scholarly journals Coexisting Optic Disc Melanocytoma and Pituitary Adenoma

2019 ◽  
Vol 5 (5) ◽  
pp. 319-322
Author(s):  
Yamini Attiku ◽  
Pukhraj Rishi ◽  
Shikha Bassi
Keyword(s):  
Visual Acuity ◽  
Pituitary Adenoma ◽  
Visual Field ◽  
Optic Disc ◽  
Uneventful Recovery ◽  
Ophthalmological Examination ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
High Degree ◽  
The Brain

Aim: To report a rare case of optic disc melanocytoma coexistent with pituitary adenoma. Methods: Ophthalmological examination with perimetry and magnetic resonance imaging (MRI) of the brain and orbits was done. Results: A 42-year-old woman presented with complaints of progressive diminution of vision in the right eye of 6 weeks’ duration. Visual acuity in the affected right eye was 6/60 and in the left eye it was 6/6. On examination, a brown-black lesion was noted over the optic nerve head in the right eye. On perimetry, the visual field was constricted in the right eye and a superior altitudinal defect was found in the left eye. MRI of the brain and orbits revealed a pituitary adenoma with suprasellar extension. The patient underwent endoscopic transphenoidal pituitary adenoma excision with uneventful recovery. Three months following surgery, visual acuity improved to 6/6 in both eyes with partial visual field recovery and was maintained at 10 months of follow-up. There was no recurrence or metastasis. Conclusion: A high degree of suspicion is required to screen for possible coexistent orbital or central nervous system pathology in cases of optic disc melanocytoma with disproportionate signs or symptoms.

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 A Decrease In Visual Acuity Revealing A Pituitary Apoplexy

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Joumany Brahim Salem ◽  
Sidi Dahi ◽  
Mahdi Khammaily ◽  
Wafa Akioud ◽  
Yassine Mouzari ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Ocular Motility ◽  
Light Perception ◽  
Sudden Decrease ◽  
The Right ◽  
Acute Headache ◽  
The Brain ◽  
Decrease In Visual Acuity

Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma. It is a very serious but rare accident. We present the case of a 28-year-old patient with no specific history who had experienced severe acute headache and a sudden decrease in visual acuity. Clinical examination showed a VA with negative light perception on the right and 1/10 on the left , bilateral aréflective mydriasis ODG, ocular motility preserved bilaterally, with normal FO in both eyes. An emergency CT scan of the brain reveals a giant intra-sellar pituitary adenoma and a hemorrhagic area in it’s center evoking a picture of pituitary apoplexy.

scholarly journals Panhypopituitarism Presenting as Progressive Visual Acuity Deterioration Secondary to Suprasellar Germinoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A596-A596
Author(s):  
Rainer Wandrew Young Po ◽  
Monica Therese B Cating-Cabral
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Disc ◽  
Clinical Sign ◽  
External Beam Radiation ◽  
Optic Nerve Atrophy ◽  
Beam Radiation ◽  
Intracranial Mass ◽  
The Right ◽  
The Brain

