scholarly journals 427. Putting the ‘Eye’ in Spirochetes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S214-S214
Author(s):  
Sarwat Khalil ◽  
Madiha Fida ◽  
Douglas W Challener ◽  
Eugene Tan ◽  
Muhammad R Sohail ◽  
...  
Keyword(s):  
Vision Loss ◽  
Diagnostic Testing ◽  
Treponema Pallidum ◽  
Case Series ◽  
Ocular Syphilis ◽  
Presenting Symptoms ◽  
Ocular Symptoms ◽  
Ocular Findings ◽  
Elevated Protein ◽  
Number Of Patients

Abstract Background Ocular syphilis is an infrequent presentation of Treponema pallidum infection. It is often seen in association with neurosyphilis but can occur in isolation as well. Here we describe a case series of 10 patients with ocular syphilis seen at our institution. Methods Patients with a diagnosis of ocular syphilis at the three sites of Mayo Clinic were identified from June 2006 to February 2019. Patient’s baseline characteristics, clinical presentation, diagnostic testing, and treatment were abstracted from Electronic Medical Records. Results We identified 10 patients (17 eyes) during the study period, half being diagnosed in the last 5 years. The median age was 51 years (IQR 21–66), and the majority were males (7/10). Characteristics of the patients are outlined in Table 1. Common presenting symptoms included vision loss (8/10), photophobia (4/10), and irritation (5/10). Seven of 10 patients had bilateral involvement. Of the 17 eyes, 59% had pan-uveitis and 82% had disc edema (Table 2). Rapid Plasma Reagin (RPR) was positive in 9 patients and median serum RPR was 1:128 (IQR 1:2-1:1024). One patient was diagnosed with a positive TP-PA, and characteristic ocular findings. One patients had positive 16S Ribosomal RNA Gene PCR/Sanger Sequencing on vitreous humor specimen for Treponema species. The majority of patients had isolated ocular symptoms at presentation; two patients also had an associated skin rash. All patients underwent a lumbar puncture (LP). Half had pleocytosis (TNC > 5) and elevated protein elevated (mean 63.6 mg/dL), although not significantly high. 3/10 patients had VDRL positive in the CSF. Protein levels were much higher in those with positive VDRL. Each patient was treated with intravenous (IV) penicillin for at least 2 weeks. Nine patients received ocular steroids as well. At last available follow-up, 8 had complete and 1 had partial resolution. One had worsened eye findings with eventual scarring. Conclusion Our findings are congruent with increasing incidence of ocular syphilis nationwide. Bilateral eye involvement and pan-uveitis were the most common ocular findings. Although only 3 patients had a positive VDRL in the CSF, pleocytosis and elevated protein were found in a large number of patients. Majority of the patients had clinical resolution with appropriate treatment. Disclosures All authors: No reported disclosures.

Pulseless and blindness – An ophthalmologist’s role in diagnosing Takayasu arteritis: Case series and brief review of literature

2021 ◽  
pp. 112067212199057
Author(s):  
Snigdha Mahajan ◽  
Umesh Chandra Behera ◽  
Savla Laxmi Pravabati ◽  
Miloni Shah ◽  
Srikanta Kumar Padhy ◽  
...  
Keyword(s):  
Takayasu Arteritis ◽  
Vision Loss ◽  
Care Center ◽  
Case Series ◽  
Medical Attention ◽  
Presenting Symptoms ◽  
Ocular Symptoms ◽  
The Common ◽  
Systemic Symptoms ◽  
Systemic Condition

Purpose: To study the initial presenting symptoms of Takayasu arteritis in unsuspecting patients. Methods: The underlying systemic condition was suspected in five subjects at a tertiary eye care center based on their ocular features. Similar reports in the literature were collated and analyzed for the common presenting features of undiagnosed Takayasu arteritis. Results: The most common presenting ophthalmic symptoms were vision loss (86.8%), ocular pain (21.1%), eye redness (18.4%), and photophobia (5.3%). There were no reports of glaucoma at presentation. Pupillary abnormalities (42.1%), microaneurysms in retinal mid-periphery (42.1%) and venous engorgement (28.9%) were the most common presenting signs. Despite systemic symptoms such as headache, dizziness, fatigue, weakness, arm claudication, fever, anorexia, weight loss, and syncope in 76.3% of cases, the patients in this series had never sought medical care before developing ocular symptoms. Conclusion: Takayasu arteritis may remain latent until the ophthalmic complications compel the patient to seek medical attention. Hence, ophthalmologists need to be aware of the seemingly innocuous presentations of the disease.

