Approach to Common Visual Complaints Presenting to the Outpatient Neurologist

2021 ◽  
Vol 41 (06) ◽  
pp. 699-716
Author(s):  
Christine Greer ◽  
Marc Dinkin
Keyword(s):  
Systematic Approach ◽  
Vision Loss ◽  
Temporal Arteritis ◽  
Pituitary Apoplexy ◽  
Posterior Communicating Artery ◽  
Dry Eyes ◽  
Visual Phenomena ◽  
Congenital Strabismus ◽  
Visual Complaints ◽  
Localize Disease

AbstractVisual complaints are commonly encountered by the practicing neurologist. We review assessment of vision loss, diplopia, and positive visual phenomena, all of which require a thoughtful evaluation to localize disease and refine management. While many causative entities are unlikely to cause poor visual outcomes, including dry eyes, migraine, and congenital strabismus, others may threaten vision, life, or both, such as posterior communicating artery aneurysms, pituitary apoplexy, or temporal arteritis. A systematic approach to vision loss and diplopia is reviewed along with focused differential diagnoses.

Apoplectic lymphocytic hypophysitis

2003 ◽  
Vol 98 (1) ◽  
pp. 183-185 ◽  
Author(s):  
Michael S. Lee ◽  
Misha Pless
Keyword(s):  
Magnetic Resonance Imaging ◽  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Lymphocytic Hypophysitis ◽  
Histopathological Analysis ◽  
Resonance Imaging ◽  
Content Type ◽  
Sellar Lesion ◽  
Suprasellar Extension ◽  
Fine Print

✓ Pituitary apoplexy has not been reported in the setting of lymphocytic hypophysitis. The authors present the case of a woman with sudden vision loss and headache. Magnetic resonance imaging revealed focal hemorrhages in a sellar lesion with suprasellar extension. The results of histopathological analysis were consistent with lymphocytic hypophysitis.

scholarly journals Central serous retinopathy: an unusual cause of acute visual loss

CJEM ◽  
2013 ◽  
Vol 15 (05) ◽  
pp. 311-313
Author(s):  
Jennifer L. Chu ◽  
Jeffrey Tyberg
Keyword(s):  
Emergency Medicine ◽  
Visual Loss ◽  
Vision Loss ◽  
Temporal Arteritis ◽  
Typical Case ◽  
Central Serous Retinopathy ◽  
Functional Disorders ◽  
Emergency Physicians ◽  
Acute Visual Loss ◽  
Ed Visits

ABSTRACT Ophthalmologic complaints represent approximately 2% of emergency department (ED) visits. Acute vision loss is the most serious of such presentations and requires prompt assessment for a treatable cause. The differential diagnosis for acute vision loss includes retinal detachment, macular disorders, vaso-occlusive disorders, temporal arteritis, neuro-ophthalmologic disorders, and functional disorders. We report the case of a previously healthy 33-year-old man who presented to the ED with acute bilateral vision loss that was ultimately diagnosed as central serous retinopathy (CSR), an idiopathic, self-limited condition that typically affects males age 20 to 50 years. This condition is not mentioned in standard emergency medicine textbooks or the emergency medicine literature, and our hope is that our report will serve to illustrate a typical case of CSR and help prompt emergency physicians to consider this diagnosis in the appropriate circumstances.

scholarly journals Temporal Arteritis and Vision Loss in Microscopic Polyangiitis: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Alexander G. Goglia ◽  
Michael Makar ◽  
Craig Vanuitert ◽  
Vadim Finkelstein
Keyword(s):  
Vision Loss ◽  
Temporal Arteritis ◽  
Microscopic Polyangiitis ◽  
Systemic Vasculitis ◽  
Temporal Artery ◽  
Multiple Organ ◽  
The Body ◽  
Temporal Artery Biopsy ◽  
Rare Finding ◽  
Organ Systems

Microscopic polyangiitis (MPA) is an idiopathic autoimmune disease characterized by systemic vasculitis. While the lungs and kidneys are the major organs affected by MPA, it is known to involve multiple organ systems throughout the body. Temporal artery involvement is a very rare finding in MPA. This report presents a patient whose initial presentation was consistent with giant cell arteritis but was ultimately found to have microscopic polyangiitis. It highlights the importance of considering alternative types of vasculitis in the differential diagnosis for patients with atypical temporal artery biopsy findings.

