Acute Visual Disorders—What Should the Neurologist Know?

2019 ◽  
Vol 39 (01) ◽  
pp. 053-060 ◽  
Author(s):  
Anthony Brune ◽  
Daniel Gold
Keyword(s):  
Vision Loss ◽  
Normal Function ◽  
Normal Vision ◽  
Acute Therapy ◽  
Subtle Change ◽  
Acute Setting ◽  
Life Threatening ◽  
Anatomic Distribution ◽  
Eye Symptoms ◽  
Efferent Pathways

AbstractNormal vision requires coordination of precisely controlled and coordinated eye movements and normal function of a large cortical and subcortical sensory network. Given the required precision of the system and wide anatomic distribution of the motor and sensory visual systems, vision can be disrupted by a variety of central and peripheral nervous system disorders. While many of these may be relatively benign or have no proven therapy, several may be isolated presentations or harbingers of more serious neurologic conditions. Both monocular and binocular vision losses may be isolated presentations of stroke or its equivalent. Other etiologies of monocular vision loss may represent the initial presentation of potentially disabling conditions. Binocular diplopia, caused by impaired movement of one or both eyes, may represent a condition with no acute therapy and a benign natural history, or a progressive potentially life-threatening syndrome. Most people are heavily reliant upon vision, so that even a subtle change in vision due to disturbed afferent or efferent pathways is invariably noticed, and presentation to the emergency department for eye symptoms is common. The accurate evaluation of these patients in the acute setting is essential to identify the patients requiring immediate testing or treatment.

scholarly journals Catheter Ablation of Life-Threatening Ventricular Arrhythmias in Athletes

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 205
Author(s):  
Nicola Tarantino ◽  
Domenico G. Della Rocca ◽  
Nicole S. De Leon De La Cruz ◽  
Eric D. Manheimer ◽  
Michele Magnocavallo ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Ventricular Arrhythmias ◽  
Individual Factors ◽  
Substantial Part ◽  
Arrhythmogenic Substrate ◽  
Life Threatening ◽  
History Of ◽  
Anatomic Distribution ◽  
Artery Disease ◽  
Surveillance Analysis

A recent surveillance analysis indicates that cardiac arrest/death occurs in ≈1:50,000 professional or semi-professional athletes, and the most common cause is attributable to life-threatening ventricular arrhythmias (VAs). It is critically important to diagnose any inherited/acquired cardiac disease, including coronary artery disease, since it frequently represents the arrhythmogenic substrate in a substantial part of the athletes presenting with major VAs. New insights indicate that athletes develop a specific electro-anatomical remodeling, with peculiar anatomic distribution and VAs patterns. However, because of the scarcity of clinical data concerning the natural history of VAs in sports performers, there are no dedicated recommendations for VA ablation. The treatment remains at the mercy of several individual factors, including the type of VA, the athlete’s age, and the operator’s expertise. With the present review, we aimed to illustrate the prevalence, electrocardiographic (ECG) features, and imaging correlations of the most common VAs in athletes, focusing on etiology, outcomes, and sports eligibility after catheter ablation.

scholarly journals Uveal Melanoma and Secondary Angle-Closure Crisis: A Case Report and Literature Review

2021 ◽  
pp. 476-480
Author(s):  
Tung Thanh Hoang ◽  
Tuan Anh Hoang ◽  
Peter McCluskey ◽  
John Grigg
Keyword(s):  
Retinal Detachment ◽  
Uveal Melanoma ◽  
Vision Loss ◽  
Serous Retinal Detachment ◽  
Anterior Segment ◽  
Angle Closure ◽  
Large Tumor ◽  
Tumor Mass ◽  
Healthy Female ◽  
Life Threatening

A 66-years-old Vietnamese healthy female patient presented with prolonged severe right ocular pain and complete vision loss in that eye. Anterior segment assessment including gonioscopy identified angle-closure configuration. A suspected ciliary body melanoma was seen through the pupil. Posterior segment examination revealed a large tumor mass and 360° retinal detachment (kissing configuration). An ultrasound examination was consistent with a uveal tumor. The painful, blind right eye with a tumor mass was enucleated. Histopathology confirmed a type A uveal spindle cell melanoma associated with total serous retinal detachment without evidence of tumor necrosis, epithelioid cells, scleral, or optic nerve infiltration. There was no evidence of metastasis after 1-year of follow-up. It is critically important to differentiate primary and secondary angle closure, especially in cases with life-threatening ocular malignancy as uveal melanoma.

