Neurology

Case Report: Optical Coherence Tomography, as a Non-Invasive Approach to Evaluate Intracranial Pressure in Normal Pressure Hydrocephalus Patients, as with their Treatment Follow-ups and VP Shunts Reprogramming Procedures

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Ventriculoperitoneal Shunts are nowadays a reliable solution to control NPH symptoms and maintain patients’ quality of care by its re-programming ability [1]. However, post VP shunt implementation follow-ups are mostly consisted of clinical reviews that rely on observable signs and symptoms by neurologists Williams M, et al. (2016) [2]. In some conditions though ventricle dilation and cortical atrophy extension may address the demand for VP shut to be re-programed [3]. The presenting case outlines difficulties in evaluating the functionality of the VP shunt for an NPH patient. OCT has been therefore experienced to be a non-invasive low-cost study to assist the neurology practice to lead the patient to VP shunt re-programming, due to its possible low pressure that became authentic during its adjustment procedure.

Six Questions About the Role of OCT in Neuro Evaluations

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Approaching neuro-ophthalmic disease may be daunting for many eyecare practitioners, given the wide array of possible differential diagnoses and systemic implications. With the ability to visualize structural changes from the retinal nerve fiber layer (RNFL) to the posterior aspects of the lamina cribrosa, optical coherence tomography (OCT) is an indispensable tool for disease screening, differential diagnosis, prognostication and progression analysis for patients with optic nerve disease. This article will answer six neuro-ophthalmic questions optometrists may face in clinical practice with a focus on the role of OCT in clinical decision-making.   1. Can OCT explain non-pathological field loss? When a patient presents with bitemporal visual field loss, often the first thing that comes to mind is chiasmal syndrome—but is this always the case? Tilted disc syndrome is a benign physiological anomaly that presents with some characteristic clinical features. These include tilt or...

Retinal ganglion cell loss is associated with future disability worsening in early relapsing remitting multiple sclerosis

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Background Thinning of the retinal combined ganglion cell and inner plexiform layer (GCIP) as measured by optical coherence tomography (OCT) is a common finding in patients with multiple sclerosis. This study aimed to investigate whether a single retinal OCT analysis allows prediction of future disease activity after a first demyelinating event. Methods Observational cohort study including 201 patients with recently diagnosed clinically isolated syndrome or relapsing remitting multiple sclerosis from two German tertiary referral centers. Individuals underwent neurological examination, MRI and OCT at baseline and at yearly follow-up visits. Results Patients were included at a median disease duration of 2.0 months. During a median follow-up of 59 (interquartile range 43 – 71) months, 82% of patients had ongoing disease activity as demonstrated by failing the no evidence of disease activity (NEDA)-3 criteria and 19% presented with confirmed disability worsening. A GCIP threshold ≤...

World’s First Intracranial Use of a New High-Frequency Imaging System to Directly Visualize Neurovascular Pathologies

First human procedures performed by Prof Vitor Mendes Pereira at St. Michael’s Hospital, a site of Unity Health Toronto Gentuity, LLC, an advanced imaging technology firm, today announced the first human use of the Vis-MTM High-Frequency Optical Coherence Tomography (HF-OCT) imaging system and probe. This represents a significant technological advance for the field of neurointervention, making high resolution intravascular imaging in the brain possible. “This is an incredibly exciting milestone. The direct visualization technology we evaluated here offers unprecedented potential in the diagnosis and treatment of aneurysms, stroke, intra-cranial atherosclerotic disease (ICAD) and other neurological pathologies,” said Vitor Mendes Pereira, MD. “I am proud and honored to have the opportunity to perform the first cases. The system and imaging probes performed very well, integrating with our workflow seamlessly, and provided us with important information that we cannot obtain with any ...

Use of optical coherence tomography in selected patients with recurrent cryptogenic stroke: A case series and technical discussion

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Background Despite advances in secondary stroke prevention during the last several years, cryptogenic stroke remains associated with a high risk of recurrence. Studies have shown that the recurrence risk is higher in patients with large artery disease in which complex carotid plaques and carotid WEBs are identified. Methods This is a case series of six patients with cryptogenic recurrent stroke in which conventional imaging and extensive workup did not identify an etiology. Intravascular optic coherence tomography (OCT) was performed using a ballon-guided flow-arrest technique to identify possible covert carotid lesions. Results We present six cases in which, with the help of OCT, we identified three carotid WEBs with associated thrombosis and two ulcerated carotid artery plaques. Four patients were subsequently treated with endovascular stent placement without complications. OCT permitted the distinction between complicated carotid artery plaque and carotid WEB. Conclusion I...

