A Stereotyped Syndrome with Retro-Ocular Pain, Photophobia, and Visual Disturbance Masquerading as Optic Neuritis: Case Series

Background: Craniopharyngioma is a benign tumor of sellar & Suprasellar area with bimodal distribution. Visual disturbance isone of the common clinical presentation. Early surgical intervention results in favourable results.Objective: To analyze visual outcome after surgical removal of craniopharyngioma via pterional craniotomy.Material and Methods: This observational descriptive case series was conducted at department of neurosurgery,LRH/Peshawar. Duration of study was 18 months from Jan 2017 to June 2018. The study included patients withcraniopharyngioma, who underwent surgery in elective setup, newly diagnosed cases and patients operated via pterionalapproach. All those patients who presented in crisis like acute hydrocephalus, operated via other approaches and recurrent caseswere excluded from this study. The changes of visual function (visual acuity and field) of the patients were assessed preoperativelyand postoperatively, documented by a predesigned proforma and paired data of this change were compared. Visual assessmentwas done on follow up visits on 2 weeks,1 month,3 months and 6 months. Chi square test was applied as statistical test. Data wasanalysed through SPSS version 17.Results: Total number of patients were (30) with Male to female ratio was 1.5:1.Age of patients were Ranging from 4 year to 62years (mean 35 years).There were 23 Children (76.6%) and 7 Adults (23.3%).Out of 30 patients, 21 patients(70%) presented withvisual disturbance and 9 patients (30%) had non opthalmogical symptoms. Optic atrophy was seen in 6 patients (20%) preoperatively.Per operatively tumor was found in suprasellar area in 24 patients(80%) and in both supra+infrasellar area in 6patients(20%). Tumor size was less than 3cm in 19 patients(63.3%) and more than 3cm in 11 patients(36.6%). Morphology peroperatively was cystic in 19 patients(63.3%), solid in 5 patients(16.6%) and both solid and cystic in 6 patients(20%). Calcification intumor was seen in 16 patients(53.3%). Gross total resection(GTR) of tumor was done in only 21 patients(70%). Post-operativefollow up assessment of visual status showed that (50%) of patients improved.Conclusion: Craniopharyngioma is a benign tumor with malignant behaviour so timely intervention give favourable results.

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Vision improvement in severe acute isolated optic neuritis after plasma exchange treatment in Chinese population: a prospective case series study

Therapeutic Advances in Neurological Disorders ◽

10.1177/1756286420947977 ◽

2020 ◽

Vol 13 ◽

pp. 175628642094797

Author(s):

Shaoying Tan ◽

Tsz Kin Ng ◽

Quangang Xu ◽

Mo Yang ◽

Yuan Zhuang ◽

...

Keyword(s):

Optic Neuritis ◽

Plasma Exchange ◽

Time Window ◽

Case Series ◽

Visual Outcome ◽

Chinese Patients ◽

High Dose ◽

Visual Outcomes ◽

Double Filtration Plasmapheresis ◽

Case Series Study

Background: Plasma exchange (PE) is often considered as an effective treatment for neuromyelitis optica spectrum disorder (NMOSD) and several inflammatory demyelinating disorders of the central nervous system. This study aimed to evaluate the visual outcomes of Chinese patients with severe acute isolated optic neuritis (ON) who received PE therapy after high-dose intravenous methylprednisolone (IVMP) treatment. Methods: Thirty-seven acute isolated ON patients experiencing their first attack of severe visual impairment without neurological disability were recruited. All subjects received five cycles of double-filtration plasmapheresis. Visual acuity (VA) was documented at onset, 1 day before PE treatment, at each cycle of PE therapy and at the 1-month follow-up visit. Results: This study included 26 female (70.3%) and 11 male (29.7%) subjects, and 18 subjects (48.6%) had bilateral involvement. The time window between onset and PE treatment was 27.3 ± 12.7 days (range: 6–53 days). Mean VA (logMAR) of the studied eyes at onset, 1-day before PE treatment/after IVMP and after the fifth PE treatment were 3.41 ± 1.50, 2.61 ± 1.64 and 1.66 ± 1.52, respectively ( p < 0.001). Nineteen eyes (51.4%) showed no light perception at the onset, and 17 eyes (45.9%) improved to Snellen VA >20/800 after IVMP and PE treatments, among which five eyes (13.5%) recovered to Snellen VA 20/20 ( p < 0.001). Predictors of good visual outcome included body mass index [odds ratio (OR) = 0.734, p = 0.044], serum AQP4 antibody-positive status (OR = 0.004, p = 0.001), bilaterality (OR = 0.042, p = 0.008) and time window from onset to PE therapy per 1 day (OR = 0.79, p = 0.002). Conclusion: This study revealed that PE treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. Better visual outcomes can be achieved with early PE treatment.