Life-threatening presentation of a parahiatal hernia after esophagectomy: a case report and review of the literature

2021 ◽  
Vol 14 (6) ◽  
pp. e242158
Author(s):  
Camille Plourde ◽  
Émilie Comeau
Keyword(s):  
Small Bowel ◽  
Transverse Colon ◽  
Acute Abdominal Pain ◽  
Haemodynamic Instability ◽  
Acute Setting ◽  
X Ray ◽  
Left Diaphragm ◽  
Life Threatening ◽  
Chest X Ray ◽  
Obstructive Shock

A woman presented to our hospital with acute abdominal pain 7 months following an oesophagectomy. A chest X-ray revealed a new elevation of the left diaphragm. CT demonstrated a large left diaphragmatic hernia incarcerated with non-enhancing transverse colon and loops of small bowel. She deteriorated rapidly into obstructive shock and was urgently brought to the operating room for a laparotomy. The diaphragmatic orifice was identified in a left parahiatal position, consistent with a parahiatal hernia. Incarcerated necrotic transverse colon and ischaemic loops of small bowel were resected, and the diaphragmatic defect was closed primarily. Because of haemodynamic instability, the abdomen was temporarily closed, and a second look was performed 24 hours later, allowing anastomosis and definitive closure. Parahiatal hernias are rare complications following surgical procedures and can lead to devastating life-threatening complications, such as an obstructive shock. Expeditious diagnosis and management are required in the acute setting.

scholarly journals Scapulothoracic dissociation

2019 ◽  
Vol 92 (1101) ◽  
pp. 20190090
Author(s):  
Kimia Khalatbari Kani ◽  
Felix S Chew
Keyword(s):  
Differential Diagnosis ◽  
Shoulder Girdle ◽  
High Energy ◽  
Imaging Evaluation ◽  
Acute Setting ◽  
High Energy Trauma ◽  
Diagnosis And Management ◽  
Life Threatening ◽  
Spectrum Imaging ◽  
Scapulothoracic Dissociation

Scapulothoracic dissociation is a rare and potentially limb- and life-threatening injury, that results from high-energy trauma. Scapulothoracic dissociation has the potential to be overlooked in the acute setting, especially in the setting of polytrauma. Therefore, a careful search for this condition should be performed in all patients with high-energy shoulder girdle injuries. The goals of this article are to review the anatomy of the scapulothoracic articulation as well as the spectrum, imaging evaluation, differential diagnosis and management of scapulothoracic dissociations.

Abstract 12913: Trabectedin Related Reversible Cardiogenic Shock: A Rare Side Effect of Anti-neoplastic Drug

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Samir Jha ◽  
Jimmy Wang ◽  
Roshan Jha ◽  
Jerel M Zoltick
Keyword(s):  
Cardiogenic Shock ◽  
Synovial Sarcoma ◽  
Side Effect ◽  
Palliative Chemotherapy ◽  
Stress Test ◽  
Progression Free Survival ◽  
Cardiac Risk ◽  
Risk Profile ◽  
Normal Function ◽  
Life Threatening

