Optometric Management of Sports-related Post-concussion Visual Symptoms in Teenagers with Vision Therapy: A Case Series

2016 ◽  
pp. 34-51
Keyword(s):  
Visual Processing ◽  
Clinical Observation ◽  
Case Reports ◽  
Case Series ◽  
Ocular Motility ◽  
Blurred Vision ◽  
Visual Symptoms ◽  
History Of ◽  
Reading Glasses ◽  
Vision Therapy

Background: Sports-related concussions are among the most common causes of mild traumatic brain injury (mTBI) in children and young adults. Post-concussion visual problems include: changes in refractive status, binocularity, accommodation, ocular motility, visual processing, and vestibular-visual interaction. Modifications to the traditional optometric exam, use of prisms, lenses, binasal occlusion, tints, filters, and a sequence of in-office vision therapy (VT) can successfully rehabilitate the visual symptoms and improve the quality of life (QoL) for this very unique patient population. Case Reports: 1) A 14 year old male presented with a history of a concussion from soccer. His symptoms included headaches, decreased concentration, difficulty copying form the board and difficulty transitioning from near to far activities. Clinical testing revealed an accommodative and oculomotor dysfunction (OMD). He was prescribed BU yoked prism glasses and vision therapy. 2) A 16 year old female presented with a history of two sports-related concussions from cheerleading. Her symptoms included headaches, blurry vision at near and difficulty keeping her place when reading. Clinical observation revealed OMD and accommodative insufficiency. She was prescribed reading glasses to relieve visual stress when reading while she completed vision therapy. 3) A 19 year old female presented with a history of multiple sports concussions while playing collegiate soccer, which resulted in headaches that became worse when reading, decreased reading stamina and difficulty keeping her place when reading. Clinical observation revealed accommodative insufficiency, binocular dysfunction and OMD. She was prescribed reading glasses and vision therapy. Conclusion: This case series outlines the exam procedures and therapy techniques used to manage three teenagers with postconcussive visual disorders. Symptoms such as blurred vision, headaches and difficulty reading can profoundly affect activities of daily living (ADLs). Optometric examinations and management through the use of prisms, tints, reading glasses, and in-office vision therapy can successfully resolve these visual complaints. Each patient described completed 10-12 sessions of in-office vision therapy [over a span of four to eight months], with home re-enforcement, and graduated with marked improvement of their visual signs and symptoms.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

548 Heterotopic Ossification or Dystrophic Calcinosis Cutis in Burn Scars - A Case Series

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S122-S123
Author(s):  
Sigrid A Blome-Eberwein ◽  
Cassandra Pinataro
Keyword(s):  
Heterotopic Ossification ◽  
Calcium Metabolism ◽  
Case Reports ◽  
Case Series ◽  
Preoperative Assessment ◽  
X Rays ◽  
Calcinosis Cutis ◽  
Pathologic Evaluation ◽  
Burn Survivors ◽  
History Of

Abstract Introduction Heterotopic ossification of large joints is a commonly seen and described entity in Burn survivors. We have observed a rather uncommon phenomenon in a series of 4 Burn survivors who presented to our Burn center for scar treatment and open wounds many years after their injuries. A chronic, small, splinter-like subcutaneous irritation led to open wounds and infections in their burn scars. A similar condition is known as dystrophic calcinosis cutis in the dermatologic literature, but caused by calcium metabolism changes in otherwise healthy skin. Methods The demographics and history of illness was documented in all 4 patients. A literature review was performed. The calcified bone-like irritant was removed surgically in all patients, sometimes in more than one location. Pathologic evaluation was performed on the removed specimen. Strategies leading to healing of the wounds were evaluated. Results Four publications were found addressing this phenomenon in Burn scars, all case reports. All of our patients had undergone curettage of the lesions by a dermatologist in the past without resolution. All lesions were excised surgically and proved to extend subcutaneously far more extensively than the visible skin lesion. X rays proved not helpful in preoperative assessment of the extent. All wounds healed after the irritant was removed. Conclusions All lesions appeared to have formed along tendon or fascia remnants underneath the burn scars, exerting pressure on the overlying epithelium which eventually led to breakdown and necrosis. This finding prompted the term “heterotopic cutaneous ossification”. Chronic tension and inflammation were assumed in the etiology, rather than calcium metabolism abnormalities or systemic connective tissue disease, which were not present in these patients. Research is needed to establish the prevalence, cause, and prevention of this condition in Burn survivors.

