anatomy, Causes, and Neuroimaging Findings. Radiographics 2023; 43:e230039. [PMID: 37535461 DOI: 10.1148/rg.230039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Meningeal lesions can be caused by various conditions and pose diagnostic challenges. The authors review the anatomy of the meninges in the brain and spinal cord to provide a better understanding of the localization and extension of these diseases and summarize the clinical and imaging features of various conditions that cause dural and/or leptomeningeal enhancing lesions. These conditions include infectious meningitis (bacterial, tuberculous, viral, and fungal), autoimmune diseases (vasculitis, connective tissue diseases, autoimmune meningoencephalitis, Vogt-Koyanagi-Harada disease, neuro-Behçet syndrome, Susac syndrome, and sarcoidosis), primary and secondary tumors (meningioma, diffuse leptomeningeal glioneuronal tumor, melanocytic tumors, and lymphoma), tumorlike diseases (histiocytosis and immunoglobulin G4-related diseases), medication-induced diseases (immune-related adverse effects and posterior reversible encephalopathy syndrome), and other conditions (spontaneous intracranial hypotension, amyloidosis, and moyamoya disease). Although meningeal lesions may manifest with nonspecific imaging findings, correct diagnosis is important because the treatment strategy varies among these diseases. ©RSNA, 2023 Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Mariko Kurokawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Saiko Isshiki
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Taisuke Harada
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Moto Nakaya
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Shotaro Naganawa
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Jayapalli Bapuraj
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Osamu Abe
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology, University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109 (R.K., M.K., A.B., S.N., J.K., J.B., A.S., T.M.); Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K., M.K., M.N., S.N., O.A.); Department of Radiology, Niizashiki Central General Hospital, Saitama, Japan (S.I.); and Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan (T.H.)
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23
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Chen YJ, Hsu AY, Lin CJ, Hsia NY, Meng PP, Liao PL, Hsu MY, Tien PT, Lai CT, Chen HS, Chiang CC, Tsai YY. Tinnitus as a Potential Risk Factor for Uveitis: A 14-Year Nationwide Population-Based Cohort Study in Taiwan. Ocul Immunol Inflamm 2023:1-7. [PMID: 37437268 DOI: 10.1080/09273948.2023.2232444] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/15/2023] [Accepted: 06/28/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Tinnitus and uveitis have shared commonality in pathophysiology in terms of autoimmunity. However, no studies that have linked any association between the conditions of tinnitus and uveitis. METHODS This is a retrospective study conducted from the Taiwan National Health Insurance database in order to investigate whether tinnitus patients are at increased risk of uveitis. Patients newly diagnosed with tinnitus between 2001 and 2014 were recruited and followed up until 2018. The endpoint of interest was a diagnosis of uveitis. RESULTS A total of 31,034 tinnitus patients and 124,136 matched comparisons were analyzed. Tinnitus patients were found to have a significantly higher cumulative incidence for uveitis than those without the diagnosis of tinnitus with incidence rate of 1.68 (95% CI 1.55-1.82) per 10 000 person-months for tinnitus group and 1.48 (95% CI 1.42-1.54) per 10 000 person-months for non-tinnitus group. CONCLUSION Tinnitus patients were found to have increased risk of developing uveitis.
