1
|
Aseem F, Lin V, Gilbert AL, Rivadeneira AC, Jennette JC, Bouldin TW, Khoshbakht F, Lee YZ, Chamberlin K, Gelinne A, Mehrabyan AC, Javed B, Dujmovic Basuroski I, Diaz MM. ANCA-associated vasculitis presenting with isolated neurological manifestations in a patient with cocaine abuse: a case report and literature review. Clin Rheumatol 2024; 43:1401-1407. [PMID: 38416306 DOI: 10.1007/s10067-024-06919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare conditions predominantly affecting small vessels of skin, musculoskeletal, pulmonary, renal, and rarely central and peripheral nervous systems. Isolated neurological manifestations of AAV are uncommon and challenging to diagnose. Cocaine has been reported as a potential trigger for the development of AAV. There are only a few case reports of isolated neurological involvement in cocaine-induced AAV with poorly characterized histopathological features. We present a unique case of AAV with isolated neurological manifestations presenting with multiple cranial neuropathies, leptomeningeal enhancement on imaging and histopathologic evidence of small-vessel vasculitis in the leptomeninges and brain and extensive dural fibrosis in a patient with cocaine abuse. The patient's progressive neurological deficits were controlled after starting immunosuppression with rituximab and prednisone. We also reviewed the literature to provide the diagnostic overview of AAV and evaluate intervention options. To our knowledge, this is the first case of AAV with isolated neurological manifestations and histopathologic evidence of small-vessel vasculitis in a patient with cocaine abuse. Patients with multiple cranial neuropathies and meningeal involvement should be screened for AAV, especially if they have a history of cocaine abuse.
Collapse
Affiliation(s)
- Fazila Aseem
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Victor Lin
- Department of Neurology, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Abigail L Gilbert
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Alfredo C Rivadeneira
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - J Charles Jennette
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Thomas W Bouldin
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Freshta Khoshbakht
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Kelly Chamberlin
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Aaron Gelinne
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, 27599, USA
| | - Anahit C Mehrabyan
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Bushra Javed
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Irena Dujmovic Basuroski
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA
| | - Monica M Diaz
- Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB 7025, Chapel Hill, NC, 27599, USA.
| |
Collapse
|
2
|
Choi EY, Boisvert CJ, Basuroski ID, Khagi S. Paraneoplastic Optic Neuropathy in a Patient With Glioblastoma. J Neuroophthalmol 2024; 44:e42-e44. [PMID: 36166778 DOI: 10.1097/wno.0000000000001613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology (EYC, CJB), Duke University Medical Center, Durham, North Carolina; Department of Neurology (IDB), University of North Carolina School of Medicine, Chapel Hill, North Carolina; and Department of Medicine (SK), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | | | | |
Collapse
|
3
|
Li X, Morantes Gomez L, Al Masry M, Basuroski ID. "String of pearls" in spinal cord sarcoidosis. Ann Neurol 2022; 92:686-687. [PMID: 35929108 DOI: 10.1002/ana.26471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Xiaoyang Li
- University of North Carolina School of Medicine, Department of Neurology, Chapel Hill, North Carolina, USA
| | | | - Mahmoud Al Masry
- University of North Carolina REX Hospital, Raleigh, North Carolina, USA
| | - Irena Dujmovic Basuroski
- University of North Carolina School of Medicine, Department of Neurology, Chapel Hill, North Carolina, USA.,The Bodford Family Transverse Myelitis Center, Hillsborough, NC, USA
| |
Collapse
|
4
|
Tsai C, O'Reggio A, Mehrabyan A, Williams D, Dujmovic Basuroski I. Bilateral Acute Hippocampal Ischemia in Two Patients Abusing Cocaine: What is the Outcome? Cureus 2022; 14:e26435. [PMID: 35915690 PMCID: PMC9337781 DOI: 10.7759/cureus.26435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/05/2022] Open
