Optic perineuritis secondary to hyaluronic acid injections: a case report

Abstract Background Although a safe, excellent administration method for hyaluronic acid derivatives has been documented; improper injections can lead to devastating and irreversible consequences. Here, we present the first known case of optic perineuritis caused by hyaluronic acid. Case presentation A young female experienced sudden orbital pain in the right eye after receiving hyaluronic acid injections to the eyebrows. She presented to the eye clinic two weeks later, after developing blurred vision in the right eye. Visual acuity was reduced significantly in the right eye. Automated visual field examination showed defects in both eyes. Fundus examination revealed bilateral swelling of optic discs. Magnetic resonance imaging of the brain demonstrated bilateral perineural enhancement consistent with optic perineuritis. The patient was treated with retrobulbar injection of hyaluronidase and oral prednisolone. Her vision improved with treatment. Conclusions The prognosis for visual outcomes in patients with optic perineuritis is generally excellent. However, a poor prognosis is associated with delays to the initiation of treatment. Recognizing this condition is important, and treatment with corticosteroids should be initiated early.

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

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405617666211117142203 ◽

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.

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P32 Relapsing polychondritis with anterior scleritis in young female

Rheumatology Advances in Practice ◽

10.1093/rap/rkab068.031 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Umair Arain ◽

Abimbola Phillips ◽

Ben Burton ◽

Damodar Makkuni

Keyword(s):

Rheumatoid Arthritis ◽

Case Report ◽

Visual Fields ◽

Delayed Diagnosis ◽

Relapsing Polychondritis ◽

Young Female ◽

Blurred Vision ◽

Ocular Findings ◽

Anterior Scleritis ◽

The Right

Abstract Case report - Introduction Relapsing polychondritis (RP) was first recognized as a clinical entity in 1923 by Jaksch-Wartenhorst (1923) and reported by him under the title "polychondropathia". The term "relapsing polychondritis" was first used by Pearson, Kline, and Newcomer (1960). Because the ocular findings can be the initial findings of RP, ophthalmologists should know the major ocular findings of this disease. Isaak et al reported that the most common ocular finding is episcleritis (39%) and the second is scleritis (14%). Other signs are iritis (9%), retinopathy (9%), muscle paresis (5%), and optic neuritis (5%). Case report - Case description A 45-year-old female with known rheumatoid arthritis referred by rheumatology in eye clinic due to blurred vision and dry eye. The patient was on hydroxychloroquine and sulfasalazine. No retinal toxicity was found on examination, OCT and Visual Fields. The vision was 6/6 both eyes. Follow-up was in 12 months. She presented 6 months later in casualty with severe pain in her right eye. Examination showed diffuse anterior scleritis with secondary conjunctival inflammation. Anterior chamber cells present. Posterior segment showed no inflammation. Left eye was unremarkable. She was started on Froben 100mg tds with omeprazole. She was seen after a week and condition was improving. She was asked to taper off the meds. Inflammation resolved with 6/5 vision in both eyes and the next appointment was made in a year to monitor for hydroxychloroquine toxicity. In November 2020 she was seen by ENT with inflammation of the right ear cartilage. The pictures showed that the pinna was spared and cartilage was only involved. There was nasal crusting and stuffy nose but without any respiratory symptoms. She was prescribed 50mgs of prednisolone and this helped with her inflammation. She was seen by rheumatology later on and hydroxychloroquine and sulfasalazine was stopped, and she was started on methotrexate 10mgs weekly and folic acid 5mg weekly. Pulmonary function test and echocardiogram was ordered. The case was discussed in MDT rheumatology and it was decided that if joint symptoms got worse than biologics could be started. Methotrexate increased to 15mg subcut. Echocardiogram was normal with satisfactory blood tests. Her next appointment is in October 2021. Case report - Discussion Initially the patient was diagnosed with rheumatoid arthritis with ocular inflammation (anterior scleritis) and was given the standard treatment of steroids to which the patient responded as well. Later when she developed the ear inflammation which involved only the cartilage the diagnosis was revised by rheumatology and changed to RP. As this is a rare life-threatening disease management was switched to immunosuppressive therapy to which she is currently responding well. Case report - Key learning points It is important to consider the possibility that a rheumatology patient may have more than one diagnosis or be open to the idea of revising the diagnosis as the clinical picture evolves over the time. Given the nature of the disease all the systemic features should be examined thoroughly as any one missed area can lead to delayed diagnosis.

