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: Overcorrection of angle at fusion segments requiring O-C7 angle change was a risk factor for late subaxial lesion in patients with RA with fragile bones and joints. Correction should be limited, considering the residual mobility of the cervical unfixed segments. PMID: 30424593 [PubMed - as supplied by publisher]
Source: Asian Spine Journal - Category: Orthopaedics Tags: Asian Spine J Source Type: research
Authors: van Egmond N, van Grinsven S, van Loon CJ Abstract The short-term clinical and radiographic outcomes of two different valgus unloading braces were compared in patients with medial knee osteoarthritis (OA) and a varus leg alignment. A RCT was performed in 100 patients (50 Bledsoe Thruster brace, 50 SofTec OA brace) with symptomatic medial knee OA and a varus leg alignment. Outcomes were the visual analogue scale pain and satisfaction, Dutch Western Ontario and McMaster Universities Osteoarthritis Index, SF-12, 6-Minutes Walking Test, hip-knee-ankle alignment, analgesic use, complications and compliance afte...
Source: Acta Orthopaedica Belgica - Category: Orthopaedics Tags: Acta Orthop Belg Source Type: research
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Source: Acta Orthopaedica Belgica - Category: Orthopaedics Tags: Acta Orthop Belg Source Type: research
Authors: Özkan Y, Akalin Y, Çevik N, Cansabuncu G, Öztürk A Abstract The aim is to show the efficacy of 1,2-intercompartmental supraretinacular artery pedicled vascularised bone graft in treatment of scaphoid non-union with concomitant proximal end avascular necrosis retrospectively. Twentytwo cases of scaphoid nonunion with concomitant proximal end avascular necrosis were evaluated. Radiographic evaluation was made with radiographs, computed tomography, and magnetic resonance imaging. Clinical evaluation was made according to the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Ma...
Source: Acta Orthopaedica Belgica - Category: Orthopaedics Tags: Acta Orthop Belg Source Type: research
Authors: Turgut A, Kalenderer Ö, Akan I, Ilyas G, Kumbaraci M, Karapinar L Abstract A total of 129 patients were included in the study. Haemoglobin levels on admission and at 24 hours were evaluated. Radiographs and computed tomography of the pelvis were also evaluated. The patients were divided into subgroups, according to the accompanying occult posterior pelvic injuries, whether they received anticoagulant-antiaggregant treatment, the number of pubic ramus fractures (single or multiple), the level of energy (low or high) and the zone(s) of the fracture(s). The mean haemoglobin decrease was 1.21 g/dL. Forty-...
Source: Acta Orthopaedica Belgica - Category: Orthopaedics Tags: Acta Orthop Belg Source Type: research
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Source: Acta Orthopaedica Belgica - Category: Orthopaedics Tags: Acta Orthop Belg Source Type: research
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Source: Ocular Immunology and Inflammation - Category: Allergy & Immunology Tags: Ocul Immunol Inflamm Source Type: research
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Source: International Journal of Oral and Maxillofacial Implants - Category: ENT & OMF Tags: Int J Oral Maxillofac Implants Source Type: research
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Source: Italian Journal of Pediatrics - Category: Pediatrics Source Type: research
AbstractBacterial and opportunistic infections are a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE) and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis owing to treatment with immunosuppressants. Commonly used laboratory tests are unreliable in differentiating infection from active disease patients. Fc receptor (Fc γR1 or CD64) expression on neutrophils and soluble TREM-1 (triggering receptor expressed on monocytes) are potential biomarkers of bacterial infections. Our aim was to measure the clinical usefulness of quantitative CD64 measurement on neutrophil...
Source: Clinical Rheumatology - Category: Rheumatology Source Type: research
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