A Decrease In Visual Acuity Revealing A Pituitary Apoplexy

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.

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Coexisting Optic Disc Melanocytoma and Pituitary Adenoma

Ocular Oncology and Pathology ◽

10.1159/000496149 ◽

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.

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Intraorbital Wooden Foreign Body with Intracranial Extension : A Case Report

Ophthalmologica Indonesiana ◽

10.35749/journal.v44i1.155 ◽

2018 ◽

Vol 44 (1) ◽

pp. 4

Author(s):

Amanda N Shinta ◽

Purjanto Tepo Utomo ◽

Agus Supartoto

Keyword(s):

Visual Acuity ◽

Foreign Body ◽

Frontal Lobe ◽

Vital Sign ◽

Intracranial Extension ◽

Ocular Motility ◽

Light Perception ◽

Bone Segment ◽

Wooden Foreign Body ◽

Wooden Stick

Purpose : The aim of this study is to report a case of intraorbital wooden foreign body with intracranial extension to the frontal lobe and its management. Method : This is a descriptive study: A 53 year-old male referred due to wooden stick stucked in the orbital cavity causing protruding eyeball and vital sign instability. Result : Right eye examination revealed light perception visual acuity, with bad light projection and bad color perception, inwardly folded upper eyelid, proptosis, conjunctival chemosis, corneal erosion and edema, dilated pupil with sluggish pupillary light reflex and limited ocular movement in all direction. Vital sign was unstable with decreasing blood pressure, increasing temperature and heart rate. CT Scan showed complete fracture of the orbital roof due to penetration of the wooden stick, pneumoencephalus, cerebral edema and hematoma. Emergency craniotomy was performed to remove the penetrating wooden stick and bone segment in the frontal lobe and fracture repair. Ophthalmologist pulled the remaining stick, released the superior rectus muscle and repaired the lacerated eyelid. Outcome visual acuity was no light perception with lagophthalmos and limited ocular motility. Patient was admitted to Intensive Care Unit one day post-operatively and treated with systemic and topical antibiotic. Conclusion : Any case presenting with intraorbital foreign body must undergo immediate neuroimaging to exclude any intracranial extension, especially in patients with worsening general condition.

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Choroidal metastases: case report and review

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920001090 ◽

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.

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Pituitary Apoplexy and Its Effect on Vision

Neurosurgery ◽

10.1227/00006123-199111000-00005 ◽

1991 ◽

Vol 29 (5) ◽

pp. 669-675 ◽

Cited By ~ 74

Author(s):

Robert M. McFadzean ◽

David Doyle ◽

Roy Rampling ◽

Evelyn Teasdale ◽

Graham Teasdale

Keyword(s):

Pituitary Adenoma ◽

Clinical Diagnosis ◽

Clinical Features ◽

Visual Function ◽

Pituitary Apoplexy ◽

Diagnostic Errors ◽

Large Series ◽

Ocular Motility ◽

Pathological Findings ◽

Results Of Treatment

Abstract A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

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Trauma Okular oleh Serangan Kerbau – Laporan Kasus

e-CliniC ◽

10.35790/ecl.v9i2.33847 ◽

2021 ◽

Vol 9 (2) ◽

pp. 424

Author(s):

Wenny Supit

Keyword(s):