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Acute disseminated encephalomyelitis followed by recurrent or monophasic optic neuritis in pediatric patients

Multiple Sclerosis Journal ◽

10.1177/1352458512466317 ◽

2012 ◽

Vol 19 (7) ◽

pp. 941-946 ◽

Cited By ~ 91

Author(s):

Peter Huppke ◽

Kevin Rostasy ◽

Michael Karenfort ◽

Brenda Huppke ◽

Rainer Seidl ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Optic Neuritis ◽

Pediatric Patients ◽

Case Series ◽

Acute Disseminated Encephalomyelitis ◽

Oligoclonal Bands ◽

Central Nervous System Disorders ◽

Established Disease

Background: Some pediatric patients with inflammatory demyelinating central nervous system disorders cannot be classified under any of the established disease entities, making their treatment and prognosis difficult. Objective: The objective of this study is to characterize a subgroup of pediatric patients with recurrent demyelinating central nervous system disorders. Methods: This study includes a case series of pediatric patients with monophasic or recurrent acute disseminated encephalomyelitis (ADEM) who later presented with either monophasic or recurrent optic neuritis (ON). Results: We describe seven patients with a median follow-up of six years (five females, two males) who presented at a median age of 6 years (range 4–8 years) with monophasic ( n = 4) or recurrent ADEM (two to four attacks) followed by monophasic ( n = 3) or recurrent ON (two to nine attacks). Cranial magnetic resonance imaging (MRI) was typical for ADEM ( n = 6) with complete or almost complete resolution of lesions on follow-up. Cerebrospinal (CSF) studies at the time of ADEM showed a pleocytosis in six patients and were negative for oligoclonal bands (OCBs) in all. In all patients high titers for serum anti-MOG antibodies were detected. Conclusion: ADEM followed by ON is a rare but distinct clinical phenotype among pediatric patients. Further studies are needed to allow recommendations on treatment or prognosis.

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Ethambutol induced optic neuritis: a case series

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20195788 ◽

2019 ◽

Vol 9 (1) ◽

pp. 207

Author(s):

Sruthi N. ◽

Anuradha M.

Keyword(s):

Optic Neuritis ◽

Case Series ◽

Control Program ◽

Chemotherapeutic Agents ◽

Fixed Dose ◽

Patient Acceptability ◽

National Tuberculosis Control Program ◽

Periodic Monitoring ◽

National Tuberculosis ◽

Pre Treatment

Ethambutol is one of the first line chemotherapeutic agents used in the treatment of tuberculosis used both in the intensive and continuation phase according to the new Revised National Tuberculosis Control Program guidelines. Patient acceptability is rather good with this drug as it produces comparatively lesser adverse effects. The most important and serious side effect reported is optic neuritis, resulting in loss of visual acuity, color vision and field defects. The incidence of optic neuritis is generally directly proportional to the dose and duration of ethambutol therapy. Here we report four cases of ethambutol induced optic neuritis in patients on fixed dose combinations (FDC) of ethambutol, isoniazid, pyrazinamide and rifampicin who presented in Ophthalmology OPD in a span of 2 months, between June and July 2019. Contradictory to the rare occurrence of ethambutol induced optic neuritis this comparatively higher incidence of optic neuritis is alarming. We observed that the presentation of ethambutol induced optic neuritis can vary and dose of ethambutol along with other factors can also contribute to it. So proper pre-treatment evaluation, dosage adjustment, periodic monitoring and early detection have a significant role in prevention and treatment of ethambutol induced optic neuritis.