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Affiliation(s)
- Yi-Jye Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Alan Y Hsu
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Department of General Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ping-Ping Meng
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Pei-Lun Liao
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Min-Yen Hsu
- Department of Ophthalmology, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Chun-Chi Chiang
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Optometry, Asia University, Taichung, Taiwan
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24
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Gonzalez-Fierro C, Fonte C, Dufourd E, Cazaentre V, Aydin S, Engelhardt B, Caspi RR, Xu B, Martin-Blondel G, Spicer JA, Trapani JA, Bauer J, Liblau RS, Bost C. Effects of a Small-Molecule Perforin Inhibitor in a Mouse Model of CD8 T Cell-Mediated Neuroinflammation. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200117. [PMID: 37080596 PMCID: PMC10119812 DOI: 10.1212/nxi.0000000000200117] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/21/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Alteration of the blood-brain barrier (BBB) at the interface between blood and CNS parenchyma is prominent in most neuroinflammatory diseases. In several neurologic diseases, including cerebral malaria and Susac syndrome, a CD8 T cell-mediated targeting of endothelial cells of the BBB (BBB-ECs) has been implicated in pathogenesis. METHODS In this study, we used an experimental mouse model to evaluate the ability of a small-molecule perforin inhibitor to prevent neuroinflammation resulting from cytotoxic CD8 T cell-mediated damage of BBB-ECs. RESULTS Using an in vitro coculture system, we first identified perforin as an essential molecule for killing of BBB-ECs by CD8 T cells. We then found that short-term pharmacologic inhibition of perforin commencing after disease onset restored motor function and inhibited the neuropathology. Perforin inhibition resulted in preserved BBB-EC viability, maintenance of the BBB, and reduced CD8 T-cell accumulation in the brain and retina. DISCUSSION Therefore, perforin-dependent cytotoxicity plays a key role in the death of BBB-ECs inflicted by autoreactive CD8 T cells in a preclinical model and potentially represents a therapeutic target for CD8 T cell-mediated neuroinflammatory diseases, such as cerebral malaria and Susac syndrome.
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Affiliation(s)
- Carmen Gonzalez-Fierro
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Coralie Fonte
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Eloïse Dufourd
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Vincent Cazaentre
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Sidar Aydin
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Britta Engelhardt
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Rachel R Caspi
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Biying Xu
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Guillaume Martin-Blondel
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Julie A Spicer
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Joseph A Trapani
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Jan Bauer
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
| | - Roland S Liblau
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France.
| | - Chloé Bost
- From the Toulouse Institute for Infectious and Inflammatory Diseases (Infinity) (C.G.-F., C.F., E.D., V.C., G.M.-B., R.S.L., C.B.), University of Toulouse, CNRS, INSERM, UPS, France; Theodor Kocher Institute (S.A., B.E.), University of Bern, Switzerland; Laboratory of Immunology (R.R.C., B.X.), National Eye Institute, National Institutes of Health, Bethesda, MD; Department of Infectious and Tropical Diseases (G.M.-B.), Toulouse University Hospital, France; Auckland Cancer Society Research Centre (J.A.S.), Faculty of Medical and Health Sciences, The University of Auckland, New Zealand; Cancer Immunology Program (J.A.T.), Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology (J.A.T.), The University of Melbourne, Parkville, Australia; Department of Neuroimmunology (J.B.), Center for Brain Research, Medical University of Vienna, Austria; and Department of Immunology (R.S.L., C.B.), Toulouse University Hospital, France
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25
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Jiang F, Ma Z, Chen Z, Yang M, Huang H, Chen L, He C. Susac syndrome can be diagnosed by examination and cured by comprehensive therapy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 171:329-337. [PMID: 37783562 DOI: 10.1016/bs.irn.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Affiliation(s)
- Feifei Jiang
- Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, P.R. China.
| | - Zhiming Ma
- Department of Neurosurgery, Urumqi General Hospital of Lanzhou Military Region, Urumqi, Xinjiang, P.R. China
| | - Zhizhi Chen
- Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, P.R. China
| | - Ming Yang
- Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, P.R. China
| | - Hongyun Huang
- Beijing Hongtianji Neuroscience Academy, Beijing, P.R. China
| | - Lin Chen
- Department of Neurosurgery, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Beijing, P.R. China
| | - Chao He
- Department of Neurosurgery, Zhuji Affiliated Hospital of Wenzhou Medical University, Zhuji, Zhejiang, P.R. China.