Unexplained Vision Loss

2019 ◽  
pp. 89-92
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Clinical Features ◽  
Refractive Error ◽  
Visual Function ◽  
Vision Loss ◽  
Diagnostic Evaluation ◽  
Cone Dystrophy ◽  
Autoimmune Retinopathy ◽  
Clinical Strategies ◽  
Cancer Associated Retinopathy ◽  
Visual Complaints

When visual complaints are out of proportion to examination findings, nonorganic vision loss or a disorder of higher visual function may be suspected. However, certain ophthalmic causes of vision loss should also be considered. In this chapter, we begin by reviewing potential causes of unexplained vision loss, including refractive error, corneal disorders (e.g., keratoconus), optic neuropathy, and occult retinopathy. We next discuss clinical strategies and investigations that can help to identify certain causes of unexplained vision loss. Lastly, we discuss the clinical features, causes, and diagnostic evaluation of occult retinopathy, with a focus on conditions that cause cone photoreceptor dysfunction, such as cone dystrophy, cancer-associated retinopathy, and autoimmune retinopathy.

scholarly journals Rapid Pituitary Apoplexy Regression: What Is the Time Course of Clot Resolution?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Devon L. Jackson ◽  
Jamie J. Van Gompel
Keyword(s):  
Time Course ◽  
Spontaneous Regression ◽  
Pituitary Apoplexy ◽  
Mass Effect ◽  
Sudden Onset ◽  
Pituitary Mass ◽  
Initial Event ◽  
Original Size ◽  
Visual Complaints

A 29-year-old male patient with a functioning pituitary macroadenoma is discussed. The pituitary mass was detected by MRI after the patient presented with sudden onset of headache, suggestive of an apoplectic event. The headache resolved with analgesic medications. Within a follow-up period of one week, the pituitary mass had spontaneously regressed to nearly half its original size without any therapy. The patient never reported any visual complaints and displayed no signs of hypopituitarism. Elevated prolactin levels were present. Seven weeks after the initial event, the pituitary mass showed continued regression on MRI. Prolactin levels remained elevated. This case provides a unique look at the rapid spontaneous regression of mass effect that may occur following apoplexy of a pituitary adenoma.

scholarly journals Pituitary Apoplexy May Be Mistaken for Temporal Arteritis

2019 ◽  
Vol 6 (11) ◽  
pp. 1
Author(s):  
Bárbara Pedro ◽  
Tereza Patrícia ◽  
Fernando Aldomiro
Keyword(s):  
Temporal Arteritis ◽  
Pituitary Apoplexy

Hemorrhagic Presentation of Rathke Cleft Cysts: A Surgical Case Series

2019 ◽  
Vol 18 (5) ◽  
pp. 470-479 ◽  
Author(s):  
Lauren Schooner ◽  
Michelle A Wedemeyer ◽  
Phillip A Bonney ◽  
Michelle Lin ◽  
Kyle Hurth ◽  
...  
Keyword(s):  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Acute Onset ◽  
Oculomotor Nerve Palsy ◽  
Rare Presentation ◽  
Presenting Symptoms ◽  
Endocrine Disturbances

Abstract BACKGROUND Rathke cleft cysts (RCCs) are benign sellar and suprasellar lesions commonly presenting as asymptomatic incidental findings. Rarely, RCCs hemorrhage and mimic pituitary apoplexy on presentation. OBJECTIVE To review a series of hemorrhagic RCCs for physicians encountering this rare presentation. METHODS A database review of >1700 transsphenoidal pituitary operations was performed at the USC Pituitary Center to identify patients with pathologically confirmed RCCs presenting with acute symptoms and evidence of hemorrhage at the time of surgery. Surgical treatment involved transsphenoidal RCC fenestration and drainage. Clinical, endocrine, and imaging outcomes were reviewed. RESULTS A total of 119 RCCs were identified, and 6 (5.0%) presented with hemorrhage mimicking pituitary apoplexy. Presenting symptoms included acute onset headaches (5/6), vision loss (2/6), and oculomotor nerve palsy (n = 1). Endocrine disturbances at presentation included pre-existing amenorrhea in all female patients (3/3), hypothyroidism (n = 2), panhypopituitarism (n = 2), and one with profound hyponatremia (Na 116 meq/L). All patients underwent endonasal transsphenoidal fenestration and drainage with no major complications. Over mean follow-up of 38.4 mo, 2/2 patients with vision loss reported improvement, and 2/5 patients with headaches reported improvement. Although all women resumed menses, patients with preoperative hypopituitarism did not experience pituitary axis improvement. Follow-up magnetic resonance imaging showed no instances of RCC recurrence with a mean imaging follow-up of 38.6 mo. CONCLUSION RCCs occasionally present with hemorrhage and clinical symptoms that may be confused with apoplexy. Outcomes following hemorrhagic RCC treatment are excellent when treated at tertiary pituitary centers. Although hyperprolactinemia often improves following surgery, other pituitary axis deficits typically do not.

