Optic neuropathy secondary to perhexiline and amiodarone

2021 ◽  
Vol 14 (1) ◽  
pp. e237727
Author(s):  
Yiran Tan ◽  
Paul Sia ◽  
Sumu Simon
Keyword(s):  
Optic Disc ◽  
Optic Neuropathy ◽  
Temporal Artery ◽  
Underlying Mechanism ◽  
Emission Tomography ◽  
Temporal Artery Biopsy ◽  
Ocular Side ◽  
Positron Emission ◽  
Life Threatening ◽  
Optic Disc Swelling

Bilateral optic disc swelling is an important clinical sign for potentially life-threatening and sight-threatening conditions, with the most common being raised intracranial pressure and pseudopapillitis. Perhexiline-related and amiodarone-related optic disc swellings are diagnoses of exclusion. This report describes the diagnosis of a man with perhexiline-induced and amiodarone-induced optic neuropathy after extensive investigation consisting of full ophthalmic examination, biochemical screen, temporal artery biopsy, CT, MRI, positron emission tomography and lumbar puncture. There was partial to complete resolution of optic neuropathy following cessation of the causative medication. We postulate that the underlying mechanism of perhexiline toxicity could be mitochondrial dysfunction related. Our case demonstrates that patients treated with perhexiline and amiodarone should be monitored closely for ocular side effects.

Positron Emission Tomography/Computerized Tomography in Newly Diagnosed Patients with Giant Cell Arteritis Who Are Taking Glucocorticoids

2017 ◽  
Vol 44 (12) ◽  
pp. 1859-1866 ◽  
Author(s):  
Alison H. Clifford ◽  
Elana M. Murphy ◽  
Steven C. Burrell ◽  
Mathew P. Bligh ◽  
Ryan F. MacDougall ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Computerized Tomography ◽  
Temporal Artery ◽  
Emission Tomography ◽  
Temporal Artery Biopsy ◽  
Fdg Uptake ◽  
Positron Emission ◽  
Pet Ct

Objective.Large vessel uptake on positron emission tomography/computerized tomography (PET/CT) supports the diagnosis of giant cell arteritis (GCA). Its value, however, in patients without arteritis on temporal artery biopsy and in those receiving glucocorticoids remains unknown. We compared PET/CT results in GCA patients with positive (TAB+) and negative temporal artery biopsies (TAB−), and controls.Methods.Patients with new clinically diagnosed GCA starting treatment with glucocorticoids underwent temporal artery biopsy and PET/CT. Using a visual semiquantitative approach, 18F-fluorodeoxyglucose (FDG) uptake was scored in 8 vascular territories and summed overall to give a total score in patients and matched controls.Results.Twenty-eight patients with GCA and 28 controls were enrolled. Eighteen patients with GCA were TAB+. Mean PET/CT scores after an average of 11.9 days of prednisone were higher in patients with GCA compared to controls, for both total uptake (10.34 ± 2.72 vs 7.73 ± 2.56; p = 0.001), and in 6 of 8 specific vascular territories. PET/CT scores were similar between TAB+ and TAB− patients with GCA. The optimal cutoff for distinguishing GCA cases from controls was a total PET/CT score of ≥ 9, with an area under the receiver-operating characteristic curve of 0.75, sensitivity 71.4%, and specificity 64.3%. Among patients with GCA, these measures correlated with greater total PET/CT scores: systemic symptoms (p = 0.015), lower hemoglobin (p = 0.009), and higher platelet count (p = 0.008).Conclusion.Vascular FDG uptake scores were increased in most patients with GCA despite exposure to prednisone; however, the sensitivity and specificity of PET/CT in this setting were lower than those previously reported.

scholarly journals Chest Pain: The Need to Consider Less Frequent Diagnosis

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Pedro Magalhães ◽  
Anabela Morais ◽  
Sofia Carvalho ◽  
Joana Cunha ◽  
Ana R. Lima ◽  
...  
Keyword(s):  
Chest Pain ◽  
Takayasu Arteritis ◽  
Temporal Artery ◽  
Lower Limbs ◽  
Temporal Artery Biopsy ◽  
Acute Phase Reactants ◽  
Granulomatous Vasculitis ◽  
Positron Emission ◽  
Clinical Scenarios ◽  
Underlying Causes

