scholarly journals Early phase Vogt-Koyanagi-Harada Disease in Nepalese Elderly woman: A case report

2020 ◽  
Vol 12 (1) ◽  
pp. 146-152
Author(s):  
Bikram Bahadur Thapa ◽  
Shanti Gurung ◽  
Sweta Singh ◽  
Mahesh Aryal
Keyword(s):  
Early Phase ◽  
Hand Movement ◽  
Autoimmune Disorder ◽  
Oral Steroid ◽  
Ocular Surgery ◽  
History Of ◽  
Systemic Manifestations ◽  
Work Up ◽  
Chronic Use ◽  
Pulse Steroid

Introduction: Vogt–Koyanagi–Harada (VKH) disease is defined as an autoimmune disorder characterized by bilateral granulomatous panuveitis with systemic manifestations, such as tinnitus, vertigo, and meningism caused by melanocyte antigen-reactive T-cells. Majority of VKH patients present at the age between 20 and 50 years. VKH is uncommon in elderly and challenging to manage. VKH is one of the important differential diagnosis of bilateral pan uveitis Case: A 65 year/ female brought with chief complaint of sudden loss of vision in both eyes, headache and hearing problem for 1 month. She didn’t give any history of other systemic illness, ocular surgery, ocular trauma, chronic use of medicament. Her visual acuity was hand movement with accurate projection of rays (HM) in both eyes The intraocular pressure (IOP) was 12mmHg in both eye. Slit-lamp bio microscopy revealed features of Pan uveitis in both eye. Systemic work up revealed no any other abnormalities. A diagnosis of early phase VKH was made and treated with intravenous pulse steroid therapy followed by tapering dose of oral steroid along with immunemodulator resulting in a very good visual recovery. Conclusion: VKH can present in elderly. immunomodulator should be considered in elderly to prevent side effect of steroid along with recurrence of inflammation.

scholarly journals Behçet’s Disease and Tuberculosis: A Complex Relationship

2020 ◽  
Author(s):  
Sara Mendonça Freitas ◽  
Joana Silva Marques ◽  
Ana Grilo ◽  
Rodolfo Gomes ◽  
Fernando Martos Gonçalves
Keyword(s):  
Behçet’S Disease ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Systemic Vasculitis ◽  
Gastrointestinal Involvement ◽  
Behcet's Disease ◽  
History Of ◽  
Systemic Manifestations ◽  
Work Up

Behçet’s disease (BD) is a systemic vasculitis characterized by recurrent orogenital ulceration and several systemic manifestations (such as gastrointestinal involvement, vascular disease or arthritis). The pathogenesis is still unknown but the trigger role of certain pathogens such as Mycobacterium tuberculosis is well documented. Furthermore, patients with BD are more susceptible to tuberculosis due to immunity defects. Here, we describe the case of a 70-year-old woman with a history of recurrent oral aphthae and inflammatory arthritis presenting with extensive thrombosis of left upper limb major veins, a positive HLA B51 genotype and colon ulceration; hence, BD diagnosis was made after excluding other causes. Simultaneously, the patient had cutaneous abscesses not associated with immunosuppressive therapy with continuous development, and after recurrent negative tuberculosis work-up, M. tuberculosis was isolated in an abscess culture.

scholarly journals Bilateral Papilledema as the First Sign of Ventriculoperitoneal Shunt Dysfunction§

2015 ◽  
Vol 9 (1) ◽  
pp. 25-27
Author(s):  
Juan Carlos Serna-Ojeda ◽  
Montserrat Aguirre-Mireles ◽  
Mayra Fabiola Camargo-Suarez
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Interesting Case ◽  
Increased Intracranial Pressure ◽  
Initial Finding ◽  
History Of ◽  
Ophthalmologic Examination ◽  
Shunt Dysfunction ◽  
Systemic Manifestations ◽  
Work Up ◽  
Decrease In Visual Acuity

