Ocular complications of cat scratch disease

2020 ◽  
Vol 104 (12) ◽  
pp. 1640-1646 ◽  
Author(s):  
Alan Johnson
Keyword(s):  
Bartonella Henselae ◽  
Case Series ◽  
Retinal Artery Occlusion ◽  
Evidence Base ◽  
Artery Occlusion ◽  
Cat Scratch Disease ◽  
Positive Serology ◽  
History Of ◽  
Systemic Symptoms ◽  
Parinaud’S Oculoglandular Syndrome

Cat scratch disease (CSD) in humans is caused by infection with Bartonella henselae or other Bartonella spp. The name of the disease reflects the fact that patients frequently have a history of contact (often involving bites or scratches) with infected cats. Patients with CSD typically develop lesions at the site where the skin is broken together with regional lymphadenopathy but may go on to exhibit systemic symptoms and with deep-seated infections at a range of sites including the eye. Patients with CSD may present with a range of inflammatory eye conditions, including Parinaud’s oculoglandular syndrome, neuroretinitis, multifocal retinitis, uveitis and retinal artery occlusion. Bartonella spp. are fastidious bacteria that are difficult to culture from clinical specimens so microbiological diagnosis is frequently made on the basis of positive serology for anti-Bartonella antibodies or detection of bacterial DNA by PCR. Due to the lack of clinical trials, the evidence base for optimal management of patients with CSD-associated eye infections (including the role of antibiotics) is weak, being derived from single reports or small, uncontrolled case series.

scholarly journals Concurrent Bilateral Central Retinal Artery Occlusion Secondary to Sickle Cell Crisis

2021 ◽  
Vol 9 ◽  
pp. 232470962110283
Author(s):  
Gowri Renganathan ◽  
Piruthiviraj Natarajan ◽  
Lela Ruck ◽  
Roberto Prieto ◽  
Bharat Ved Prakash ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Cell Disease ◽  
Sickle Cell Crisis ◽  
History Of ◽  
Retinal Artery

Vascular occlusive crisis with a concurrent vision loss on both eyes is one of the most devastating disability for sickle cell disease patients. Reportedly occlusive crisis in the eyes is usually temporary whereas if not appropriately managed can result in permanent vision loss. A carefully managed sickle cell crisis could prevent multiple disabilities including blindness and stroke. We report a case of a 24-year-old female with a history of sickle cell disease who had acute bilateral vision loss during a sickle crisis and recovered significantly with a timely emergent erythrocytapheresis.

Abstract 23: Detection of Atrial Fibrillation by Implantable Cardiac Monitoring After Acute Central Retinal Artery Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Brian C Mac Grory ◽  
Paul D Ziegler ◽  
Sean Landman ◽  
Amador Delamerced ◽  
Anusha Boyanpally ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Cardiac Device ◽  
History Of ◽  
Implantable Cardiac Device ◽  
Retinal Artery

Introduction: Central retinal artery occlusion (CRAO) is a form of ischemic stroke and necessitates a comprehensive workup, including for cardioembolic sources such as atrial fibrillation (AF). However, the incidence of new AF diagnosed after CRAO is unknown. We aimed to examine the incidence of new, cardiac device-detected AF after CRAO in a large population-based cohort. Methods: Using patient-level data from the Optum® de-identified EHR dataset (2007-2017) linked with Medtronic implantable cardiac device data, we identified patients that had a diagnosis-code corresponding to CRAO and no known history of AF, and who also had either a device in-situ at the time of CRAO or implanted ≤1 year post-CRAO with continuous AF monitoring data available. AF incidence was defined as ≥2 minutes of device-detected AF in a day. Results: Of 467,167 patients screened, 246/433 (56.8%) with CRAO had no history of AF, of whom 39 had an eligible implantable cardiac device (mean age 66.7±14.8, 41.0% female). Prevalence of vascular risk factors was high (hypertension, 71.8%; hyperlipidemia, 61.5%; coronary artery disease, 46.2%). Within 3 months, 7.7% of these patients (n=3) had device-detected AF. At 36 months, 33.3% of patients (n=13). The maximum daily AF burden post CRAO ranged from 2 minutes to 24 hours with a mean of 390±530 minutes. Of the patients with device-detected AF, 9 were found by an implantable cardiac monitor and 4 by pacemaker or defibrillator. Discussion: The rate of long-term AF detection after CRAO was high in patients with implanted cardiac devices, and appears comparable with rates seen after cryptogenic ischemic stroke and in other high-risk populations. Our findings warrant future prospective studies not limited by selection bias.

Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Cephalalgia ◽  
2021 ◽  
pp. 033310242110562
Author(s):  
Nikita Chhabra ◽  
Chia-Chun Chiang ◽  
Marie A Di Nome ◽  
Odette Houghton ◽  
Rachel E Carlin ◽  
...  
Keyword(s):  
Visual Loss ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Monocular Vision ◽  
Ischemic Optic Neuropathy ◽  
Migrainous Infarction ◽  
Ischemic Complications ◽  
History Of

Background Retinal migraine is defined by fully reversible monocular visual phenomena. We present two cases that were complicated by permanent monocular vision deficits. Cases A 57-year-old man with history of retinal migraine experienced persistent monocular vision loss after one stereotypical retinal migraine, progressing to finger-count vision over 4 days. He developed paracentral acute middle maculopathy that progressed to central retinal artery occlusion. A 27-year-old man with history of retinal migraine presented with persistent right eye superotemporal scotoma after a retinal migraine. Relative afferent pupillary defect and superotemporal visual field defect were noted, consistent with ischemic optic neuropathy. Conclusion Retinal migraine can complicate with permanent monocular visual loss, suggesting potential migrainous infarction of the retina or optic nerve. A thorough cerebrovascular evaluation must be completed, which was unrevealing in our cases. Acute and preventive migraine therapy may be considered in retinal migraine patients, to mitigate rare but potentially permanent visual loss.

scholarly journals Case Report: Central Retinal Artery Occlusion in a COVID-19 Patient

2020 ◽  
Vol 11 ◽  
Author(s):  
Andrea Montesel ◽  
Claudio Bucolo ◽  
Victoria Mouvet ◽  
Emmanuelle Moret ◽  
Chiara M. Eandi
Keyword(s):  
Vision Loss ◽  
Previous History ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
History Of ◽  
Severe Vision Loss ◽  
Retinal Artery ◽  
Vascular Occlusions

We report a case of central retinal artery occlusion (CRAO) in a patient with a previous history of severe COVID-19 disease. This disease has been associated with inflammatory-induced homeostasis changes leading to endothelial dysfunction and a procoagulant state with multi-organ involvement, but the burden of thromboembolic complications in COVID-19 patients is currently unknown. The pathogenesis of retinal artery occlusions is a multifactorial process where inflammation and hypercoagulation state are established risk factors. Even if our experience may represent a coincidental relationship, it is likely that COVID-19 patients could be at risk of developing retinal vascular occlusions. A focused ophthalmological surveillance is advisable to prevent and manage this possible cause of severe vision loss that has an important impact in health care system.

scholarly journals A Cardiac Pseudoaneurysm as a Thromboembolic Source: Acute Visual Loss due to Cardiac Emboli

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Fernando Montenegro Sá ◽  
Sara I. L. Fernandes ◽  
Rita J. R. Carvalho ◽  
Luís M. G. Santos ◽  
José A. S. Antunes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Transoesophageal Echocardiography ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Acute Visual Loss ◽  
History Of ◽  
Retinal Artery

Acute visual loss is rarely caused by a heart condition. This manuscript transcribes a case report of a 36-year-old patient with a 2-year history of aortic valve replacement due to bicuspid aortic valve endocarditis that presents to the emergency department with an acute right eye visual loss. After ophthalmologic investigation identified a central retinal artery occlusion, a transthoracic echocardiography was performed to search for a possible cardiac embolus, despite the patient presenting INR values of 2-2.5 for the last year. A mitral-aortic intervalvular fibrosa pseudoaneurysm was identified. A transoesophageal echocardiography was then performed, identifying a small clot logged inside the pseudoaneurysm that protruded to the left ventricle outflow tract. After INR-adjusted warfarin treatment to levels between 3 and 4, the pseudoaneurysm was surgically closed. This is a rare case since the likely source of embolism to the central retinal artery was the thrombus logged inside the pseudoaneurysm despite a standardly accepted therapeutic INR.