scholarly journals Prevalence of Self-reported Neurologic and Ocular Symptoms in Early Syphilis Cases

2020 ◽  
Author(s):  
Laura A S Quilter ◽  
Alex de Voux ◽  
Rachel M Amiya ◽  
Erin Davies ◽  
Robin R Hennessy ◽  
...  
Keyword(s):  
Lumbar Puncture ◽  
Diagnostic Testing ◽  
Clinical Information ◽  
Health Department ◽  
Surveillance Network ◽  
Ocular Syphilis ◽  
Early Syphilis ◽  
Ocular Manifestations ◽  
Ocular Symptoms ◽  
Low Prevalence

Abstract Background Neurosyphilis, a complication of syphilis, can occur at any stage of infection. Measuring the prevalence of neurosyphilis is challenging, and there are limited data on the prevalence of neurologic or ocular symptoms among patients with syphilis. We sought to describe the prevalence of neurologic and/or ocular symptoms among early syphilis (ES) cases and the clinical management of symptomatic cases enrolled in the STD Surveillance Network (SSuN) Neuro/Ocular Syphilis Surveillance project. Methods Persons diagnosed with ES were selected for interviews based on current health department protocols in 5 participating SSuN jurisdictions from November 2016 through October 2017. All interviewed ES cases were screened for self-reported neurologic and/or ocular symptoms. Additional clinical information on diagnostic testing and treatment for cases concerning for neurosyphilis/ocular syphilis was obtained from providers. Results Among 9123 patients with ES who were interviewed, 151 (1.7%; 95% confidence interval [CI], 1.4%–1.9%) reported ≥ 1 neurologic or ocular symptom. Of the 53 (35%) who underwent lumbar puncture, 22 (42%) had documented abnormal cerebrospinal fluid, of which 21 (95%) were treated for neurosyphilis/ocular syphilis. Among the remaining 98 symptomatic patients with no documented lumbar puncture (65%), 12 (12%) were treated for and/or clinically diagnosed with neurosyphilis/ocular syphilis. Conclusions We observed a low prevalence of self-reported neurologic and/or ocular symptoms in interviewed ES cases. Approximately one-third of ES cases who self-reported symptoms underwent further recommended diagnostic evaluation. Understanding barriers to appropriate clinical evaluation is important to ensuring appropriate management of patients with possible neurologic and/or ocular manifestations of syphilis.

Giant osteomas: Clinical results and surgical approach from ophthalmic point of view

2020 ◽  
pp. 112067212096204
Author(s):  
Selam Yekta Sendul ◽  
Aysegul Mavi Yildiz ◽  
Ali Atakhan Yildiz
Keyword(s):  
Vision Loss ◽  
Case Series ◽  
Clinical Results ◽  
Point Of View ◽  
Neurological Damage ◽  
Presenting Symptoms ◽  
Ocular Manifestations ◽  
Pupillary Light ◽  
Benign Nature ◽  
Radiologic Investigation

Purpose: To present clinical ocular manifestations, radiological features and surgical results of giant paranasal osteomas involving the orbit. Design: Retrospective, interventional, case series Methods: The study included patients treated for giant paranasal osteoma involving the orbit. Total or subtotal excision of the tumor was performed via external approach. Clinical characteristics including presenting symptoms, radiologic investigation, histopathology and details of the surgery were recorded. Results: Of the six patients included; four were male and two were female. Mean age was 46.8 years (range 12–70 years). Five patients had unilateral, one patient had bileteral disease. The presenting complaints included complete ( n = 2/6) or partial ( n = 4/6) limitation of eye movements depending on the location and size of the tumor, diplopia ( n = 5/6), vision loss ( n = 2/6) exophthalmos ( n = 6/6) and reduced pupillary light reflex ( n = 2/6). The presumed origin of the tumor was frontoethmoidal region ( n = 2/6), frontal sinus ( n = 3/6) and ethmoid sinus ( n = 1/6). Total resection was achieved in three of the patients whereas partial resection was achieved in remaining three patients due to risk of incremental neurological damage. Mild ptosis was observed in all patients during the postoperative period (temporary, n = 4; permanent, n = 2). Conclusion: Despite the benign nature of osteomas, severe functional impairment including vision loss due to compression of the optic nerve and diplopia might occur in case of orbital involvement. Osteomas with an orbital extension > %50 of the bony orbit volume are more prone to cause irreversible visual loss. Surgical resection is still the mainstay of therapy.