scholarly journals Ayahuasca, dimethyltryptamine, and psychosis: a systematic review of human studies

2017 ◽  
Vol 7 (4) ◽  
pp. 141-157 ◽  
Author(s):  
Rafael G. dos Santos ◽  
José Carlos Bouso ◽  
Jaime E. C. Hallak
Keyword(s):  
Systematic Review ◽  
Family History ◽  
Adverse Reactions ◽  
Population Studies ◽  
Case Reports ◽  
Case Series ◽  
Lysergic Acid ◽  
Psychotic Illness ◽  
History Of ◽  
Low Incidence

Ayahuasca is a hallucinogen brew traditionally used for ritual and therapeutic purposes in Northwestern Amazon. It is rich in the tryptamine hallucinogens dimethyltryptamine (DMT), which acts as a serotonin 5-HT2A agonist. This mechanism of action is similar to other compounds such as lysergic acid diethylamide (LSD) and psilocybin. The controlled use of LSD and psilocybin in experimental settings is associated with a low incidence of psychotic episodes, and population studies corroborate these findings. Both the controlled use of DMT in experimental settings and the use of ayahuasca in experimental and ritual settings are not usually associated with psychotic episodes, but little is known regarding ayahuasca or DMT use outside these controlled contexts. Thus, we performed a systematic review of the published case reports describing psychotic episodes associated with ayahuasca and DMT intake. We found three case series and two case reports describing psychotic episodes associated with ayahuasca intake, and three case reports describing psychotic episodes associated with DMT. Several reports describe subjects with a personal and possibly a family history of psychosis (including schizophrenia, schizophreniform disorders, psychotic mania, psychotic depression), nonpsychotic mania, or concomitant use of other drugs. However, some cases also described psychotic episodes in subjects without these previous characteristics. Overall, the incidence of such episodes appears to be rare in both the ritual and the recreational/noncontrolled settings. Performance of a psychiatric screening before administration of these drugs, and other hallucinogens, in controlled settings seems to significantly reduce the possibility of adverse reactions with psychotic symptomatology. Individuals with a personal or family history of any psychotic illness or nonpsychotic mania should avoid hallucinogen intake.

CASE REPORT: POURFOUR DU PETIT SYNDROME IN A PATIENT WITH MIGRAINE

2015 ◽  
Vol 86 (11) ◽  
pp. e4.169-e4
Author(s):  
Aseel Al-Ansari ◽  
Richard Jon Llewellyn Walters
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Sympathetic Chain ◽  
Horner’S Syndrome ◽  
Eyelid Retraction ◽  
Horner's Syndrome ◽  
Blurred Vision ◽  
History Of ◽  
Cervical Sympathetic ◽  
Unusual Symptoms

A 45-year old woman presented with a twelve-month history of intense migraines. She described episodes of blurred vision in association with the headaches, during which she invariably found that one or other of her pupils became dilated with a degree of eyelid retraction on the affected side. These unusual symptoms resolved spontaneously with improvement of the headache.After exclusion of a lesional cause with brain and neck imaging, we concluded that her symptoms were secondary to autonomic dysfunction in relation to her headache.Horner's syndrome is due to paralysis of the ipsilateral cervical sympathetic chain and comprises ptosis, miosis, enopthalmos and anhidrosis. A Reverse Horner's syndrome, otherwise known as Pourfour du Petit, in theory, is the opposite, and comprises eyelid retraction, mydriasis and hyperhidrosis. Where documented, it is attributed to irritation, rather than complete deficiency of the ipsilateral sympathetic chain. Previous case reports have shown that Pourfour du Petit can occur due to the same mechanisms as a Horner's syndrome. In only one other case report has it been described as an autonomic feature in relation to headache.

