Recurring meningoencephalitis in sinusitis-associated acute posterior multifocal placoid pigment epitheliopathy under prednisone tapering

Joswig, Holger; Flueckiger, C; Infanger, A.; Tettenborn, Barbara; Felbecker, Ansgar

doi:10.1136/bcr.02.2011.3820

Cited by 1 publication

(2 citation statements)

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“…The features of headache complicating AMPPE are poorly characterised in published case histories but where described the headaches were severe [5,6,17,22,23], persistent [17,26,27], localised [5] or diffuse [6]. Meningitic symptoms were described in the minority with only 4/52 (8%) patients experiencing either neck stiffness [9,10], fever [18] or photophobia [22].…”

Section: Neurological Complications Of Amppementioning

confidence: 94%

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Neurological complications of acute multifocal placoid pigment epitheliopathy

Brownlee

Anderson

Sims

et al. 2016

Journal of Clinical Neuroscience

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Acute multifocal placoid pigment epitheliopathy (AMPPE) is an autoimmune chorioretinal disease that can be complicated by neurological involvement. There is limited information on this potentially treatable condition in the neurological literature. The objective of this patient series is to describe the neurological complications of AMPPE. We retrospectively identified patients with neurological complications of AMPPE seen at Auckland Hospital between 2008 and 2013 and summarised cases in the literature between 1976 and 2013. We identified five patients with neurological complications of AMPPE at Auckland Hospital and 47 reported patients. These patients demonstrated a spectrum of neurological involvement including isolated headache, stroke or transient ischaemic attack, seizures, venous sinus thrombosis, optic neuritis, sensorineural hearing loss and peripheral vestibular disorder. We propose criteria to define AMPPE with neurological complications. A cerebrospinal fluid (CSF) lymphocytosis in a patient with isolated headache may predict the development of cerebrovascular complications of AMPPE. Patients with cerebrovascular complications of AMPPE have a poor prognosis with high rates of death and neurological disability among survivors. Predictors of poor outcome in those who develop neurological complications of AMPPE are a relapsing course, generalised seizures and multifocal infarction on MRI. All patients with neurological complications of AMPPE, including headache alone, should be investigated with an MRI brain and CSF examination. Patients with focal neurological symptoms should receive intravenous (IV) methylprednisolone followed by a tapering course of oral steroids for at least 3months. Patients with AMPPE and an isolated headache with a CSF pleocytosis should be treated with oral steroids.

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Section: Neurological Complications Of Amppementioning

confidence: 94%

“…One patient had focal seizures associated with a new DWI lesion on MRI imaging [26]. Two other patients had generalised seizures; both patients died.…”

Section: Neurological Complications Of Amppementioning

confidence: 97%