scholarly journals Paraneoplastic optic neuropathy secondary to adenocarcinoma of the lung

2021 ◽  
Vol 14 (5) ◽  
pp. e242082
Author(s):  
Jin Yi Yap ◽  
Wan-Hazabbah Wan HItam ◽  
Sanihah Abdul Halim ◽  
Nurul Ain Masnon
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Hand Movement ◽  
Healthy Woman ◽  
Lung Mass ◽  
Adenocarcinoma Of The Lung ◽  
Acute Visual Loss ◽  
Lung Lobectomy ◽  
The Right

We describe an uncommon cause of paraneoplastic optic neuropathy in adenocarcinoma of the lung. A 45-year-old healthy woman presented with seizure and encephalitis, followed by an acute visual loss in both eyes for 1 week. Her visual acuity was no perception of light in the right eye and hand movement in the left eye. There was a generalised restriction of extraocular muscle movements in both eyes. Funduscopy showed a bilateral pale optic disc. A paraneoplastic antigen autoimmune profile showed a positive anti-CV2/CRMP-5 antibody. CT of the thorax revealed the presence of right apical lung mass, confirmed to be adenocarcinoma through a biopsy. She was scheduled for lung lobectomy and chemotherapy. Unfortunately, her health deteriorated and she passed away eventually.

scholarly journals Leber’s hereditary optic neuropathy following unilateral painful optic neuritis: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chaeyeon Lee ◽  
Kyung-Ah Park ◽  
Ga-In Lee ◽  
Sei Yeul Oh ◽  
Ju-Hong Min ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Early Stage ◽  
Leber’S Hereditary Optic Neuropathy ◽  
Leber's Hereditary Optic Neuropathy ◽  
Intravenous Methylprednisolone ◽  
The Right ◽  
Hereditary Optic Neuropathy

Abstract Background Leber’s hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disease, characterized by acute or subacute, painless, bilateral visual loss. LHON is often misdiagnosed as optic neuritis at an early stage because of the similarity of their clinical presentation. To date, there has been no reported case of actual optic neuritis and LHON in one patient. Case presentation A 40-year-old, healthy man was referred to our clinic with acute painful visual loss in the right eye for 2 weeks. In the right eye, visual acuity decreased to 20/40, and the Ishihara colour test score was 8/14 with a relative afferent pupillary defect. Optic disc swelling was found only in the right eye, and magnetic resonance imaging revealed enhancement of the the right optic nerve, consistent with optic neuritis. After receiving 1 g of intravenous methylprednisolone daily for three days, his ocular pain resolved, and visual acuity improved to 20/20 within 2 weeks. Seven months later, the patient developed acute painless visual loss in the right eye. Visual acuity decreased to 20/200 in the right eye. There was no response to the intravenous methylprednisolone therapy at that time. Eight months later, he developed subacute painless visual loss in the left eye. Genetic testing for LHON was performed and revealed the pathologic mtDNA 11778 point mutation. Conclusions We report a case with painful unilateral optic neuritis preceding the onset of LHON. Even if a typical optic neuritis patient has completely recovered from steroid treatment once in the past, it is advisable to keep in mind the possibility of LHON if acute or subacute loss of vision subsequently or simultaneously occurs in both eyes and does not respond to steroids.

scholarly journals Presumed clomiphene-induced optic neuropathy: A case report

2021 ◽  
Author(s):  
Yousef Alizadeh ◽  
Zahra Moravvej ◽  
Yaser Khakpour ◽  
Ebrahim Azaripour ◽  
Mitra Akbari ◽  
...  
Keyword(s):  
At Risk ◽  
Visual Acuity ◽  
Optic Neuropathy ◽  
Clomiphene Citrate ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Acute Visual Loss ◽  
Estrogen Receptor Ligand ◽  
Sudden Decrease ◽  
The Right

