scholarly journals Idiopathic Chiasmal Optic Neuritis in a Pediatric Patient

2021 ◽  
Vol 62 (12) ◽  
pp. 1679-1684
Author(s):  
Jae Pyeong Jeon ◽  
Donghun Lee ◽  
Jong Won Moon
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Pediatric Patient ◽  
Demyelinating Disease ◽  
Late Onset ◽  
Systemic Disease ◽  
Brain Magnetic Resonance Imaging ◽  
Visual Disturbance ◽  
Systemic Steroid ◽  
The Right

Purpose: We report a case of idiopathic chiasmal optic neuritis in a pediatric patient.Case summary: A 13-year-old boy with no history of systemic disease was referred to our ophthalmology clinic because of visual disturbance in both eyes of 5 days in duration. The best-corrected visual acuity was 0.08 in the right eye and finger counting at 30 cm in the left eye; mild blurring of the disc margins (both eyes) was evident on fundus examination, as were temporal hemianopsia in the right eye and diffuse field loss in the left eye. Brain magnetic resonance imaging revealed focal nodular enhancement in the optic chiasm. Blood and cerebral fluid analysis yielded no evidence of infection or autoimmune disease. Therefore, we diagnosed isolated idiopathic chiasmal optic neuritis and commenced a systemic steroid. After 5 days, the visual acuity began to improve, and the field defect was almost eliminated (except for a small central scotoma) at 1 month. He has remained stable to the time of writing (4 months after treatment) and his visual acuity has normalized.Conclusions: Isolated idiopathic chiasmal optic neuritis developed in a pediatric patient and the visual function improved after steroid treatment. Although there was no evidence of systemic demyelinating disease, regular observation is scheduled given the possibility of late-onset disease.

scholarly journals Bilateral internuclear ophthalmoplegia in multiple sclerosis of very late onset

2021 ◽  
Author(s):  
Guilherme Drumond Jardini Anastacio ◽  
Stella de Angelis Trivellato ◽  
Hendrick Henrique Fernandes Gramasco ◽  
Ana Claudia Pires Carvalho ◽  
Omar Gurrola Arambula ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Visual Acuity ◽  
Demyelinating Disease ◽  
Hip Prosthesis ◽  
Age Of Onset ◽  
Late Onset ◽  
Oligoclonal Bands ◽  
Internuclear Ophthalmoplegia ◽  
Lower Limb Pain ◽  
The Right

Context: Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. The average age of onset is in the range of 28 to 31 years, but it can occur from the first year of life or after the seventh decade. If diagnosed over 60 years of age, it is called very late onset, with low prevalence. Bilateral internuclear ophthalmoplegia is a rare syndrome characterized by bilateral restriction of the adduction of the eyes in the conjugated horizontal gaze, which is generally secondary to demyelinating and vascular diseases. Case report: A 64-year-old man, brown, with a history of alcoholism, gout, hypothyroidism, arterial hypertension and generalized osteoarthritis with a right hip prosthesis with difficulty walking, presented a five-day subacute bilateral visual turbidity and binocular horizontal diplopia. On physical examination, he presented bilateral internuclear ophthalmoplegia, with a reduction in bilateral visual acuity worse on the right, in addition to lower limb pain pseudoparesis, with bilateral Babinski sign. Investigation with visual evoked potential demonstrated bilateral demyelinating optic neuropathy on the right, cerebrospinal fluid with more than two oligoclonal bands present, neuroaxis magnetic resonance imaging showing a change in the signal of the right optic nerve and multiple demyelinating lesions, fulfilling the criteria for dissemination in space and time. Therapy with Methylprednisolone 1g / day for 5 days was performed, with improvement of the condition, maintaining only visual sequelae with decreased visual acuity, and disease-modifying therapy was also started with stabilization of the condition. Conclusions: Despite being more rare, very late-onset MS should be considered as a diagnosis, even with singular presentations as in the case reported.

scholarly journals Optic Neuropathy with Features Suggestive of Optic Neuritis in Cerebrotendinous Xanthomatosis

