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|LETTER TO EDITOR
|Year : 2013 | Volume
| Issue : 4 | Page : 428-429
Eales' disease with neurological complications
Sidharth Shankar Anand, Gautam Das, Durga Prasad Chakraborty, Shankar Prasad Saha, Biman Bose
Department of Neurology, NRS Medical College and Hospital, Kolkata, West Bengal, India
|Date of Submission||12-May-2013|
|Date of Decision||24-Jul-2013|
|Date of Acceptance||26-Jul-2013|
|Date of Web Publication||4-Sep-2013|
Sidharth Shankar Anand
Department of Neurology, NRS Medical College and Hospital, Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Anand SS, Das G, Chakraborty DP, Saha SP, Bose B. Eales' disease with neurological complications. Neurol India 2013;61:428-9
Eales' disease is an idiopathic disease and is characterized by retinal perivasculitis affecting the peripheral retina during the inflammatory stage, followed by sclerosis of the retinal veins and retinal ischemia, and finally, retinal or optic disk neovascularization and recurrent hemorrhages with or without retinal detachment. The disease is more common in the Indian subcontinent. Neurological complications have been described in Eales' disease.
A 29-year-old male developed acute onset blurring of vision in the left eye. The ophthalmologist made the diagnosis of retinal vasculitis and prescribed oral steroids. After 2 months, the patient's visual acuity improved, but he developed sever headache. Two days after the onset of headache, he developed left-sided hemiparesis. Computed tomography (CT) scan brain showed large hematoma in the right fronto-parieto-temporal region [Figure 1]. Magnetic resonance veinogram (MRV) revealed the absence of right rolandic vein [Figure 2]. On conservative management, his weakness gradually improved within 3 months. Four months later, he again developed acute onset blurring of vision in his right eye. Opthalmoscopic examination showed features of active retinal vasculitis in both the eyes, with multiple retinal hemorrhages and disk neovascularization [Figure 3]. Panretinal photocoagulation was done to prevent further hemorrhages.
|Figure 1: CT scan head showing large intraparenchymal hematoma in right fronto‑parieto‑temporal region with midline shift|
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|Figure 2: MRV of brain showing absence of vein of Trolard on the right side|
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|Figure 3: Picture of retina showing neovascularization, microaneurysms, arteriovenous shunts, venous beading, hard exudates, and cotton‑wool spots|
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Six years later, he developed sudden-onset weakness of both lower limbs, along with retention of urine. Opthalmoscopic examination showed features of old retinal vasculitis. Lower limbs' power was graded at 1/5 bilaterally. There was sensory loss for all modalities below T4 vertebral level. Bilateral plantar response was upgoing. Magnetic resonance imaging (MRI) thoracic spine showed long segment of nonenhancing intramedullary hyperintense signal in the thoracic spine [Figure 4]. Hemogram, blood biochemistry, erythrocyte sedimentation rate, C- reactive protein and vasculitic profile were all normal. Cerebrospinal fluid (CSF) examination showed high protein (99.0 mg/ dl) with normal glucose and cell count. Oligoclonal band was not seen; CSF Angiotensin converting enzyme (ACE) level was negative. Mantoux test had an induration of 21 × 21 mm. Serum IgM and IgG antibodies against tuberculosis were negative. Chest X-ray was normal.
|Figure 4: MRI T2W image of dorsal spine showing long segment of altered signal intensity in the dorsal spinal cord, suggestive of myelitis|
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Taking the total clinical features and laboratory data, the diagnostic possibility of Eales' disease with neurological complications was considered. He was put on steroids with which he showed gradual improvement. At 1-month follow-up, he improved remarkably with motor power of 4/5 in both lower limbs.
Henry Eales, a British ophthalmologist, described the clinical picture of recurrent retinal hemorrhages in young patients, which was later described by Wadsworth as retinal inflammation involving vessels.  Eales' disease predominantly affects healthy young adults with a male preponderance. Often, the disease starts in one eye, but eventually affects both the eyes in 70-80% of patients, though the extent of retinal involvement may not be the same.  Stroke and transient ischemia in Eales' disease are attributed to leptomeningeal vasculitis.  Occurrence of myelopathy and stroke together in the same patient is rarely described. Mishra et al. reported a case of young man with recurrent vitreous hemorrhages and acute amnestic confusional state, who subsequently developed myelopathy. Treatment of neurological complications in Eales' disease is controversial, but definite improvement with oral corticosteroids was seen in this patient.
| » References|| |
|1.||Das T, Biswas J, Kumar A, Nagpal PN, Namperumalsamy P, Patnaik B, et al. Eales' disease. Indian J Opthalmol 1994;42:3-18. |
|2.||Singhal BS, Dastur DK. Eales' disease with neurological involvement Part 1. Clinical features in 9 patients. J Neurol Sci 1976;27:313-21. |
|3.||Mishra UK, Jha S, Kalita J, Sharma K. Stroke: A rare presentation of Eales' disease. A case report. Angiology 1996;47:73-6. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]