Neurology

Intrasession Repeatability of Optical Coherence Tomography Angiography Parameters in Neurodegenerative Disease

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Purpose To assess the intrasession repeatability of macular optical coherence tomography angiography (OCTA) parameters in Alzheimer disease (AD), mild cognitive impairment (MCI), Parkinson disease (PD), and normal cognition (NC). Design Cross sectional study. Subjects, Participants, and/or Controls Patients with a clinical diagnosis of AD, PD, MCI, or normal cognition were imaged. Images with poor quality and of those with diabetes mellitus, glaucoma or vitreoretinal disease were excluded from analysis. Methods, Intervention or Testing All participants were imaged using the Zeiss Cirrus HD-5000 with AngioPlex (Carl Zeiss Meditec, Dublin, CA, Software Version 11.0.0.29946) and repeat OCTA images were obtained for both eyes. Perfusion density (PFD), vessel density (VD), and FAZ area (FAZ) were measured from 3x3mm and 6x6mm OCTA images centered on the fovea using an ETDRS (Early Treatment Diabetic Retinopathy Study) grid overlay. Main Outcome Measures Intraclass correlation co...

Microvascular impairments detected by optical coherence tomography angiography in multiple sclerosis patients: A systematic review and meta-analysis

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Purpose: A systematic review and meta-analysis was conducted to investigate changes in retinal and choroidal microvasculature in patients with multiple sclerosis (MS) using optical coherence tomography angiography (OCTA). Methods: PubMed and Google Scholar were searched for studies that compared retinal and choroidal microvasculature between MS and healthy controls (HC) with OCTA. MS patients were divided into 2 groups: MS with (MSON) or without optic neuritis (MSNON). Results: Totally, 13 studies including 996 MS eyes and 847 HC eyes were included. Compared with the HC, the vessel density of the whole superficial vascular complex (SVC) was reduced by 2.27% and 4.30% in the MSNON and MSON groups, respectively. The peripapillary vessel density was 2.28% lower and 4.96% lower in the MSNON and MSON groups, respectively, than in the HC. Furthermore, the MSON group had significant lower vessel density of the SVC (mean difference [MD] = −2.17%, P < 0.01) and lower peripapillary v...

Optical Coherence Tomography as a Biomarker in Amnestic Mild Cognitive Impairment: an Umbrella Review of Systematic Reviews (Thesis)

Introduction: People with mild cognitive impairment (MCI) are at a higher risk of developing Alzheimer’s disease (AD), one of the most expensive diseases that lead to death and burden society. Therefore, early diagnosis is crucial to implement early and optimal AD treatment and prevent or delay disease progression. As a part of the central nervous system, the retina provides a unique and easy method for studying neurodegenerative disorders. Purpose: The aim of this review was to screen existing systematic review results to describe the relationship between amnestic MCI and changes in the retinal layers measured with optical coherence tomography (OCT). Methods: An umbrella review of English literature of systematic reviews was conducted on 1 October 2022 in three electronic databases (PubMed, CINAHL and MED-LINE). Studies of retinal thickness measurements by OCT in ageing people with amnestic MCI were screened from the past ten years. Studies with not related OCT and...

Editorial: Optical imaging and laser technologies in neuro-oncology

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Use of light in neuro-oncology can be twofold, for either diagnosis or therapeutics. The optical bioimaging technologies, such as confocal microscopy, multiphoton tomography, optical coherence tomography, Raman spectroscopy, fluorescence and polarization imaging are the most trending methods currently to guide surgical procedures and intraoperative “optical” biopsy. On the other side, using lasers as the surgical tools in the interstitial thermal therapy and photodynamic therapy can provide targeted destruction of brain tumor cells. Moreover, the combination of diagnostic and therapeutic applications of light opens the avenue for the new developments in biomedical engineering. In this Frontiers issue, “Optical imaging and Laser technologies in Neuro-Oncology”, we are privileged to present a collection of 8 open-access publications that describe the recent advances in research and practice of using optical technologies in neuro-oncology. These articles were selected through an ope...

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...

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