scholarly journals Glaucoma Management in Carotid Cavernous Fistula

2016 ◽  
Vol 7 (2) ◽  
pp. 296-302 ◽  
Author(s):  
Silvia Calafiore ◽  
Andrea Perdicchi ◽  
Gianluca Scuderi ◽  
Maria Teresa Contestabile ◽  
Solmaz Abdolrahimzadeh ◽  
...  
Keyword(s):  
Vision Loss ◽  
Transarterial Embolization ◽  
Multidisciplinary Treatment ◽  
Clinical Signs ◽  
Field Testing ◽  
Laser Iridotomy ◽  
Mri Angiography ◽  
The Right ◽  
Carotid Cavernous Fistulas

Carotid cavernous fistulas (CCF) are vascular communications between the carotid artery and the cavernous sinus. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features. A 73-year-old female was referred to our glaucoma center clinic. Eight years before, she had started receiving medication for glaucoma and had undergone laser iridotomy, but a satisfactory management of intraocular pressure (IOP) had not been achieved. The patient was complaining of intermittent diplopia, bilateral proptosis, and conjunctival chemosis over the past 6 months. Best-corrected visual acuity in the right (OD) and left eye (OS) was 9/10 and 10/10, respectively. Visual field testing showed slight paracentral field defects mostly in OS. IOP was 20 mm Hg in OD and 34 mm Hg in OS. We referred the patient to neuroradiology, and MRI angiography revealed a CCF with angiographic classification of Cognard grade 2. Closure of the CCF by transarterial embolization was performed in the neuroradiology department. One week following the procedure, the clinical signs of diplopia, proptosis, and conjunctival chemosis had greatly improved, and IOP was reduced to 12 mm Hg OD and 19 mm Hg in OS. Glaucoma treatment was maintained with topical brimatoprost, brinzolamide, and timolol. Owing to the risk of vision loss associated with vascular stasis, retinal ischemia, and high IOP, ophthalmologists must be aware of the clinical features of CCF and should request appropriate imaging studies such as MRI angiography in order to confirm the diagnosis and plan multidisciplinary treatment.

A CASE OF BILATERAL RENAL B-CELL LYMPHOMA WITH UVEITIS AND SECONDARY POLYCYTHEMIA IN A JACK RUSSELL TERRIER

2021 ◽  
pp. 1-8
Author(s):  
Shu-Fang Yang ◽  
Heng-Leng Yang ◽  
Hui-Wen Chang ◽  
Yu-Han Hsieh ◽  
Peng-Chen Wang ◽  
...  
Keyword(s):  
B Cell ◽  
Vision Loss ◽  
Clinical Signs ◽  
B Cell Lymphoma ◽  
Cell Marker ◽  
Abdominal Ultrasonography ◽  
General Physical Examination ◽  
General Physical ◽  
The Right ◽  
End Stage

An 8-year-old, castrated male, Jack Russell Terrier was presented with clinical signs of uveitis and glaucoma in the right eye (oculus dexter (OD)) for 2–3 months. Ophthalmic examination revealed OD episcleral congestion, corneal vascularization, aqueous flare, iris bombe, and vision loss. OD glaucoma and uveitis were under control by medical treatment. After 8 months, the dog had acute uveitis in the left eye (oculus sinister (OS)). General physical examination, blood examinations, radiography, and urinalysis were unremarkable. No improvement was observed after for 1 month of uveitis treatment, and more examinations were strongly suggested. Abdominal ultrasonography revealed several hypoechoic masses or cysts on both kidneys. Computed tomography (CT) showed diffuse nonenhancing hypodense patches in both kidneys. Renal tumor was highly suspected, but biopsy was declined by the owner. Ten days after CT examination, the dog suddenly developed anorexia, weakness, uremia, hyperkalemia, and polycythemia. The dog was euthanatized because of the worsening clinical condition, poor prognosis, and financial constraints, and both kidneys were biopsied for histopathology. Immunohistochemically, the neoplastic cells were positive for B-cell marker (CD20) and negative for T-cell marker (CD3). Bilateral renal B-cell origin lymphoma was diagnosed by histologic and immunophenotyping examinations. In conclusion, bilateral renal lymphoma may be diagnosed with no systemic signs except bilateral uveitis. Renal function impairment was acutely developed with severe clinical signs at the end stage of the disease. Early, aggressive, complete examinations, and treatments are strongly recommended.