Background: Clomiphene citrate is an estrogen receptor ligand with mixed agonistic–antagonistic properties used for the treatment of female and male infertility. Various visual disturbances and several irreversible visual outcomes have been associated with clomiphene citrate. In this report, we present a patient with presumed clomiphene-induced optic neuropathy. Case: A 33-yr-old man with acute visual loss of the right eye was referred to Amiralmomenin Hospital, Rasht, Iran in November 2018. His only medication was clomiphene citrate 100 mg daily, taken for 2 wk for fertility issues. The patient presented with a sudden decrease of visual acuity in the right eye on the 14th day of starting the treatment and subsequently developed complete loss of inferior visual field within a few days. On examination, the visual acuity was 6/20 in the right and 20/20 in the left eyes, with a right relative afferent pupillary defect and decreased red color saturation. The fundus examination revealed optic disc swelling with venous dilation in the right eye and a normal left fundus with a crowded disc (disc-at-risk). The patient was evaluated for systemic disorders, all of which were normal. Findings were suggestive of non-arteritic anterior ischemic optic neuropathy most likely due to clomiphene. Conclusion: As clomiphene may increase blood viscosity, it is hypothesized that reduced flow in a posterior ciliary artery in conjunction with the disc-at-risk contributes to the anterior ischemic optic neuropathy. It is advised that patients with disc-at-risk be aware of the possible non-arteritic anterior ischemic optic neuropathy and those experiencing visual symptoms while taking clomiphene be examined promptly for evidence of optic nerve injury. Key words: Clomiphene citrate, Optic neuropathy, Visual acuity, Ischemia.

scholarly journals Compressive Optic Neuropathy Caused by Orbital Non-Hodgkin's Lymphoma

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Mohammed M. Ziaei ◽  
Hadi Ziaei
Keyword(s):  
Optic Nerve ◽  
Paranasal Sinus ◽  
Optic Neuropathy ◽  
Hodgkin’S Lymphoma ◽  
Visual Loss ◽  
Hodgkin's Lymphoma ◽  
Compressive Optic Neuropathy ◽  
Acute Visual Loss ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Purpose. To present a unique case of Non-Hodgkin’s-Lymphoma- (NHL) associated compressive optic neuropathy.Method. An 89-year-old male presenting with acute unilateral visual loss and headache.Results. Patient was initially diagnosed with occult giant cell arteritis; however after visual acuity deteriorated despite normal inflammatory markers, an urgent MRI scan revealed an extensive paranasal sinus mass compressing the optic nerve.Conclusion. Paranasal sinus malignancies occasionally present to the ophthalmologist with signs of optic nerve compression and must be included in the differential diagnosis of acute visual loss.

scholarly journals Bilateral Syphilitic Optic Neuropathy with Secondary Autoimmune Optic Neuropathy and Poor Visual Outcome

2019 ◽  
Vol 10 (1) ◽  
pp. 81-88 ◽  
Author(s):  
Tanya Kowalski ◽  
Dujon  Fuzzard ◽  
Isla Williams ◽  
Jonathan Darby ◽  
Heather Gwen Mack
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Nerve Palsy ◽  
Visual Loss ◽  
Visual Outcome ◽  
High Dose ◽  
Optic Nerve Atrophy ◽  
Poor Visual Outcome ◽  
Appropriate Treatment

We describe the case of a 65-year-old man who suffered progressive visual loss despite appropriate treatment of ocular syphilis. Our patient initially presented with a unilateral 6th nerve palsy and associated double vision, which self-resolved over 6 months. His ophthalmic examination was otherwise normal. 12 months after the initial complaint, he represented with dyschromatopsia, reduced visual acuity, tonic pupils, and optic nerve atrophy. He tested positive for syphilis and was admitted for treatment of neurosyphilis with high-dose benzylpenicillin. Despite treatment, at a 4-month review his visual acuity remained poor and progression of optic nerve atrophy was noted alongside the development of bilateral central scotomas. Further testing was congruent with a diagnosis of autoimmune optic retinopathy. We propose this to be secondary to his syphilitic infection. Syphilis is known as the “great mimicker,” and despite being quite treatable, this case highlights ongoing complexity in the diagnosis and management of syphilis, unfortunately with a poor visual outcome.

