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Neuro-ophthalmology

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https://www.readbyqxmd.com/read/29796056/diffusion-weighted-magnetic-resonance-imaging-in-acute-retinal-pathology
#1
Omar Alsinaidi, Aasef G Shaikh
The authors describe diffusion-weighted magnetic resonance imaging (DWI) as an accessible way to screen for acute retinal pathology in emergency setting. They describe three proof-of-principle patients who had abrupt onset of vision loss from acute retinal pathology where DWI was diagnostic. The deficits included central retinal artery occlusion and acute retinitis with retinal necrosis. DWI can be non-specific for aetiology, but it can rapidly localise the retinal pathology and initiate early therapeutic interventions in the emergency room...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796055/metastatic-melanoma-of-the-optic-nerve-sheath
#2
Neil M D'souza, Huy D Nguyen, Stacy V Smith, Priyadharsini Nagarajan, Adi Diab, Richard C Allen, Dan S Gombos, Andrew G Lee
A 23-year-old man with a history of metastatic melanoma developed painful vision loss to counting fingers with enhancement of optic nerve on contrast-enhanced magnetic resonance imaging (MRI) and received a diagnosis of optic neuritis from an outside hospital. Despite empiric corticosteroid therapy, the patient worsened and developed secondary central retinal vein occlusion with further deterioration of vision. Repeat MRI demonstrated optic nerve sheath (ONS) involvement suggestive of optic perineuritis (OPN) and an ONS biopsy confirmed a rare case of isolated metastatic melanoma...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796054/optical-coherence-tomography-characterization-of-macular-changes-secondary-to-arteriovenous-fistula
#3
Isabel Pascual-Camps, Clara Martínez-Rubio, Roberto Gallego-Pinazo, Enrique España-Gregori
Arteriovenous fistulas (AVFs) are abnormal shunts between the arterial and venous vascular systems. These usually produce ocular pain, increased intraocular pressure (IOP), and diplopia. Less frequently, they may cause retinal changes with visual impairment. Our purpose is to illustrate different retinal manifestations of AVF. We report the multimodal imaging study of three cases with retinal changes due to AVF, showing neurosensory retinal detachment, macular oedema, and macular ischemia. In conclusion, AVF may appear with different ophthalmic alterations...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796053/ipilimumab-induced-adenohypophysitis-and-orbital-apex-syndrome-importance-of-early-diagnosis-and-management
#4
Bahareh Hassanzadeh, Jeffrey DeSanto, Jorge C Kattah
Ipilimumab is a novel anti-melanoma agent known to infrequently cause multi-organ autoimmunity. We report a case of pituitary hypophysitis and orbital inflammation followed by an orbital apex syndrome. A 64-year-old woman with a history of skin melanoma, receiving ipilimumab treatment, was seen for near total loss of vision in the right eye and proptosis. Headache of 3-month duration preceded the onset of diplopia followed by severe loss of vision in the right eye. Neuro-ophthalmologic examination was consistent with an orbital apex syndrome...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796052/pseudotumor-cerebri-syndrome-with-resolution-after-discontinuing-high-vitamin-a-containing-dietary-supplement-case-report-and-review
#5
Jason T Chisholm, Michelle M Abou-Jaoude, Amy B Hessler, Padmaja Sudhakar
A 24-year-old non-obese, but slightly overweight, female presented with a two-week history of progressive severe headache associated with two days of blurry vision. Clinical exam was significant for bilateral papilledema and an enlarged blind spot on visual field testing. Contrast enhanced MRI head revealed no space occupying lesion. A lumbar puncture revealed an elevated opening pressure of 38 cm H2 O with normal cerebrospinal fluid composition leading to a diagnosis of pseudotumor cerebri syndrome (PTCS)...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796051/visual-function-improvement-after-optic-nerve-sheath-fenestration-in-osteopetrosis-patients-with-optic-canal-stenosis-a-report-of-two-cases
#6
Daniah Alshowaeir, Abdulrazag Ajlan, Sajjad Hussain, Adel Alsuhaibani
The outcome of two patients with visual loss from osteopetrosis who underwent an optic nerve sheath fenestration (ONSF) is reported. A 20-year-old male and 26-year-old female with osteopetrosis had optic nerve edema. Computed tomography and magnetic resonance imaging demonstrated optic canals stenosis. Both patients underwent unilateral ONSF. After ONSF, the patients experienced improvement in visual acuity and optic nerve appearance. Therefore, when papilledema is recognized in osteopetrosis patients, it may be reasonable to start with an ONSF even if the optic canal seems to be stenotic because of the lower morbidity that is associated with this procedure compared with other surgical options...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796050/angiographic-findings-in-the-tolosa-hunt-syndrome-and-resolution-after-corticosteroid-treatment
#7
Krishnan Ravindran, Philip Schmalz, Nurhan Torun, Michael Ronthal, Yu-Ming Chang, Ajith J Thomas