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Simultaneous Arterial and Venous Brain Infarctions in a Patient with COVID-19.

10.21203/rs.3.rs-693846/v1 ◽

2021 ◽

Author(s):

Sonia Bermúdez ◽

Paula Forero ◽

Vanessa Salej ◽

Silvia González ◽

Jaime Toro

Keyword(s):

Rt Pcr ◽

Brain Images ◽

Case Presentation ◽

Cortical Vein ◽

Left Hand ◽

Brain Infarcts ◽

Starting Point ◽

Severity Of The Disease ◽

The Right ◽

The Brain

Abstract Introduction: Stroke is one of the manifestations of COVID-19 associated coagulopathy. Arterial infarcts are the most common presentation, however involvement of both arterial and venous irrigation is possible but rare. We report, what is, to our knowledge, the second case of concomitant arterial and venous brain thrombosis evidenced in magnetic resonance. Case presentation: A 62-year-old man presented with acute weakness of the left hand and lack of coordination in the left arm. Nine days earlier, he was positive for SARS-CoV-2 RT-PCR. The brain images revealed two subacute infarcts, one corresponding to the territory of the right middle cerebral artery, and the other in the right frontal cortical vein. Conclusion: The existence of both venous and arterial brain infarcts due to COVID-19 infection, has been previously reported once. Most of the cases of stroke are due to only arterial thrombosis, therefore this could be the starting point to start collecting data about simultaneous compromise in order to assess and compare outcomes, severity of the disease, among other variables.

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A cerebral Arteriovenous Malformation mistakenly diagnosed as Dry Eye and Glaucoma: a case report

10.21203/rs.2.158/v3 ◽

2019 ◽

Author(s):

Shuhao Shen ◽

Xiaoyong Liu ◽

Jian Chen ◽

Chengyou Yang ◽

Changzheng Shi ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Dry Eye ◽

Cerebral Arteriovenous Malformation ◽

Digital Subtraction ◽

Occipital Area ◽

Case Presentation ◽

Recurrent Headache ◽

Eye Symptoms ◽

The Right ◽

The Brain

Abstract Background To report a case of a cerebral Arteriovenous Malformation(AVM) with eye symptoms firstly and review the characteristic of this case and the main confusing point for diagnosis of such case. Case presentation A 58-year-old women presented to the ophthalmology clinic with 1 and an half year of right eye redness, Ocular hypertension and recurrent headache. One and a half year ago she was diagnosed as right eye dry eye and glaucoma and had received treatment according to diagnosis, however all the treatment did not lead to any improvement of redness and headache. On physical examination, it revealed dry eye and severe corkscrew hyperemia with dilated vessels in the right eye. After we consider that the symptom may be related to intracranial abnormal vessels, Computed tomography angiography and venography (CTA+CTV) were performed and the results showed an arteriovenous malformation (AVM) of right parietal-occipital area in the brain. The AVM was definitely located by the further examination of Digital subtraction angiography (DSA). After the AVM endovascular embolism treatment, the conjunctival congestion of the right eye was significantly relieved and the intraocular pressure was decreased to normal. Conclusion In clinical practice, when found corkscrew hyperemia accompanied by neurological symptoms, it might be considered as a result from cerebral vessels diseases, so in this case ophthalmologists diagnosis should combine disease history and imaging examination.

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Reconstruction of Photoreceptor Outer Layers after Steroid Therapy in Solar Retinopathy

Case Reports in Ophthalmological Medicine ◽

10.1155/2018/7850467 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Masaki Nakamura ◽

Koji Komatsu ◽

Satoshi Katagiri ◽

Takaaki Hayashi ◽

Tadashi Nakano

Keyword(s):