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Miyuki Miyamoto ◽  
Nobuyuki Ishii ◽  
Hitoshi Mochizuki ◽  
Kazutaka Shiomi ◽  
Tomoko Kaida ◽  
...  
Keyword(s):  
Optic Neuritis ◽  
Optic Neuropathy ◽  
Storage Disease ◽  
Elevated Serum ◽  
Brain Magnetic Resonance Imaging ◽  
Cerebrotendinous Xanthomatosis ◽  
Gadolinium Enhancement ◽  
Lipid Storage Disease ◽  
Optic Disc Swelling ◽  
The Right

We describe our encounter with a 39-year-old man who exhibited acute painless visual loss and progressive gait disturbance. He had tendinous xanthoma and several neuroophthalmological findings indicative of optic neuropathy in the right eye, including afferent pupillary defect, cecocentral scotoma, and optic disc swelling. Neurological examination showed cerebellar ataxia and pyramidal weakness. Brain magnetic resonance imaging revealed bilateral swelling in the optic nerves with gadolinium-enhancement suggesting optic neuritis, an enlarged fourth ventricle, atrophy of the cerebellum, and hyperintensities in the bilateral dentate nuclei. The patient was diagnosed with cerebrotendinous xanthomatosis (CTX) based on an elevated serum cholestanol level and a homozygous missense mutation in CYP27A1. CTX is a genetic lipid storage disease caused by dysfunction of the mitochondrial enzyme sterol 27-hydroxylase. With respect to ophthalmological manifestations, juvenile cataracts and optic neuropathy are common findings in patients with CTX, but there have been no reports of optic neuropathy with features suggestive of optic neuritis. Thus, this case illustrates that clinicians should consider a diagnosis of CTX in patients with cardinal features of CTX even if the patients show signs indicative of optic neuritis.

scholarly journals Optic Neuritis Caused by Rathke’s Cleft Cyst in Young Adult

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Namie Kobayashi ◽  
Toshiyuki Oshitari ◽  
Kentaro Kobayashi ◽  
Takatsugu Onoda ◽  
Hidetoshi Ikeda ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Young Adult ◽  
Optic Neuritis ◽  
Rathke’S Cleft Cyst ◽  
Rathke's Cleft Cyst ◽  
Rathke's Cleft ◽  
One Year ◽  
The Right ◽  
Transsphenoidal Resection

We report a case of right optic neuritis caused by Rathke's cleft cyst (RCC) in a young adult. A 15-year-old boy presented with reduced visual acuity in the right eye. He was diagnosed with optic neuritis in the right eye 4 years earlier at other clinics before he was referred to our department. During our one-year examinations, the cause of the reduced vision in his right eye could not be determined conclusively. At the age of 17 years, a RCC was detected by a neurosurgeon who specialized in hypophyseal diseases. He underwent microscopic transsphenoidal resection of the cyst, and his vision recovered to 1.2 and he has had no recurrence for at least 9 months. We suggest that repeated rupturing of the RCC was the cause of the optic neuritis, and a RCC can be successfully treated by surgery even after 3 years of optic neuritis.

scholarly journals IMPROVEMENT OF LEUKEMIC RETINOPATHY AFTER LEUKAPHERESIS IN CHRONIC MYELOGENOUS LEUKEMIA WITH LEUKOSTASIS

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Ruchyta Ranti ◽  
Sauli Ari Widjaja ◽  
Wimbo Sasono ◽  
Muhammad Firmansjah ◽  
Ima Yustiarini ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Chronic Myelogenous Leukemia ◽  
Visual Disturbance ◽  
Myelogenous Leukemia ◽  
Laboratory Examination ◽  
Retinal Hemorrhages ◽  
Case Presentation ◽  
Retinal Blood Vessels ◽  
Wbc Count ◽  
The Right