A 12 year-old girl patient with a history of ventriculoperitoneal shunt placement at the age of 6 months presented with progressive bilateral decrease in visual acuity. Ophthalmologic examination was consistent with bilateral papilledema. No other systemic manifestations of increased intracranial pressure were evident and laboratory work-up excluded other inflammatory or infectious processes. We present here an interesting case of a patient with ophthalmologic manifestations as the initial finding of ventriculoperitoneal shunt dysfunction.

scholarly journals Hyperthyroidism associated with intraocular pressure and dry eye

2020 ◽  
Vol 5 (7) ◽  
pp. 183-189
Author(s):  
Dr. Madhuri Patil ◽  
◽  
Dr. M Gitanjali ◽  
Keyword(s):  
Dry Eye ◽  
Contact Lenses ◽  
Age Groups ◽  
Rectus Muscle ◽  
Autoimmune Disorder ◽  
Ocular Surgery ◽  
Thyroid Orbitopathy ◽  
Threatening Condition ◽  
History Of ◽  
A Prospective Study

Graves’ orbitopathy/ophthalmopathy (GO) also known as thyroid eye disease (TED),dysthyroid/thyroid-associated ophthalmopathy (TAO), is an autoimmune disorder representing thecommonest and most important extrathyroidal manifestation of Graves’ disease. Materials andMethods: This is a prospective study conducted for 2 years. A total of 60 established cases ofHyperthyroidism of all Age groups with either gender subjects who were diagnosed with Thyroidorbitopathy at hospitals were included in this study. History of ocular surgery or medications, thosedemonstrating the recent use of contact lenses, pregnant or lactating women. All the cases withsimilar presentation not proved to be Thyroid Orbitopathy and patients who did not report for thefollow-up were excluded from the study. Result: A total of 60 patients were examined. Of the 60cases analyzed, female preponderance was noted and 41-60 years age group had the highestincidence of thyroid orbitopathy. The most common presentation was found to be unilateral. Inferiorrectus muscle was the commonest muscle involved with 48.3% followed by Medial rectus muscle38.3%, Superior rectus muscle 23.3%, and Lateral rectus muscle involved least with 11.6% indescending order. None of the patients reported a loss of vision. Conclusions: Dry eye andincreased IOP have commonly seen outcomes that should be managed diligently. This potentialsight-threatening condition is seen worldwide and has many functional and cosmetic consequencesthat need to be recognized. Hyperthyroidism was significantly associated with the severity.

Case Report: Management of a Patient with mTBI and Vestibular Hypofunction with the Binasal Occlusion Technique

2018 ◽  
pp. 87-90
Keyword(s):  
Case Report ◽  
Visual Motion ◽  
Hand Movement ◽  
Motion Sensitivity ◽  
Vestibular Hypofunction ◽  
First Case ◽  
Neurological Exam ◽  
History Of ◽  
Occlusion Technique ◽  
Visual Vertigo

Background: Binasal Occlusion (BNO) is a clinical technique used by many neurorehabilitative optometrists in patients with mild traumatic brain injury (mTBI) and increased visual motion sensitivity (VMS) or visual vertigo. BNO is a technique in which partial occluders are added to the spectacle lenses to suppress the abnormal peripheral visual motion information. This technique helps in reducing VMS symptoms (i.e., nausea, dizziness, balance difficulty, visual confusion). Case Report: A 44-year-old AA female presented for a routine eye exam with a history of mTBI approximately 33 years ago. She was suffering from severe dizziness for the last two years that was adversely impacting her ADLs. The dizziness occurred in all body positions and all environments throughout the day. She was diagnosed with vestibular hypofunction and had undergone vestibular therapy but reported little improvement. Neurological exam revealed dizziness with both OKN drum and hand movement, especially in the left visual field. BNO technique resulted in immediate relief of her dizziness symptoms. Conclusion: To our knowledge, this is the first case that illustrates how the BNO technique in isolation can be beneficial for patients with mTBI and vestibular hypofunction. It demonstrates the success that BNO has in filtering abnormal peripheral visual motion in these patients.