Steroid Therapy ◽

Clinical Course ◽

Oral Prednisolone ◽

Central Scotoma ◽

Case Presentation ◽

Ellipsoid Zone ◽

Corrected Visual Acuity ◽

Interdigitation Zone ◽

The Right ◽

Best Corrected Visual Acuity

Purpose. To report the clinical course of solar retinopathy after steroid therapy. Case Presentation. A 45-year-old male gazed at the sun and noticed bilateral central scotoma and decreased vision after the episode. After 7 weeks from onset, ophthalmic examinations were firstly performed. Decimal best corrected visual acuity (BCVA) was decreased to 0.8 and 0.7 in the right and left eyes. Funduscopy showed a tiny, yellowish spot in the fovea bilaterally. Corresponding to the lesion, optical coherence tomography (OCT) images showed an elevated and blurred ellipsoid zone and loss of the interdigitation zone. A posterior sub-Tenon triamcinolone injection in the right eye and oral prednisolone therapy were performed as a medication. BCVA was improved to 1.2 and 1.0 in the right and left eyes at 9 weeks after medication. OCT images showed ellipsoid zone was gradually improved bilaterally, which became nearly normal at 4 weeks in the right eye and at 21 weeks in the left eye. The loss of the interdigitation zone remained at 12 weeks in the right eye and at 21 weeks at the left eye. Conclusions. We described a case with solar retinopathy who exhibited anatomical recovery of the photoreceptor outer layers by steroid therapy, started after 7 weeks from onset.

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Legionnaires’ disease arising with hirsutism: case report of an extremely confusing event

BMC Infectious Diseases ◽

10.1186/s12879-021-06247-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gabriella Serio ◽

Francesco Fortarezza ◽

Federica Pezzuto ◽

Luigi Santacroce ◽

Pietro Nazzaro ◽

...

Keyword(s):

Legionella Pneumophila ◽

Clinical Course ◽

Tracheal Aspirate ◽

Young Female ◽

Case Presentation ◽

Systemic Involvement ◽

Serotype 1 ◽

Autopsy Examination ◽

Legionnaires Disease ◽

The Brain

Abstract Background Legionella bacteria is a common cause of pneumonia, but the infection may affect several organs in the most serious cases. A systemic involvement ab initio could be non-specific, leading to a diagnostic misinterpretation. Case presentation A 33-year-old woman had been complaining of mental confusion, restlessness, aggressiveness, and, subsequently, hirsutism. After 3 weeks, the patient developed pneumonia and died during the hospitalization. The autopsy examination revealed a multi-organ necrotizing exudative disease involving the lung, the heart and the brain. The microbiological tests of tracheal aspirate were positive for Legionella pneumophila serotype 1. Conclusion The Legionella infection may show a proteiform clinical course and an extra-pulmonary manifestation may be the first sign of the disease. Herein, we report a case of Legionella infection in a young female, presenting with non-specific neurological symptoms and hirsutism at onset, misdiagnosed as a metabolic disease.

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Optic neuritis as the ocular manifestation of dengue infection: a case report

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v3i1.152 ◽

2021 ◽

Vol 3 (1) ◽

pp. 46-51

Author(s):

Indra Tri Mahayana ◽

Andreas Surya Anugrah ◽

Ika Kartika ◽

Natalia Christina Angsana ◽

Tatang Talka Gani

Keyword(s):

Visual Acuity ◽

Optic Neuritis ◽

Vision Loss ◽

Early Recognition ◽

Dengue Infection ◽

Young Female ◽

Blurred Vision ◽

Colour Perception ◽

Optic Neuritis Treatment Trial ◽

Optic Discs

Optic neuritis is characterized by decreased vision, impaired colour perception, relative afferent pupillary defects, and scotoma. Optic neuritis following dengue infection is rare and might be underdiagnosed. The pathophysiology of optic neuritis after dengue infection is still unclear and there are only a few reports. We report a case of bilateral simultaneous optic neuritis in a young female adult following dengue haemorrhagic fever. On presentation, she complained of blurred vision, pain around the eyes, central scotoma, and progressively worsening visual acuity to no perception of light in both eyes. The next day, laboratory examination showed leucopoenia (6.74 [4.5–11.5 103/μL]) and lymphocytosis (52.7 [18–42%]), suggesting viral infection with positive anti-dengue IgM and IgG. The patient received intravenous pulse steroid therapy according to the Optic Neuritis Treatment Trial. At 3 months follow-up, best corrected visual acuity improved to 6/6, with pale optic discs but normal perimetry. Although complications of dengue fever in the eye are rare, early recognition must be established to prevent permanent vision loss.