scholarly journals Unmasking of Neurosarcoidosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A618-A618
Author(s):  
Sharini Venugopal ◽  
Binita Neupane ◽  
Mahesh Nepal ◽  
Luis F Chavez
Keyword(s):  
Diabetes Insipidus ◽  
Medical History ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Primary Hypothyroidism ◽  
Past Medical History ◽  
Water Excretion ◽  
History Of ◽  
Glucocorticoid Deficiency

Abstract Introduction: Central diabetes insipidus is a rare complication of neurosarcoidosis. In patients with concomitant adrenal insufficiency (AI), the symptoms of Diabetes Insipidus (DI) can be masked. Case: A 55-year-old female with past medical history of sarcoidosis presented to the hospital with hematemesis, nausea and dizziness. She has a past medical history of cardiac sarcoidosis that was revealed on a PET scan done before 10 years for which she was being treated with methotrexate and prednisone. She was off prednisone for a year prior to hospitalization. She underwent an upper endoscopy that showed diffusely erythematous gastric mucosa in the antrum. She was also hypotensive on admission, and she received packed red blood transfusions after which her sodium increased from 145mmol/L to 165mmol/L (Normal: 135-145mmol/L) in 48 hours. Further workup revealed persistent hypernatremia and urine osmolality was 75mOsm/kg H2O. (Normal: 50-1200mOsm/kg H2O). She was also hypoglycemic and hypotensive requiring multiple fluid boluses throughout her hospitalization. This prompted us to perform a random cortisol that came back at 2.1ug/dl (Normal: 3-23ug/dl) and 1.8ug/dl on two occasions. Cortisol Stimulation test was subsequently ordered, but was done only at 30 minutes, and Cortisol increased from 1.8ug/dl to 6.3ug/dl. Free thyroxine was 0.5 ng/dl (Normal: 0.9-1.8 ng/dl) and her TSH was 7.58uIU/ml (Normal: 0.55-4.78uIU/ml). MRI of the brain revealed extensive areas of extra-axial supra-sellar/infundibular nodular homogeneous intense enhancement that is most consistent with neuro-sarcoid. She was started on prednisone 40 mg daily, Desmopressin 0.05 mg twice daily, and levothyroxine as well. Her sodium level normalized and was 137mmol/L at discharge. She followed up later with outpatient Endocrinology and reported around 90lbs weight gain and no more episodes of nausea or vomiting or epistaxis or lightheadedness. Conclusion: The involvement of the hypothalamic-pituitary axis in sarcoidosis is extremely rare and attributes to < 1% of patients with a sellar mass. Small case series have shown that hypogonadism is the most common endocrine abnormality followed by DI. Our patient had a long-standing history of sarcoidosis with her pituitary dysfunction unmasked only on admission for other causes. She did not manifest any symptoms of DI or AI. There have been case reports where the symptoms of DI are masked due to underlying glucocorticoid deficiency. There have been theories that glucocorticoid deficiency impairs renal water excretion by both ADH (Anti-diuretic hormone) dependent and ADH independent pathways. Another notable feature in our case is that our patient presented with primary hypothyroidism. In fact, sarcoidosis has been commonly implicated in auto-immune polyglandular syndromes type 3, which can present with auto-immune thyroiditis more so in females.

scholarly journals Ehrlichia Meningoencephalitis: A Case Series

2021 ◽  
Vol 8 (2) ◽  
Author(s):  
Morena J ◽  
◽  
Antimisiaris M ◽  
Singh D ◽  
◽  
...  
Keyword(s):  
Elderly Patients ◽  
Direct Detection ◽  
Case Reports ◽  
Case Series ◽  
Suspected Case ◽  
Severe Thrombocytopenia ◽  
Laboratory Findings ◽  
Elevated Protein ◽  
History Of

