Vision salvage after resection of a giant meningioma in a patient with a loss in light perception

2009 ◽  
Vol 110 (1) ◽  
pp. 109-111 ◽  
Author(s):  
Michael E. Sughrue ◽  
Michael W. McDermott ◽  
Andrew T. Parsa
Keyword(s):  
Optic Nerve ◽  
Vision Loss ◽  
Case Series ◽  
Optic Chiasm ◽  
Surgical Removal ◽  
Compression Stress ◽  
Light Perception ◽  
Nerve Dysfunction ◽  
Mass Lesions ◽  
Giant Meningioma

Clinical approaches to the surgical management of optic chiasm compression stress quick action, as several case series have demonstrated minimal vision restoration following aggressive decompression in patients presenting more than 3 days after the onset of blindness. The authors here report the case of a 48-year-old woman who presented with near-complete binocular vision loss but regained visual function following surgical removal of a giant planum-tuberculum meningioma, which was performed 8 days after a documented loss in light perception. The interval between the patient's vision loss and successful vision-restoring decompressive surgery is the longest recorded to date in the literature. This case shows the importance of aggressive decompression of mass lesions despite extended intervals of optic nerve dysfunction.

Outcomes of Steroid Therapy in Combination with Endoscopic Optic Nerve Decompression Surgery for Direct Traumatic Optic Neuropathy: A Case-Series

2021 ◽  
Vol 104 (7) ◽  
pp. 1166-1171
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Optic Neuropathy ◽  
Poor Prognosis ◽  
Combined Treatment ◽  
Treatment Protocol ◽  
Case Series ◽  
Light Perception ◽  
Traumatic Optic Neuropathy ◽  
Nerve Decompression

Background: Direct traumatic optic neuropathy (TON) carries a poor prognosis. However, the outcome of this injury is diverse and is related to time to treatment and treatment protocol. Objective: To evaluate the outcomes of the combined treatment protocol in patients with direct TON. Materials and Methods: The authors retrospectively reviewed the medical records of patients between January 2015 and August 2019. Main outcome was visual acuity (VA) improvement after the treatment. Results: Thirteen patients (15 eyes) were included. The mean age was 38.61 years with a range of 13 to 65 years. Initial VA varied from no light perception (NPL) in seven eyes of six patients, light perception (PL) in one eye, counting fingers in two eyes, 20/200 in three eyes, and 20/60 in two eyes. Average timing to treatment was 2.8 days (range 0 to 7 days). There were no side effects of high-dose corticosteroids treatment in all patients. During a follow-up period of three months, six of 13 patients (46.1%) had VA improvement. Conclusion: Despite poor prognosis of direct TON, the combined treatment protocol provides a favorable successful rate with most patients on having stable vision, and some having visual improvement from reducing intracanalicular pressure of the optic nerve. Keywords: Endoscopic optic nerve decompression; Traumatic optic neuropathy; Visual acuity; Case series

scholarly journals Pediatric Idiopathic Intracranial Hypertension: A not so Rare and Benign Condition

2014 ◽  
Vol 7 (1) ◽  
pp. 5-9
Author(s):  
Manish Modi ◽  
Karan Gupta
Keyword(s):  
Optic Nerve ◽  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Vision Loss ◽  
Fluid Pressure ◽  
Case Series ◽  
Invasive Procedure ◽  
Positive Outcome ◽  
Benign Condition ◽  
Work Up