Idiopathic Intracranial Hypertension

2019 ◽  
pp. 47-54
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Older Adults ◽  
Visual Field ◽  
Intracranial Pressure ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Clinical Signs ◽  
Field Testing ◽  
Obese Women ◽  
Childbearing Age

Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in obese women of childbearing age, although it can also occur in children, men, and older adults. Papilledema is usually present and can cause irreversible vision loss if left untreated. In this chapter, we begin by reviewing the symptoms of this condition, which include headache, transient visual obscurations, and pulse-synchronous tinnitus. We next review the clinical signs and common findings on formal visual field testing. We then discuss the diagnostic evaluation and review the diagnostic criteria for this condition. Lastly, we review the goals and management of this condition, which must be tailored depending on the severity of symptoms, papilledema, and vision loss.

scholarly journals Iridotrabecular and Iridocorneal Contact Changes after Cataract Surgery and Endothelial Keratoplasty in Bilateral Iridoschisis

2021 ◽  
pp. 198-203
Author(s):  
Takashi Omoto ◽  
Chisato Agata ◽  
Reina Akiyama ◽  
Kohdai Kitamoto ◽  
Tetsuya Toyono ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Surgical Procedures ◽  
Vision Loss ◽  
Anterior Segment ◽  
Corneal Oedema ◽  
Endothelial Keratoplasty ◽  
Laser Iridotomy ◽  
Before And After ◽  
The Right ◽  
Endothelial Decompensation

We report a case of bilateral iridoschisis with corneal oedema and a quantitative evaluation of the changes in iridotrabecular and iridocorneal contact before and after cataract surgery and after Descemet stripping automated endothelial keratoplasty (DSAEK). A 76-year-old woman with iridoschisis and cataracts, previously managed with laser iridotomy, experienced progressive vision loss. The preoperative iridotrabecular contact (ITC) index measured by anterior segment optical coherence tomography was 23.6% in the right eye and 24.4% in the left eye. Preoperative corneal oedema in the right eye was more severe than that in the left eye. Cataract surgery, followed by DSAEK, was performed in the right eye and subsequently in the left eye. Her visual acuity improved postoperatively, and the corneal oedema of both eyes was treated successfully. Moreover, the ITC index improved in both eyes, to 4.7 and 6.9% after cataract surgery and to 0 and 0% after DSAEK in the right and left eyes, respectively. Staged cataract surgery and DSAEK were effective for endothelial decompensation caused by iridoschisis. Additionally, we confirm that iridotrabecular and iridocorneal contacts improved after both surgical procedures not only after cataract surgery but also after DSAEK. This case report showed the clinical usefulness of the ITC index in the detection of changes after different surgical procedures.

scholarly journals Transarterial Embolization of a Transverse Sinus Dural Arteriovenous Fistula: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E41-E42
Author(s):  
Santiago Gomez-Paz ◽  
Yosuke Akamatsu ◽  
Mohamed M Salem ◽  
Justin M Moore ◽  
Christopher S Ogilvy ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vision Loss ◽  
Transarterial Embolization ◽  
Sudden Onset ◽  
Strenuous Exercise ◽  
Initial Assessment ◽  
Significant Past Medical History ◽  
Patient Consent ◽  
The Right