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Myelin Oligodendrocyte Glycoprotein (MOG) Optic Neuritis: A Case Series

Cureus ◽

10.7759/cureus.14452 ◽

2021 ◽

Author(s):

Masnon Nurul-Ain ◽

Zuhratun Nazihah Khairul Kamal ◽

Wan-Hazabbah Wan Hitam ◽

Maimunah Abd Munaaim ◽

Faizah Mohd Zaki

Keyword(s):

Optic Neuritis ◽

Case Series ◽

Myelin Oligodendrocyte Glycoprotein

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A Rare Case of Recurrent Lymphocytic Hypophysitis Spanning 8 Years

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1155 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A566-A567

Author(s):

Aprajita Prahdan ◽

Sunil Kumar Mishra ◽

M Shafi Kuchay ◽

Varindera Paul Singh ◽

Jayesh Ashok Kumar Modi

Keyword(s):

Hormone Replacement ◽

Case Series ◽

Mass Effect ◽

Visual Disturbance ◽

Lymphocytic Hypophysitis ◽

Serum Igg4 ◽

Long Term Follow Up ◽

Autoimmune Aetiology

Abstract Background: Lymphocytic Hypophysitis (LH) is predominantly a self-limiting condition. Reports of recurrent LH have been limited to case series, predominantly within first two years of initial presentation (1). There is paucity of data on long term follow up of these cases and late recurrence of LH is considered very rare (2). Clinical Case: We describe the clinical course of a 47-year female, who first presented to us, 8 years back, with headache, visual disturbance and secondary amenorrhea. Her MRI pituitary was suggestive of a pituitary mass, which was removed by trans-sphenoidal surgery. Histopathology of the mass was suggestive of LH. Patient had symptomatic improvement, and remained well on out-patient follow-up, on hormone replacement therapy. She took replacement dose of glucocorticoid for 4 years after the initial surgery and then it was discontinued. However, she re-presented to us with headache and visual disturbance this time associated with xerostomia and xerophthalmia. In this presentation, due to presence of sicca symptoms a suspicion of autoimmune aetiology was kept. Her lab parameters were consistent with pan hypopituitarism along with new appearance of anti-TPO antibodies. She underwent two consecutive trans-sphenoidal surgeries for relief of pressure symptoms, and has been started immunosuppressive doses of glucocorticoids along with methotrexate. Other causes of recurrent hyophysitis, as IgG4 related Hypophysitis, were excluded by immunohistochemistry and normal serum IgG4 level (0.72g/l). She has since been discharged, and remains well on outpatient follow-up with no mass effect. MRI pituitary done at 2 months follow up is not suggestive of residual regrowth or mass effect. Conclusion: This case highlights the importance of long term follow up of LH patients. Other autoimmune aetiology maybe considered in cases unresponsive to standard treatment, necessitating titration of additional immunosuppressive therapy. References: 1.M.N. Joshi et al, Hypophysitis: diagnosis and treatment, European Journal of Endocrinology 2018, 179, R151-R1632.Honegger et al, Treatment of Primary Hypophysitis in Germany: Journal Clinical Endocrinology and Metabolism, September 2015, 100(9):3460 –3469

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Visual outcome after intravenous dexamethasone therapy for idiopathic optic neuritis in an Indian population: A clinical case series

Indian Journal of Ophthalmology ◽

10.4103/0301-4738.27069 ◽

2006 ◽

Vol 54 (3) ◽

pp. 177 ◽

Cited By ~ 8

Author(s):

Radhika Tandon ◽

HarinderSingh Sethi ◽

Vimla Menon ◽

Pradeep Sharma ◽

Sudarshan Khokhar

Keyword(s):

Optic Neuritis ◽

Clinical Case ◽

Indian Population ◽

Case Series ◽

Visual Outcome ◽

Dexamethasone Therapy

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Vogt-Koyanagi-Harada Disease Following COVID-19 Infection

Case Reports in Ophthalmology ◽

10.1159/000518834 ◽

2021 ◽

pp. 804-808

Author(s):

Juan B. Yepez ◽

Felipe A. Murati ◽

Michele Petitto ◽

Jazmin De Yepez ◽

Jose M. Galue ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Visual Acuity ◽

