Tumour resection conferred a survival advantage. Wider use of laparoscopy is advocated. Improved selection for surgery should result in a lower mortality rate.
Vogt-Koyanagi-Harada (VKH) disease is a T-cellmediated multisystemic autoimmune inflammatory disorder characterized by skin, ocular, auditory, and neurologic involvement. The T-cell-mediated granulomatous intraocular inflammation is responsible for vitritis, disk edema, serous retinal detachments, and eventual sunset glow fundus. 1 T cells target melanocytes, with an ensuing cascade leading to four distinct disease phases as follows: prodromal, uveitis, convalescent, and recurrent. 2 VKH symptoms include headache, meningismus, hearing loss, poliosis, alopecia, and vitiligo. 3 It is most prevalent in Asians, Native Americans, Hispanics, and Middle Easterners. If promptly and adequately treated, patients can experience good outcomes and avoid complications including sunset glow fundus, cataracts, glaucoma, subretinal fibrosis, and choroidal neovascularization. Some studies have reported the link between some viral infections such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV) and the development of VKH. It has been postulated that similarity between peptides on melanocytes and some exogenous viral peptides lead to adverse T cells attacks on melanocytes-containing tissues and lead to the symptoms seen in VKH. 4 We report a case of a VKH syndrome in a patient diagnosed with COVID-19. | CASE REPORTA 27-year-old male patient with no significant past medical history presented with a two-week history of intermittent unilateral headache, bilateral eye pain with photophobia, and phonophobia, followed by tinnitus and blurry vision, which ultimately progressed to total bilateral vision loss. His initial physical examination was unremarkable including vitals, except for total bilateral visual loss with preserved light perception. An ophthalmologic examination revealed normal intraocular pressure and panuveitis with serous retinal detachments bilaterally.The patient was admitted for further evaluation. Infectious work-up revealed positive COVID-19 PCR. Other infectious and metabolic panels were unremarkable. Cerebrospinal fluid studies (CSF), venereal disease research laboratory test (VDRL), fluorescent treponemal antibody absorption test (FTA), QuantiFERON gold, flow cytometry, cytology, and cultures were all negative, except for moderate pleocytosis with lymphocytic predominance
Background and Purpose Randomized trials proved the benefits of mechanical thrombectomy (MT) for select patients with large vessel occlusion (LVO) within 24 hours of last-known-well (LKW). Recent data suggest that LVO patients may benefit from MT beyond 24 hours. This study reports the safety and outcomes of MT beyond 24 hours of LKW compared to standard medical therapy (SMT).Methods This is a retrospective analysis of LVO patients presented to 11 comprehensive stroke centers in the United States beyond 24 hours from LKW between January 2015 and December 2021. We assessed 90-day outcomes using the modified Rankin Scale (mRS).Results Of 334 patients presented with LVO beyond 24 hours, 64% received MT and 36% received SMT only. Patients who received MT were older (67±15 vs. 64±15 years, <i>P</i>=0.047) and had a higher baseline National Institutes of Health Stroke Scale (NIHSS; 16±7 vs.10±9, <i>P</i><0.001). Successful recanalization (modified thrombolysis in cerebral infarction score 2b-3) was achieved in 83%, and 5.6% had symptomatic intracranial hemorrhage compared to 2.5% in the SMT group (<i>P</i>=0.19). MT was associated with mRS 0–2 at 90 days (adjusted odds ratio [aOR] 5.73, <i>P</i>=0.026), less mortality (34% vs. 63%, <i>P</i><0.001), and better discharge NIHSS (<i>P</i><0.001) compared to SMT in patients with baseline NIHSS ≥6. This treatment benefit remained after matching both groups. Age (aOR 0.94, <i>P</i><0.001), baseline NIHSS (aOR 0.91, <i>P</i>=0.017), Alberta Stroke Program Early Computed Tomography (ASPECTS) score ≥8 (aOR 3.06, <i>P</i>=0.041), and collaterals scores (aOR 1.41, <i>P</i>=0.027) were associated with 90-day functional independence.Conclusion In patients with salvageable brain tissue, MT for LVO beyond 24 hours appears to improve outcomes compared to SMT, especially in patients with severe strokes. Patients’ age, ASPECTS, collaterals, and baseline NIHSS score should be considered before discounting MT merely based on LKW.
Purpose To review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD. Methods A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included, “imaging modalities in ICAD,” “ICAD diagnostic,” “Neuroimaging of ICAD,” “Evaluation of ICAD”. A summary and comparison of each modality's basic principles, advantages and disadvantages were included. Results A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD. Conclusions ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario, a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
To report a case of Vogt-Koyanagi-Harada disease (VKH) in a 27-year-old male two weeks proceeding COVID-19 infection onset. Severe complications of VKH can be avoided by early diagnosis and adequate treatment with corticosteroids and immunosuppressants. It is possible that COVID-19 was a potential immunological trigger of VKH in our patient.
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