Chest pain is one of the most frequent patient’s complaints. The commonest underlying causes are well known, but, sometimes, in some clinical scenarios, it is necessary to consider other diagnoses. We report a case of a 68-year-old Caucasian male, chronically hypertensive, who complained of recurrent episodes of chest pain and fever with elevated acute phase reactants. The first investigation was negative for some of the most likely diagnosis and he quickly improved with anti-inflammatory drugs. Over a few months, his symptoms continued to recur periodically, his hypertension was aggravated, and he developed headaches and lower limbs claudication. After a temporal artery biopsy that was negative for vasculitis, he underwent a positron emission tomography suggestive of Takayasu Arteritis. Takayasu Arteritis is a rare chronic granulomatous vasculitis of the aorta and its first-order branches affecting mostly females up to 50 years old. Chest pain is experienced by >40% of the patients and results from the inflammation of the aorta, pulmonary artery, or coronaries.

scholarly journals Rare Tauopathies

2019 ◽  
Vol 39 (02) ◽  
pp. 264-273 ◽  
Author(s):  
Farwa Ali ◽  
Keith Josephs
Keyword(s):  
Clinical Phenotype ◽  
Genetic Disorders ◽  
Underlying Mechanism ◽  
Emission Tomography ◽  
Disease Modification ◽  
Tau Pathology ◽  
Protein Tau ◽  
Positron Emission ◽  
Cellular Inclusions ◽  
The Brain

Tauopathies are rare neurodegenerative disorders related to microtubule-associated protein tau, which functions to stabilize microtubules. Pathological changes caused by overexpression or hyperphosphorylation of tau lead to the disengagement of tau from microtubules and accumulation of toxic intracellular inclusions. Tau pathology is the underlying mechanism for several sporadic and genetic disorders. These are collectively known as tauopathies. Each tauopathy is differentiated from others by its neuropathological features such as the presence of specific isoforms of tau, type of cellular inclusions, and the regions of the brain affected. Neuropathological features, with a few exceptions however, do not correspond to distinct clinical phenotypes. There is considerable phenotypic overlap between the different tauopathies. Interaction between tau and other protein inclusions further alters the clinical phenotype.Recent advances in the development of tau biomarkers, especially the development of tau radioligands used in positron emission tomography neuroimaging, and a better understanding of biology and pathology of tau are important first steps toward the ultimate goal of accurate diagnosis and disease modification in tauopathies.

THUR 149 ANCA/MPO vasculitis presenting with bilateral ischaemic optic neuropathy

2018 ◽  
Vol 89 (10) ◽  
pp. A17.3-A17
Author(s):  
Mehta Dwij ◽  
Wade Charles
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Temporal Artery ◽  
Neurological Deficits ◽  
Temporal Artery Biopsy ◽  
Meningeal Enhancement ◽  
Csf Analysis ◽  
Ischaemic Optic Neuropathy ◽  
Systemic Symptoms ◽  
The Right

An 80 year old gentleman presented with bilateral, sequential ischaemic optic neuropathy. He initially developed progressive loss of vision in left eye with loss of colour vision and subsequently developed similar symptoms in the right eye with headaches, weight loss, malaise and lethargy. His visual acuity dropped to 6/12 on the right and counting fingers on the left. He had a dense central scotoma in left eye with left-sided RAPD but no other focal neurological deficits.Blood tests revealed an ESR of 107 with an MPO ANCA titre of 19. MRI brain with contrast showed prominent meningeal enhancement and infiltration with ischaemic changes in the brain. CSF analysis revealed WCC of 24 (95% lymphocytes), RCC 22 and protein 0.4 g/L with negative bacterial culture. Temporal artery biopsy was normal.He was treated initially with IV methylprednisolone and 6 cycles of IV cyclophosphamide and subsequently put on methotrexate. His systemic symptoms have resolved completely and his visual acuity continues to gradually improve.MPO-ANCA vasculitis can mimic temporal arteritis and should be considered in patients presenting with an ischaemic optic neuropathy. It is also a treatable cause of meningeal disease.

scholarly journals Calciphylaxis: Temporal Artery Calcification Preceding Widespread Skin Lesions and Penile Necrosis

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Manzoor A. Shah ◽  
Michael W. Roppolo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Optic Neuropathy ◽  
Temporal Artery ◽  
Skin Lesions ◽  
Anterior Ischemic Optic Neuropathy ◽  
High Dose ◽  
Ischemic Optic Neuropathy ◽  
Temporal Artery Biopsy ◽  
Loss Of Vision

