Neurological complications of acute multifocal placoid pigment epitheliopathy. (September 2016) - Brownlee, W.J.
Highlights: AMPPE is an autoimmune chorioretinal disease that can be complicated by neurological involvement. A CSF lymphocytosis with isolated headache may predict cerebrovascular complications of AMPPE. Predictors of poor outcome are relapses, generalised seizures and multifocal infarction on MRI. MRI brain and CSF examination is recommended in AMPPE with neurological symptoms. AMPPEE with focal neurology or a CSF pleocytosis should be treated with steroids. Abstract: 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 3 months. Patients with AMPPE and an isolated headache with a CSF pleocytosis should be treated with oral steroids.