Browsing by Author "Kuruppu, Dulanji K."

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    Concurrent cerebral toxoplasmosis and cytomegalovirus retinitis in a patient with human immunodeficiency virus
    (Elsevier, 2019) Kuruppu, Dulanji K.; Giuliari, G. Paolo; Mackay, Devin D.; Neurology, School of Medicine
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    Unilateral Optic Neuritis and Central Retinal Vasculitis due to Ocular Syphilis
    (Wolters Kluwer, 2020) Khan, Murtaza S.; Kuruppu, Dulanji K.; Popli, Tanav A.; Moorthy, Ramana S.; Mackay, Devin D.; Neurology, School of Medicine
    Purpose: Report a case of concurrent unilateral optic neuritis and central retinal artery occlusion as the presenting signs of syphilis. Methods: A case report of a 22-year-old man with progressive unilateral vision loss. Results: With no known previous history of syphilis, genital lesions, or other extraocular manifestations, the patient presented with pain with eye movements and decreased color vision. His vision dramatically worsened after a course of oral steroids. Examination was remarkable for severe right optic disk edema with a macular cherry-red spot and mild posterior uveitis. Magnetic resonance imaging of the orbits with contrast revealed enhancement and enlargement of the distal right optic nerve. Fluorescein angiography demonstrated delayed filling of the right central retinal artery, suggestive of impending central retinal artery occlusion. Syphilis serologies were positive from the serum, and cerebrospinal fluid Venereal Disease Research Laboratory test was reactive, consistent with neurosyphilis. Oral steroids were discontinued and vision improved with 2 weeks of intravenous penicillin. Conclusion: This unusual case highlights one of the possible initial presentations of syphilis: unilateral optic neuritis and central retinal artery vasculitis with mild posterior uveitis. The worsening of vision after administration of oral steroids also highlights a potential complication of oral steroid use in the absence of a known etiology of vision loss. A thorough history and examination may be helpful in identifying risk factors for infectious causes, including syphilis, and should prompt additional evaluation.
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    Young-Onset Dementia
    (Thieme, 2013) Kuruppu, Dulanji K.; Matthews, Brandy R.; Neurology, School of Medicine
    Young-onset dementia (YOD) is an neurological syndrome that affects behavior and cognition of patients younger than 65 years of age. Although frequently misdiagnosed, a systematic approach, reliant upon attainment of detailed medical history, collateral history from an informant, neuropsychological testing, laboratory studies, and neuroimaging, may facilitate earlier and more accurate diagnosis with subsequent intervention. The differential diagnosis of YOD is extensive and includes early-onset forms of adult neurodegenerative conditions including Alzheimer's disease, vascular dementia, frontotemporal dementia, Lewy body dementias, Huntington's disease, and prion disease. Late-onset forms of childhood neurodegenerative conditions may also present as YOD and include mitochondrial disorders, lysosomal storage disorders, and leukodystrophies. Potentially reversible etiologies including inflammatory disorders, infectious diseases, toxic/metabolic abnormalities, transient epileptic amnesia, obstructive sleep apnea, and normal pressure hydrocephalus also represent important differential diagnostic considerations in YOD. This review will present etiologies, diagnostic strategies, and options for management of YOD with comprehensive summary tables for clinical reference.