Visual Disorders in Neuroborreliosis： An Electro-physiological Investigation

Visual disorders may occur in Neuroborreliosis, Multiple Sclerosis, and many other diseases. The aim of this work was to find electro-physiological cues for differentiation. The study was based on the investigation of 178 patients presenting visual disorders. Out of them 57 were affected by Neuroborreliosis （demonstrated by positive serologic investigation： Western Blot and immuno-assay）. The electro-physiological research consisted in Electroencephalography （EEG） Mapping and average Visual Evoked Potentials （VEPs） investigation. Characteristic for the Lyme disease was the non-homogenous slowing of the cortical electrical activity, associated with signs of excessive cortical excitability to flash stimulation. In Multiple Sclerosis （MS） there were no similar changes, but signs of sub-cortical white matter lesions. Primary cortical VEP components were significantly attenuated in amplitude in the Lyme disease and delayed in MS. Magnetic Resonance Imaging （MRI） showed the presence of not differentiated ＂demyelization lesions＂ in all these cases. The electro-physiologic investigation confirms the existence of cerebral （cortical） dysfunction in subjects serologically confirmed with Borrelia infection. It may be used in time for the follow up of the Lyme disease patients.

Visual Disorders Outcome after Endoscopic Endonasal Trans-Sphenoidal Surgery of Pituitary Macroadenomas

Objective: Describe the outcome of visual disorders after endonasal transsphenoidal (EET) surgery of pituitary macroadenomas with preoperative chiasmal compression. Patients and Methods: From 2009 to 2013, 225 patients underwent EET surgery for sellar tumor. Among them, 168 suffered from visual disorders induced by chiasmatic compression, of which 88 met the inclusion criteria for this study. Average duration of follow up was 1.8 yrs ± 0.4 yrs. All patients had sellar MRI before surgery and yearly postoperatively, visual acuity (VA) and/or visual field (VF) measurements before, 3 months after surgery and yearly postoperatively. Results: All tumors were macroadenomas with a mean preoperative MRI-estimated volume of 10.0 {plus minus} 9.07 cm3. Preoperative VA was impaired with an average of 0.43 ± 0.13 LogMAR (left eye) and 0.36 ± 0.14 LogMAR (right eye) and VF was disturbed in 99% ± 2% of the cases with the most frequent disorder being bitemporal hemianopsia (38 patients). Post-operatively, the mean residual MRI-estimated tumor volume was 3.15 ± 3.71 cm3. Mean tumor volume reduction was 62% ± 9% (p < 0.001). Optic chiasmal compression resolved in 72% ± 10% of the cases. Visual function improved in 86% ± 7% of cases (p < 0.001). Conclusion: Endoscopic endonasal management of pituitary gland neoplasms is effective to reduce tumor volume. This technique achieved significant visual improvement in the majority of cases presenting with chiasmal compression syndrome.

Finger or Light:Stimulation Sensitivity of Visual Startle in the Coma Recovery Scale-Revised for Disorders of Consciousness

Dear Editor,Coma, the vegetative state （VS）, and the minimally- conscious state （MCS）, often collectively referred to as disorders of consciousness （DOCs）, typically occur after severe traumatic or non-traumatic brain injury [1]. The boundary between awareness and unawareness remains elusive, making it difficult to correctly distinguish MCS from VS patients. It is possible to employ noninvasive neuroimaging techniques, such as functional MRI （fMRI） [2] to assess residual cognitive processing as well as consciousness. However, the causal link between neural activity in specific brain areas and specific behavioral tasks is hard to dissect using fMRI [3]. Therefore, detecting residual cognitive function and consciousness in patients surviving severe brain injury remains extremely challenging.