Trabectedin, an alkylating agent, is used as palliative chemotherapy of soft-tissue sarcoma after failure of first-line treatment. It is labeled as a low cardiac risk profile. We present a case of a lady with metastatic synovial sarcoma with a pre-treatment normal echocardiography, who received 3 cycles of Trabectedin, and presented in cardiogenic shock which reversed back to normal function with vasopressor, diuresis and inotrope support. Case report: A 66-year-old female with metastatic synovial sarcoma of lungs (post right upper lobectomy and chemotherapy), with positive mediastinal and hilar nodes improvement, was transferred in with hypotension and respiratory distress. She was recently started on trabectedin as palliative chemotherapy, about 2 months prior to this admission, received 3 cycles, the last cycle was 4 days prior to admission. There was an elevation of high-sensitivity troponin (peaked to 2000) which trended down. With metastatic disease and ongoing thrombocytopenia (post-chemotherapy), cardiac catheterization was not deemed appropriate, managed medically with inotrope, and pressor support for cardiogenic shock. A nuclear stress test done after weaning off all intravenous medicine showed an LVEF of 55% without any area of ischemic defect. As no other precipitants were identified and with reversibility of cardiac function over time, we considered these events were related to trabectedin toxicity. Discussion: For the use of Trabectedin, there is no specific caution for patients with cardiac disease or risk factors hence labeled as low cardiac risk profile by comprehensive analysis. This case highlights a rare but life-threatening side effect of this drug. It is important to balance the potential of an increase in progression-free survival with chemotherapy versus a life-threatening adverse effect which may counter-effect the mortality benefit and highlights a need for close serial monitoring.

Atrial fibrillation and supraventricular arrhythmias

2021 ◽  
pp. 719-739
Author(s):  
Demosthenes G Katritsis ◽  
A John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Differential Diagnosis ◽  
Cycle Length ◽  
Accessory Pathway ◽  
Atrial Arrhythmias ◽  
Supraventricular Arrhythmias ◽  
Acute Setting ◽  
Epidemiology Data ◽  
Life Threatening ◽  
Appropriate Therapy

The term supraventricular tachycardia (SVT) refers to atrial arrhythmias, including atrial fibrillation, atrioventricular nodal reentry, and atrioventricular reentry due to accessory pathway(s). In clinical practice, SVT may present as narrow- or wide-QRS tachycardias, and with the potential exception of atrial fibrillation, most of them are usually, although not invariably, manifest as regular rhythms. They are usually intrusive, symptomatic, and anxiety provoking but not dangerous. However, depending on their cycle length and the patient's background, they could also be, rarely, life-threatening conditions. In the acute setting, consideration of epidemiology data, clinical presentation, and the 12 lead ECG can provide diagnostic clues for differential diagnosis between SVT and ventricular arrhythmias, and guide appropriate therapy.

scholarly journals The effects of temporal pressure on obstacle negotiation and gaze behaviour in young adults with simulated vision loss

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Tjerk Zult ◽  
Jonathan Allsop ◽  
Matthew A. Timmis ◽  
Shahina Pardhan
Keyword(s):  
Vision Loss ◽  
Time Pressure ◽  
Normal Vision ◽  
Movement Kinematics ◽  
Blurred Vision ◽  
Constant Frequency ◽  
Everyday Activities ◽  
Fixation Durations ◽  
Gaze Behaviour ◽  
Temporal Pressure

Abstract Individuals with vision loss adapt their locomotion and gaze behaviour to safely negotiate objects in temporally unconstrained situations. However, everyday activities are often performed under time-pressure. We investigated the effects of blur on anxiety, movement kinematics and gaze behaviour during the negotiation of a floor-based obstacle under three amounts of pressure: 1) no-pressure; 2) tonal-pressure: an intermittent tone was played at a constant frequency; 3) tonal + time pressure: the intermittent tone increased in frequency and participants had to walk 20% faster to reach the end of the lab. Irrespective of the amount of pressure, the blurred vs. normal vision group reported 32% more anxiety, lifted the lead foot 43% higher and 10% slower over the obstacle, and looked 6% longer and 6% more frequently ahead of the obstacle. In the tonal + time pressure vs. no-pressure condition, both groups were more anxious, showed adaptations in movement kinematics related to walking faster, and adopted a ‘checking strategy’ by shortening their fixation durations at the obstacle. These results show that irrespective of temporal pressure, the blurred vision group remained more cautious as to how the lead foot negotiated the obstacle, in order to reduce the chance of tripping during crossing.