Objective: We present the distinct clinical and laboratory findings in two cases of Ehrlichia meningoencephalitis, along with one suspected case. Background: The number of cases of Ehrlichia chaffeensis reported to the CDC has more than doubled from 2007-2017. A PubMed literature search using the words “Ehrlichiosis and meningoencephalitis” revealed five case reports with neurologic manifestations. Design/Methods: This is a retrospective observational study. Two elderly patients presented with encephalopathy, fever, transaminitis, thrombocytopenia, a positive E. chaffeensis Polymerase Chain Reaction (PCR) in Serum, and Cerebrospinal Fluid (CSF) with a lymphocytic or neutrophilic pleocytosis and elevated protein. One patient had similar symptoms and a positive E. chaffeensis PCR, but lumbar puncture was unable to be performed due to severe thrombocytopenia. They presented in May or June. Doxycycline was started within 2-3 days after presentation to the hospital. Follow up five months later revealed all patients were close, or back to baseline. Results and Conclusions: Suspicion of Ehrlichia meningoencephalitis should be raised in elderly patients presenting with fever and encephalopathy in the summer season with history of tick bite or residence in wooded areas. Thrombocytopenia and transaminitis should raise further suspicion. CSF studies typically show a lymphocytic pleocytosis and elevated protein. PCR technique allows for direct detection of pathogen-specific DNA and is the preferred method of detection during the acute phase of illness. Prompt treatment with doxycycline results in good outcomes. Doxycycline is not included in the typical meningitis regimen, therefore, this disease is important to quickly identify as delay in Doxycycline can result in worse outcomes.

BYNOCS®1 – A Cloud-Based Indigenous Tele-Health Vision Therapy Software for the Assessment and Management of Binocular Vision Disorders

2020 ◽  
pp. 243-251
Keyword(s):  
Visual Acuity ◽  
Binocular Vision ◽  
Case Reports ◽  
Case Series ◽  
Strabismus Surgery ◽  
Care Practice ◽  
Digital Era ◽  
Vision Assessment ◽  
User Friendly ◽  
Vision Therapy

Background: Binocular vision assessment is an integral part of an eye and vision care practice. With the need for a user friendly, simplified, and comprehensive tool especially in this digital era, we propose a new indigenous cloudbased software, Bynocs.® This manuscript describes the technical details, the functioning of this indigenous software, and a case series demonstrating the application and efficacy of Bynocs® as a tele-health vision therapy tool. All the three cases were handled remotely through the Bynocs tele-health vision therapy platform. Case Reports: Case 1: This is a case of symptomatic convergence insufficiency who had prior compliance issues with a conventional vision therapy approach. With 10 sessions of Bynocs vision therapy focused on improving convergence amplitudes, the patient showed significant improvements in both subjective and objective parameters. Case 2: This case is of a 12 year old child with residual anisometropic amblyopia who had excellent compliance with patching therapy for 3 years but visual acuity had plateaued over the last 6 months. After 20 sessions of Dichoptic amblyopia therapy, best-corrected visual acuity (BCVA) improved by 3 log MAR lines, with improvements in stereoacuity to 100 sec of arc. Case 3: This case of a 10 year old child with residual exophoria after strabismus surgery was referred for managing the residual deviation and associated visual complaints. The child had 20/20 visual acuity in both eyes and 10 prism diopters of residual exophoria at distance and near. After 30 sessions of vision therapy, improvements in fusional vergence amplitudes was achieved along with the deviation restoring to orthophoria at both distance and near, with further improvements in stereoacuity from 400 sec of arc to 120 sec of arc. Conclusions: As tele-health is finding favor across the globe, Bynocs® can be a valuable tele-health vision therapy tool for in the management of binocular vision anomalies and amblyopia with the functionality for remote diagnosis and therapy.

scholarly journals Cavernous Thrombophlebitis Secondary to Cavernous Internal Carotid Mycotic Aneurysm

2019 ◽  
Vol 10 (3) ◽  
pp. 221-223
Author(s):  
Devin J. Burke ◽  
Ashutosh Jadhav
Keyword(s):  
Mycotic Aneurysm ◽  
Internal Carotid ◽  
Case Reports ◽  
Case Series ◽  
Intravenous Drug Use ◽  
Cavernous Sinus Syndrome ◽  
Full Resolution ◽  
Fungal Endocarditis ◽  
History Of ◽  
Mycotic Aneurysms