Optic Nerve ◽

Plexiform Layer ◽

Visual Disturbance ◽

Ocular Pain ◽

Ocular Movements ◽

Interdigitation Zone ◽

The Right ◽

Retinal Folds

A 29-year-old female presented to the emergency clinic with gradual visual disturbance in both eyes for 15 days duration, accompanied by bilateral tinnitus, and ocular pain that increased with ocular movements. One month prior to presentation, the patient had tested positive for severe acute respiratory syndrome coronavirus-2 but without complications. Visual acuity was 20/100 in the right eye and 20/300 in the left eye. Funduscopy demonstrated optic nerve swelling, radial nerve fiber striation disruption, and bilateral retinal folds. Optical coherence tomography showed serous (bacillary) retinal detachment and multifocal areas of hyper-reflective changes in the inner and outer plexiform layer with inner nuclear layer thickening and disruption of the interdigitation zone bilaterally. We present a case of incomplete Vogt-Koyanagi-Harada disease following COVID-19 infection.

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Clinical profile and neuroimaging in pediatric optic neuritis in Indian population: A case series

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_939_16 ◽

2017 ◽

Vol 65 (3) ◽

pp. 242 ◽

Cited By ~ 3

Author(s):

Rutika Khadse ◽

Meenakshi Ravindran ◽

Neelam Pawar ◽

Padmavathy Maharajan ◽

Ramakrishnan Rengappa

Keyword(s):

Optic Neuritis ◽

Indian Population ◽

Case Series ◽

Clinical Profile

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Efficacy for the Annual Relapse Rate after the Immunosuppressive Therapy in Patients Associated with Anti-AQP4 or Anti-MOG Antibody-Positive Optic Neuritis

Journal of Ophthalmology ◽

10.1155/2020/8871146 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Sotaro Mori ◽

Takuji Kurimoto ◽

Yusuke Murai ◽

Kaori Ueda ◽

Mari Sakamoto ◽

...

Keyword(s):

Optic Neuritis ◽

Immunosuppressive Therapy ◽

Relapse Rate ◽

Case Series ◽

Oral Prednisolone ◽

University Hospital ◽

Double Positive ◽

Before And After ◽

The Impact ◽

Aqp4 Antibody

Purpose. Although oral prednisolone is the first-line treatment for preventing recurrent optic neuritis (ON) after the completion of acute-phase treatment, especially anti-aquaporin 4 (AQP4) antibody-positive ON, and anti-myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON, some patients experience relapses. Immunosuppressants could be effective in reducing the recurrence rate for neuromyelitis optica spectrum disorder and MOG antibody-related diseases, but there have been few studies addressing this issue focusing on the changes in ophthalmic parameters. The objective of the study was to analyze the impact of off-label uses of immunosuppressants to reduce recurrent ON. Design. Retrospective observational study, clinical case series. Methods. We reviewed the medical charts of 11 cases (22 eyes) who underwent immunosuppressive therapy in Kobe University Hospital and compared the annualized relapse rate (ARR) before and after immunosuppressive therapy. We also evaluated the dosage of prednisolone, complications of immunosuppressants, and other visual functional ophthalmologic parameters. Results. Eleven cases in total had AQP4 antibody (9 cases) and/or MOG antibody (3 cases). One case was double positive for these antibodies. Nine patients received azathioprine and two received mycophenolate mofetil as an initial immunosuppressive therapy. The median duration of immunosuppressant treatment was 2.8 years. The median ON ARR before immunosuppressive therapy was 0.33, and this decreased significantly to 0 after the therapy ( p = 0.02 ). The dose of prednisolone was reduced from 17.8 ± 7.1 mg/day before to 5.8 ± 2.2 mg/day after immunosuppressive therapy ( p < 0.01 ). Although two patients presented with mild elevation of liver enzymes and nausea, all patients were able to continue taking the immunosuppressants. Conclusions. Immunosuppressants can potentially decrease relapses and steroid dosage in patients with anti-AQP4 or MOG antibody-positive ON without severe adverse events and the exacerbation of visual acuities.

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