Abstract A 40-yr-old male with no significant past medical history presented with sudden onset right-sided retro-orbital headache associated with vision loss after a session of strenuous exercise. Initial assessment with noncontrast head computed tomography at the local emergency department revealed a right sided occipital intracranial hemorrhage (ICH). On arrival the patient ad a left quadrantopsia with Glasgow Coma Scale of 15 and an ICH score of 0. A computed tomographic angiography showed a high density 6 × 9 mm vascular lesion associated with 2 tortuous vessels. Cerebral angiography revealed a right sided dural arteriovenous fistula, Cognard Type IV, with arterial feeders arising from dural branches of the right vertebral artery, the posterior division of the right middle meningeal artery and meningeal branches distal to the neuromeningeal trunk of the left ascending pharyngeal artery.1 Four days after the ICH event the patient was treated with endovascular Onyx embolization of the fistula, through a transradial approach. Immediate angiographic assessment showed complete obliteration of the dAVF. The patient was discharged home and recovered his visual field deficit over 3 mo. The following operative video includes a discussion of the endovascular technique and treatment nuances associated with the transarterial management of a dural arteriovenous fistula. Patient consent was given prior to the procedure and consent and approval for this operative video was waived due to the retrospective nature of this manuscript and the anonymized video material.

Surgical removal of embolic material after its unexpected migration through extracranial-intracranial anastomosis in the treatment of Barrow Type D carotid-cavernous fistula: case report

2018 ◽  
Vol 128 (3) ◽  
pp. 731-734 ◽  
Author(s):  
Jae-Sang Oh ◽  
Dong-Sung Kim ◽  
Jai-Joon Shim ◽  
Seok-Mann Yoon
Keyword(s):  
Cerebral Artery ◽  
Transarterial Embolization ◽  
Cerebral Arteries ◽  
Surgical Removal ◽  
Embolic Material ◽  
Type D ◽  
History Of ◽  
The Right ◽  
Carotid Cavernous Fistulas ◽  
Transvenous Approach

Endovascular occlusion via the transvenous route is the favored treatment for indirect carotid-cavernous fistulas (CCFs). However, transarterial embolization can be used as an alternative method in patients with an inaccessible venous route. The authors present the case of a 49-year-old woman with a 2-month history of chemosis and proptosis in her right eye. Angiography demonstrated a Barrow Type D CCF. Transarterial Onyx embolization through the accessory meningeal artery was performed after an unsuccessful transvenous approach. Unexpected Onyx migrations to the cerebral arteries were detected while injecting the embolic material. Three hours after failed attempts to retrieve the Onyx cast endovascularly, it was microsurgically removed from the right middle cerebral artery. To the authors' knowledge, this is the first report of the surgical removal of Onyx from a normal cerebral artery.

Usefulness of C-Arm Cone-Beam Computed Tomography in Endovascular Treatment of Traumatic Carotid Cavernous Fistulas

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 467-470 ◽  
Author(s):  
Kenichi Sato ◽  
Yasushi Matsumoto ◽  
Ryushi Kondo ◽  
Teiji Tominaga
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Cavernous Sinus ◽  
Cone Beam Computed Tomography ◽  
Treatment Strategy ◽  
Internal Carotid ◽  
Transarterial Embolization ◽  
Cone Beam ◽  
The Right ◽  
Carotid Cavernous Fistulas

Abstract BACKGROUND Detailed information about the anatomy of traumatic carotid cavernous fistula (CCF) is required for determining the appropriate treatment strategy. OBJECTIVE We report the usefulness of C-arm cone-beam computed tomography (CBCT) for visualizing traumatic CCF during endovascular treatment. CLINICAL PRESENTATION A 63-year-old woman presented with right pulsating tinnitus 1 week after a bicycle accident. Right internal carotid angiography demonstrated a right CCF but failed to visualize its precise location because the cavernous portion of the right internal carotid artery (ICA) was hidden by early filling of the cavernous sinus during both conventional digital subtraction angiography (DSA) and 3-dimensional digital angiography. TECHNIQUE C-arm CBCT, performed with a flat-panel detector mounted in a C-arm angiographic system, clearly depicted the tear in the medial wall of the C4 segment of the right ICA. Transarterial embolization with coils achieved complete occlusion of the CCF, and the patient's symptoms resolved immediately after the procedure. CONCLUSION C-arm CBCT is useful to visualize the communication between the ICA and cavernous sinus and helps to determine the treatment strategy for traumatic CCFs.