|
5
|
Kisic Tepavcevic D, Pekmezovic T, Dujmovic Basuroski I, Mesaros S, Drulovic J. Bladder dysfunction in multiple sclerosis: a 6-year follow-up study. Acta Neurol Belg 2017; 117:83-90. [PMID: 28092018 DOI: 10.1007/s13760-016-0741-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/24/2016] [Indexed: 01/18/2023]
Abstract
Bladder dysfunction (BD) is the most common autonomic disturbance in multiple sclerosis, but often overlooked and undertreated. The purpose of this longitudinal study was to explore the changes in the frequency of BD symptoms in MS cohort after a period of 3 and 6 years of follow-up, as well as to investigate the correlations between the presence of BD symptoms and both clinical characteristics and the health-related quality of life (HRQoL) at each subsequent point of estimation. The study population comprises a cohort of 93 patients with MS (McDonald's criteria, 2001). At each time point (baseline, and at the 3- and 6-year follow-up) of estimation, Expanded Disability Status Scale, Hamilton Rating Scale for Depression, Fatigue Severity Scale, Szasz Sexual Functioning Scale and HRQoL (measured by MSQoL-54) were assessed. The proportion of patients with at least one symptom of BD significantly increased over time, for both men and women (from 48.1% at baseline to 51.9% after 3 years and to 71.4% after 6 years of follow-up for males and from 45.5% at baseline to 50.0% after 3 years and to 66.7% after 6 years of follow-up for females). The most common BD problem was urgency of urination. The presence of BD was statistically significantly associated with higher level of physical disability, sexual dysfunction and HRQoL at each point of follow-up, for both men and women. Our results suggested outstanding frequency of BD in patients with MS, with increasing tendency over time.
Collapse
Affiliation(s)
- Darija Kisic Tepavcevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26, Belgrade, 11000, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26, Belgrade, 11000, Serbia
| | - Irena Dujmovic Basuroski
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia.
| |
Collapse
|
6
|
Nedeljkovic U, Dackovic J, Tepavcevic DK, Basuroski ID, Mesaros S, Pekmezovic T, Drulovic J. Multidisciplinary rehabilitation and steroids in the management of multiple sclerosis relapses: a randomized controlled trial. Arch Med Sci 2016; 12:380-9. [PMID: 27186184 PMCID: PMC4848347 DOI: 10.5114/aoms.2015.47289] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Periodic relapses are one of the main characteristics of multiple sclerosis (MS), from which recovery is often incomplete despite high-dose methylprednisolone (HDMP) treatment. The aim of our study was to evaluate the potential benefits of short-term HDMP combined with multidisciplinary rehabilitation (MDR) in persons with MS in relapse in order to assess whether combination of steroid therapy with MDR is more beneficial than steroid therapy alone. MATERIAL AND METHODS This investigation was conducted as a randomized controlled trial. The MS patients were eligible if they had an established diagnosis and relapse requiring application of HDMP. Forty-nine patients were included in the study and randomized to control and treatment groups, and 37 completed the study. High-dose methylprednisolone was administered to all patients. The treatment group additionally underwent an MDR program over a 3-week period. All outcome measures were completed at baseline and 1 and 3 months later. RESULTS The Expanded Disability Status Scale (EDSS) and Functional Independence Measure (FIM) motor scores improved statistically significantly 1 month after HDMP, in both treatment and control groups. During the study period, in the treatment group, a sustained large effect size (ES) was found for both physical and mental composite scores of Multiple Sclerosis Quality of Life-54 (MSQoL-54), while in the controls, a sustained moderate ES was demonstrated only for physical composite score. CONCLUSIONS Our findings suggest that MDR improves MS relapse outcome.
