scholarly journals Chronic neuroborreliosis with pseudotumor cerebri (clinical case, discussion)

2021 ◽  
Vol 17 (6) ◽  
pp. 57-61
Author(s):  
K.A. Taryanyk ◽  
M.Yu. Delva ◽  
T.Y. Purdenko ◽  
L.A. Samarchenko
Keyword(s):  
Cerebrospinal Fluid ◽  
Visual Acuity ◽  
Lumbar Puncture ◽  
Optic Disc ◽  
Visual Analog Scale ◽  
Nerve Palsy ◽  
Clinical Case ◽  
Hospital Treatment ◽  
Analog Scale ◽  
Optic Disc Swelling

The article describes a clinical case of chronic neuroborreliosis in form of cerebral pseudotumor syndrome in a 30-year-old patient. The patient complained of dizziness, double vision, decreased visual acuity in both eyes, a feeling of “fog before the eyes”, constant headache (7–8 points on a visual analog scale), sleep disturbances. During last summer (5–6 months before disease onset), there were repeated tick bites with skin redness, the patient did not seek medical help. The disease started 1.5 months ago in form of a headache; one month ago vision began to decrease and diplopia appeared. In the neurological status: left abductor nerve palsy. Brain MRI: empty sella turcica, flattening of the posterior scleras, optic nerves tortuosity. Ophthalmologist: visual acuity of the right eye — 0.3, left eye — 0.8, optic disc swelling of both eyes. Cerebrospinal fluid analysis: the pressure of 300 mm Hg (lumbar puncture in supine position), proteins — 0.198 g/l, cytosis — 5 in 1 ml (lymphocytes), anti-borreliosis IgG — 38.15 U/ml, IgM — 5.61 U/ml. Immediately after the lumbar puncture, the patient noted a significant reduction in headache and diplopia. Cerebrospinal fluid-serum index for anti-borreliosis IgG — 1.2. Diagnosis: chronic neuroborreliosis with cerebral pseudotumor syndrome, left abductor nerve palsy, and visual impairments. Treatment: ceftriaxone, rheosorbilact, citicoline, acetazolamide, melatonin, phenibut. The patient refused repeated lumbar punctures. During hospital treatment, the patient’s condition improved: headaches decreased (to 3–4 points on the visual analog scale), diplopia disappeared, left eyeball movements fully restored, optic disc swelling diminished. Three months later, the patient by phone reported no complaints except for vision impairments. Thus, in patients with cerebral pseudotumor syndrome, among the potential etiological factors Lyme disease should be also excluded.

scholarly journals Different Characteristics of Aquaporin-4 and Myelin Oligodendrocyte Glycoprotein Antibody-Seropositive Male Optic Neuritis in China

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Honglu Song ◽  
Huanfen Zhou ◽  
Mo Yang ◽  
Junqing Wang ◽  
Hongjuan Liu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Ganglion Cell ◽  
Nerve Fiber ◽  
Optic Disc ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Aquaporin 4 ◽  
Optic Disc Swelling ◽  
Male Patients ◽  
Retinal Nerve Fiber

Purpose. To describe different clinical characteristics and prognosis of optic neuritis (ON) in male patients with seropositive aquaporin-4 antibody (AQP4-Ab) or myelin oligodendrocyte glycoprotein antibody (MOG-Ab) in China. Method. Males with ON were recruited from the Neuro-ophthalmology Department of the Chinese People’s Liberation Army, General Hospital from January 2016 to February 2018. They were assigned to two groups based on antibodies status: MOG-Ab-seropositive ON (MOG-ON) and aquaporin-4 Ab-seropositive ON (AQP4-ON). Results. Seventy-six male patients were assessed, including 44 MOG-ON (57.9%) and 32 AQP4-ON (42.1%). The MOG-ON patients were significantly younger at onset compared to the AQP4-ON group (p<0.001). Frequencies of optic disc swelling, presence of abnormal autoimmune antibodies, and elevated levels of CSF IgG were significantly higher in the AQP4-ON group than the MOG-ON group (p=0.040, p=0.016, and p=0.10, respectively). At the final visit, 85.3% of MOG-ON eyes had increased visual acuity (≥0.5) compared to 35.1% of AQP4-ON eyes (p<0.001). The ratio of this steroid-dependent condition is higher in MOG-ON patients than the AQP4-ON group (p<0.001). The ratio of conversion to NMO is higher in the AQP4-ON group than the MOG-ON group, with more AQP4-ON patients developing NMO by the follow-up (p=0.012). MOG-ON patients had thicker average peripapillary retinal nerve fiber layers and macular ganglion cell-inner plexiform than AQP4-ON patients (p=0.008 and p=0.012, respectively). Orbital MRI revealed more AQP4-ON patients had chiasmal involvement than MOG-ON patients (p<0.001). Conclusion. Male MOG-ON patients had different clinical features including earlier age of onset, higher optic disc swelling ratio, better visual acuity recovery, thicker peripapillary retinal nerve fiber and macular ganglion cell-inner plexiform layers, and less chiasmal involvement than male AQP4-ON patients. Serum antibody may be a potential biomarker for determining visual prognosis in male ON.