scholarly journals Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shahana Perveen ◽  
Karmaine A. Millington ◽  
Suchitra Acharya ◽  
Amit Grag ◽  
Vita Boyar
Keyword(s):  
Differential Diagnosis ◽  
Compartment Syndrome ◽  
Upper Extremity ◽  
Preterm Neonate ◽  
Review Of Literature ◽  
Case Presentation ◽  
Ischemic Limb ◽  
History Of ◽  
Hand Amputation ◽  
Work Up

AbstractObjectivesTo describe challenges in diagnosis and treatment of congenital neonatal gangrene lesions associated with history of maternal coronavirus disease 2019 (COVID-19) infection.Case presentationA preterm neonate was born with upper extremity necrotic lesions and a history of active maternal COVID-19 infection. The etiology of his injury was challenging to deduce, despite extensive hypercoagulability work-up and biopsy of the lesion. Management, including partial forearm salvage and hand amputation is described.ConclusionsNeonatal gangrene has various etiologies, including compartment syndrome and intrauterine thromboembolic phenomena. Maternal COVID-19 can cause intrauterine thrombotic events and need to be considered in a differential diagnosis.

861 Vascular dementia presenting as rapidly progressive dementia secondary to zolpidem

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A335-A335
Author(s):  
Cameron Barber ◽  
Dylan Carroll ◽  
Bhavani Suryadevara
Keyword(s):  
Vascular Dementia ◽  
Microvascular Disease ◽  
Altered Mental Status ◽  
Progressive Dementia ◽  
Personality Changes ◽  
The Us ◽  
History Of ◽  
Gait Abnormalities ◽  
Scheduled Time ◽  
Chronic Use

Abstract Introduction Rapidly progressive dementia is a condition with a wide differential which remains difficult to accurately diagnose. The potential pathologies responsible include thyroid, vitamin, and electrolytes abnormalities, infectious, and malignant causes. Vascular dementia, however, typically has a slow and insidious presentation. Zolpidem (Ambien) is among the top 50 prescribed medications in the US. Report of case(s) An 84-year-old Caucasian male with a past medical history of insomnia, and sleep apnea who is noncompliant with CPAP presented after a fall associated with altered mental status. He has taken zolpidem 10 mg nightly for over six years. The patient and wife reported notable personality changes beginning six months prior, as well as four months of progressively worsening auditory and visual hallucinations. Additionally, the patient noted developing urinary incontinence, and worsening gait steadiness with recurrent falls. The patient then developed sleep-wake inversion during the three weeks prior to his fall, and an outpatient referral to neurology was subsequently sent for dementia evaluation. On the night prior to his presentation, the patient took his usual nighttime zolpidem at 22:00 and later fell and was unable to get up. Subsequent testing was negative for reversible causes of dementia and MRI Brain revealed only chronic microvascular disease. His zolpidem dose was decreased to 5 mg and scheduled earlier which resulted in the resolution of his hallucinations, gait abnormalities, and acute encephalopathy. Conclusion One month later, the patient presented to the hospital after a repeat fall secondary to taking his zolpidem at his previously scheduled time. Once more, his dosage was further decreased to 2.5 mg and scheduling earlier, resulting again, in the complete resolution of his symptoms. Zolpidem, has an increased potential for delirium in elderly patients and especially those with dementia. Chronic use of zolpidem with insidiously progressive vascular dementia led to a worsening delirium which resolved after adjustment of timing and reduction of zolpidem dosing. Support (if any):

scholarly journals Metastatic adrenal pheochromocytoma to the thoracic spine

2010 ◽  
Vol 9 (3) ◽  
pp. 343-346 ◽  
Author(s):  
Michael T. Scalfani ◽  
Paul M. Arnold ◽  
Karen K. Anderson
Keyword(s):  
Differential Diagnosis ◽  
Surgical Intervention ◽  
Hepatic Metastases ◽  
Posterior Fixation ◽  
Original Diagnosis ◽  
Average Survival ◽  
Progression Of Disease ◽  
Adrenal Pheochromocytoma ◽  
History Of ◽  
Work Up