ABSTRACT Objective Pediatric idiopathic intracranial hypertension is an underdiagnosed entity with catastrophic presentations. High index of suspicion with early diagnosis and prompt treatment is the key to successful management. Trans-nasal trans-sphenoid Endoscopic Optic Nerve Fenestration is an effective surgical modality for the reversal of vision loss in pediatric idiopathic intracranial hypertension (IIH). Materials and methods This is a single center observational prospective case series. Five diagnosed pediatric patients of IIH satisfying the modified Dandy criteria and reported to the out-patient services of otolaryngology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India in the year 2012 were included in this study. All children underwent thorough clinical examination, complete Neuro-ophthalmological work-up including Visual acuity (V/A), Visual field charting (V/F), Fundus venogram and Radiological work-up with MRI for special optic nerve sections in sagittal reconstruction. Cerebro-Spinal Fluid pressure (CSF) measured preoperatively for all children. Standard endoscopic optic nerve Sheath Fenestration was performed on all children. visual improvement was assessed by comparing preoperative ophthalmological findings. Results Improvement in vision was taken as a positive outcome. Vision improved in all except one child, who had pre-existing optic nerve atrophy. Conclusion Endoscopic optic nerve fenestration is an effective minimally invasive procedure to revert visual loss in pediatric idiopathic intracranial hypertension. How to cite this article Gupta AK, Gupta K, Modi M, Gupta A. Pediatric Idiopathic Intracranial Hypertension: A not so Rare and Benign Condition. Clin Rhinol An Int J 2014;7(1):5-9.

Occult Vascular Malformations of the Optic Chiasm: Magnetic Resonance Imaging Diagnosis and Surgical Laser Resection

Neurosurgery ◽  
1990 ◽  
Vol 27 (3) ◽  
pp. 466-470 ◽  
Author(s):  
Gary K. Steinberg ◽  
Michael P. Marks ◽  
Lawrence M. Shuer ◽  
Richard L. Sogg ◽  
Dieter R. Enzmann ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Optic Nerve ◽  
Magnetic Resonance ◽  
Carbon Dioxide Laser ◽  
Vascular Malformations ◽  
Imaging Modality ◽  
Optic Chiasm ◽  
Surgical Removal ◽  
Resonance Imaging ◽  
Mri Scan

Abstract Angiographically occult vascular malformations of the optic nerve and chiasm are extremely rare. Before the advent of magnetic resonance imaging (MRI), it was difficult to diagnose these lesions preoperatively. We report MRI scan findings of optic chiasm cavernous angiomas in two patients with chiasmal syndrome. MRI was useful in localizing the vascular malformation and delineating its characteristics, especially chronic hemorrhage. One patient underwent biopsy of the lesion. The other patient underwent complete microsurgical resection of the malformation with the carbon dioxide laser with preservation of vision. Occult vascular malformations of the optic nerve and chiasm may be a more common cause of visual deterioration than previously recognized. The MRI scan is the imaging modality of choice for diagnosing and following these lesions. In certain patients, these vascular malformations may be amenable to complete surgical removal with stabilization or improvement of visual function.

scholarly journals Optic Neuritis in Pediatric Patients

2021 ◽  
Vol 8 (2) ◽  
pp. 102
Author(s):  
Atik Rahmawati ◽  
Dina Fatmawati
Keyword(s):  
Body Weight ◽  
Optic Nerve ◽  
Physical Examination ◽  
Optic Neuritis ◽  
Pediatric Patients ◽  
Vision Loss ◽  
Case Series ◽  
Atypical Symptoms ◽  
Ophthalmologic Examination ◽  
Symptoms And Signs

Optic neuritis denotes an inflammation of the optic nerve characterized by loss of vision progressing over a few hours to a few days. Based on the site involved, optic neuritis is classified as retrobulbar (2/3 cases), atypical, and typical optic neuritis. In some cases, pediatric patients with optic neuritis have atypical symptoms and signs and no comprehensive medical history leading to a challenging diagnosis. In this case series, we report cases of optic neuritis in pediatric patients at different ages and clinical features treated with methylprednisolone 1 mg/kg body weight and oral mecobalamin and respective management. With a poor initial vision at presentation, the patients recovered rapidly.  The diagno-sis of optic neuritis was based on anamnesis, ophthalmologic examination, and simple laboratory and physical examination. The administration of steroids at a dose of 1 mg/kg body weight followed by a taper of dose can improve vision loss.