Intravitreal slow-releasing dexamethasone implant for idiopathic neuroretinitis

2020 ◽  
pp. 112067212095307
Author(s):  
Osman Çekiç ◽  
Samet Gülkaş
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Optic Disc ◽  
Vision Loss ◽  
Dexamethasone Implant ◽  
Optic Disc Edema ◽  
Intravitreal Dexamethasone Implant ◽  
Optic Disc Swelling ◽  
Intravitreal Dexamethasone

Introduction: The purpose of this report is to describe a successful management of idiopathic neuroretinitis with intravitreal dexamethasone implant. Method: Interventional case report. Clinical Case: A 34-year-old man with an acute painless unilateral vision loss, optic disc swelling, and a macular edema was diagnosed as idiopathic neuroretinitis, and he underwent 0.7 mg dexamethasone intravitreous implant injection. Macular edema responded quickly and visual acuity improved from 20/50 to 20/25 within 2 weeks and to 20/20 within a month. One month after the injection, optic disc edema disappeared. No recurrence occurred and visual acuity was stable at 20/20 during 3 years of follow-up. Conclusion: Idiopathic neuroretinitis can be treated with intravitreal dexamethasone implant.

A clinical case of newly detected far-advanced primary open-angle glaucoma against the background of optic disc drusen

Reflection ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 52-57
Author(s):  
R.A. Burya ◽  
◽  
E.L. Sorokin ◽  
◽  
Keyword(s):  
Optical Coherence Tomography ◽  
Differential Diagnosis ◽  
Optic Disc ◽  
Clinical Case ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Optic Disc Drusen ◽  
Optic Disc Swelling ◽  
The Brain

Aim. To present a clinical case of glaucoma development against the background of optic disc drusen (ODD), demonstrating the difficulties of differential diagnosis between such nosologies as glaucomatous optic neuropathy, optic disc swelling, and chronic optic neuropathy caused by ODD. Methods. Patient S., 72 years old, was referred to clinic with suspected optic disc swelling, initial senile cataract of both eyes. The patient underwent additional investigations: Maklakov tonometry registered an increase of intraocular pressure level exceeding permissible norm; perimetry which has revealed narrowing of visual field boundaries in both eyes; ß-scan ultrasonography has visualized morphological changes with highly reflective drusen in both eyes; optical coherence tomography of optic nerve and ganglion cell layer revealed decrease in nerve fiber layer thickness on nasal side. For differential diagnosis, the patient underwent magnetic resonance imaging (MRI) of the brain, according to which intracranial pathology was excluded. Results. Using modern diagnostic methods it was possible to establish clinical diagnosis: newly detected primary open-angle glaucoma (POAG) III b, explicit ODD, initial senile cataract, pseudoexfoliation syndrome grade 2. Hypotensive regimen did not result in target pressure; therefore, the patient was prescribed surgical treatment (microinvasive non-penetrating deep sclerectomy on both eyes). Conclusion. The presented clinical case showed that against the background of ODD creating the picture of pseudo-swelling and masking the changes in optic nerve because of glaucoma process, the patient had POAG in far-advanced stage. MRI of the brain, as well as additional ophthalmological investigations using modern technologies, made it possible to establish correct diagnosis and prescribe the necessary therapy for this nosology. Key words: optic disc drusen; primary open-angle glaucoma; perimetry; optical coherence tomography.

scholarly journals Abducens nerve palsy with associated retinal involvement secondary to rickettsia typhi infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kaies Abderrahim ◽  
Sourour Zina ◽  
Molka Khairallah ◽  
Hager Ben Amor ◽  
Sana Khochtali ◽  
...  
Keyword(s):  
Optic Disc ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Retinal Hemorrhage ◽  
Abducens Nerve Palsy ◽  
Fundus Examination ◽  
Rickettsia Typhi ◽  
Rickettsial Disease ◽  
History Of ◽  
Optic Disc Swelling

Abstract Objective To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection. Material and methods A single case report documented with multimodal imaging. Results A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate. Conclusion Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.