Take care of your senses: The science behind sensory loss and dementia risk

Take care of your senses: The science behind sensory loss and dementia risk Alison Abraham, Ph.D., M.S., M.H.S., associate professor of epidemiology and ophthalmology at the University of Colorado School of Public Health, has long studied the relationship between the eyes and the brain. She is a principal investigator with the NIA-funded Eye Determinants of Cognition (EyeDOC) Study. Abraham has a family history of vision problems that has fueled her personal interest in how vision loss affects emotional well-being, physical functioning, social interaction, and brain health. In her work, she collaborates with community groups and care providers on strategies for increasing routine vison screening and broadening access to vision care for older adults.  Credit: Vascular details from a retinal eye scan. Image provided by Alison Abraham, Ph.D., M.S., M.H.S., University of Colorado School of Public Health Abraham’s research focuses on the retina, the area at the rear of the eyeball that relays visual information through the optic nerve to the brain....

Optical coherence tomography reflects clinically relevant gray matter damage in patients with multiple sclerosis

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Background Retinal degeneration leading to optical coherence tomography (OCT) changes is frequent in patients with multiple sclerosis (PwMS). Objective To investigate associations among OCT changes, MRI measurements of global and regional brain volume loss, and physical and cognitive impairment in PwMS. Methods 95 PwMS and 52 healthy controls underwent OCT and MRI examinations. Mean peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell/inner plexiform layer (GCIPL) volume were measured. In PwMS disability was quantified with the Expanded Disability Status Scale (EDSS) and Symbol Digit Modalities Test (SDMT). Associations between OCT, MRI, and clinical measures were investigated with multivariable regression models. Results In PwMS, pRNFL and GCIPL were associated with the volume of whole brain (p < 0.04), total gray matter (p < 0.002), thalamus (p ≤ 0.04), and cerebral cortex (p ≤ 0.003) –both globally and regionally–, but not white matter. p...

Predicting acute and post-recovery outcomes in cerebral malaria and other comas by Optical Coherence Tomography (OCT)

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Children in Africa continue to die in large numbers from CM, mostly with severe brain swelling. New treatments for severe brain swelling and to reduce intracranial pressure (ICP) in CM are under clinical trial, but rely on MRI scans to identify severe brain swelling. Hardly any children with CM have access to MRI scanning, so those likely to benefit from new treatments are not identifiable. Children in coma for other causes would also benefit from the identification of raised intracranial pressure. Children who survive CM are at high risk of neurological and developmental complications. It is thought that this may be due to cerebral ischaemia but at present there is no method to identify these children other than waiting for their deficit to become manifest. Identifying CM patients at risk of neurological deficit or developmental delay would enable early intervention. Identifying a link between cerebral ischaemia and neurodevelopmental deficit (NDD) would also support the developm...

The Usefulness of Optical Coherence Tomography in Disease Progression Monitoring in Younger Patients with Relapsing-Remitting Multiple Sclerosis: A Single-Centre Study

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The purpose of the study was to assess the usefulness of optical coherence tomography (OCT) in the detection of the neurodegenerative process in younger patients with multiple sclerosis (MS). The study group consisted of 61 patients with a relapsing remitting course of MS (mean age 36.4 ± 6.7 years) divided into two groups: short (≤5 years) and long (>10 years) disease duration. OCT, P300 evoked potential, Montreal Cognitive Assessment, and performance subtests (Picture Completion and Digit Symbol) of the Wechsler Adult Intelligence Scale were performed in all patients. Mean values of most parameters assessed in OCT (pRNFL Total, pRNFL Inferior, pRNFL Superior, pRNFL Temporalis, mRNFL, GCIPL, mRNFL+GCIPL) were significantly lower in MS patients in comparison to controls. And in patients with longer disease duration in comparison to those with shorter. Most OCT parameters negatively correlated with the EDSS score (p < 0.05). No significant correlation was found between OCT resu...

Decrease Retinal Thickness in Patients with Chronic Migraine Evaluated by Optical Coherence Tomography

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The purpose of this study is to determine the possible alterations that may occur in the thickness of the retinal nerve fibre layer (RNFL), ganglion cell layer (GCL), and macular thickness in patients with chronic migraines compared with healthy controls. Hence, we examined some of the possibilities that are offered by optical coherence tomography (OCT) in order to study different neurological diseases and to study its application, in this case, how it may be applied to patients with chronic migraines. This was an observational cross-sectional study in adults aged 18–65 years. The study group consisted of 90 patients (90 eyes) with chronic migraines who met the inclusion criteria, and 90 healthy controls (90 eyes) matched for age and sex. Retinal thickness was measured by spectral domain OCT (SD-OCT). The thickness of the superior quadrant of the peripapillary RNFL, as well as the mean thickness in the macula, RNFL macular, and GCL was significantly thinner in chronic migraine patie...