The Tolosa-Hunt syndrome is a rare clinical condition characterized by painful opthalmoparesis associated with idiopathic granulomatous inflammation of the orbital apex and cavernous sinus. Historically, this condition was thought to result from arteritic changes in the internal carotid artery and cavernous sinus. Modern digital angiographic techniques were unavailable when THS was initially described, and few reports exist on its high-resolution angiographic findings. Painful ophthalmoparesis, especially of the oculomotor nerve, warrants vascular imaging because of the concern for an underlying aneurysm...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796049/basal-encephalocele-presenting-with-bitemporal-hemianopsia-in-an-adult-male
#8
Tyler Moore, Kenn Freedman
Basal encephaloceles are uncommon malformations that are usually congenital in nature, although, occasionally, they can be traumatic. When they are congenital, they are associated with skull and facial midline defects, central nervous system abnormalities, and possible ocular and visual problems. The authors present a case of an adult male with a basal encephalocele who presented with a bitemporal hemianopsia. Ocular abnormalities, visual loss, and visual field deficits have previously been reported in patients with basal encephalocele; however, there does not appear to be any reported cases with formal visual field testing to demonstrate specific defects such as a bitemporal hemianopsia...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796048/the-role-of-botulinum-toxin-in-the-management-of-ophthalmoplegia-secondary-to-miller-fisher-syndrome
#9
Siegfried K Wagner, Nabil Uddin, Saurabh Jain
Miller Fisher syndrome is an acute demyelinating polyneuropathy classically presenting with ataxia, areflexia, and ophthalmoplegia. The authors report the case of a 27-year-old female, who presented with limb weakness and double vision following a prodromal pharyngitis. Ophthalmic examination revealed fluctuant ophthalmoplegia eventually consistent with bilateral sixth cranial nerve palsies, prompting investigation for anti-ganglioside antibodies, which returned positive. Due to disabling diplopia, the patient was treated with botulinum toxin, with a resulting favourable reduction in the size of strabismus...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796047/eyelid-myokymia-with-concomitant-cerebral-tumour-a-case-report
#10
Yoshiyuki Kitaguchi, Maria Suzanne Sabundayo, Hirohiko Kakizaki
Eyelid myokymia is a localised movement disorder of the orbicularis oculi muscle with involuntary, fine, continuous, and undulating contractions. Although this entity is thought to be peripheral nerve origin, it rarely occurs with an intracranial lesion. The authors report a case of eyelid myokymia with concomitant cerebral tumour. A 52-year-old woman had a 6-month history of left eyelid myokymia accompanied by upper eyelid ptosis and lower eyelid reverse ptosis. Magnetic resonance imaging showed a solid mass measuring 20 × 25 × 20 mm in the temporal lobe of the cerebral cortex, showing isointense on T1-weighted and hyperintense on T2-weighted images...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796046/evaluation-of-a-relative-afferent-pupillary-defect-using-the-rapdx-%C3%A2-device-before-and-after-treatment-in-patients-with-optic-nerve-disease
#11
Tsukasa Satou, Hitoshi Ishikawa, Toshiaki Goseki, Ken Asakawa
We evaluated the amplitude and latency scores in the RAPDx® device together with other ophthalmic examinations, before and after treatment in four patients with optic nerve disease. In all patients, the visual acuity (VA) and visual field (VF) after treatment was resolved. Both scores after treatment were lower, with reduced laterality-based differences in VA and critical flicker fusion frequency (CFF). Even after treatment, 3 patients had laterality-based differences in circumpapillary retinal nerve fiber layer thickness (cpRFNLT)...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796045/relative-afferent-pupillary-defects-in-homonymous-visual-field-defects-caused-by-stroke-of-the-occipital-lobe-using-pupillometer
#12
Go Takizawa, Atsushi Miki, Fumiatsu Maeda, Katsutoshi Goto, Syunsuke Araki, Tsutomu Yamashita, Yoshiaki Ieki, Junichi Kiryu, Kiyoshi Yaoeda
Relative afferent pupillary defects (RAPD) may be detected in patients with occipital lobe lesions. However, no previous report has used an objective technique to record the abnormal pupillary light reflex in such cases. Therefore, we measured the pupillary light reflex objectively in 15 patients with homonymous visual field defects (HVFD) due to occipital stroke using a new pupillometer. This study detected significantly smaller and slower pupillary light reflexes in the contralateral eyes than in the other eyes, which is equivalent to the presence of RAPD in patients with HVFDs caused by retrogeniculate lesions using an objective technique...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29796044/steroids-in-the-management-of-synkinesis-after-traumatic-oculomotor-palsy-in-india
#13
Peter W MacIntosh, Virna Shah
Traumatic oculomotor nerve palsies may result in aberrant regeneration and synkinesis that can impair normal facial function. We retrospectively investigated 16 patients with traumatic oculomotor nerve palsies who were treated with and without steroids to evaluate the rates of aberrant regeneration. The overall rates of aberrant regeneration were similar between the two groups and in line with other published series. Some limitations to our study may limit our ability to detect real differences, and additional studies would be beneficial...