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 Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis

Eye ◽  
2021 ◽  
Author(s):  
Josef Huemer ◽  
Hagar Khalid ◽  
Daniel Ferraz ◽  
Livia Faes ◽  
Edward Korot ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Optic Disc ◽  
Case Series ◽  
Retinal Nerve Fibre Layer ◽  
Optical Coherence ◽  
Patients With Diabetes ◽  
Optic Disc Swelling ◽  
The Mean

Abstract Background/Objectives To re-evaluate diabetic papillopathy using optical coherence tomography (OCT) for quantitative analysis of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL) and inner nuclear layer (mINL) thickness. Subjects/Methods In this retrospective observational case series between June 2008 and July 2019 at Moorfields Eye hospital, 24 eyes of 22 patients with diabetes and optic disc swelling with confirmed diagnosis of NAION or diabetic papillopathy by neuro-ophthalmological assessment were included for evaluation of the pRNFL, mGCL and mINL thicknesses after resolution of optic disc swelling. Results The mean age of included patients was 56.5 (standard deviation (SD) ± 14.85) years with a mean follow-up duration of 216 days. Thinning of pRNFL (mean: 66.26, SD ± 31.80 µm) and mGCL (mean volume: 0.27 mm3, SD ± 0.09) were observed in either group during follow-up, the mINL volume showed no thinning with 0.39 ± 0.05 mm3. The mean decrease in visual acuity was 4.13 (SD ± 14.27) ETDRS letters with a strong correlation between mGCL thickness and visual acuity (rho 0.74, p < 0.001). Conclusion After resolution of acute optic disc swelling, atrophy of pRNFL and mGCL became apparent in all cases of diabetic papillopathy and diabetic NAION, with preservation of mINL volumes. Analysis of OCT did not provide a clear diagnostic distinction between both entities. We suggest a diagnostic overlay with the degree of pRNFL and mGCL atrophy of prognostic relevance for poor visual acuity independent of the semantics of terminology.

scholarly journals Immediate Desensitization in Teeth Affected by Amelogenesis Imperfecta

2016 ◽  
Vol 27 (3) ◽  
pp. 359-362 ◽  
Author(s):  
Rudá França Moreira ◽  
Rossana Gomes Figueiredo ◽  
Henrique Eduardo Oliveira ◽  
Ana Christina Lamosa da Fonseca ◽  
Mauro Sayão de Miranda
Keyword(s):  
Visual Analog Scale ◽  
Clinical Case ◽  
Adhesive System ◽  
Amelogenesis Imperfecta ◽  
Adolescent Patient ◽  
Analog Scale ◽  
Universal Adhesive ◽  
Tooth Sensitivity ◽  
Self Etch

Abstract The aim of this paper was to describe a clinical case of immediate dental desensitization using a self-etch adhesive system in an adolescent patient diagnosed with amelogenesis imperfecta (AI). AI was associated with severe tooth sensitivity, treated by the application of a universal adhesive system for desensitization of the teeth affected by AI. Reduction of tooth sensitivity was assessed using a visual analog scale during all reevaluations. The technique was effective for reducing tooth sensitivity. It was concluded that the adhesive system for tooth desensitization had an immediate effect and maintained its effectiveness during a 12-month follow-up period.

scholarly journals Abducens nerve palsy with associated retinal involvement secondary to rickettsia typhi infection

2021 ◽  
Author(s):  
Kaies Abderrahim ◽  
Sourour Zina ◽  
Molka Khairallah ◽  
Hager Ben Amor ◽  
Sana Khochtali ◽  
...  
Keyword(s):  
Optic Disc ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Retinal Hemorrhage ◽  
Abducens Nerve Palsy ◽  
Fundus Examination ◽  
Rickettsia Typhi ◽  
Rickettsial Disease ◽  
History Of ◽  
Optic Disc Swelling

Abstract Objective: To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection Material and methods: A single case report documented with multimodal imagingResults: A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate.Conclusion: Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.