Awareness and Decision Making in Professional Ethics

2000 ◽  
Vol 5 (1) ◽  
pp. 19-27 ◽  
Author(s):  
Ronny Swain
Keyword(s):  
Decision Making ◽  
Professional Ethics ◽  
Ethical Decision Making ◽  
Code Of Ethics ◽  
Professional Autonomy ◽  
Ethical Awareness ◽  
Ethical Decisions ◽  
The Right ◽  
Aid Decision

The paper describes the development of the 1998 revision of the Psychological Society of Ireland's Code of Professional Ethics. The Code incorporates the European Meta-Code of Ethics and an ethical decision-making procedure borrowed from the Canadian Psychological Association. An example using the procedure is presented. To aid decision making, a classification of different kinds of stakeholder (i.e., interested party) affected by ethical decisions is offered. The author contends (1) that psychologists should assert the right, which is an important aspect of professional autonomy, to make discretionary judgments, (2) that to be justified in doing so they need to educate themselves in sound and deliberative judgment, and (3) that the process is facilitated by a code such as the Irish one, which emphasizes ethical awareness and decision making. The need for awareness and judgment is underlined by the variability in the ethical codes of different organizations and different European states: in such a context, codes should be used as broad yardsticks, rather than precise templates.

Acute abdomen in pregnancy: a retrospective study of pregnant patients hospitalised for abdominal pain

2020 ◽  
Vol 99 (3) ◽  
pp. 131-135
Keyword(s):  
Abdominal Pain ◽  
Clinical Signs ◽  
University Hospital ◽  
Diagnostic Process ◽  
Abdominal Emergency ◽  
Lower Abdominal Quadrant ◽  
Abdominal Emergencies ◽  
The Right ◽  
Abdominal Quadrant ◽  
In Pregnancy

Introduction: Abdominal emergencies occur in pregnant women with the rate of 1:500−635 pregnancies. Such conditions usually develop from full health and worsen rapidly. Symptoms are often similar to those in physiological pregnancy (abdominal pain, vomiting, constipation). The diagnostic process is thus difficult and both the mother and her child are at risk. Our aim was to evaluate the frequency of abdominal emergencies in the Department of Surgery, University Hospital in Pilsen and to consider their impact on pregnancy and on the newborn. Methods: We acquired a set of patients by retrograde collection of data. We searched for pregnant patients suspected of developing an abdominal emergency admitted to the Department of Surgery, Faculty of Medicine, Pilsen between 2004 and 2015. We evaluated a number of clinical signs to statistically describe the set. Results: The set included 121 patients; 42 of the patients underwent a surgical procedure and 79 received conservative treatment. 38 patients underwent appendectomy; 6 appendixes were with no pathologies. McBurney’s incision was an approach of choice in most cases. The most frequent symptom was pain in the right lower abdominal quadrant. The foetus has been lost in none of the cases. Conclusion: Acute appendicitis was the most frequent abdominal emergency in our set and also the most frequent reason for surgical intervention. The most specific sign was pain in the right lower abdominal quadrant. No impact of appendicitis or appendectomy on the health of the newborn has been observed. Even though abdominal emergencies in pregnancy are relatively rare, the results of the department are very good.

scholarly journals Proning related bilateral anterior ischaemic optic neuropathy in a patient with COVID-19 related acute respiratory distress syndrome

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsty Michelle Clarke ◽  
Vivi Riga ◽  
Amy-lee Shirodkar ◽  
Joel Meyer
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Visual Field ◽  
Respiratory Distress Syndrome ◽  
Distress Syndrome ◽  
Vision Loss ◽  
Prone Positioning ◽  
Disc Oedema ◽  
Ischaemic Optic Neuropathy ◽  
The Right