ABSTRACT Introduction: to report a case of bilateral leukemic retinopathy due to leukostasis that was successfully managed by leukapheresis. Case Presentation: 31-year-old male with mild visual disturbance was referred to ophthalmology department. He suffered from Chronic Myelogenous Leukemia (CML) with white blood cell (WBC) count 533.900/microL. He was started on hydroxyurea, allopurinol, and once leukapheresis. Ophthalmologic evaluation revealed visual acuity of 4/4 in the right eye and 4/6,3 in the left eye. Funduscopy examination showed the presence of bilateral papilledema, venous engorgement, tortuosity, and retinal hemorrhages. Then this patient continued with second leukapheresis. Result: Visual acuity, laboratory examination, and funduscopic finding was evaluated. His visual acuity was improved, papilledema and retinal blood vessels abnormality had markedly reduced concurring with the patient’s hematological remission. Decreasing WBC count after leukapheresis has improved blood flow that reflected from the retinal findings and visual acuity improvement. Conclusion: Leukapheresis treatment is sufficient to improved clinical condition for leukemic retinopathy caused by CML with leukostasis. Keywords: chronic myelogenous leukemia (CML), hyperleukocytosis, leukostasis, leukemic retinopathy

scholarly journals Vogt-Koyanagi-Harada Disease Following COVID-19 Infection

2021 ◽  
pp. 804-808
Author(s):  
Juan B. Yepez ◽  
Felipe A. Murati ◽  
Michele Petitto ◽  
Jazmin De Yepez ◽  
Jose M. Galue ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Optic Nerve ◽  
Plexiform Layer ◽  
Visual Disturbance ◽  
Ocular Pain ◽  
Ocular Movements ◽  
Interdigitation Zone ◽  
The Right ◽  
Retinal Folds

A 29-year-old female presented to the emergency clinic with gradual visual disturbance in both eyes for 15 days duration, accompanied by bilateral tinnitus, and ocular pain that increased with ocular movements. One month prior to presentation, the patient had tested positive for severe acute respiratory syndrome coronavirus-2 but without complications. Visual acuity was 20/100 in the right eye and 20/300 in the left eye. Funduscopy demonstrated optic nerve swelling, radial nerve fiber striation disruption, and bilateral retinal folds. Optical coherence tomography showed serous (bacillary) retinal detachment and multifocal areas of hyper-reflective changes in the inner and outer plexiform layer with inner nuclear layer thickening and disruption of the interdigitation zone bilaterally. We present a case of incomplete Vogt-Koyanagi-Harada disease following COVID-19 infection.

First Clinical Experience with Anti-myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis

2020 ◽  
Vol 237 (04) ◽  
pp. 458-463 ◽  
Author(s):  
Jan Heckmann ◽  
Margarita Todorova ◽  
Stefanie Müller ◽  
Philip Julian Broser ◽  
Veit Sturm
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Pulse Therapy ◽  
Myelin Oligodendrocyte Glycoprotein ◽  
Individual Treatment ◽  
Igg Antibodies ◽  
Intravenous Methylprednisolone ◽  
Finger Counting ◽  
The Right

Abstract Background Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been consistently found in a range of demyelinating disorders. In this context, MOG-IgG-associated optic neuritis (ON) has been suggested as a new subset of optic neuropathy. However, clinical manifestations and distinctive characteristics have only rarely been described. Patients and Methods A retrospective case series of three patients with MOG-IgG-associated ON. Clinical morphological features using imaging techniques are presented. Results Three patients (8-year-old boy, 28-year-old female, 48-year-old male) were included. An 8-year-old boy suffered from a bilateral ON with severe visual loss. The best-corrected visual acuity (BCVA) was 0.05 in the right eye and finger counting in the left eye. The patient had a previous episode of acute disseminated encephalomyelitis (ADEM) with a right abducens nerve palsy. Visual acuity recovered after repeated cycles of intravenous methylprednisolone pulse therapy and 10 cycles of plasma exchange. During the last follow-up, BCVA was 0.9 in the right eye and 0.8 in the left eye. A 28-year-old female presented with a bilateral ON. Her BCVA was 0.5 in the right eye and 0.8 in the left eye. She fully recovered with pulse methylprednisolone therapy (1000 mg/d) with tapering after the second cycle and had a BCVA of 1.0 during the last follow-up visit. A 48-year-old male suffered from a relapsing bilateral ON. At first presentation, BCVA was 0.1 in the right eye and finger counting in the left eye. BCVA fully recovered after each pulse therapy with intravenous methylprednisolone (two cycles). Since the first relapse, the patient has been receiving long-term immunosuppression with rituximab. Despite rituximab and low-dose oral prednisone, the patient had another relapse with a left ON. After a third cycle with intravenous methylprednisolone, he partially recovered. BCVA at last follow-up was 1.0 in the right and 0.8 in the left eye. Conclusions MOG-IgG antibodies have been identified in different acquired demyelinating syndromes. The patients reported had an ADEM followed by bilateral ON, an isolated bilateral ON, and a relapsing bilateral ON. Individual treatment strategies led to substantial visual recovery in all patients. We recommend inclusion of MOG-IgG antibodies in the diagnostic workup at least after the first recurrence of ON since they can serve as a diagnostic and potential prognostic tool and might lead to specific therapeutic recommendations.