Abstract Background: Overall the incidence of germ cell tumors worldwide is 0.1% with 60% comprising of germinomas. These may present in the suprasellar region a third of the time and thus impart variability in its presenting characteristics. Clinical Case: A 27-year male presented with progressive blurring of vision with incongruent visual acuity and refraction grade with optic disc pallor assessed with normal angiography. Patient also presented with increasing docility, sluggishness and more withdrawn behavior paired with polyuria, polydipsia and cold intolerance. Progressive worsening of vision led to cranial CT revealing an enhancing hyper density in the right caudate head later elucidated via MRI with several interspersed non-enhancing foci in the right caudate nucleus, both internal capsules with associated mild mass effect. The largest component located in the right capsular region with measurement of 21 x 21 x 16 mm with enhancing lesions in the hypothalamus and pituitary stalk. Endocrine evaluation revealed low serum cortisol at 91.03nmol/L (NV 138-685 nmol/L), responsive to ACTH stimulation test (65.94nmol/L to 387nmol/L), high prolactin at 856.9 mIU/L (42.4-296.8mIU/L) and low FT4 8.62pmol/l (9.01-19.05 pmol/L) despite normal TSH 1.528uIU/ml (0.35-4.94 uIU/mL). Optic nerve atrophy was now attributed to compressive intracranial mass. Secondary adrenal insufficiency was managed with hydrocortisone 50mgIV every 8 hours, and central hypothyroidism was managed with levothyroxine 75mcgtab 1tab once a day. Increased urinary output assessed as diabetes insipidus was given desmopressin 60mcg/tab ½ tab 2x a day at this time. Stereotactic biopsy of the brain revealed a germinoma of the right caudate lobe. Given the nature of the intracranial mass with high sensitivity to chemotherapeutic and radiotherapy, a multidisciplinary approach to treatment was taken with radiotherapy, hormonal and steroid replacement. Patient underwent external beam radiation therapy of the brain and spine for a total of 51 treatments allowing for improvement of visual acuity to counting, with polyuria less than 2-3 diaper changes per day. Conclusion: Optic disc pallor is a clinical sign that indicates optic nerve atrophy reflective of the optic tract. This may be an important clinical sign to increase clinical suspicion for intracranial mass lesion especially with correlation to manifestation of pituitary hormone deficiencies.

Choroidal metastases: case report and review

2020 ◽  
pp. 1-7
Author(s):  
Victor Duque ◽  
Carolina de la Pinta ◽  
Ciriaco Corral ◽  
Carmen Vallejo ◽  
Margarita Martin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Side Effects ◽  
External Beam Radiotherapy ◽  
Choroidal Metastasis ◽  
Good Visual Acuity ◽  
Good Local Control ◽  
Radiological Response ◽  
The Right ◽  
The Brain

Abstract Introduction: Choroidal metastases are the most frequent intraocular secondary tumours, with a prevalence of 2–7% according to the literature. Our aim was to review a clinical case of choroidal metastasis. We present a case of a 63-year-old male patient diagnosed in 2018 with lung adenocarcinoma cT4N0M1. The patient had three metastases in the brain, which were successfully treated with radiosurgery (RS). The patient was treated with chemotherapy with pemetrexed–cisplatin schedule. Five months after diagnosis, the patient presented with decreased vision in the right eye. After ophthalmologic evaluation, he was diagnosed with a right choroidal metastasis, which was treated with external beam radiotherapy with 20 Gy in five fractions, resulting in improved visual acuity and a complete clinical and radiological response. The patient took part in a clinical trial that continued with systemic chemotherapy. Twenty-two months after radiotherapy to the eye, the patient has good visual acuity without any side effects. Conclusions: Choroidal metastasis treated with radiotherapy achieves good local control, with limited side effects, allowing an improvement in visual acuity and consequently, an improvement in the patient´s quality of life.

Lateral Medullary Infarction with Contralateral Segmental Dysesthesia and Ipsilateral Headache: A Case Report

2021 ◽  
Vol 17 ◽  
Author(s):  
Renjie Wang ◽  
Yankun Shao ◽  
Lei Xu
Keyword(s):  
Medulla Oblongata ◽  
Clinical Manifestations ◽  
Lateral Medullary Infarction ◽  
Case Presentation ◽  
Specific Sign ◽  
Temperature Sense ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
The Brain ◽  
Medullary Infarction

