There is a two-fold increased risk of HT in SLE patients. Anti-Sm antibodies favor this association and also double antibody positivity. Disease activity and cumulative damage are not related to HT or with autoantibodies.

BACKGROUND: Thyroid autoimmunity is more common in patients with rheumatic diseases than in healthy populations. The degree of association seems subject to influence from patients' geographical location. Here, we aimed to ascertain the prevalence of thyroid autoantibodies in a cohort of patients with systemic rheumatic disease and the degree of association between its presence and inflammatory activity. DESIGN AND SETTING: Cross-sectional observational study in a rheumatology unit. METHODS: 301 patients with systemic lupus erythematosus (SLE), 210 with rheumatoid arthritis (RA), 58 with scleroderma (SSc) and 80 with spondyloarthritis (SpA) were studied regarding thyroid function (TSH and T4), anti-thyroglobulin (TgAb) and anti-thyroperoxidase (TPOab) and compared with 141 healthy controls. Disease activity in patients with rheumatic disease was assessed through appropriate indexes. RESULTS: There were more antithyroid antibodies in SLE patients with hypothyroidism (P = 0.01; odds ratio, OR 2.7; 95% confidence interval, CI: 1.20-6.26) and in those without hypothyroidism (P = 0.06; OR 2.4; 95% CI: 1.28-4.55) than in controls. SSc patients also showed P = 0.03 both with antithyroid antibodies and hypothyroidism (OR 3.4; 95% CI: 1.06-10.80) and without hypothyroidism (OR 3.1; 95% CI: 1.11-0.13). RA and SpA patients had the same prevalence as controls (P not significant). Presence of autoantibodies with and without hypothyroidism was not associated with the activity or functional indexes evaluated. CONCLUSION: SLE and SSc were associated with higher prevalence of thyroid autoantibodies in patients with and without hypothyroidism, unlike SpA and RA. There was no link between thyroid autoantibody presence and disease activity or functional impairment.

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Ischemia of the optic nerve (ON) is an important cause of visual field deficit provoked by tuberculum sellae (TS) meningiomas. Indocyanine green (ICG) videoangiography could provide prognostic information. Moreover, it allows new insight into the pathophysiology of visual disturbance. The authors present the case of a 48-year-old woman with visual field impairment. Magnetic resonance imaging (MRI) depicted a lesion highly suggestive of a TS meningioma. Following microsurgical resection, ICG videoangiography demonstrated improvement of right ON pial blood supply. In this case, there was one lesion causing visual impairment through both direct compression over the left ON and ischemia to the right nerve. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21155

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Posterior fossa epidermoid cysts are slow growing lesions that can present with involvement of multiple neurovascular structures. [1][2][3][4][5][6] We present the case of a 49-year-old woman with a long-term history of headache, imbalance, nausea and vomiting, and hearing loss. Gait disturbance was also identified on physical examination. Preoperative MRI demonstrated a lesion highly suggestive of a giant posterior fossa epidermoid cyst with significant compression of the brainstem and bilateral extension. Because of the important mass effect and worsening of symptoms, microsurgical resection was indicated. A presigmoid (posterior petrosal) approach combined with a retrosigmoid route was used, and neurophysiological monitoring was essential during the procedure. The patient was placed in a true lateral position, and initially, the mastoidectomy was performed, followed by the craniotomy encompassing both middle and posterior cranial fossae. Dural incisions posterior and anterior to sigmoid sinus were performed. An incision at the base of the middle fossa dura was connected with the presigmoid one by ligation of the superior petrosal sinus. Then, the tentorium was all the way cut toward incisura. Multiple working corridors were provided, and the lesion was completely resected. A third ventriculostomy was also performed considering preoperative hydrocephalus. Postoperative imaging demonstrated complete lesion removal. The patient presented improvement of symptoms and evolved with a slight left facial palsy contralateral to the side of the approach, progressively recovering with physical therapy. Laboratory training is essential to get familiarized with the neuroanatomic nuances of this approach. Informed consent was obtained from the patient for the procedure and publication of her images in this operative video.

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