Visual Acuity ◽

Ocular Trauma ◽

Recovery Period ◽

Anterior Segment ◽

Visual Sensitivity ◽

Ocular Motility ◽

Light Perception ◽

Ocular Trauma Score ◽

Hand Motion ◽

Trauma Score

Abstract: Of the many ocular blunt traumas, trauma due to typical buffalo attack thrrough leverage has not been reported. We reported a 65-year-old man attacked by a buffalo on his left eye. The patients complained of pain of his left eye associated with swelling, bleeding, and blurred vision. Eye examination revealed that visual acuity of the left eye was classified as hand motion (HM), limited ocular motility, blepharospasm, and a crescent-shaped anterior lamella laceration with lateral canthal involvement. Anterior segment examination revealed bullous subconjunctival hemorrhage, corneal edema, and rosette-shaped opacification (RSO) of the lens. Head-CT showed traumatic cataract and periorbital haemorrhage; no abnormalities in the right eye. Ovular trauma score (OTS) of the patient was three indicating that the possible visual prognosis was 2% as no light perception (NLP), 11% as light perception (LP) or hand motion (HM), 15% as 1/200-19/200, 31% as 20/200-20/50, and 41% as >20/40. Literature data showed that the visual sensitivity of OTS prediction in NLP, 20/200-20/50, and 20/40 was 100%. The specificity of OTS in predicting vision in LP/HM 1/200-19/200 was 100%. After a recovery period of approximately two months and the sutured wound healed, the patient came to the eye clinic of Prof. Dr. R. D. Kandou Hospital Manado. After a cataract surgery was performed on the left eye of the patient, his visual acuity improved to 20/40.Keywords: ocular trauma, buffalo attack, ocular trauma score (OTS) Abstrak: Dari sekian banyaknya trauma tumpul, trauma akibat rudapaksa tipikal serangan kerbau yang menggunakan gaya ungkit belum pernah dilaporkan. Kami melaorkan seorang laki-laki berusia 65 tahun yang mendapat serangan kerbau pada mata kiri dengan keluhan nyeri disertai pembengkakan, pendarahan, dan penglihatan kabur. Pemeriksaan mata menunjukkan ketajaman visual mata kiri dengan gerakan tangan, motilitas okular terbatas, blefarospasme, dan laserasi lamela anterior berbentuk bulan sabit dengan keterlibatan kantal lateral. Pemeriksaan segmen anterior menunjukkan perdarahan subkonjungtiva bulosa, edema kornea, dan rosette-shaped opacification (RSO) pada lensa. Hasil CT-kepala menunjukkan katarak traumatik dan perdarahan periorbital, tanpa kelainan pada mata kanan. Skor trauma okular pasien (OTS) ialah tiga yang menandakan kemungkinan prognosis pada visual pasien ialah 2% menjadi no light perception (NLP), 11% menjadi light perception (LP) atau hand motion (HM), 15% menjadi 1/200-19/200, 31% menjadi 20/200-20/50, dan 41% menjadi >20/40. Penggunaan OTS pada kasus ini karena data literatur menunjukkan bahwa sensitivitas penglihatan prediksi OTS di NLP, 20/200-20/50, dan 20/40 ialah 100%. Kekhususan OTS dalam memrediksi visi di LP/HM 1/200-19/200 ialah 100%. Setelah masa pemulihan sekitar dua bulan dan luka penjahitan sembuh, pasien datang kontrol ke poliklinik mata RSUP Prof. Dr. R. D. Kandou Manado. Setelah dilakukan operasi katarak pada mata kiri didapatkan tajam penglihatan mata kiri pasien 20/40.Kata kunci: trauma mata, serangan kerbau, ocular trauma score (OTS)

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Clinical and imaging features of suspected pituitary apoplexy in a domestic rat

Veterinary Record Case Reports ◽

10.1136/vetreccr-2019-001062 ◽

2020 ◽

Vol 8 (2) ◽

pp. e001062

Author(s):

Stephen James Everest ◽

Tobias Schwarz ◽

David Walker ◽

Kevin Eatwell ◽

Katia Marioni-Henry

Keyword(s):