Diplopia, Orbital Pain, and Vision Loss in a Middle-Aged Woman

2021 ◽  
pp. 165-167
Author(s):  
Lauren M. Webb ◽  
Eoin P. Flanagan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Magnetic Resonance ◽  
Vision Loss ◽  
Light Perception ◽  
Resonance Imaging ◽  
Orbital Pain ◽  
Facial Numbness ◽  
Noncaseating Granulomas

A 59-year-old woman with type 2 diabetes had development of fluctuating, binocular, painless diplopia. She experienced headache, orbital pain, facial numbness, and progressive vision loss in the left eye. Her left eye vision worsened. Magnetic resonance imaging of the brain and orbit showed bilateral optic nerve enhancement. She started treatment with empiric intravenous corticosteroids for presumed optic neuritis, which resulted in transient improvement. Subsequently, her vision worsened to no light perception in the left eye, and she had fluctuating vision loss in the right eye. Cerebrospinal fluid evaluation was performed because the patient’s fluctuating diplopia and facial numbness suggested involvement of multiple cranial nerves. The cerebrospinal fluid showed white blood cells with lymphocytes, increased protein concentration, and negative oligoclonal bands and cytologic findings. Repeated brain magnetic resonance imaging 1 year after symptom onset showed persistent bilateral (left > right) optic nerve enhancement along with oculomotor nerve and left midbrain enhancement. We recommended left optic nerve biopsy to obtain the diagnosis and attempt to preserve vision in the threatened right eye. Because the patient had no light perception in the left eye for 5 months, with significant pallor of the optic nerve, it was unlikely that she had salvageable left eye vision. Furthermore, there was concern for lymphomatous infiltration of the optic nerve. Confirmation of a lymphoma diagnosis would be critical for initiation of specific chemotherapy. The pathologic analysis identified noncaseating granulomas. The finding of noncaseating granulomas was consistent with neurosarcoidosis infiltrating the left optic nerve. The patient was treated with intravenous methylprednisolone followed by prolonged, high-dose, oral corticosteroids along with corticosteroid prophylaxis of calcium, vitamin D, a proton-pump inhibitor, and dapsone for Pneumocystis prophylaxis Sarcoidosis is a systemic disease of unknown cause that can occur anywhere in the body but most commonly involves the lungs. The pathologic hallmark of sarcoidosis is noncaseating granulomas.

scholarly journals Congenital Herniation of the Gyrus Rectus Resulting in Compressive Optic Neuropathy

2020 ◽  
Vol 47 (6) ◽  
pp. 820-821
Author(s):  
Kia Gilani ◽  
Pejman Jabehdar Maralani ◽  
Arun NE Sundaram
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Ocular Trauma ◽  
Optic Chiasm ◽  
Compressive Optic Neuropathy ◽  
Neurological Exam ◽  
History Of ◽  
The Right ◽  
Mass Lesions ◽  
Gyrus Rectus

We report a 34-year-old male with a previously uninvestigated lifelong blindness of the right eye from compressive optic neuropathy secondary to congenital herniation of the gyrus rectus (HGR). His past medical history was otherwise unremarkable, with no history of prior head or ocular trauma. On examination, he had no light perception in the right eye, right relative afferent pupillary defect (RAPD), and primary optic atrophy. His left eye had normal visual acuity, color vision, and a healthy optic disc. There was a sensory exotropia in the right eye; however, extraocular movements were intact and the remainder of his neurological exam was normal. MRI revealed compression of the prechiasmatic right optic nerve from HGR and atrophy of the right optic nerve and optic chiasm (Figures 1 and 2), without any parenchymal mass lesions. There were no signal abnormalities in the optic nerves or the chiasm.

scholarly journals Acknowledging the Blind Spot of Bitemporal Hemianopsia: Keeping a High Index of Suspicion for Pituitary Macroadenomas in Uncommon Presentations

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A569-A569
Author(s):  
Joseph Raco ◽  
Maria Macias ◽  
Rohit Jain
Keyword(s):  
Vision Loss ◽  
Visual Fields ◽  
Optic Chiasm ◽  
Blind Spot ◽  
Surgical Removal ◽  
Double Vision ◽  
Neurologic Examination ◽  
Pituitary Macroadenoma ◽  
Free T4 ◽  
Gait Disturbances