Temporal artery calciphylaxis has rarely been described in chronic kidney disease patients on dialysis. We report a case of 72-year-old Caucasian man with multiple comorbidities and end-stage renal disease on dialysis who presented with temporal artery calcification leading to bilateral loss of vision followed by extensive skin lesions including one on glans penis. While on peritoneal dialysis, he developed anterior ischemic optic neuropathy, had no improvement on high dose steroids, and temporal artery biopsy showed marked calcification without any evidence of vasculitis. Few weeks later on hemodialysis, he developed widespread cutaneous lesions on extremities and penile necrosis with skin biopsy revealing calciphylaxis. On literature review of calciphylaxis in chronic kidney disease, we found only four cases of temporal artery calciphylaxis leading to anterior ischemic optic neuropathy and blindness. We believe this is the first case in which the rare temporal artery calciphylaxis and the uncommon penile necrosis are being described together. The objective is to emphasize the need to recognize this condition early in the CKD patients on dialysis presenting with visual symptoms as the different treatment strategies may help prevent complete loss of vision and also modify or prevent a full blown calciphylaxis.

scholarly journals Nonarteritic Anterior Ischemic Optic Neuropathy following COVID-19 Vaccination: Consequence or Coincidence

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Rika Tsukii ◽  
Yuka Kasuya ◽  
Shinji Makino
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Visual Field Defect ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Optic Disc Swelling ◽  
The Right ◽  
Field Defect

To report a patient with nonarteritic anterior ischemic optic neuropathy (NA-AION) occurring soon after the COVID-19 vaccination. A 55-year-old woman presented with a 4-day history of inferior visual field disturbance in the right eye 7 days after receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. Examination revealed a best-corrected visual acuity of 20/20 in both eyes. A relative afferent pupillary defect was observed in the right eye. Fundoscopy revealed diffuse optic disc swelling in the right eye, which was prominent above the optic disc. Goldmann visual field testing identified an inferior altitudinal visual field defect with I/2 isopter in the right eye. Although typical complete inferior visual field defect was not detected, a diagnosis of NA-AION was made. The patient was followed without any treatment. During the 2-month follow-up period, the optic disc swelling was gradually improved, and visual acuity was maintained 20/20; however, the optic disc looked diffusely pale in the right eye. Although it is uncertain whether the development of NA-AION after COVID-19 vaccination was consequential or coincidental, we speculate that the close temporal relationship with COVID-19 vaccination suggests the possibility of vasculopathy on the microvascular network of optic nerve head as background of inflammatory or immune-mediated element to the timing of the onset of NA-AION. The aim of this case report is to present this biological plausibility and to elucidate potential ophthalmological complications.

scholarly journals Optic Nerve Head Microcirculation in Eyes with Vogt-Koyanagi-Harada Disease Accompanied by Anterior Ischemic Optic Neuropathy

2021 ◽  
pp. 899-908
Author(s):  
Yui Yamashita ◽  
Yuki Hashimoto ◽  
Kenichi Namba ◽  
Kazuomi Mizuuchi ◽  
Susumu Ishida
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Optic Nerve Head ◽  
Visual Field Defects ◽  
Ischemic Optic Neuropathy ◽  
Optic Disc Swelling ◽  
Vkh Disease ◽  
Field Defects

Anterior ischemic optic neuropathy (AION) is infrequently complicated with Vogt-Koyanagi-Harada (VKH) disease. We quantitatively examined sequential changes in the morphology and circulation hemodynamics, using a C-scan of optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG) in a patient with VKH disease accompanied by AION. A 65-year-old female complained of blurred vision in both of her eyes. The patient presented with optic disc swelling and remarkable choroidal thickening detected by OCT bilaterally. The diagnosis of VKH disease was established based on the presence of pleocytosis detected in the cerebrospinal fluid and hypofluorescent dark dots scattered all around the fundus, detected by indocyanine green angiography. Goldmann perimetry detected visual field defects, similar to superior altitudinal hemianopsia in the right eye and similar to inferior altitudinal hemianopsia in the left eye. The patient was suspected to have developed AION in both eyes. The patient received methylprednisolone pulse therapy, followed by oral prednisolone. With these treatments, the optic disc swelling disappeared. However, optic disc atrophy with visual field defects remained in both eyes. An OCT C-scan showed the ganglion cell complex (GCC) and circumpapillary retinal nerve fiber layer (cpRNFL) thickness getting thinner below the normal range, and LSFG showed the decrease in optic nerve head (ONH) tissue microcirculation. These results supported the occurrence of AION in this patient with VKH disease. The analysis of GCC and cpRNFL thickness and ONH microcirculation would be useful for supporting the occurrence of AION in a case of VKH disease.

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