scholarly journals Leber’s hereditary optic neuropathy following unilateral painful optic neuritis: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chaeyeon Lee ◽  
Kyung-Ah Park ◽  
Ga-In Lee ◽  
Sei Yeul Oh ◽  
Ju-Hong Min ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Neuritis ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Early Stage ◽  
Leber’S Hereditary Optic Neuropathy ◽  
Leber's Hereditary Optic Neuropathy ◽  
Intravenous Methylprednisolone ◽  
The Right ◽  
Hereditary Optic Neuropathy

Abstract Background Leber’s hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disease, characterized by acute or subacute, painless, bilateral visual loss. LHON is often misdiagnosed as optic neuritis at an early stage because of the similarity of their clinical presentation. To date, there has been no reported case of actual optic neuritis and LHON in one patient. Case presentation A 40-year-old, healthy man was referred to our clinic with acute painful visual loss in the right eye for 2 weeks. In the right eye, visual acuity decreased to 20/40, and the Ishihara colour test score was 8/14 with a relative afferent pupillary defect. Optic disc swelling was found only in the right eye, and magnetic resonance imaging revealed enhancement of the the right optic nerve, consistent with optic neuritis. After receiving 1 g of intravenous methylprednisolone daily for three days, his ocular pain resolved, and visual acuity improved to 20/20 within 2 weeks. Seven months later, the patient developed acute painless visual loss in the right eye. Visual acuity decreased to 20/200 in the right eye. There was no response to the intravenous methylprednisolone therapy at that time. Eight months later, he developed subacute painless visual loss in the left eye. Genetic testing for LHON was performed and revealed the pathologic mtDNA 11778 point mutation. Conclusions We report a case with painful unilateral optic neuritis preceding the onset of LHON. Even if a typical optic neuritis patient has completely recovered from steroid treatment once in the past, it is advisable to keep in mind the possibility of LHON if acute or subacute loss of vision subsequently or simultaneously occurs in both eyes and does not respond to steroids.

scholarly journals Fulminant Progressive Atypical Acute Zonal Occult Outer Retinitis

2021 ◽  
Vol 62 (8) ◽  
pp. 1148-1154
Author(s):  
Sung Joon Kim ◽  
Hyeshin Jeon ◽  
Ik Soo Byon ◽  
Ji Eun Lee ◽  
Sung Who Park
Keyword(s):  
Visual Acuity ◽  
Healthy Woman ◽  
Brain Magnetic Resonance Imaging ◽  
Visual Disturbance ◽  
Posterior Pole ◽  
Peripheral Retina ◽  
High Dose ◽  
Central Visual Field ◽  
Hand Motion ◽  
Outer Retinitis

Purpose: To report a case of unilateral progressive atypical acute zonal outer retinitis in a healthy young female.Case summary: A 32-year-old healthy woman presented with visual disturbance in the left eye for 1 week. Best corrected visual acuity was 0.4 in the left eye. No abnormal findings were detected on brain magnetic resonance imaging and a laboratory work-up. Zonal retinal opacity around the optic nerve disc was noticed in a fundus photo which was consistent with the outer retinal signal defect on optical coherence tomography and a defect in the central visual field from perimetry. Multiple evanescent white dot syndrome was suspected based on fluorescein angiography and indocyanine green angiography. Prednisolone was prescribed. Visual acuity was reduced to hand-motion after 10 days with extended zonal retinal opacity. No virus was detected by multiplex polymerase chain reaction of the aqueous humor. The lesion did not improve despite high-dose intravenous steroid and antiviral treatment.Conclusions: Visual function was lost with the progression of outer retinitis. This case differed from previous cases as the outer retinitis progressed rapidly from the posterior pole to the peripheral retina. It was named fulminant progressive atypical acute zonal outer retinitis.