Selective Thrombophilia Screening in Young Patients with Retinal Artery Occlusion

2016 ◽  
Vol 235 (4) ◽  
pp. 189-194 ◽  
Author(s):  
Claudia Kuhli-Hattenbach ◽  
Peter Hellstern ◽  
Wolfgang Miesbach ◽  
Thomas Kohnen ◽  
Lars-Olof Hattenbach
Keyword(s):  
Odds Ratio ◽  
Strong Association ◽  
Young Patients ◽  
Multivariate Logistic Regression Analysis ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Healthy Controls ◽  
Thrombophilia Screening ◽  
History Of ◽  
Retinal Artery

Purpose: To investigate the prevalence of various thrombophilic disorders among young patients with retinal artery occlusion (RAO). Procedures: We retrospectively reviewed thrombophilia screening data of young patients ≤60 years of age with RAO and healthy controls matched for gender and age. Results: Thrombophilia screening data of 25 young patients and 62 healthy controls were analyzed. Mean patient age by the time of the RAO was 43.3 ± 10.8 years. Overall, thrombophilic defects were found to be present in 17 patients (68%) compared with 11 of 62 controls (17.7%; p < 0.0001). Multivariate logistic regression analysis confirmed a statistically significant association between the development of RAO and increased levels of lipoprotein(a) (odds ratio: 9.48; p = 0.001) and factor VIII (odds ratio: 6.41; p = 0.024). There was a strong association between the presence of thrombophilic disorders and a personal or family history of thromboembolism (p = 0.01). Conclusions: Our results indicate that screening for thrombophilic disorders among selected young patients with RAO yields positive results in a high percentage of cases.

scholarly journals Pediatric Bartonella Infection (Cat Scratch Disease) Presenting as Inguinal Lymphadenopathy

2020 ◽  
Vol 5 ◽  
Author(s):  
Ganesh Maniam ◽  
Aisha Khan ◽  
Raphael Mattamal
Keyword(s):  
Bartonella Henselae ◽  
Surgical Excision ◽  
Empiric Antibiotic Therapy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Cat Scratch Disease ◽  
Positive Serology ◽  
Recent Infection ◽  
Left Groin ◽  
Inguinal Lymphadenopathy

Cat scratch disease is an infectious disease resulting from inoculation of Bartonella species through a cat scratch or bite, often presenting as an erythematous papule at the site of inoculation with nearby painful lymphadenopathy. The diagnosis of this disease is complicated by a wide variety of clinical presentations, as the primary lesion may not be initially noticed. Furthermore, cervical and axillary lymph nodes are the most commonly involved regions of tender lymphadenopathy, but there have been reported cases that do not fit the typical clinical picture – such the case discussed in this report of a pediatric Bartonella henselae infection that initially presented as left inguinal lymphadenopathy with underlying necrosis and abscess formation. In this case, a 9-year-old boy presented to the ED with a 4-day history of increasing mass in the left groin, as well as a subjective fever for the previous 2 days. An ultrasound revealed a necrotic abscess in the left inguinal lymph node which necessitated empiric antibiotic therapy and surgical excision; titers revealed a recent infection with Bartonella henselae. Atypical presentations of cat scratch disease, such as inguinal lymphadenopathy, have historically confounded the diagnosis. However, positive serology studies ultimately yielded the correct diagnoses in these children. Given that cat scratch disease can present in an atypical fashion in approximately 5 - 25% of cases, physicians should keep the disease on the differential even when presented with rare presentations such as inguinal lymphadenopathy; serological testing for B. henselae can be utilized once more likely etiologies have been ruled out.

Pelvic ureteric junction obstruction: Natural history, nephrological considerations and current evidence base for surgical management in poorer functioning kidneys

2019 ◽  
Vol 13 (2) ◽  
pp. 116-121 ◽  
Author(s):  
Dora Moon ◽  
Timothy Napier-Hemy
Keyword(s):  
Natural History ◽  
Systemic Disease ◽  
Case Series ◽  
Evidence Base ◽  
Poor Quality ◽  
Quality Data ◽  
Current Evidence ◽  
Current Evidence Base ◽  
History Of ◽  
Split Function