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26
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Cardozo P, Marrodán M, Gilmore A, Fiol MP, Chaves H. Leptomeningeal Interfoliar Enhancement on Vessel Wall MR Imaging as a Unique Radiologic Finding of Susac Syndrome. AJNR Am J Neuroradiol 2023; 44:271-273. [PMID: 36797034 PMCID: PMC10187801 DOI: 10.3174/ajnr.a7801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Susac syndrome is a rare disorder affecting the brain, retina, and inner ear, probably triggered by an immune-mediated endotheliopathy. Diagnosis is based on clinical presentation and ancillary test findings (brain MR imaging, fluorescein angiography, and audiometry). Recently, vessel wall MR imaging has shown increased sensitivity in the detection of subtle signs of parenchymal, leptomeningeal, and vestibulocochlear enhancement. In this report, we describe a unique finding identified using this technique in a series of 6 patients with Susac syndrome and discuss its potential value for diagnostic work-up and follow-up.
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Affiliation(s)
- P Cardozo
- From the Diagnostic Imaging Department (P.C., A.G., H.C.)
| | - M Marrodán
- Neurology Departments (M.M., M.P.F.), Fleni, Buenos Aires, Argentina
| | - A Gilmore
- From the Diagnostic Imaging Department (P.C., A.G., H.C.)
| | - M P Fiol
- Neurology Departments (M.M., M.P.F.), Fleni, Buenos Aires, Argentina
| | - H Chaves
- From the Diagnostic Imaging Department (P.C., A.G., H.C.)
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27
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Jesser J, Bendszus M. [Imaging pathologies of the corpus callosum]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:209-219. [PMID: 36688985 DOI: 10.1007/s00117-022-01111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The corpus callosum is the largest fiber bundle in the cerebral white matter in the human brain. A multitude of disorders including congenital malformations, acute and chronic traumatic lesions, ischemia, neoplasms, secondary manifestations of metabolic, toxic or degenerative diseases as well as chronic inflammatory and demyelinating diseases can primarily or secondarily affect the corpus callosum. This article presents magnetic resonance imaging (MRI) characteristics of the most relevant diseases affecting the corpus callosum.
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Affiliation(s)
- J Jesser
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - M Bendszus
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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28
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Bianco A, Colò F, Falso S, Russo R, Carlà MM, Minucci A, Cadoni G, Lucchini M, Cicia A, Calabresi P, Mirabella M. New onset of Susac syndrome after mRNA COVID-19 vaccine: a case report. J Neurol 2023; 270:614-617. [PMID: 36222903 PMCID: PMC9555271 DOI: 10.1007/s00415-022-11406-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Assunta Bianco
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy. .,Department of Neurosciences, Catholic University of Sacred Heart, 00168, Rome, Italy.
| | - Francesca Colò
- Department of Neurosciences, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Silvia Falso
- Department of Neurosciences, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Rosellina Russo
- Neuroradiology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.,Institute of Radiology, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Matteo Maria Carlà
- Institute of Ophtalmology, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Angelo Minucci
- Departmental Unit of Molecular and Genomic Diagnostics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Gabriella Cadoni
- Otorhinolaryngology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.,Department of Otorhinolaryngology, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Matteo Lucchini
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.,Department of Neurosciences, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Alessandra Cicia
- Department of Neurosciences, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Paolo Calabresi
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.,Department of Neurosciences, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Massimiliano Mirabella
- Multiple Sclerosis Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.,Department of Neurosciences, Catholic University of Sacred Heart, 00168, Rome, Italy
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29
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Wu G, Jiang W, Li Z, Huang D, Wu L. Misdiagnosis of Susac syndrome as demyelinating disease and primary angiitis of the central nervous system: A case report. Front Neurol 2022; 13:1055038. [PMID: 36570458 PMCID: PMC9772262 DOI: 10.3389/fneur.2022.1055038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
Susac syndrome (SuS) is a rare neuroinflammatory disease that manifests with a triad of hearing loss, branch retinal artery occlusions, and encephalopathy. Patients with SuS are frequently misdiagnosed because the clinical trial is incompletely present at disease onset. In this report, we present a case of a 29-year-old man manifesting sleepiness, epilepsy, urinary dysfunction, and hemiparesis at the initial stage. Magnetic resonance imaging (MRI) revealed multiple abnormal signals located in the lateral paraventricular, corpus callosal, and pons. In addition, the patient had sustained elevation of CSF pressure and protein. ADEM was considered according to the clinical and radiographic findings. However, symptoms were not significantly improved after methylprednisolone therapy. He showed a vision decline in the third month after the disease onset. It was considered from intracranial hypertension or optic neuritis, and therefore retinal arteriolar impairment was ignored. As the disease progresses, cognitive decline was presented. Brain MRI exhibits multiple significant hyperintensities on the DWI sequence with speck-like gadolinium enhancement. Thus, PACNS was diagnosed. The SuS was not made until the presence of hearing decline in the 4 months after the disease onset. The case will be helpful for clinicians to better recognize the atypical initial manifestation of SuS.