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 Pancytopenia of Unknown Cause in Adult Patients Admitted to a Tertiary Hospital in Ethiopia: Case series

1970 ◽  
Vol 28 (4) ◽  
Author(s):  
Esayas Kebede Gudina ◽  
Hiwot Amare ◽  
Kasahun Benti ◽  
Shoba Ibrahim ◽  
Gashahun Mekonnen
Keyword(s):  
Large Scale ◽  
Complete Blood Count ◽  
White Cell Count ◽  
Case Series ◽  
Adult Patients ◽  
University Hospital ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
The Mean ◽  
Jimma University

BACKGROUND: Over the past few years, we have witnessed a dramatic increase in the number of patients presenting with severe pancytopenia to Jimma University Hospital. We now present sociodemographic and clinical characteristics of adult patients admitted with pancytopenia of unknown cause to Jimma University Hospital during the period of March 2015 to June 2016. Complete blood count and other diagnostic tests were done for all patients to uncover underlying causes.RESULT: Out of 65 cases admitted with pancytopenia during the specified period, 40 were excluded for various reasons. The rest 25 patients were included in this review. The mean age was 32.1 years (SD=14.9); 14 were younger than 30 years of age. The mean hemoglobin level, white cell count and platelet count were 48.6 g/L (SD=1.9), 1,918 /μL (SD=879.8) and 36,200 /μL (SD=26,131) respectively. The major presenting symptoms were generalized malaise and fever. No geographic or seasonal clustering of the caseswas seen.CONCLUSION: The number of cases with pancytopenia of unidentified cause seen at the hospital over the specified period is alarmingly high and deserves great attention. The hematologic alteration in most of the patients was found to be severe with poor clinical outcome. This calls for large scale community based investigation to uncover the root cause of the problem.KEYWORDS: Aplastic anemia, Pancytopenia, Ethiopia, Jimma

scholarly journals Leptomeningeal Carcinomatosis with Delayed Ocular Manifestations

2021 ◽  
pp. 98-100
Author(s):  
Craig Czyz ◽  
Kyle Blair ◽  
Reece Bergstrom
Keyword(s):  
Vision Loss ◽  
Leptomeningeal Carcinomatosis ◽  
Monocular Vision ◽  
Ocular Involvement ◽  
Unique Case ◽  
Presenting Symptoms ◽  
Ocular Manifestations ◽  
Ocular Symptoms ◽  
Cranial Nerve Palsies ◽  
Multiple Cranial Nerve

The most common presenting symptoms of leptomeningeal carcinomatosis (LC) are ocular manifestations with vision loss. There are multiple reports of undiagnosed LC causing sudden, complete, monocular vision loss as the presenting symptom; however, sudden bilateral vision loss 6 months following diagnosis has not been described. Any new ocular involvement or worsening of previous ocular symptoms warrants reimaging and prompt ophthalmology consultation, as this likely indicates disease progression. This report details a unique case of LC where a previously diagnosed patient developed sudden, complete, bilateral vision loss and multiple cranial nerve palsies with progression of LC on imaging.

scholarly journals Ocular findings in the chronic renal failure

2015 ◽  
Vol 10 (2) ◽  
pp. 18-26 ◽  
Author(s):  
P Dahal ◽  
S Gouli
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Vision Loss ◽  
Medical Science ◽  
Neovascular Glaucoma ◽  
Ocular Symptoms ◽  
Ocular Findings ◽  
Department Of Ophthalmology ◽  
Stage Renal Disease ◽  
End Stage

BACKGROUND The aim of the study was to evaluate the ocular signs in chronic renal failure (CRF) in diabetes and hypertensive patients. MATERIALS AND METHODS Two hundred and thirty eight cases were enrolled in the study from the nephrology unit of College Of Medical Science, Bharatpur, Nepal and examined in the department of Ophthalmology. The study duration was carried out over 2 years from January 2011 to December 2012. RESULT The number of cases in each grade of CRF were mild 80 (26.67%), moderate 84 (28%), severe 75 (25%), end stage renal disease 61 (20.33%). In all the groups the commonest cause of CRF were Hypertension (HTN) 123 out of 300(41%) and diabetes 98(32.67%). The commonest ocular symptoms in CRF was blurring of vision 68%. CONCLUSION Many important ocular findings like vitreous haemorrage, retinal detachment, neovascular glaucoma and cataract are the presentation in chronic renal failure, which can cause marked vision loss. Hence proper awareness should be provided to the people in time to prevent these ocular complications.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12949 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 18-26

scholarly journals What Every Internist-Endocrinologist Should Know about Rare Genetic Syndromes in Order to Prevent Needless Diagnostics, Missed Diagnoses and Medical Complications: Five Years of ‘Internal Medicine for Rare Genetic Syndromes’