Pelvic ureteric junction obstruction (PUJO) can pose a management challenge to urologists. The natural history of the disease, particularly in adults is poorly understood and management decisions are largely based on historical, poor quality data. Additionally, many older patients may already have a degree of renal impairment secondary to systemic disease, further compounding the situation. The purpose of this paper is to detail the pathophysiology and natural history of PUJO, discuss the implications of chronic kidney disease in this population detailing the current evidence base for poorer functioning kidneys and describe the nephrological advantages of accurate renal function testing. There exists accurate methods to assess both glomerular filtration rate (GFR) and split function which could potentially provide both the urologist and patient with more relevant data on which to base their decisions when contemplating surgical intervention. The existing, low patient number case series currently published fail to address the relevance of overall GFR on the outcomes after pyeloplasty, no studies use single unit GFR and there is no clear consensus on what constitutes surgical success. PUJO is an area of benign upper tract disease that is in need of high-quality scientific studies to identify when intervention is necessary, long-term success of both surgery and conservative management in poorer functioning kidneys and clear guidelines for urologists.

Direct carotid puncture for endovascular thrombectomy in acute ischemic stroke

2019 ◽  
Vol 11 (7) ◽  
pp. 647-652 ◽  
Author(s):  
Adam Roche ◽  
Emma Griffin ◽  
Seamus Looby ◽  
Paul Brennan ◽  
Alan O’Hare ◽  
...  
Keyword(s):  
Central Retinal Artery Occlusion ◽  
Case Series ◽  
Intravenous Thrombolysis ◽  
Standard Of Care ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Anterior Circulation ◽  
Arterial Access ◽  
Femoral Approach ◽  
Access Complications

BackgroundMechanical thrombectomy is the standard of care for acute ischemic strokes with proximal intracranial occlusion. Arterial access is commonly achieved with femoral artery puncture, although this is not always possible. In this case series, we describe 11 cases of anterior circulation stroke where direct carotid puncture was used to obtain vascular access.Methods and materialsA review of a prospectively maintained thrombectomy database over a 2-year period (August 2016 – August 2018) was undertaken to identify cases where direct carotid access was performed. CT and angiographic imaging were reviewed. Indications for carotid access, techniques used, technical success of procedure, recanalization rates, procedure-related complications, and patient outcomes were assessed.ResultsEleven patients out of 498 overall thrombectomy procedures (2.2% thrombectomies) underwent direct carotid access. Median National Institutes of Health Stroke Scale was 20. Seventy three percent of patients received intravenous thrombolysis. The direct carotid approach was performed following the failed femoral approach due to unfavorable aortic arch anatomy, vessel tortuosity, and severe atherosclerotic disease. Direct carotid puncture was successful in 10 patients, and unsuccessful in one. Successful recanalization (TICI 2b–3) was achieved in eight patients. One patient had spontaneously recanalized on angiography. There was failed recanalization in one patient with tandem ICA and M1 occlusion. Carotid access complications included one patient with both neck hematoma and asymptomatic ICA dissection, and one of delayed central retinal artery occlusion.ConclusionThis case series highlights direct carotid puncture as a successful alternative when the femoral approach is not possible, allowing thrombectomy in patients who would otherwise be unsuitable.

Eritema nodoso: gatta ci cova

2021 ◽  
Vol 24 (10) ◽  
pp. 304-308
Author(s):  
Caterina Bacci ◽  
Sara Picariello ◽  
Francesco Vierucci ◽  
Carlo Mazzatenta ◽  
Angelina Vaccaro
Keyword(s):  
Clinical Manifestation ◽  
Erythema Nodosum ◽  
Bartonella Henselae ◽  
Diagnostic Evaluation ◽  
Cat Scratch Disease ◽  
Clinical Presentations ◽  
Atypical Manifestations ◽  
Systemic Symptoms ◽  
Atypical Manifestation ◽  
Subsequent Onset

Erythema nodosum is a panniculitis that can be triggered by many different stimuli. The paper describes the case of a child who presented with erythema nodosum as the unique clinical manifestation of cat scratch disease. Bartonella henselae infection usually presents with non-tender papule in the scratch line followed by subsequent onset of regional lymphadenopathy eventually associated with systemic symptoms. It can also present with atypical manifestation, such as erythema nodosum. The heterogeneity of the clinical presentations makes the disease to be underdiagnosed, whereby it is important to recognize atypical manifestations. Therefore, it is recommended to include Bartonella henselae serology in the diagnostic evaluation of erythema nodosum.

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