Introduction: The medulla oblongata is the lowest segment of the brain stem, located adjacent to the spinal cord, with a complex anatomical structure. Thus, a small injury to the medulla oblongata can show complex clinical manifestations. Case Presentation: A patient experienced dysesthesia, which manifested as numbness in her right lower limb and decreased temperature sense, and dizziness 20 days before admission. The numbness worsened 1 week before admission, reaching the right thoracic (T) 12 dermatomes. Her thermoception below the T12 dermatomes decreased, and the degree of dizziness increased, accompanied by nausea and vomiting. Magnetic resonance imaging (MRI) of the neck, chest, and abdomen performed at a local hospital showed no abnormalities. MRI of the brain was performed after admission. One week after admission, she experienced a severe headache in the upper left periorbital area. The numbness extended to T4, and thermoception decreased below T4. Diagnosis: Lateral medullary infarction. Interventions: Anti-platelet aggregation and mitochondrial nutritional therapies were performed along with treatments for improving circulation and establishing collateral circulation. Outcomes: The intensity of limb numbness decreased, and the symptoms of headache and dizziness resolved. Conclusion: Lesions leading to segmental sensory disorders can occur in the medulla oblongata. Ipsilateral headaches with contralateral segmental paresthesia can be a specific sign of lateral medullary infarction.

Charles Bonnet syndrome as first manifestation of occipital infarction

2022 ◽  
pp. 112067212110697
Author(s):  
Marta Isabel Martínez-Sánchez ◽  
Gema Bolívar
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Field Tests ◽  
Visual Field Loss ◽  
Visual Hallucinations ◽  
Correct Treatment ◽  
Cerebral Magnetic Resonance Imaging ◽  
Full Field ◽  
Charles Bonnet Syndrome ◽  
The Right

Purpose To describe a case of Charles Bonnet syndrome as the first manifestation of occipital infarction in a patient with preserved visual acuity. Observations We report a 78-year-old man followed in our department with a two-month-long history of visual hallucinations based on the vision of flowers and fruits intermittently, being perceived as unreal images. Best-corrected visual acuity was stable in the follow-up time being 20/20 in the right eye and 20/25 in the left eye. Extraocular muscle function testing, pupillary reflexes, biomicroscopy, fundus and optical coherence tomography examinations did not reveal any interesting findings. In order to rule out occipital pathology, orbital-cerebral magnetic resonance imaging was performed, showing an image compatible with the chronic ischemic right occipital lesion. The patient was diagnosed with Charles Bonnet syndrome secondary to occipital infarction and neurology decided that no treatment was required. 24-2 and 10-2 visual field tests showed no remarkable alterations and Full-field 120 point screening test showed nonspecific peripheral defects. Hallucinations improved over the months, being described as not annoying and increasingly infrequent. Conclusions and Importance Charles Bonnet syndrome is a condition characterized by the presence of recurrent and complex visual hallucinations in patients with visual pathway pathologic defects. Visual acuity or visual field loss is not a requirement for diagnosis. Charles Bonnet syndrome should be suspected in all patients with non-disturbing visual hallucinations, even though they present good visual acuteness. It will be essential to perform complementary explorations to identify the underlying pathology that allows the starting of a correct treatment option.

scholarly journals Submacular Cysticercosis Successfully Treated through Conservative Management: Case Report

2020 ◽  
Vol 11 (2) ◽  
pp. 315-321
Author(s):  
Renata García Franco ◽  
Alejandro Arias Gómez ◽  
Juvenal Guzman Cerda ◽  
Marlon García Roa ◽  
Paulina Ramirez Neria
Keyword(s):  
Visual Acuity ◽  
Medical Management ◽  
Central Nervous System Involvement ◽  
Vitreoretinal Surgery ◽  
Visual Outcome ◽  
Clinical Findings ◽  
Ophthalmological Examination ◽  
Blurred Vision ◽  
Elevated Lesion ◽  
The Right