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Overlapping syndrome mimicking infectious meningoencephalitis in a patient with MOG and GFAP IgG

BMC Neurology ◽

10.1186/s12883-021-02381-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Suqiong Ji ◽

Chenchen Liu ◽

Zhuajin Bi ◽

Huajie Gao ◽

Jian Sun ◽

...

Keyword(s):

White Matter ◽

Oral Prednisolone ◽

Pulse Therapy ◽

Tuberculosis Treatment ◽

Case Presentation ◽

Steroid Pulse ◽

Csf Analysis ◽

Magnetic Resonance Imaging Mri ◽

The Right

Abstract Background Central nervous system overlapping autoimmune syndromes are uncommon, especially with the coexistence of MOG-IgG and GFAP-IgG. Case presentation A 23-year-old woman presented with transient convulsions, a loss of consciousness, persistent fever, headache, and vomiting. Cerebrospinal fluid (CSF) analysis revealed elevated cellularity, and magnetic resonance imaging (MRI) showed diffuse leptomeningeal enhancement. She had fever and headache with antiviral and antibiotic treatment for 2 weeks, and she had empirical anti-tuberculosis treatment and oral prednisolone therapy. She was followed for 3 months after presentation with improved symptoms and normal CSF analysis. A 3-month follow-up MRI showed asymmetric lesions in the cerebellum, corona radiata, and white matter with enhancement. The anti-tuberculosis treatment was continued, and steroid therapy was discontinued. After she stopped taking prednisolone, an interrupted headache gradually appeared. MRI at 4 months after presentation revealed a partial reduction in lesions but enlarged areas in the left cerebellum and right parietal white matter and a new lesion in the region of the right ependyma with linear enhancement. Her CSF was positive for anti-myelin oligodendrocyte glycoprotein (MOG) and anti-glial fibrillary acidic protein (GFAP) antibodies using a transfected cell-based assay. She was diagnosed with overlapping syndrome of MOG‑IgG‑associated disease and GFAP astrocytopathy. She received steroid pulse therapy (methylprednisolone, 1 g for 5 days), followed by a gradual tapering of oral prednisolone and the addition of an immunosuppressant (tacrolimus, 3 mg per day). Six months after the initial presentation, she had no symptoms. An MRI showed that the lesions had diminished, and no enhancement was found. Conclusions We report a case that was positive for double antibodies, which was initially misdiagnosed as infectious meningoencephalitis. This case broadens the clinical and phenotypic presentation of the overlapping syndrome spectrum.

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Terson syndrome with macular hole: A case report

10.21203/rs.2.9798/v1 ◽

2019 ◽

Author(s):

Hui Qi ◽

tao hong Yan ◽

Yan Cheng ◽

Ling Zuo

Keyword(s):

Macular Hole ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Vitreous Hemorrhage ◽

Blurred Vision ◽

Case Presentation ◽

Terson Syndrome ◽

Inner Limiting Membrane ◽

Temporal Side ◽

The Right

Abstract Background Terson’s syndrome with macular hole (MH) is rarely seen, and the mechanism of which is not clear. Here we report a case of Terson Syndrome with the inner limiting membrane (ILM) peeled off spontaneously associated with a rare finding: MH. Case presentation This report presents the case of a 36-year-old female patient with aneurysmal subarachnoid hemorrhage (SAH) and Terson syndrome in the right eye was admitted to our hospital with blurred vision in August 2018. Pas plana vitrectomy (PPV) was performed in the right eye, a hyaloid detachment and dyeing of the ILM with indocyanine green (ICG) was assisted. After removal of the vitreous hemorrhage (VH), a full-thickness MH was noted and we also noticed a particular aspect: the ILM was already peeled spontaneously. So we conducted gas tamponade, and face-down positioning after PPV. At two weeks follow-up, spectral domain optical coherence tomography (SD-OCT) confirmed that the MH had closed, while the thickness of nasal retina was 0.137 nm thicker than that in the temporal side. Her best corrected visual acuity (BCVA) was 0.15 in the right eye and 1.0 in the left eye. Conclusions MH is a rarely seen complication of Terson Syndrome. We conferred that the pathogenic mechanisms of this unusual MH may include stretching forces at the ILM-macular interface.

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