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.

Late-stage sequela of an isolated optic neuropathy after acute magnesium valproate overdose: A case report

2020 ◽  
pp. 112067212097494
Author(s):  
Xuhao Chen ◽  
Haohao Di ◽  
Ying Hong ◽  
Chun Zhang
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Hyperbaric Oxygen ◽  
Optic Neuropathy ◽  
Visual Function ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Early Stage ◽  
Systemic Treatments ◽  
The Right

Background: Magnesium valproate is a valproic acid (VPA) derivative that is widely used for the treatment of epilepsy and bipolar disorders. Acute overdose of VPA may cause complicated systemic syndromes; however, the reports of ocular sequelae caused by toxic optic neuropathy (TON) are rare. Case presentation: We present a case of a 19-year-old female with bilateral damage to visual function after acute VPA overdose. She was comatose and received systemic treatments for 1 month, during which she suffered a substantial loss of visual function without any evident neurological sequelae. The first recorded visual acuity was no light perception in the right eye (OD) and hand motion in the left eye (OS). Her best-corrected visual acuity improved to 20/100 OS after 4 months of hyperbaric oxygen therapy and neurotrophic treatments. Her visual field was limited to an inferior nasal area OS. Therefore, a diagnosis of TON was made. Her visual function remained stable in the left eye, but did not recover in the right eye during the 5-month follow-up. We found damage to the optic nerve pathway during ophthalmic examinations. Conclusion: We report a rare case of TON caused by acute VPA overdose. Hyperbaric oxygen therapy, and neuroprotective and neurotrophic treatments might be effective at the early stage but cannot fully reverse the damage to the optic nerve. The present case indicates the potential neurotoxicity of VPA. It is crucial to determine the severity of an isolated optic nerve sequela caused by VPA overdose, though it might be rare as observed in previous reports. Further confirmation of the likelihood of its causation and its pathophysiology is needed in the future.

scholarly journals Leber hereditary optic neuropathy following head trauma and ocular trauma on contralateral eye: a case report

2020 ◽  
Author(s):  
Hoon Dong Kim
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Dna Analysis ◽  
Ocular Trauma ◽  
Leber Hereditary Optic Neuropathy ◽  
Fellow Eye ◽  
Orbital Wall ◽  
Contralateral Eye ◽  
The Right ◽  
Hereditary Optic Neuropathy

Abstract Purpose To present a case of activation of Leber hereditary optic neuropathy (LHON) following head and ocular trauma of the fellow eye in the patient with no remarkable symptoms and normal visual acuity prior to trauma. Case summary A 31-year-old healthy man was referred to our hospital after a traffic accident. He had blowout fractures of medial and inferior orbital wall of the left eye, subcutaneous hematoma of the left forehead, and bony fragment that compressed the left optic nerve. Initially, best-corrected visual acuity (BCVA) was 20/20 in the right and 20/1000 in the left eyes. Relative afferent pupillary defect of the left eye was apparent, and fundus examination revealed choroidal rupture circumferentially crossing the macular area. Nine months later, the patient complained with gradual vision loss in the right eye, which was the contralateral eye of the ocular trauma. BCVA was 20/200, and perimetry revealed cecocentral scotoma in the right eye. BCVA in both eyes reduced to 20/2000 1 year post-trauma. Visual evoked potentials revealed markedly decreased in amplitudes and elongated latencies for both eyes. Mitochondrial DNA analysis revealed a G11778A mutation; therefore, a diagnosis of activation of LHON followed by trauma was made for the previously unaffected carrier. Conclusions This is a case in which activation of LHON occurred in a healthy carrier following head and ocular trauma of the fellow eye. This observation suggests the possibility that LHON activation in healthy carriers may occur in patients who experience head or ocular trauma even in the fellow eye.