Abstract Background: Hyperglycemia in patients with type 2 diabetes mellitus commonly manifests as symptoms of polyuria, polydipsia, fatigue, and weight loss as a result of insulin resistance. In cases of severe hyperglycemia, patients may also experience visual disturbances and dizziness as a result of swelling of the lens and dehydration respectively. These symptoms are not generally accompanied by gait disturbance or fixed, focal deficits on neurological examination. As such, symptoms such as double vision, peripheral field vision loss, cranial nerve deficits, or significant unsteadiness may warrant a more extensive neurologic workup rather than simply attributing all symptoms to hyperglycemia. Clinical Case: A 57-year-old woman presented to the emergency department with five days of fatigue, polyuria, polydipsia and pre-syncope associated with dizziness. She also described double vision in her peripheral visual fields and episodes of gait disturbances causing her to have to lower herself to the ground on multiple occasions, without loss of consciousness. Her neurologic examination demonstrated mildly ataxic finger-to-nose testing and concern for peripheral field vision loss. Intake lab work revealed a blood glucose of 725 mg/dL and a hemoglobin A1C of 13.4%. Initial neuroimaging with computed tomography was unremarkable. Though her symptoms were thought to be due to severe hyperglycemia, an MRI brain was obtained due to abnormal neurologic examination. MRI demonstrated a 1.9 cm pituitary macroadenoma abutting the optic chiasm with concern for hemorrhage. Subsequent lab evaluation determined the pituitary macroadenoma non-functional with TSH, free T4, free T3, AM cortisol, AM ACTH, and prolactin all within normal limits. Her hyperglycemia was treated with insulin with clinical improvement in all regards except visual symptoms. She was deemed safe for discharge with neurosurgical follow-up regarding surgical removal of her macroadenoma. Conclusion: Although hyperglycemia may present with broad symptoms including vague neurologic symptoms, it is critical to keep a broad differential diagnosis when atypical symptoms such as persistent vision changes and gait disturbances are present, especially after improvement in glycemic control has been obtained. A low threshold should be held for obtaining neuroimaging, as it is prudent to rule-out life-threatening causes of neurologic dysfunction.

Neuro-ophthalmologic manifestations of corona virus disease (COVID-19): A case series

2021 ◽  
pp. 42-44
Author(s):  
Mohammad Afzal Mahfuzullah ◽  
Md Sharfuddin Ahmed ◽  
Md Zafar Khaled ◽  
Nuzhat Choudhury ◽  
Shah Noor Hassan ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Virus Disease ◽  
Case Series ◽  
Recovery Phase ◽  
Acute Illness ◽  
Corona Virus ◽  
Nerve Dysfunction ◽  
Late Recovery ◽  
Phase Optic

Manifold neuro-ophthalmological signs & symptoms have been described in association with corona virus disease 19 (COVID-19). These presenting manifestations probably due to the result of a range of pathophysiological mechanisms throughout the course from acute illness to recovery phase & late recovery phase. Optic nerve dysfunction like optic neuropathy is associated with post COVID-19 infection. In this case series we want to highlight about the course, sequelae & association of optic neuropathy in COVID-19 patients. BSMMU J 2021; 14 (COVID -19 Supplement): 42-44

Management of Optic Neuritis in Ayurveda - A Special Case Report

2018 ◽  
Vol 3 (5) ◽  
Author(s):  
Dr. Harsha S. ◽  
Dr. Mamatha KV.
Keyword(s):  
Optic Nerve ◽  
Optic Neuritis ◽  
Visual Information ◽  
Vision Loss ◽  
Specific Treatment ◽  
Interesting Case ◽  
Treatment Modalities ◽  
Further Development ◽  
Special Case

The optic nerve carries visual information from your eye to your brain. Optic neuritis is when your optic nerve becomes inflamed. Optic neuritis can flare up suddenly from an infection or nerve disease. The inflammation usually causes temporary vision loss that typically happens in only one eye. Those with Optic neuritis sometimes experience pain. As you recover and the inflammation goes away, your vision will likely return. There are no direct references in our classics regarding optic neuritis but can be contemplated as a condition by name Parimlayi Timira. The specific management as such is not cited but a transcendence approach can be done with adopting the treatment which has the ability to pacify the already occurred pathology and prevent the further development of the disease. One such interesting case study on Optic neuritis is elaborated here where in specific treatment modalities (Shodana, Shamana and Kriyakalpas) played role in pacifying the condition.

Sign in / Sign up

Export Citation Format

Share Document