Pituitary Apoplexy ◽

Acute Onset ◽

Postmortem Examination ◽

Female Rat ◽

Imaging Features ◽

Gradient Echo ◽

History Of ◽

The Right ◽

The Brain

A two-year-ten-month-old entire female fancy rat was evaluated for acute-onset neurological signs following a two-month history of lethargy and behavioural changes. Physical examination revealed generalised muscle atrophy. Neurological examination localised the lesion likely to the right thalamus based on suspected left unilateral hemineglect. The patient was euthanased over quality-of-life concerns, and postmortem MRI of the brain was performed, followed by postmortem examination. This showed a lesion in the region of the pituitary which was T1 hyperintense to the brain, T2 isointense to the white matter and hypointense on gradient echo sequences, suggesting subacute haemorrhage. The authors described the clinical presentation and imaging features (MRI) of suspected pituitary apoplexia secondary to a pituitary macroadenoma in an aged female rat. Of particular interest are the findings of unilateral hemineglect and blooming artefact on MRI gradient echo sequences that lead to suspicion of pituitary apoplexia confirmed on postmortem examination.

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A Rare Case of Acute Hemorrhagic Retinopathy Following Intravitreal Melphalan Injection for Persistent Vitreous Seeds in Retinoblastoma

Journal of VitreoRetinal Diseases ◽

10.1177/24741264211024147 ◽

2021 ◽

pp. 247412642110241

Author(s):

Renu P. Rajan ◽

Usha Kim ◽

Aditya Maitray ◽

Soumya Jena ◽

Sagnik Sen

Keyword(s):

Visual Acuity ◽

Rare Case ◽

Hemorrhagic Complication ◽

Bilateral Retinoblastoma ◽

Hemorrhagic Events ◽

Hemorrhagic Complications ◽

Sudden Decrease ◽

The Right ◽

Vitreous Seeds ◽

Intraretinal Hemorrhages

Purpose: This report describes a case of acute occlusive hemorrhagic complication after intravitreal melphalan for vitreous seeds in retinoblastoma. Methods: A case report is presented. Results: Intravitreal melphalan has been used extensively for vitreous seeds in retinoblastoma. Although melphalan is relatively safe at optimal doses, it can sometimes cause inadvertent complications like hemorrhagic events if the drug is administered close to the retina or in more pigmented eyes. We report a case of a 5-month-old patient with bilateral retinoblastoma who underwent enucleation of the right eye and 2 intravitreal melphalan injections in the left eye (20 µg/0.02 mL) at a 1-month interval for persistent vitreous seeds. After the second injection, there was a sudden decrease in the child’s visual acuity in the left eye, and the retina showed multiple intraretinal hemorrhages and diffuse chorioretinal atrophy. Conclusion: Intravitreal melphalan may cause acute hemorrhagic complications after intravitreal use for retinoblastoma seeds, especially in pigmented eyes.

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Catastrophic vision loss from radiation-induced optic neuropathy

BMJ Case Reports ◽

10.1136/bcr-2019-233706 ◽

2020 ◽

Vol 13 (2) ◽

pp. e233706

Author(s):

Sultan Aldrees ◽

Jonathan A Micieli

Keyword(s):

Optic Neuropathy ◽

Vision Loss ◽

High Dose ◽

Ophthalmological Examination ◽

Light Perception ◽

Motion Vision ◽

Hand Motion ◽

Radiation Induced ◽

The Right ◽

The Brain

A 68-year-old woman presented with profound vision loss of 2-month duration in the right eye and 1-week duration in her left eye. This occurred in the context of craniopharyngioma that was twice resected and irradiated (54 Gy in 30 fractions) 9 months before her presentation. Ophthalmological examination revealed hand motion vision in the right eye and light perception vision in the left eye with poorly reactive pupils and bilateral optic disc pallor. A non-contrast MRI of the brain and sella showed significant reduction of the sellar mass. A repeat MRI of the brain and orbits with gadolinium showed pre-chiasmatic enhancement of both optic nerves. The diagnosis of radiation-induced optic neuropathy was made. Despite treatment with high-dose intravenous corticosteroids, 19 sessions of hyperbaric oxygen therapy, and 3 doses of intravenous bevacizumab, her vision worsened to no light perception in both eyes.