Hereditary Angioedema: Management of Laryngeal Attacks

2011 ◽  
Vol 25 (6) ◽  
pp. 379-382 ◽  
Author(s):  
Sandra C. Christiansen ◽  
Bruce L. Zuraw
Keyword(s):  
Hereditary Angioedema ◽  
Treatment Options ◽  
The United States ◽  
Fresh Frozen Plasma ◽  
C1 Inhibitor ◽  
Acute Therapy ◽  
Fresh Frozen ◽  
Life Threatening ◽  
Frozen Plasma ◽  
Future Management

Background Hereditary angioedema (HAE) patients suffering from laryngeal attacks in the United States faced severely limited treatment options until 2008. These potentially life-threatening episodes occur in over one-half of the patients affected by HAE during their lifetimes. Acute therapy had been relegated to supportive care, intubation, and consideration of fresh frozen plasma (FFP)–-the latter with the potential for actually accelerating the speed and severity of the swelling. Methods In this article we will review the recently approved and emerging HAE treatments that have evolved from the recognition that bradykinin generation is the fundamental abnormality leading to attacks of angioedema. Results Acute therapy for laryngeal attacks will be discussed including purified plasma–derived C1 inhibitor (C1INH), recombinant C1INH, an inhibitor of plasma kallikrein (ecallantide), and a B2 receptor antagonist (icatibant). Prophylactic care has also been transformed from a reliance on attenuated androgens with their attendant side effects to C1INH replacement. Conclusion The arrival of these novel therapies promises to transform the future management of HAE.

scholarly journals Decreased Vision as Initial Presenting Symptom of Acute Lymphoblastic Leukemia: A Case Report

2016 ◽  
Vol 7 (2) ◽  
pp. 377-383 ◽  
Author(s):  
Christoph Palme ◽  
Nikolaos E. Bechrakis ◽  
Martin Stattin ◽  
Gertrud Haas ◽  
Claus Zehetner
Keyword(s):  
Bone Marrow ◽  
Case Report ◽  
Acute Lymphoblastic Leukemia ◽  
Bone Marrow Biopsy ◽  
Vision Loss ◽  
Lymphoblastic Leukemia ◽  
Interdisciplinary Approach ◽  
Crucial Importance ◽  
Hematologic Disorders ◽  
Life Threatening

This case illustrates that hematologic disorders must be considered as a potentially life-threatening cause for vision loss. Proper laboratory workup and timely interdisciplinary approach are essential to ensure the best possible care for ophthalmic patients. Historically, before the use of bone marrow biopsy, the ophthalmologist was often asked to assist in the diagnosis of leukemia. Since ophthalmological symptoms may be the initial presenting signs of leukemia as highlighted in this case, the ophthalmogist is still of crucial importance.

scholarly journals Nonspecific abdominal pain: Do I have to allocate a specific diagnosis for every patient?

2022 ◽  
Keyword(s):  
Abdominal Pain ◽  
Care Setting ◽  
Acute Abdominal Pain ◽  
Scoring Systems ◽  
Acute Care Setting ◽  
Acute Setting ◽  
The World ◽  
Threatening Condition ◽  
Chief Complaints ◽  
Life Threatening

Acute abdominal pain is one of the most common chief complaints in the acute setting all over the world. The definitive diagnoses of these patients vary depending on age, gender, geographical and sociodemographic characteristics etc. Apart from these, aging of the population, obesity, advanced diagnostic imaging modalities and changes in nutritional habits also have an impact on the rates of specific diagnoses. On the other hand, nonspecific abdominal pain constitutes almost half of all visits due to acute abdominal pain in the acute care setting. This phenomenon is the main differential diagnostic problem in the management of these patients because missing a life-threatening condition can cause enormous medicolegal problems for the caregivers. Certain diagnostic scoring systems have also been developed to facilitate recognition and management of these conditions. This article aims to review the entity and underline the challenges it can bring to the scene.

Sign in / Sign up

Export Citation Format

Share Document