Acute Pontine Infarct in a 16-Year-Old Man with Acute Posterior Multifocal Placoid Pigment Epitheliopathy. A Case Report

Jaramillo, Arturo; Gaete, Germán; Romero, Pablo; Orellana, Patrícia; Illanes, Sergio

doi:10.1016/j.jstrokecerebrovasdis.2008.08.004

Cited by 9 publications

(6 citation statements)

References 12 publications

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Section: Discussionmentioning

confidence: 99%

“…Whereas a benefit of the use of corticosteroids in APMPPE without involvement of the central nervous system cannot be clearly stated,1 there is no doubt about the benefit of immunosuppressive therapy in cases with neurological complications 2 11 12 16. Although extremely rare, neurological complications of APMPPE had proved to be severe4 5 9–12 16 or even fatal 2 15. Attempts to control neurological complications in patients with recurrences under corticoid tapering have been made with azathioprine,4 9 14 cyclophosphamide12 14 or mitoxantrone 17.…”

Section: Discussionmentioning

confidence: 99%

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Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under prednisone tapering

Joswig

Flueckiger²,

Infanger³

et al. 2011

Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under prednisone tapering

Joswig

Flueckiger²,

Infanger³

et al. 2011

Case Reports

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“…The features of headache complicating AMPPE are poorly characterised in published case histories but where described the headaches were severe [5,6,17,22,23], persistent [17,26,27], localised [5] or diffuse [6]. Meningitic symptoms were described in the minority with only 4/52 (8%) patients experiencing either neck stiffness [9,10], fever [18] or photophobia [22].…”

Section: Neurological Complications Of Amppementioning

confidence: 99%

Neurological complications of acute multifocal placoid pigment epitheliopathy

Brownlee

Anderson

Sims

et al. 2016

Journal of Clinical Neuroscience

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Acute multifocal placoid pigment epitheliopathy (AMPPE) is an autoimmune chorioretinal disease that can be complicated by neurological involvement. There is limited information on this potentially treatable condition in the neurological literature. The objective of this patient series is to describe the neurological complications of AMPPE. We retrospectively identified patients with neurological complications of AMPPE seen at Auckland Hospital between 2008 and 2013 and summarised cases in the literature between 1976 and 2013. We identified five patients with neurological complications of AMPPE at Auckland Hospital and 47 reported patients. These patients demonstrated a spectrum of neurological involvement including isolated headache, stroke or transient ischaemic attack, seizures, venous sinus thrombosis, optic neuritis, sensorineural hearing loss and peripheral vestibular disorder. We propose criteria to define AMPPE with neurological complications. A cerebrospinal fluid (CSF) lymphocytosis in a patient with isolated headache may predict the development of cerebrovascular complications of AMPPE. Patients with cerebrovascular complications of AMPPE have a poor prognosis with high rates of death and neurological disability among survivors. Predictors of poor outcome in those who develop neurological complications of AMPPE are a relapsing course, generalised seizures and multifocal infarction on MRI. All patients with neurological complications of AMPPE, including headache alone, should be investigated with an MRI brain and CSF examination. Patients with focal neurological symptoms should receive intravenous (IV) methylprednisolone followed by a tapering course of oral steroids for at least 3months. Patients with AMPPE and an isolated headache with a CSF pleocytosis should be treated with oral steroids.

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“…Symptoms include acute or subacute binocular visual blurring, metamorphopsia, and scotomas (1,6). Fluorescein angiography characteristically shows a pattern of early hypofluorescence and late hyperfluorescence, which is considered to indicate lobular obstruction of the choriocapillaris caused by vascular inflammation (7). Spectral domain optical coherence tomography (SD-OCT; Cirrus, Carl Zeiss Meditec, Dublin, CA) findings in acute AMPPE lesions include elevated perifoveal retinal thickness, hyperreflectance of the outer retinal layers with photoreceptor disorganization and, rarely, intraretinal cysts or loculations (4,8).…”

mentioning

confidence: 99%

“…Neurological involvement associated with AMPPE includes headaches (6,9,18), strokes (6,7,17,19), cerebral venous sinus thrombosis (20), seizures (5,6), and CNS vasculitis (6,17,21). These neurological complications tend to occur early in the clinical course and are usually self-limited (18).…”

mentioning

confidence: 99%

Fatal Ischemic Stroke Complicating Acute Multifocal Placoid Pigment Epitheliopathy

Tsang

Chauhan

Haward

et al. 2014

Journal of Neuro-Ophthalmology

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A previously healthy 29-year-old man was admitted to a tertiary referral center with acute left hemiparesis followed shortly by de novo convulsive status epilepticus. This was in the context of a 2-month history of flu-like symptoms, severe headaches, and retinopathy recently diagnosed as acute multifocal placoid pigment epitheliopathy. Neuroimaging demonstrated bilateral, multiple territory cerebral infarction. Despite intravenous methylprednisolone and craniotomy for the management of raised intracranial pressure, the patient deteriorated and died 14 days later. At autopsy, multiple infarcts of varying ages within a 10-day period were seen in association with a segmental giant cell vasculopathy of meningeal arteries.

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Acute Pontine Infarct in a 16-Year-Old Man with Acute Posterior Multifocal Placoid Pigment Epitheliopathy. A Case Report

Cited by 9 publications

References 12 publications

Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under prednisone tapering

Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under prednisone tapering

Neurological complications of acute multifocal placoid pigment epitheliopathy

Fatal Ischemic Stroke Complicating Acute Multifocal Placoid Pigment Epitheliopathy

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