2021 ◽  
Vol 10 (22) ◽  
pp. 5457
Author(s):  
Anna G. W. Rosenberg ◽  
Minke R. A. Pater ◽  
Karlijn Pellikaan ◽  
Kirsten Davidse ◽  
Anja A. Kattentidt-Mouravieva ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Life Expectancy ◽  
Diagnostic Testing ◽  
Case Series ◽  
Multiple Organ ◽  
Clinical Approach ◽  
Genetic Syndromes ◽  
Organ Systems ◽  
Number Of Patients ◽  
Missed Diagnoses

Patients with complex rare genetic syndromes (CRGS) have combined medical problems affecting multiple organ systems. Pediatric multidisciplinary (MD) care has improved life expectancy, however, transfer to internal medicine is hindered by the lack of adequate MD care for adults. We have launched an MD outpatient clinic providing syndrome-specific care for adults with CRGS, which, to our knowledge, is the first one worldwide in the field of internal medicine. Between 2015 and 2020, we have treated 720 adults with over 60 syndromes. Eighty-nine percent of the syndromes were associated with endocrine problems. We describe case series of missed diagnoses and patients who had undergone extensive diagnostic testing for symptoms that could actually be explained by their syndrome. Based on our experiences and review of the literature, we provide an algorithm for the clinical approach of health problems in CRGS adults. We conclude that missed diagnoses and needless invasive tests seem common in CRGS adults. Due to the increased life expectancy, an increasing number of patients with CRGS will transfer to adult endocrinology. Internist-endocrinologists (in training) should be aware of their special needs and medical pitfalls of CRGS will help prevent the burden of unnecessary diagnostics and under- and overtreatment.

scholarly journals Is Biofeedback through an Intra-Aural Device an Effective Method to Treat Bruxism? Case Series and Initial Experience

2020 ◽  
Vol 18 (1) ◽  
pp. 51
Author(s):  
Kira Pfeiffer ◽  
Thaqif El Khassawna ◽  
Deeksha Malhan ◽  
Christine Langer ◽  
Barbara Sommer ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Positive Impact ◽  
Case Series ◽  
Physiological Status ◽  
Initial Experience ◽  
Ear Canal ◽  
Number Of Patients ◽  
Patient Reported ◽  
Unpleasant Feeling ◽  
Ear Canals

Biofeedback was reported as an effective concept for bruxism treatment, through increasing patient’s awareness of the habit. During bruxing both ear canals become tighter, therefore, an in-ear device can provide biofeedback. The in-ear device is fitted to the ear canal in physiological status, during bruxing the ear-canal tightens resulting in stress on the canal walls and unpleasant feeling. Subsequently, patients stop their bruxing habit. The aim of this study is to provide first clinical evidence that in-ear devices have a positive impact on relieving bruxism in patients. Despite the low number of patients, this early study was designed as a controlled prospective study. The trial included seven female patients with a median age of 47.3 years (23–64 years). Only two patients implemented their devices for eight and seven months, respectively. One patient reported a relief in her symptoms, like headaches and pain intensity during the night, by 50% after three month and 80% after six months. Despite the limited number of participants, the study reflects a potential of Intra-aural devices as effective biofeedback devices in treating bruxism.

scholarly journals Intracranial Venous Sinus Stenting in Idiopathic Intracranial Hypertension: A Case Report and Review of the Literature

2021 ◽  
Vol 11 (3) ◽  
pp. 382
Author(s):  
Dinesh Ramanathan ◽  
Zachary D. Travis ◽  
Emmanuel Omosor ◽  
Taylor Wilson ◽  
Nikhil Sahasrabudhe ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Transverse Sinus ◽  
Venous Sinus ◽  
Subdural Hygroma ◽  
Presenting Symptoms ◽  
Minimal Improvement ◽  
Sinus Stenosis ◽  
Work Up

We describe a case of severe headaches, double vision, and progressive vision loss secondary to a ruptured intracranial cyst (IAC) in a 31-year-old woman with no relevant past medical history. The case is peculiar because drainage of the subdural hygroma led to a minimal improvement in vision with persistent elevated intracranial pressure (ICP). Further exploration revealed transverse sinus stenosis necessitating stenting. Evaluation post-stenting showed marked reduction of ICP and improvement in symptoms. This report underscores the importance of comprehensive work-up and suspicion of multiple underlying etiologies that may be crucial to complete resolution of presenting symptoms in some cases. We provide an overview of the clinical indications and evidence for venous sinus stenting in treating idiopathic intracranial hypertension (IIH).

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