Neuromyelitis optica and neuromyelitis optica-IgG seropositivity in Saudis with demyelinating diseases of the central nervous system

Background and Objective: Neuromyelitis optica (NMO) shares certain features with multiple sclerosis (MS). Similar phenotypes, wide spectrum and the differential prevalence of NMO among ethnic backgrounds pose diagnostic challenges. NMO-IgG antibodies are specific biomarker for NMO and facilitate its differentiation from other demyelinating diseases. This study aimed to assess the frequency of NMO and NMO-IgG seropositivity in Saudi patients with demyelinating diseases of the central nervous system. Methods: One hundred and four patients from neurology database at King Abdulaziz Medical City, Riyadh underwent clinical and laboratory examination, neuroimaging and NMO-IgG antibodies screening. Results: The mean age at presentation was 32 (±9) years and there was an excess of females (female:male – 3:1). The mean duration of illness was 4.6 (±3.2) years. During the illness, 48.1% of patients had clinical evidence of spinal cord involvement, 29.8% had optic neuritis and 14.4% had both features. A large majority (75.8%) of brain lesions fulfilled MRI criteria for MS and 17% had lesions extending over ≥3 vertebral segments. NMO-IgG antibodies were present in only one patient – a frequency of 0.96% in our study cohort. Conclusion: Prevalence of NMO and NMO-IgG seropositivity is rare in Saudis with demyelinating diseases of the central nervous system. Hence, routine NMO-IgG testing is likely to have a low diagnostic yield

Infection related cerebral venous thrombosis

The incidence of cerebral venous thrombosis [CVT] has dropped dramatically in recent years. In the past, before the introduction of antibiotics, infection was the main cause of CVT. But this is no longer true. Recently, the occurance of septic CVT is rare, which leads to an increased chance of misdiagnosis and treatment delay. Early suspicion and recognition is very crucial to improve mortality and morbidity rates of this potentially fatal disease. Intravenous, wide spectrum, antibiotics and early surgical drainage of the primary site of infection whenever possible are essential. Anticoagulation with intravenous heparin infusion and corticosteroids use are of uncertain benefit, although some reports have shown some favorable response