The use of technetium-99m hexamethyl-propyleneamine oxime (99Tcm-HMPAO) in the diagnosis of brain death has been evaluated in 41 studies of 37 patients with severe brain injury, who were under the effect of drugs or when other diagnostic methods were equivocal. HMPAO studies were compared with conventional radionuclide angiography performed simultaneously by intravenous administration of HMPAO as a bolus. The ages of patients ranged from 4 months to 75 years. Dynamic flow images and 5-min static uptake images were acquired following bolus injection of 555 Mbq of 99Tcm-HMPAO. All patients showing no brain uptake were confirmed as brain-dead by standard clinical criteria, with no contradictory cases in the static study. In addition, all patients who were not brain-dead showed HMPAO uptake at least in the brainstem. Dynamic flow images were equivocal in five patients, four of whom had no uptake on static images and clinically confirmed brain death. In addition, two other cases showed "mismatched" dynamic and static images: in one case no perfusion was observed on flow images but uptake restricted to the posterior fossa was seen on static images; the other case showed perfusion on the dynamic study and static imaging revealed hemispheric uptake with no posterior fossa uptake. Static perfusion 99Tcm-HMPAO studies offer advantages over conventional brain scintigraphy, better results being due to adequate assessment of posterior fossa activity and avoiding equivocal studies.

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A 21-year-old female developed bilateral acute-onset paracentral scotomas three days after receiving the second dose of her Moderna COVID-19 vaccination. A clinical diagnosis of acute macular neuroretinopathy (AMN) was confirmed after classic findings were demonstrated on near-infrared reflectance imaging, spectral-domain optical coherence tomography, and colored fundus photography. The patient presented with visual acuity of 20/100-1 OD and 20/20 OS. After treatment with brimonidine and difluprednate, at a two-week follow-up, her visual acuity was 20/100-2 OD and 20/25-2 OS. There have been reported cases of AMN following flu-like illnesses as well as after receiving vaccines. However, this is the first report of AMN following vaccination with a Moderna COVID-19 vaccine.

Background: Although the main limitation of the French nationwide claims database (SNDS) is the absence of clinical information, relapse is an outcome that can be identified to assess effects of disease modifying therapies in multiple sclerosis (MS) in real word setting. Objectives: The objective of this study was to assess the validity of an algorithm identifying relapses in MS patients in SNDS. Methods: A random sample of 200 patients -100 with at least one relapse and 100 without relapse screened by the algorithm -were randomly selected from a cohort of 37,986 MS patients previously identified in the SNDS. For each case, all data available in the SNDS, in particular those related to the dispensing of corticosteroids, hospitalizations for potential MS relapse or for administration of high dose of steroids and plasmapheresis procedures were examined by 2 neurologists to assess the presence or absence of relapses, blind to the result of the algorithm. In the event of an interexpert discrepancy, the summary sheets were reviewed in a collegiate manner, in order to reach a consensus. Algorithm performance was estimated using the positive and negative predictive values (PPV, NPV). Results: Among the 200 patients randomly selected-100 with at least one relapse and 100 without relapse -the algorithm correctly detected 95% patients with relapses (PPV) and 96% of patients without relapses (NPV). Conclusions: This claim-based algorithm appeared to successfully detect MS relapse and could thus be applied to future observational MS studies in SNDS. It could be secondarily revised to include all changes proposed by the experts in order to optimize its performance.