Teaching NeuroImages: Myeloperoxidase-anti-neutrophil cytoplasmic antibody-positive hypertrophic pachymeningitis

A 49-year-old woman with chronic epistaxis presented with painless left monocular vision loss. Notable findings on examination of the left eye included visual acuity of 20/200 and relative afferent pupillary defect. MRI of the brain revealed enhancement of the left optic nerve sheath and diffuse dural thickening (figure). Laboratory workup yielded only lymphocytic pleocytosis (12 white blood cells) and positive serologies for perinuclear anti-neutrophil cytoplasmic antibodies (ANCA) and anti-myeloperoxidase (MPO) antibodies. Dural biopsy showed multifocal dense lymphoplasmacytic infiltration with vasculitis and reactive fibroplasia. A diagnosis of MPO-ANCA-positive hypertrophic pachymeningitis was made. This phenotypic variant of granulomatosis with polyangiitis is typically restricted to the CNS and upper airway; treatment involves immunosuppression.1 The patient improved clinically and radiographically with prednisone and rituximab.
Source: Neurology - Category: Neurology Authors: Tags: MRI, All Immunology, Vasculitis, All Neuro-ophthalmology, Optic nerve RESIDENT AND FELLOW SECTION Source Type: research

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CONCLUSIONS: ANCA positivity may be more related to vasculitis and immunological disorders than to a M. tuberculosis infection. Therefore, to improve diagnostic accuracy, patients with M. tuberculosis who are ANCA positive should be investigated for concurrent diseases, including the effects of drugs. Therefore, even in tuberculosis epidemic area, ANCA seropositivity, detected by ELISA, is still more suggestive of ANCA-associated vasculitides.
Source: Revista da Sociedade Brasileira de Medicina Tropical - Category: Tropical Medicine Source Type: research
ConclusionsThe present study found that interreader agreement for radiographic classification of LAE was substantial among specialists and moderate for all readers. Subjective, global assessment of radiographic LAE is better than using any single Roentgen sign.
Source: Journal of Veterinary Cardiology - Category: Veterinary Research Source Type: research
Condition:   Metatarsalgia Bilateral Intervention:   Procedure: Distal Metatarsal Metaphyseal Osteotomy (DMMO) Sponsor:   University of Padua Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Using radiographic measurements, the authors assesses spinopelvic alignment both before and after degenerative lumbar spinal fusion.Spine
Source: Medscape Today Headlines - Category: Consumer Health News Tags: Orthopaedics Journal Article Source Type: news
Conclusion: There is a considerable variation in the position of IAN throughout its course in the mandible. Henceforth, advanced diagnostic images such as CBCT should be strongly recommended in evaluating the position of IAN preoperatively before advanced implant surgical techniques, nerve repositioning, and any other surgical procedures.
Source: Indian Journal of Dental Research - Category: Dentistry Authors: Source Type: research
Conclusion: This study showed no significant difference between the occurrences of MRCs in different seasons. There was no significant difference between male and female and different decades of life. Furthermore, there was no significant difference between the involvement of right and left maxillary sinuses and different walls of the antrum.
Source: Indian Journal of Dental Research - Category: Dentistry Authors: Source Type: research
Conclusions: There was a high prevalence of hypodontia and a low incidence of hyperdontia in the studied population. Prompt diagnosis of these anomalies can help plan treatment modalities at an early age to establish a functional and esthetic dentition.
Source: Indian Journal of Dental Research - Category: Dentistry Authors: Source Type: research
AbstractBackgroundKnee osteoarthritis (OA) is a disease with a high prevalence in the adult population. Nonsteroidal anti-inflammatory drugs (NSAID) or intra-articular injections [hyaluronic acid (HA) or platelet-rich plasma (PRP)] can provide clinical benefit. Magnetic resonance imaging (MRI) has proven to be useful for the evaluation of cartilage volume and thickness in knee osteoarthritis. The purpose of this study was to evaluate the benefit provided by PRP injection in comparison with hyaluronic acid and NSAID in knee OA patients and to compare the radiographic evolution at the 52-week follow-up.MethodsOne hundred and...
Source: Journal of Orthopaedics and Traumatology - Category: Orthopaedics Source Type: research
We report a case of 22-year-old young male who presented with a 3-month history of gradual and painless decrease of vision in his right eye (RE). On ophthalmological examination, best-corrected visual acuity in his RE was counting finger close to the face. Left eye ophthalmic examination was unremarkable. RE indirect ophthalmoscopy revealed multiple telangiectatic vessels, aneurysmal dilations, extensive yellow (lipid) exudation over the posterior pole along with perivascular exudation, and multiple sclerosed vessels in peripheral retina. Fluorescein angiography also revealed progressive leakage from telangiectasias, multi...
Source: Indian Journal of Ophthalmology - Category: Opthalmology Authors: Source Type: research
ConclusionLenke type 5 curves show a significantly higher PI than controls, whereas the Lenke type 1 curves did not differ from controls. This suggests a role of pelvic morphology and spino-pelvic alignment in the pathogenesis of idiopathic scoliosis. Further longitudinal studies should explore the exact role of the PI in the initiation and progression of different AIS types.Graphical abstract These slides can be retrieved under Electronic Supplementary Material.
Source: European Spine Journal - Category: Orthopaedics Source Type: research
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