Appropriate medical management can be an alternative in those patients with submacular cysticercosis in whom achieving good visual outcome with vitreoretinal surgery is not possible. We report the case of a 25-year-old female who presented complaining of blurred vision in her left eye associated with photopsias and metamorphopsias of 3 months duration. Initial visual acuity in the right eye was 20/20 and 20/100 in the left eye. Upon indirect ophthalmoscopy in the left eye, a yellow-white, dome-shaped, elevated lesion with foveal involvement was observed. The rest of the ophthalmological examination proved normal. With clinical findings and images, submacular cysticercosis was diagnosed, and vitreoretinal surgery was suggested. Nevertheless, the patient did not accept the treatment; therefore, medical management was initiated. Central nervous system involvement was ruled out, and treatment with praziquantel and systemic prednisolone was initiated. Cysticercosis was resolved with significant improvement of her symptoms and visual acuity.

scholarly journals Low-frequency electroencephalogram oscillations govern left-eye lateralization during anti-predatory responses in the music frog

2020 ◽  
Vol 223 (21) ◽  
pp. jeb232637
Author(s):  
Jiangyan Shen ◽  
Ke Fang ◽  
Ping Liu ◽  
Yanzhu Fan ◽  
Jing Yang ◽  
...  
Keyword(s):  
Visual Field ◽  
Left Visual Field ◽  
Right Hemisphere ◽  
Brain Area ◽  
Power Spectra ◽  
Low Frequency ◽  
The Right ◽  
Electroencephalogram Eeg ◽  
The Brain ◽  
Steady Velocity

ABSTRACTVisual lateralization is widespread for prey and anti-predation in numerous taxa. However, it is still unknown how the brain governs this asymmetry. In this study, we conducted behavioral and electrophysiological experiments to evaluate anti-predatory behaviors and dynamic brain activities in Emei music frogs (Nidirana daunchina), to explore the potential eye bias for anti-predation and the underlying neural mechanisms. To do this, predator stimuli (a model snake head and a leaf as a control) were moved around the subjects in clockwise and anti-clockwise directions at steady velocity. We counted the number of anti-predatory responses and measured electroencephalogram (EEG) power spectra for each band and brain area (telencephalon, diencephalon and mesencephalon). Our results showed that (1) no significant eye preferences could be found for the control (leaf); however, the laterality index was significantly lower than zero when the predator stimulus was moved anti-clockwise, suggesting that left-eye advantage exists in this species for anti-predation; (2) compared with no stimulus in the visual field, the power spectra of delta and alpha bands were significantly greater when the predator stimulus was moved into the left visual field anti-clockwise; and, (3) generally, the power spectra of each band in the right-hemisphere for the left visual field were higher than those in the left counterpart. These results support that the left eye mediates the monitoring of a predator in music frogs and lower-frequency EEG oscillations govern this visual lateralization.

scholarly journals Bilateral Glaucomatous Optic Neuropathy Caused by Eye Rubbing

2015 ◽  
Vol 6 (3) ◽  
pp. 279-283 ◽  
Author(s):  
Alfonso Savastano ◽  
Maria Cristina Savastano ◽  
Laura Carlomusto ◽  
Silvio Savastano
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Optic Disc ◽  
Optic Neuropathy ◽  
Correct Diagnosis ◽  
Visual Fields ◽  
Pattern Electroretinogram ◽  
Glaucomatous Optic Neuropathy ◽  
Fiber Layer ◽  
The Right

In this report, we describe a particular condition of a 52-year-old man who showed advanced bilateral glaucomatous-like optic disc damage, even though the intraocular pressure resulted normal during all examinations performed. Visual field test, steady-state pattern electroretinogram, retinal nerve fiber layer and retinal tomographic evaluations were performed to evaluate the optic disc damage. Over a 4-year observational period, his visual acuity decreased to 12/20 in the right eye and counting fingers in the left eye. Visual fields were severely compromised, and intraocular pressure values were not superior to 14 mm Hg during routine examinations. An accurate anamnesis and the suspicion of this disease represent a crucial aspect to establish the correct diagnosis. In fact, our patient strongly rubbed his eyes for more than 10 h per day. Recurrent and continuous eye rubbing can induce progressive optic neuropathy, causing severe visual field damage similar to the pathology of advanced glaucoma.

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