scholarly journals Recurrent Keratoconus. Clinical Case

2021 ◽  
Vol 18 (3) ◽  
pp. 591-600
Author(s):  
M. E. Konovalov ◽  
K. V. Burdel ◽  
M. L. Zenina ◽  
A. B. Reznikova ◽  
M. M. Konovalova
Keyword(s):  
Visual Acuity ◽  
Clinical Case ◽  
Systemic Disease ◽  
Biomechanical Properties ◽  
Depth Study ◽  
The Right ◽  
Previous Visit ◽  
Posterior Keratoconus

Purpose: To provide a clinical case of recurrent keratoconus from our practice.Materials and method. A patient came to the clinic with a complaint of decreased visual acuity in the right eye. A series of standard instrumental examinations and Scheimpflug keratotopography were performed, and astigmatism of the right eye was diagnosed. Similar examinations were carried out during the patient’s attendance at follow-up examinations.Results. Based on the results of scanning Scheimpflug keratotopography, the diagnosis of keratoconus (forme fruste) was made. On examination after 1 year, there were no complaints of decreased visual acuity and data from the same instrumental examinations indicating keratoconus. After this examination, the patient came 3.5 years later with complaints of a new decreased visual acuity in the right eye. During instrumental examinations and keratopography, data were obtained indicating the presence of posterior keratoconus. After 1 year, a follow-up examination took place without complaints. The data of instrumental studies are identical to the previous visit; keratotopography revealed a decrease in posterior elevation.Discussion and conclusion. It was revealed that the patient was constantly taking the hydroxyurea drug against the background of systemic disease up to the 3rd visit, at the time of the 4th visit she had not taken it for 1 year. There are publications in the literature on the effect of this type of drugs on the collagen of the dermis of the skin, the type of which corresponds to the collagen of the cornea. We hypothesize that drugs may have an effect on the biomechanical properties of the cornea, which requires further in-depth study.

scholarly journals Acute Transient Macular Edema after Uneventful Cataract Surgery

2021 ◽  
Vol 18 (3) ◽  
pp. 442-450
Author(s):  
J. S. Beisekeeva ◽  
A. V. Bezrukov ◽  
S. A. Kochergin ◽  
A. I. Samoylenko
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Clinical Case ◽  
Systemic Disease ◽  
Biomechanical Properties ◽  
Depth Study ◽  
The Right ◽  
Previous Visit ◽  
Posterior Keratoconus

Purpose: to provide a clinical case of recurrent keratoconus from our practice.Materials and method. A patient came to the clinic with a complaint of decreased visual acuity in the right eye. A series of standard instrumental examinations and Scheimpflug keratotopography were performed, and astigmatism of the right eye was diagnosed. Similar examinations were carried out during the patient’s attendance at follow-up examinations.Results. Based on the results of scanning Scheimpflug keratotopography, the diagnosis of keratoconus (forme fruste) was made. On examination after 1 year, there were no complaints of decreased visual acuity and data from the same instrumental examinations indicating keratoconus. After this examination, the patient came 3.5 years later with complaints of a new decreased visual acuity in the right eye. During instrumental examinations and keratopography, data were obtained indicating the presence of posterior keratoconus. After 1 year, a follow-up examination took place without complaints. The data of instrumental studies are identical to the previous visit; keratotopography revealed a decrease in posterior elevation.Discussions and conclusion. It was revealed that the patient was constantly taking the hydroxyurea drug against the background of systemic disease up to the 3rd visit, at the time of the 4th visit she had not taken it for 1 year. There are publications in the literature on the effect of this type of drugs on the collagen of the dermis of the skin, the type of which corresponds to the collagen of the cornea. We hypothesize that drugs may have an effect on the biomechanical properties of the cornea, which requires further in-depth study.

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