Optical coherence tomography and angiography in Alzheimer’s disease and other cognitive disorders

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Aims The aims of this study were to analyze retinal and choroidal changes on optical coherence tomography (OCT) and OCT-Angiography (OCT-A) in Alzheimer's disease (AD) patients and compare them to other forms of major dementia. We also aimed to analyze the correlation between clinical severity of global cognitive deficiency assessed by the mini-mental state exam (MMSE) score and OCT/OCT-A parameters. Methods Retrospective cross-sectional evaluative study of AD, and age-and gender-matched patients with other dementias. Fundus examination, OCT and OCT-A were compared. Results Ninety-one eyes of AD patients and 53 eyes of patients with other dementias were included. Retinal deposits were found in 6.59% of AD cases. OCT highlighted the presence of hyperreflective deposits and localized areas of outer retina and ellipsoid zone disruption, respectively in 20.87% and 15.38% of AD cases. Hyperreflective foci were noted within inner retinal layers in 4.39% of AD cases. Quantitative anal...

Significant retinal microvascular impairments in multiple sclerosis assessed through optical coherence tomography angiography

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Purpose Multiple sclerosis (MS) is associated with different ocular disorders. This study aimed to investigate the retinal microvascular changes detected by optical coherence tomography angiography (OCTA) in eyes with MS with or without a history of optic neuritis (ON). Methods A comprehensive literature search was conducted in the Web of Science, Embase, PubMed, and Cochrane Library databases on September 26, 2021 for articles focused on OCTA manifestations in the eyes of MS patients compared with healthy controls. RevMan Manager (v.5.4) and Stata (v.14.1) were used to analyze the main differences and publication risks. Weighted mean differences and 95% confidence intervals were calculated for continuous estimates. This study also included subgroup analysis between three groups: eyes with multiple sclerosis and with optic neuritis (MSON); eyes with multiple sclerosis and without optic neuritis (MSNON); and healthy controls. Results Thirteen studies with a total of 1803 eyes we...

CAN THE OPTICAL COHERENCE TOMOGRAPHY FINDINGS BE RELATED WITH SUICIDE ATTEMPT IN BIPOLAR DISORDER?

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Background The aim was to investigate the relationship between OCT findings and suicidal behavior (SB) in patients with Bipolar Disorder type 1 (BPD1) in comparison to healthy controls. Methods Forty five euthymic BPD1 patients with previous suicide attempts (BPD1+), 46 euthymic BPD1 patients without previous suicide attempts (BPD1-) and 63 healthy controls were included. The subjects were evaluated with Sociodemographic Data Form, SCID, Suicide Behaviors Questionnaire, Beck Depression Inventory, Young Mania Rating Scale and OCT. Results All OCT measures were lower in patients with BPD1 than healthy controls (p<0.001). While no significant differences were found between (BPD1+) and (BPD1-) in all GCC levels and inferior RNFL values (p>0.05), the superior RNFL and global RNFL values were found to be lower in the (BPD1+) than in the (BPD1-) (p=0.037, p=0.028, respectively). Global RNFL was found to significantly predict suicide risk in a multivariate logistic regression mod...

Whole Brain Micro-Vascular Imaging Using Robot Assisted Optical Coherence Tomography Angiography

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Optical coherence tomography angiography (OCTA) can provide depth resolved image of microvasculature but fail to acquire both high resolution and large field imaging of an irregular sample. The robotic arm can easily scan along the sample surface to ensure that the sample at the same depth is all in the same focal plane, so OCTA can be obtained without the effect of unevenly distributed resolution and fall off as occurred in conventional imaging with linear scanning of irregular sample. So, we integrated a 120 kHz OCT with a robotic arm and proposed a novel calibration method for robotic arm with a repeatability positioning accuracy of ∼60μm. A correlation mapping (CM) masked eigen decomposition OCTA was proposed with CM > 0.6 for binarization to improve the vascular visualization and CM > 0.99 for extraction of big vessels to enhance stitching efficacy. With the aid of robotic arm, micro-vascular OCTA of whole mouse brain was achieved for the first time, to our knowledge, ove...

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