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Affiliation(s)
- Gang Wu
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China,Department of Neurology, No 984 Hospital of PLA, Beijing, China
| | - Wei Jiang
- Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Zunbo Li
- Department of Neurology, Xi'an Gao Xin Hospital, Xi'an, China
| | - Dehui Huang
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China,*Correspondence: Dehui Huang
| | - Lei Wu
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China,Lei Wu
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30
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Susac Syndrome: Description of a Single-Centre Case Series. J Clin Med 2022; 11:jcm11216549. [PMID: 36362776 PMCID: PMC9656090 DOI: 10.3390/jcm11216549] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022] Open
Abstract
This study describes the clinical characteristics, diagnostic results, treatment regimens, and clinical course of a cohort of patients with Susac syndrome (SS). It is a retrospective observational study of all patients with the diagnosis of SS evaluated at the Hospital Clinic (Barcelona, Spain) between March 2006 and November 2020. Nine patients were diagnosed with SS. The median time from the onset of the symptoms to diagnosis was five months (IQR 9.0), and the median follow-up time was 44 months (IQR 63.5). There was no clear predominance of sex, and mean age of symptoms onset was 36 years (range 19–59). Six patients (67%) presented with incomplete classical clinical triad, but this eventually developed in six patients during the disease course. Encephalopathy, focal neurological signs, visual disturbances, and hearing loss were the most frequent manifestations. Brain magnetic resonance imaging showed callosal lesions in all patients. Most were in remission within two years. Only four patients met the proposed criteria for definite SS. When SS is suspected, a detailed diagnostic workup should be performed and repeated over time to identify the clinical manifestations that will lead to a definite diagnosis.
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31
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Hardy TA. The diagnostic signature of Susac's syndrome. J Clin Neurosci 2022; 104:10-11. [PMID: 35932634 DOI: 10.1016/j.jocn.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Todd A Hardy
- Neuroimmunology Clinic, Concord Repatriation General Hospital, University of Sydney, Australia; Brain & Mind Centre, University of Sydney, NSW, Australia.
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32
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Jesser J, Bendszus M. [Imaging pathologies of the corpus callosum]. DER NERVENARZT 2022; 93:844-853. [PMID: 35829754 DOI: 10.1007/s00115-022-01347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
The corpus callosum is the largest fiber bundle in the cerebral white matter in the human brain. A multitude of disorders including congenital malformations, acute and chronic traumatic lesions, ischemia, neoplasms, secondary manifestations of metabolic, toxic or degenerative diseases as well as chronic inflammatory and demyelinating diseases can primarily or secondarily affect the corpus callosum. This article presents magnetic resonance imaging (MRI) characteristics of the most relevant diseases affecting the corpus callosum.
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Affiliation(s)
- J Jesser
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| | - M Bendszus
- Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland
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