We report a case of a 22-year-old male with a history of intravenous drug use presenting with cavernous sinus syndrome secondary to cavernous thrombophlebitis. The source of the thrombophlebitis was from a mycotic aneurysm in the setting of fungal endocarditis. With antifungal therapy and aortic valve replacement, the patient had full resolution of cranial nerve deficits. Descriptions of mycotic aneurysms of the cavernous portion of the internal carotid artery are limited to case reports and case series. Most have been nonendocarditic in etiology with poor prognosis. We present a unique case with endocarditic etiology and an excellent prognosis.

scholarly journals Relapsing Haemothorax as an Unusual Presentation of Primary Angiosarcoma of the Spleen

2020 ◽  
Author(s):  
Alba Bergas ◽  
Francesc Escrihuela-Vidal ◽  
Davinia Fernández Calvo ◽  
Olga Capdevila Pons ◽  
Xavier Corbella
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Close Relation ◽  
Final Diagnosis ◽  
Thoracic Wall ◽  
Pathological Examination ◽  
Metastatic Dissemination ◽  
Primary Angiosarcoma ◽  
History Of ◽  
Cystic Masses

Spontaneous haemothorax (SH) is a rare subcategory of haemothorax that involves the accumulation of blood within the pleural space in the absence of trauma. SH especially occurs in middle-aged or elderly patients, but data are usually limited to case reports and case series. Coagulopathy, aneurysm or aortic dissection, Rendu-Osler-Weber syndrome and malignancy have to be considered among the causes of SH. Aim: We describe a case of primary angiosarcoma of the spleen presenting as relapsing haemothorax. Results: An 81-year-old woman was referred to our hospital because of a 2-month history of relapsing haemothorax after the performance of urgent splenectomy due to active bleeding from large spleen cysts. No evidence of neoplasm was seen after pathological examination of the spleen. On admission, left haemothorax and 2 new cystic masses in the thoracic wall were documented, both in close relation to the scars of previous surgery and chest tubes. After excision of 1 mass, histological examination revealed angiosarcoma, and a final diagnosis of primary angiosarcoma of the spleen with postsurgical metastatic dissemination to the thorax and pleura was made. Conclusion: Primary angiosarcoma should be included in the differential diagnosis of haemorrhagic spleen cysts. Clinical diagnosis and management usually requires splenectomy, but it should be carefully planned in order to avoid local metastatic dissemination or haematogenous spread of the tumour.

scholarly journals Case series: coronavirus disease 2019 infection as a precipitant of atypical hemolytic uremic syndrome: two case reports

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Christine J. Kurian ◽  
Zachary French ◽  
Patrick Kukulich ◽  
Matthew Lankiewicz ◽  
Sushil Ghimire ◽  
...  
Keyword(s):  
Renal Failure ◽  
Hemolytic Uremic Syndrome ◽  
Thrombotic Microangiopathy ◽  
Influenza A ◽  
Case Reports ◽  
Atypical Hemolytic Uremic Syndrome ◽  
Case Series ◽  
Oliguric Renal Failure ◽  
History Of ◽  
Uremic Syndrome

Abstract Background Atypical hemolytic uremic syndrome is an exceedingly rare thrombotic microangiopathy caused by accelerated activation of the alternative complement pathway. Case presentation Here, we report two cases of patients presenting with suspected atypical hemolytic uremic syndrome precipitated by coronavirus disease 2019 infection. The first patient, a 25-year-old Hispanic male, had one prior episode of thrombotic microangiopathy presumed to be atypical hemolytic uremic syndrome precipitated by influenza A, and re-presented with thrombocytopenia, microangiopathic hemolytic anemia, nonoliguric renal failure, and normal ADAMTS13 activity, with confirmed coronavirus disease 2019 positivity. The second patient, a 31-year-old Caucasian female, had no personal history of thrombotic microangiopathy, though reported a family history of suspected atypical hemolytic uremic syndrome. She presented with similar laboratory derangements, oliguric renal failure requiring hemodialysis, and confirmed coronavirus disease 2019 positivity. Both patients were treated with eculizumab with complete resolution of their hematologic and renal complications. Conclusion To our knowledge, this represents the largest case series of atypical hemolytic uremic syndrome precipitated by coronavirus disease 2019 in adults.

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