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Intravitreal and Subtenon Depot Triamcinolone as Treatment of Retinitis Pigmentosa Associated Cystoid Macular Edema

Case Reports in Ophthalmological Medicine ◽

10.1155/2013/591681 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Sidnei Barge ◽

Renata Rothwell ◽

Paula Sepúlveda ◽

Luís Agrelos

Keyword(s):

Visual Acuity ◽

Retinitis Pigmentosa ◽

Macular Edema ◽

Intravitreal Injection ◽

Cystoid Macular Edema ◽

Treatment Options ◽

Corrected Visual Acuity ◽

Anatomic Results ◽

The Right ◽

Decrease In Visual Acuity

We present a case of retinitis pigmentosa (RP) related cystoid macular edema (CME) refractory to oral acetazolamide and topical ketorolac that was treated with intravitreal and subtenon depot triamcinolone. A 32-year-old male with RP presented with complaints of bilateral decrease in visual acuity. His best-corrected visual acuity (BCVA) was 20/50 in the right eye and 20/100 in the left eye. After being informed of the available treatment options, the patient received bilateral intravitreal injection triamcinolone. The patient’s BCVA improved to 20/40 in the right eye and 20/50 in the left eye and the CME was resorbed. However, 5 months after the injection in the left eye and two months in the right eye, visual acuity decreased due to recurrence of CME. We performed a second intravitreal injection in the left eye with improvement of visual and anatomic results, but we observed a recurrence of CME. Afterwards, we treated the patient with subtenon depot triamcinolone in both eyes, with the result that there was no recurrence after 4 months in OD or after 3 months in OS. We conclude that intravitreal and subtenon depot triamcinolone appear to provide at least temporary benefit in refractory CME as regards the improvement of visual acuity.

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Sudden Visual Loss after Cardiac Resynchronization Therapy Device Implantation

European Journal of Ophthalmology ◽

10.5301/ejo.5000873 ◽

2017 ◽

Vol 27 (2) ◽

pp. e28-e31

Author(s):

Luigi A. De Vitis ◽

Alessandro Marchese ◽

Chiara Giuffrè ◽

Adriano Carnevali ◽

Lea Querques ◽

...

Keyword(s):

Visual Acuity ◽

Cardiac Resynchronization Therapy ◽

Fluorescein Angiography ◽

Visual Loss ◽

Optic Disk ◽

Cardiac Resynchronization ◽

Resynchronization Therapy ◽

Device Implantation ◽

Sudden Decrease ◽

Decrease In Visual Acuity

Purpose To report a case of sudden decrease in visual acuity possibly due to a cardiogenic embolism in a patient who underwent cardiac resynchronization therapy (CRT) device implantation. Methods A 62-year-old man with severe left ventricular systolic dysfunction and a left bundle branch block was referred to our department because of a sudden decrease in visual acuity. Nine days earlier, he had undergone cardiac transapical implantation of a CRT device, which was followed, 2 days later, by an inflammatory reaction. The patient underwent several general and ophthalmologic examinations, including multimodal imaging. Results At presentation, right eye (RE) best-corrected visual acuity (BCVA) was counting fingers and RE pupil was hyporeactive. Fundus examination revealed white-centered hemorrhagic dots suggestive of Roth spots. Fluorescein angiography showed delay in vascular perfusion during early stage, late hyperfluorescence of the macula and optic disk, and peripheral perivascular leakage. The first visual field test showed complete loss of vision RE and a normal left eye. Due to suspected giant cell arteritis, temporal artery biopsy was performed. Thirty minutes after the procedure, an ischemic stroke with right hemisyndrome and aphasia occurred. The RE BCVA worsened to hands motion. Four months later, RE BCVA did not improve, despite improvement in fluorescein angiography inflammatory sign. Conclusions We report a possible cardiogenic embolism secondary to undiagnosed infective endocarditis causing monocular visual loss after CRT device implantation. It remains unclear how the embolus caused severe functional damage without altering the retinal anatomical structure.

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