To report on a case of pheochromocytoma metastases to the spine occurring more than 20 years after initial diagnosis. A 34-year-old female with a history of metastatic pheochromocytoma diagnosed at age 12 presented with weakness, heart palpitations, and circumferential back pain of five months duration. The patient had undergone multiple laparatomies for abdominal and hepatic metastases. Work-up revealed a destructive lesion at T9. After two weeks of preoperative phenoxybenzamine to control her hypertension, she underwent decompression, posterior fixation and fusion. Surgical intervention was followed by radiation therapy, zoledronic acid, and only one cycle of chemotherapy due to intolerance of side effects. The patient survived 25 years after original diagnosis, which far exceeds the average survival of less than 15 years. The patient died 26 months postoperatively due to progression of disease. Pheochromocytoma with spine metastases occurring more than 20 years after diagnosis is very uncommon, and should be considered in the differential diagnosis of a patient with a history of pheochromocytoma.

scholarly journals Parasitic hypereosinophilia in childhood: a diagnostic challenge

2018 ◽  
Vol 10 (1) ◽  
pp. 2018034
Author(s):  
Roberto Antonucci ◽  
Nadia Vacca ◽  
Giulia Boz ◽  
Cristian Locci ◽  
Rosanna Mannazzu ◽  
...  
Keyword(s):  
Eosinophil Count ◽  
Hypereosinophilic Syndrome ◽  
Igg Antibodies ◽  
Diagnostic Challenge ◽  
Etiological Diagnosis ◽  
Maximum Value ◽  
History Of ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up

Severe hypereosinophilia (HE) in children is rare, and its etiological diagnosis is challenging. We describe a case of a 30-month-old boy, living in a rural area, who was admitted to our Clinic with a 7-day history of fever and severe hypereosinophilia. A comprehensive diagnostic work-up could not identify the cause of this condition. On day 6, the rapidly increasing eosinophil count (maximum value of 56,000/mm3), the risk of developing hypereosinophilic syndrome, and the patient’s history prompted us to undertake an empiric treatment with albendazole.The eosinophil count progressively decreased following treatment. On day 13, clinical condition and hematological data were satisfactory, therefore the treatment was discontinued and the patient was discharged. Three months later, anti-nematode IgG antibodies were detected in patient serum, thus establishing the etiological diagnosis. In conclusion, an empiric anthelmintic treatment seems to be justified when parasitic hypereosinophilia is strongly suspected, and other causes have been excluded.

scholarly journals Effect of pterygium excision on mean corneal curvature.

2021 ◽  
Vol 28 (04) ◽  
pp. 568-571
Author(s):  
Saira Bano ◽  
Sumaya Khan ◽  
Mahnoor Waqar ◽  
Moniba Iqbal ◽  
Hamza Waqar Bhatti ◽  
...  
Keyword(s):  
P Value ◽  
Corneal Curvature ◽  
Ocular Surgery ◽  
Department Of Ophthalmology ◽  
Before And After ◽  
Quasi Experimental ◽  
History Of ◽  
Induced Astigmatism ◽  
Pterygium Excision ◽  
The Difference

Objective: To determine the difference in mean corneal curvatures before and after pterygium excision. Study Design: Quasi-experimental study. Setting: Department of Ophthalmology, Holy Family Hospital, Rawalpindi. Period: 1st January 2015 to 1st July 2015. Material & Methods: 68 patients aged between 18 to 65 years were included in the study. Patients with history of ocular trauma, ocular surgery, glaucoma, anti-glaucoma treatment, allergy to steroids, pseudo pterygium, recurrent pterygium and presence of corneal abnormalities such as, scarring that might affect the astigmatic value were excluded. All patients underwent comprehensive ophthalmic examination by slit lamp and best corrected visual acuity and keratometric values were noted. Pterygium excision was done by a single surgeon. BCVA and keratometric readings were taken again after 2 weeks of pterygium excision. Results: Mean age was 37.60 ± 11.11 years. Out of these 68 patients, 44 (64.71%) were male and 24 (35.29%) were females. Mean pre-operative corneal curvature was 2.99 ± 0.69D and post-operative corneal curvature was 1.70 ± 0.40D with P-value of <0.0001 which is statistically significant. Conclusion: This study concluded that pterygium excision brings significant change in corneal curvature in patients of pterygium induced astigmatism.

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