June 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29563959/bilateral-optic-nerve-involvement-combined-with-unilateral-facial-palsy-in-a-patient-with-acute-myeloid-leukaemia-a-case-report
#14
Suk-Yeon Lee, Seung-Hyun Kim, Suk-Gyu Ha
Central nervous system (CNS) involvement, including optic nerve involvement, in a patient with acute myeloid leukaemia (AML) is an extremely rare condition. We report a case of bilateral optic nerve involvement combined with unilateral facial palsy in a patient with AML who achieved complete remission following allogenic peripheral blood stem cell transplantation as a young patient. After further evaluation, the patient was diagnosed with a recurrence of AML with CNS involvement. The presentation of multiple types of CNS involvement in AML may be suspicious evidence of AML recurrence...
April 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29563958/papilloedema-and-autoimmune-retinopathy-from-systemic-lupus-erythematosus
#15
John J Chen, Neeraj Kumar, Kathleen M McEvoy, Jacqueline A Leavitt
A 33-year-old female presented with bilateral papilloedema and constricted visual fields from autoimmune retinopathy. She then developed a painful peripheral neuropathy that led to further work-up and the diagnosis of systemic lupus erythematosus. Papilloedema and autoimmune retinopathy from systemic lupus erythematosus is a unique presentation.
April 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29563957/multicentric-glioblastoma-multiforme-mimicking-optic-neuritis
#16
Francesco Pellegrini, Andrew G Lee, Cristina Cercato
A 49-year-old previously healthy woman presented with acute painless visual loss in the right eye, a right relative afferent pupillary defect, and a normal fundus examination. She was diagnosed with retrobulbar "optic neuritis" and given a course of intravenous steroids. Despite treatment, however, she continued to lose vision and serial visual field testing confirmed a junctional scotoma in the fellow eye. Cranial magnetic resonance imaging (MRI) showed a mass at the junction between the right optic nerve and the anterior aspect of the chiasm and a right frontal lesion that proved to be multicentric glioblastoma multiforme...
April 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29563956/tuberculomas-in-critical-locations-of-the-visual-pathway-a-masquerader
#17
Aastha Takkar, Karthik Vinay Mahesh, Ritu Shree, Julie Sachdeva, Sahil Mehta, Vivek Lal
Tuberculosis never stops fascinating physicians. The burden of tuberculosis is a major cause of disability. While drugs are often blamed when patients develop new focal deficits on treatment, the deterioration in these patients can have a myriad of causes including the development of new tuberculomas. Recognizing the critically located tuberculomas as potential causes of vision loss is indispensable. Here, we report two patients with strategic tuberculomas leading to vision loss. In one patient, the cause of visual morbidity was compression of the optic pathways; in the other patient, cortical vision loss was noted due to strategic location of tuberculomas...
April 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29563955/atypical-optic-neuritis-after-inactivated-influenza-vaccination
#18
Bokkwan Jun, Frederick W Fraunfelder
The existence of vaccine-associated optic neuritis is essentially based on the temporal relationship between the administration of a vaccine and the development of optic neuritis in patients with no other known aetiologies for infectious or non-infectious inflammation that could account for the optic neuritis. Influenza vaccine (inactivated or live attenuated) is considered to be one of vaccines that could be related to optic neuritis. The authors describe a rare case of bilateral asymmetric optic neuritis with leptomeningeal enhancement on magnetic resonance imaging (MRI) in a previously healthy young woman who received inactivated influenza vaccination 2 weeks before the onset of symptoms...
April 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29563954/evaluating-the-fat-distribution-in-idiopathic-intracranial-hypertension-using-dual-energy-x-ray-absorptiometry-scanning
#19
Catherine Hornby, Hannah Botfield, Michael W O'Reilly, Connar Westgate, James Mitchell, Susan P Mollan, Konstantinos Manolopoulos, Jeremy Tomlinson, Alexandra Sinclair
Idiopathic intracranial hypertension (IIH) is strongly associated with obesity. We aimed to utilise dual-energy X-ray absorptiometry (DEXA) to characterise fat distribution, and to evaluate change in fat mass and distribution following weight loss. IIH patients ( n = 24) had a similar fat distribution to body mass index (BMI)- and gender-matched obese controls ( n = 47). In the IIH cohort, truncal fat mass correlated with lumbar puncture pressure. Weight loss in IIH patients resulted in a significant reduction in disease activity and fat mass, predominantly from the truncal region (-4...
April 2018: Neuro-ophthalmology
https://www.readbyqxmd.com/read/29563953/diffusion-weighted-imaging-and-post-contrast-enhancement-in-differentiating-optic-neuritis-and-non-arteritic-anterior-optic-neuropathy
#20
Ore-Ofe O Adesina, J Scott McNally, Karen L Salzman, Bradley J Katz, Judith E A Warner, Molly McFadden, Kathleen B Digre
Non-arteritic anterior ischaemic optic neuropathy (NAION) and optic neuritis (ON) may be difficult to distinguish early in their disease courses. Our goal was to determine if specific magnetic resonance imaging characteristics differentiate acute NAION from ON. Neuroradiologists, masked to diagnosis, reviewed the diffusion-weighted imaging (DWI) and post-contrast enhancement (PCE) characteristics of the optic nerve in 140 eyes. PCE and DWI signals of the optic disc alone did not discriminate between NAION and ON...
April 2018: Neuro-ophthalmology
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