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Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy

BACKGROUND AND PURPOSE: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an immune-mediated chorioretinal disease that causes acute visual symptoms with characteristic ophthalmoscopic findings. Neurological complications are rarely reported in the literature. Here we report two...

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Autores principales: Algahtani, Hussein, Alkhotani, Ashjan, Shirah, Bader
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Neurological Association 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063873/
https://www.ncbi.nlm.nih.gov/pubmed/27819416
http://dx.doi.org/10.3988/jcn.2016.12.4.460
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author Algahtani, Hussein
Alkhotani, Ashjan
Shirah, Bader
author_facet Algahtani, Hussein
Alkhotani, Ashjan
Shirah, Bader
author_sort Algahtani, Hussein
collection PubMed
description BACKGROUND AND PURPOSE: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an immune-mediated chorioretinal disease that causes acute visual symptoms with characteristic ophthalmoscopic findings. Neurological complications are rarely reported in the literature. Here we report two new cases of APMPPE that presented with neurological manifestations, one of which was associated with peripheral neuropathy, which has not been described before. METHODS: A retrospective database review of all patients with a diagnosis of APMPPE was performed. Clinical, ophthalmological, and neurological data were analyzed, and only cases of APMPPE with neurological complications were included. A literature review of several databases was also performed, and previous case reports were reviewed and analyzed in detail. RESULTS: In total, 56 cases of APMPPE-associated neurological complications were included in the analyses: 54 from the literature and 2 from our own practice. The most common complication was cerebral vasculitis, which affected 28 patients (50%), followed by headaches in 15 patients (26.8%). The other complications include sixth-cranial-nerve palsy, transient hearing loss, meningoencephalitis, cavernous sinus thrombosis, and viral meningitis. CONCLUSIONS: This report adds to the literature of a novel association of APMPPE with peripheral neuropathy, and comprehensively reviews the neurological manifestations of this disease. A high level of suspicion should be applied when dealing with a case of APMPPE. We recommend applying detailed clinical neurological examinations and magnetic resonance imaging to APMPPE patients, and then early steroid treatment if the examination is positive or even suspicious. Early treatment with steroids and long-term treatment with immunosuppressive azathioprine with interval neurological evaluations will contribute positively to the outcomes and avoid fatal complications, namely strokes.
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spelling pubmed-50638732016-10-17 Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy Algahtani, Hussein Alkhotani, Ashjan Shirah, Bader J Clin Neurol Original Article BACKGROUND AND PURPOSE: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an immune-mediated chorioretinal disease that causes acute visual symptoms with characteristic ophthalmoscopic findings. Neurological complications are rarely reported in the literature. Here we report two new cases of APMPPE that presented with neurological manifestations, one of which was associated with peripheral neuropathy, which has not been described before. METHODS: A retrospective database review of all patients with a diagnosis of APMPPE was performed. Clinical, ophthalmological, and neurological data were analyzed, and only cases of APMPPE with neurological complications were included. A literature review of several databases was also performed, and previous case reports were reviewed and analyzed in detail. RESULTS: In total, 56 cases of APMPPE-associated neurological complications were included in the analyses: 54 from the literature and 2 from our own practice. The most common complication was cerebral vasculitis, which affected 28 patients (50%), followed by headaches in 15 patients (26.8%). The other complications include sixth-cranial-nerve palsy, transient hearing loss, meningoencephalitis, cavernous sinus thrombosis, and viral meningitis. CONCLUSIONS: This report adds to the literature of a novel association of APMPPE with peripheral neuropathy, and comprehensively reviews the neurological manifestations of this disease. A high level of suspicion should be applied when dealing with a case of APMPPE. We recommend applying detailed clinical neurological examinations and magnetic resonance imaging to APMPPE patients, and then early steroid treatment if the examination is positive or even suspicious. Early treatment with steroids and long-term treatment with immunosuppressive azathioprine with interval neurological evaluations will contribute positively to the outcomes and avoid fatal complications, namely strokes. Korean Neurological Association 2016-10 2016-09-30 /pmc/articles/PMC5063873/ /pubmed/27819416 http://dx.doi.org/10.3988/jcn.2016.12.4.460 Text en Copyright © 2016 Korean Neurological Association http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Algahtani, Hussein
Alkhotani, Ashjan
Shirah, Bader
Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy
title Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy
title_full Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy
title_fullStr Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy
title_full_unstemmed Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy
title_short Neurological Manifestations of Acute Posterior Multifocal Placoid Pigment Epitheliopathy
title_sort neurological manifestations of acute posterior multifocal placoid pigment epitheliopathy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063873/
https://www.ncbi.nlm.nih.gov/pubmed/27819416
http://dx.doi.org/10.3988/jcn.2016.12.4.460
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