scholarly journals Ruptured aneurysm–induced pituitary apoplexy: illustrative case

2021 ◽  
Vol 1 (26) ◽  
Author(s):  
Michiharu Yoshida ◽  
Takeshi Hiu ◽  
Shiro Baba ◽  
Minoru Morikawa ◽  
Nobutaka Horie ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Relevant Literature ◽  
Artery Aneurysm ◽  
Ruptured Aneurysm ◽  
Illustrative Case ◽  
Aneurysmal Rupture ◽  
Giant Pituitary Adenoma

BACKGROUND Pituitary apoplexy associated with aneurysmal rupture is extremely rare and may be misdiagnosed as primary pituitary adenoma apoplexy. The authors present a case of a patient with pituitary apoplexy caused by rupture of an anterior cerebral artery aneurysm embedded within a giant pituitary adenoma, and they review the relevant literature. OBSERVATIONS A 78-year-old man experienced sudden headache with progressive vision loss. Magnetic resonance imaging (MRI) revealed a giant pituitary tumor with abnormal signal intensity. Magnetic resonance angiography immediately before surgery showed a right A1 segment aneurysm, suggesting coexisting pituitary apoplexy and ruptured aneurysm. The patient underwent urgent transsphenoidal surgery for pituitary apoplexy. The tumor was partially removed, but the perianeurysmal component was left behind. Subsequent cerebral angiography showed a 5-mm right A1 aneurysm with a bleb that was successfully embolized with coils. Retrospective review of preoperative dynamic MRI showed extravasation of contrast medium from the ruptured aneurysm into the pituitary adenoma. Histopathologic examination showed gonadotroph adenoma with hemorrhagic necrosis. Postoperatively, the patient’s visual function improved. LESSONS MRI identification of pituitary apoplexy caused by aneurysmal rupture has not been reported previously. Aneurysmal rupture should be considered in the differential diagnosis of pituitary apoplexy. When a ruptured aneurysm is encountered, the authors recommend treating it before addressing pituitary apoplexy.

scholarly journals Endoscopic Endonasal Transsphenoidal Resection for Pituitary Apoplexy during the Third Trimester of Pregnancy

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Adesh Tandon ◽  
Juan Alzate ◽  
Patrick LaSala ◽  
Marvin P. Fried
Keyword(s):  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Third Trimester ◽  
Endoscopic Endonasal ◽  
Acute Hemorrhage ◽  
The Third ◽  
Vascular Insufficiency ◽  
The Brain ◽  
Transsphenoidal Resection

Pituitary apoplexy is an uncommon phenomenon typically characterized by vascular insufficiency or acute hemorrhage into a pituitary adenoma. The overall incidence of pituitary apoplexy ranges between 1 and 25% of all pituitary adenomas. With the widespread use of MRI technology, the diagnosis of asymptomatic intratumoral hemorrhage is closer to 10%. The authors report a case of a 27-year-old female in her 36th week of pregnancy who presented with severe onset headache and acute left-sided vision loss. MRI of the brain revealed a large hemorrhagic mass occupying the sella turcica. The patient underwent an emergent endoscopic endonasal transsphenoidal resection for pituitary apoplexy. Postoperatively, the patient’s neurologic deficit resolved. Minimally invasive endoscopic endonasal transsphenoidal resection of pituitary apoplexy can be safely utilized in third trimester pregnant women presenting with acute severe neurologic deficits.

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