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 Anterior ischemic optic neuropathy after transvenous coiling of dural arteriovenous fistulas: A case report

2019 ◽  
Author(s):  
Kazuyuki Majima ◽  
Kyoko Fujita ◽  
Shigeru Miyachi ◽  
Motohiro Kamei
Keyword(s):  
Visual Acuity ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Coil Embolization ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Intraoperative Complication ◽  
Chorioretinal Atrophy ◽  
Nasal Defect ◽  
The Right

Abstract Background A dural arteriovenous fistula (dAVF) is defined as an abnormal arteriovenous direct connection in the dura mater, with the cavernous sinus (CS) being one of the most common locations. Transarterial or transvenous embolization remains the first-line treatment for most dAVF, although these procedures are associated with rare sight-threatening ophthalmic complications. We report a case of nonarteritic anterior ischemic optic neuropathy (nAION) following successful treatment of dAVF with a coil embolization. Case presentation A 76-year-old woman complained of conjunctival hyperemia in both eyes 1 month prior to visiting our hospital. She was diagnosed with bilateral dAVF based on magnetic resonance angiography (MRA). On ophthalmic examination, her best-corrected visual acuity (BCVA) was 0.8 in the right eye and 0.7 in the left. Intraocular pressure was 27 mmHg in the right and 24 mmHg in the left. Extraocular movements were limited in all directions. Slit lamp examination disclosed red eyes with dilated corkscrew vessels. Funduscopic examination revealed normal findings in both eyes except a partial chorioretinal atrophy in the left eye. Goldmann perimetry revealed an inferior nasal defect corresponding to the chorioretinal atrophy in the left eye and normal visual field in the right eye. Transvenous coil embolization of the right CS was performed. The dAVF was completely embolized and there was no intraoperative complication. Follow-up brain MRA showed no evidence of residual dural fistula. Ten days after embolization, she developed double vision and visual disturbance in the right eye. Her right BCVA was 0.8. Fundus examination revealed pallor papilledema and splinter hemorrhages at the optic disc edge in her right eye. Fluorescein angiography showed hypofluorescence around the optic disc and a nasal lesion in the early phase. Goldman perimetry revealed lower altitudinal hemianopsia in the right eye. From these findings, nAION was diagnosed. During hospitalization, her right BCVA decreased to 0.08. Ten months later, funduscopy revealed right temporal optic disc pallor without edema, and her right visual acuity remained at 0.08. Conclusions We report a case of nAION after embolization of dAVF located in CS. This complication should be considered after embolization for dAVF.

scholarly journals Leber’s hereditary optic neuropathy - case report

2012 ◽  
Vol 2 (2) ◽  
pp. 148-152
Author(s):  
Mirjana A. Janicijevic Petrovic ◽  
Tatjana Sarenac Vulovic ◽  
Nenad Petrovic ◽  
Suncica Sreckovic ◽  
Svetlana Paunovic ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Positive Family History ◽  
Leber’S Hereditary Optic Neuropathy ◽  
Leber's Hereditary Optic Neuropathy ◽  
Inheritance Pattern ◽  
Visual Improvement ◽  
Hereditary Optic Neuropathy ◽  
Biochemical Abnormalities

Leber’s hereditary optic neuropathy is a neuro-ophthalmological entity characterized by acute or subacute bilateral, not simultaneous visual loss with centro cekal scotoma and occasional further visual improvement. This rare ophthalmological disease can be accompanied with dyschromatopsia. It is associated with a matrilineal inheritance pattern. Its diagnosis used to be solely clini¬cal, aided by imaging and neuro-physiological studies, until the advent of descriptions of mitochondrial biochemical abnormalities and genetic testing. We describe a case of 24 year old male with progressive painless deterioration of visual acuity and positive family history.

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