Immunotherapy-responsive recurrent extensive white matter disease without neuronal or glial surface antibodies: A case report

Background: Acute disseminated encephalomyelitis (ADEM) is classically considered as a monophasic immune-mediated demyelinating disorder. A relapse can occur in children but extremely rare in adults. Case-report: A 57-year-old man presented with fulminant ADEM-like episode without proceeding viral illness. Neurological deficits rapidly developed associated with extensive demyelinating brain lesions with vasogenic edema. After the initiation of aggressive immunotherapy, his symptoms resolved, but he relapsed twice during 26-month observation period;one was a mild episode characterized by rapidly evolving MRI lesions without development of symptoms, and the other was a fulminant ADEM-like episode similar to the first one. The second fulminant episode occurred only 2 days after getting a flu shot despite no clinical or radiological relapse when he received COVID-19 vaccinations. The patient's symptoms and extensive brain MRI lesions improved after the initiation of aggressive immunotherapy at the early stage. No autoantibodies against neuronal surface (such as GABA A receptor) or glial surface antigens (aquaporin 4, or myelin oligodendrocyte glycoprotein) were identified in either serum or CSF. Conclusion(s): Extensive white matter lesions can occur without neuronal or glial surface antibodies, recurrent fulminant ADEM-like episode can develop even in an adult patient, and flu shot may provoke fulminant ADEM-like episode.Copyright © 2022

Transient optic neuritis and perineuritis associated with anti-MOG antibody after SARS-CoV-2 mRNA vaccination

Backgrounds: To report the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination. Case presentation: A 39-year-old woman was referred and admitted to our hospital due to transient left visual field abnormality with left ophthalmalgia and headache 12 days after the first vaccination dose of SARS-CoV-2 (BNT162b2). On admission (Day 2), she presented with left ophthalmalgia and headache without any other neurological deficits including the movement of eyeballs, visual field, visual acuity, or nystagmus. MRI on Day 2 suggested slight left optic neural swelling;Gadolinium-enhanced MRI on Day 4 revealed left optic perineuritis. Test for serum anti-aquaporin 4 antibody was negative, whereas anti-myelin oligodendrocyte glycoprotein (MOG) antibody was positive. She was diagnosed with left optic perineuritis after SARS-CoV-2 mRNA vaccination. Her visual disturbance never recurred and her ophthalmalgia and headache subsided only with anti-inflammatory agents. Discussion(s): Many cases of optic neuritis associated with vaccinations have been reported except for SARS-CoV-2 BNT162b2 mRNA. To our knowledge, only one neuromyelitis optica case was associated with anti-MOG antibody. Therefore, we propose that SARS-CoV-2 mRNA vaccination may induce transient optic neuritis and perineuritis, associated with anti-MOG antibody in the present case. Conclusion(s): This is the first case of left optic neuritis and perineuritis associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccination.Copyright © 2022

Rapid Campimetry-A Novel Screening Method for Glaucoma Diagnosis.

One of the most important functions of the retina-the enabling of perception of fast movements-is largely suppressed in standard automated perimetry (SAP) and kinetic perimetry (Goldmann) due to slow motion and low contrast between test points and environment. Rapid campimetry integrates fast motion (=10°/4.7 s at 40 cm patient-monitor distance) and high contrast into the visual field (VF) examination in order to facilitate the detection of absolute scotomas. A bright test point moves on a dark background through the central 10° VF. Depending on the distance to the fixation point, the test point automatically changes diameter (≈0.16° to ≈0.39°). This method was compared to SAP (10-2 program) for six subjects with glaucoma. Rapid campimetry proved to be comparable and possibly better than 10-2 SAP in identifying macular arcuate scotomas. In four subjects, rapid campimetry detected a narrow arcuate absolute scotoma corresponding to the nerve fiber course, which was not identified as such with SAP. Rapid campimetry promises a fast screening method for the detection of absolute scotomas in the central 10° visual field, with a potential for cloud technologies and telemedical applications. Our proof-of-concept study motivates systematic testing of this novel method in a larger cohort.

A Case of Transient Visual Field Defect following Administration of Pfizer-BioNTech COVID-19 Vaccine.

PURPOSE: To report a case of transient visual field (VF) defect after coronavirus disease-19 (COVID-19) vaccination. CASE REPORT: A 38-year-old Caucasian, otherwise healthy female patient, presented with a complaint of vision loss in the outer quadrant in her left eye after the second dose of Pfizer®-BioNTech™ COVID-19 vaccine. The Snellen visual acuity was 20/20 in both eyes. She did not have relative afferent pupillary defect nor disturbance of color vision. Her intraocular pressures, slit lamp and fundus examinations were normal. In the VF test, a temporal hemifield defect in the left eye and a nasal peripheral VF defect in the right eye were detected. Other imaging characteristics and neurological examination were normal. She was followed without any treatment. One week later, the patient was re-evaluated and complete resolution of the VF defect was observed. CONCLUSION: Clinicians should be aware that patients can experience transient visual symptoms following COVID-19 vaccination.

Transient visual field loss after COVID-19 vaccination: Experienced by ophthalmologist, case report.

PURPOSE: The first reported case of bilateral transient visual field defect, experienced by an ophthalmologist, which developed shortly after COVID-19 vaccination (CoronaVac, Sinovac Biotech Ltd., Beijing, China) and confirmed by computerized automated perimetry. OBSERVATION: The patient is a 42-year-old Thai ophthalmologist. He developed blurred vision within an hour after the second dose of COVID-19 vaccination. We described his self-observed of sequential symptoms, chronologic events, and management steps. The visual field of left congruous hemianopia with respect to vertical midline was detected with computerized automated perimetry. The possible mechanism could be related to an acute vasospasm of the artery in the postchiasmatic visual pathway, triggered by COVID-19 vaccine, Corona Vac. CONCLUSION AND IMPORTANCE: With increasing use of the COVID-19 vaccine in the near future, it would be prudent for medical staff and ophthalmologists to be considered and aware of this associated condition.

Neuro-ophthalmologic complications of coronavirus disease 2019 (COVID-19).

Multiple neuro-ophthalmological manifestations have been described in association with COVID-19. These symptoms and signs may be the result of a range of pathophysiological mechanisms throughout the course from acute illness to recovery phase. Optic nerve dysfunction, eye movement abnormalities and visual field defects have been described.