Morphine, Morphine-6-Glucuronide, and Morphine-3-Glucuronide in Cerebrospinal Fluid and Plasma After Epidural Administration of Morphine

1997 ◽  
Vol 22 (2) ◽  
pp. 131-136
Author(s):  
Sigga Kalman ◽  
Kerstin Metcalf ◽  
Christina Eintrei
Keyword(s):  
Cerebrospinal Fluid ◽  
Postoperative Pain ◽  
Abdominal Surgery ◽  
No Value ◽  
Visual Analog Scale ◽  
Epidural Morphine ◽  
Epidural Administration ◽  
Analog Scale ◽  
High Level ◽  
Very High

Background and ObjectivesIt has been suggested that the potency of epidural morphine might be explained by spinal metabolism to the active and potent metabolite morphine-6-glucuronide (M6G). The main objective of this study was to describe the early pharmacokinetics of epidurally administered, morphine with special attention to the appearance of the glucuronated metabolites in cerebrospinal fluid (CSF).MethodsMorphine was administered epidurally to eight patients scheduled for major abdominal surgery. The concentrations of morphine and its 6-glucuronide and 3-glucuronide metabolites were monitored in blood and CSF at 10, 30, 60, and 120 minutes and 10 and 24 hours. Postoperative pain was estimated on a visual analog scale, and analgesia requirements (administered by a patient-controlled techique) were recorded.ResultsOnly traces of the metabolites were found in CSF and in only two patients throughout the 24 hours. Both metabolites appeared rapidly (within 30 minutes) in plasma in all patients and were found in plasma throughout the study period. Morphine concentration peaked in CSF within 30 minutes at a very high level; in plasma, it peaked at 10 minutes. No correlation was seen between initial or later concentrations of morphine in CSF and postoperative pain or morphine requirements.ConclusionsNo evidence of spinal metabolism of morphine could be found. Rapid distribution of morphine to CSF and plasma occurred after epidural administration. No value of initial CSF morphine concentrations for prediction of analgesic requirements could be demonstrated.

scholarly journals PROLIFERATIVE LEUKEMIC RETINOPATHY WITH BILATERAL EXUDATIVE RETINAL DETACHMENTS AND OPTIC DISC SWELLING IN A PATIENT WITH ACUTE LYMPHOBLASTIC LEUKEMIA

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Linda Susanti ◽  
Safaruddin Refa ◽  
Mirza Metita ◽  
Nadia Artha Dewi
Keyword(s):  
Visual Acuity ◽  
Acute Lymphoblastic Leukemia ◽  
Optic Disc ◽  
Early Recognition ◽  
Lymphoblastic Leukemia ◽  
Anterior Segment ◽  
Subretinal Fluid ◽  
Vitreous Haemorrhage ◽  
Maintenance Chemotherapy ◽  
Optic Disc Swelling

Introduction: To report a patient with acute lymphoblastic leukemia (ALL) who developed proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. Case Report: A 11-year-old girl diagnosed with ALL-L2 on maintenance chemotherapy presented with severe blurred vision in both eyes for the past 1 year. Her visual acuity was 0,5/60 for both eyes. Slit-lamp examination of the anterior segment was found normal. Dilated fundus examination revealed tortuous retinal vessels, retinal haemorrhage, retinal and optic disc neovascularizations, optic disc with indistinct margins, and total retinal detachments in both eyes, as well as vitreous haemorrhage in the left eye. The ultrasonography examination revealed bilateral subretinal fluid. Discussion: The patient was diagnosed with bilateral proliferative leukemic retinopathy with exudative retinal detachments and infiltrative optic neuropathy, and left eye vitreous haemorrhage due to ALL. Conservative treatment was given. She continued the maintenance chemotherapy from pediatric department. After 2 months follow up, the visual acuity did not improve although retinal detachments were reduced. There were atrophic changes at the retina of her both eyes. Conclusion: It was reported a rare case of proliferative leukemic retinopathy with bilateral exudative retinal detachments and optic disc swelling. Early recognition and treatment is crucial to improve prognosis.

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