Abstract Background Non-arteritic ischaemic optic neuropathy (NAION) is a rare but harmful complication of prone positioning. Prone mechanical ventilation is a therapeutic strategy which has been used extensively during the COVID-19 pandemic to treat acutely hypoxemic patients with COVID-19 related acute respiratory distress syndrome (ARDS). Though a small number of cases of unilateral NAION have been reported in patients testing positive for the SARS-CoV-2 virus, we describe what is to our knowledge, the first reported case of bilateral NAION occurring in a patient proned extensively for the treatment of COVID-19 related ARDS. We consider the potential aetiological factors leading to NAION after prone mechanical ventilation in patients with COVID-19 and suggest strategies to protect against its development. Case presentation : We report a case of severe, irreversible, visual impairment secondary to bilateral anterior ION in a fifty-five-year-old male who underwent eight episodes of prone mechanical ventilation to treat COVID-19 related ARDS. Once weaned from his sedation he reported bilateral painless vision loss, and bedside ophthalmological assessment identified a reduced visual acuity of 3/30 unaided in the left eye and counting fingers in the right. Dilated indirect ophthalmoscopy revealed inferotemporal optic disc oedema with splinter haemorrhages in the right eye and mild disc oedema, temporal pallor, and nerve fibre layer haemorrhages inferiorly in the left eye. Humphrey visual field 24 − 2 testing confirmed a severely constricted visual field with macular sparing on the right and depressed inferonasal vision with preserved peripheral vision on the left eye. OCT disc imaging shortly after diagnosis revealed bilateral disc swelling and flame haemorrhages in the right eye. Conclusions NAION is a devastating, but preventable complication of prone positioning, which may pose significant risk of vision loss in patients with COVID-19 related ARDS.

scholarly journals Acute otitis media in an infant complicated with osteoarthritis of temporomandibular joint and sub-periosteal abscess of the clavicle

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Kaoutar Cherrabi ◽  
Hind Cherrabi
Keyword(s):  
Septic Arthritis ◽  
Temporomandibular Joint ◽  
Nutritional Assessment ◽  
Acute Otitis Media ◽  
Clinical Signs ◽  
Rare Condition ◽  
Pediatric Emergency ◽  
Ear Infections ◽  
The Right

Abstract Background Otomastoiditis is a very frequent affection and a current complication of mal-treated benign ear infections in children. However, this a very rare case of the association of two rare complications of otomastoiditis in a newborn. On the one hand, septic arthritis of the temporomandibular joint which is a very rare condition that is difficult to diagnose, and when unrecognized or not treated accordingly, it can resolve in serious infectious complication and or definitive injury to the temporomandibular joint. On the other hand, osteomyelitis of the clavicle is also very rare, and only a few cases have been cited in the literature concerning infants. Case presentation This 46-day-old infant was brought to pediatric emergency consultation for 2 swelling inflammatory bulges, one in the right mastoid and pre-auricular regions, and another in the right basi-cervical area. The infant was hypertrophic febrile, hypotonic, and pale. He had preserved archaic reflexes. Besides, blood test showed an inflammatory syndrome, inflammatory anemia, and no other abnormalities. Upon supplementary computed tomodensitometry exam, the diagnosis of a combination of septic arthritis of the right temporomandibular joint and sub-periosteal abscess of the ipsilateral clavicle in a context of hypotrophy and malnutrition was suspected. A pus sample was obtained for bacteriological evaluation, after which the infant had a course of intravenous associated antibiotics, along with nutritional assessment and management. Surgical drainage of both collections was performed. The 6-month follow-up was satisfactory, without clinical signs of functional impact on temporomandibular joint, or acromioclavicular joint. Conclusion This work stresses the necessity of thorough clinical examination of infants even in cases of benign ear infections, as well as the importance of adapted treatment and follow-up, which could allow early diagnosis, appropriate treatment, or even prevention of severe complications that can be associated with such benign conditions.

Sign in / Sign up

Export Citation Format

Share Document