Collapse
Affiliation(s)
- Una Nedeljkovic
- Clinic of Physical Medicine and Rehabilitation, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Dackovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Irena Dujmovic Basuroski
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sarlota Mesaros
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
7
|
Kisic Tepavcevic D, Pekmezovic T, Stojsavljevic N, Kostic J, Dujmovic Basuroski I, Mesaros S, Drulovic J. Predictive value of health-related quality of life in progression of disability and depression in persons with multiple sclerosis: a 3-year study. Acta Neurol Belg 2013; 113:403-9. [PMID: 23460394 DOI: 10.1007/s13760-013-0191-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Accepted: 02/15/2013] [Indexed: 11/29/2022]
Abstract
In our study, we examined whether health-related quality of life (HRQoL) could predict changes in disability, depression, and fatigue in patients with multiple sclerosis (MS) over a 3-year follow-up period. A group of 109 consecutive MS patients (McDonald's criteria) referring to the Institute of Neurology, Belgrade were enrolled in the study. At two time points during the study (baseline, and after a 3-year period) an HRQoL (measured by MSQoL-54), EDSS, Hamilton Rating Scale for Depression (HDRS) and Fatigue Severity Scale (FSS) were assessed. At the end of a 3-year follow-up, 12 out of 109 patients (11%) had dropped out. Multiple linear regression analysis showed that Physical Health scale of MSQoL-54 is significant independent predictor of change in EDSS after 3 years (p = 0.035). Mental health composite score of MSQoL-54 was predictor of change in HDRS score (p = 0.049). In separate regression analysis, only social function was independent predictor of the development of depression (p = 0.041). None of the HRQoL domains had predictive effect on the change of FSS. Our study suggests that baseline HRQoL scores, measured by MSQoL-54, could be applied as a prognostic marker for progression of both, disability, and severity of depressive symptoms in MS.
Collapse
Affiliation(s)
- Darija Kisic Tepavcevic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Visegradska 26, 11000, Belgrade, Serbia
| | | | | | | | | | | | | |
Collapse
|
8
|
Drulovic J, Kostic J, Mesaros S, Dujmovic Basuroski I, Stojsavljevic N, Kisic-Tepavcevic D, Pekmezovic T. Interferon-beta and disability progression in relapsing-remitting multiple sclerosis. Clin Neurol Neurosurg 2013; 115 Suppl 1:S65-9. [DOI: 10.1016/j.clineuro.2013.09.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
9
|
Tepavcevic DK, Kostic J, Basuroski ID, Stojsavljevic N, Pekmezovic T, Drulovic J. The impact of sexual dysfunction on the quality of life measured by MSQoL-54 in patients with multiple sclerosis. Mult Scler 2008; 14:1131-6. [DOI: 10.1177/1352458508093619] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective Sexual dysfunction (SD) is a common but often overlooked symptom in multiple sclerosis (MS). The aim of this study was to estimate the frequency, type, and intensity of SD in our patients with MS and to investigate its influence on all the domains of quality of life. Methods The study population comprised a cohort of 109 patients with MS (McDonald's criteria, 2001). SD was quantified by a Szasz sexual functioning scale. Health-related quality of life was measured by a disease-specific instrument MSQoL-54 (Serbian version). Results The presence of at least one symptom of SD was found in about 84% of the men and in 85% of the women. The main complaints in women were reduced libido, difficulties in achieving orgasm, and decreased vaginal lubrication; in men, the main complaints were reduced libido, incomplete erections, and premature ejaculation. In women, statistically significant negative correlations between the presence and level of SD and quality of life domains were reached for all subscales ( P < 0.01), except for the Pain subscale ( P = 0.112). In men, negative correlations were also observed for all domains, but they were statistically significant for physical health, physical role limitations, social function, health distress, sexual function, and sexual function satisfaction ( P < 0.01). We found that the presence of all the analyzed types of sexual problems statistically significantly lowered scores on the sexual function and the sexual function satisfaction subscales in both men and women ( P < 0.01). The most prominent impact on both domains was observed for the total loss of erection in men and for anorgasmia in women. Conclusions Our results reveal that frequent occurrence of SD in MS patients prominently affects all aspects of their quality of life.
Collapse
Affiliation(s)
- DK Tepavcevic
- Institute of Epidemiology, School of Medicine, Belgrade, Serbia
| | - J Kostic
- Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia
| | - ID Basuroski
- Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia
| | - N Stojsavljevic
- Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia
| | - T Pekmezovic
- Institute of Epidemiology, School of Medicine, Belgrade, Serbia; Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia
| | - J Drulovic
- Institute of Neurology, Clinical Centre of Serbia, Belgrade, Serbia
| |
Collapse
|