Pachymeningitis in a Patient With Granulomatosis With Polyangiitis; A Case Report

Introduction: Granulomatosis with polyangiitis (GPA) is a systematic and necrotizing vasculitis with positive autoimmune antibodies. Some studies have reported the prevalence of eye involvement between 40%-50% of cases. Retro orbital granuloma is a rare complication of GPA which should be treated by surgical involvements, while pachymeningitis can be diagnosed by MRI and treated by medical management. In this study, we tried to present a case of GPA with optic neuritis and typical central nervous system (CNS) involvement, while there were no definite features of sinusitis or kidney injuries. Case Presentation: A 15-year-old girl was admitted because of blurred vision in her left eye. She was a known case of GPA three years ago with initial features, including left facial nerve paresis due to pan-sinusitis and pulmonary cavity. Neurologic evaluations, including sensory and motor features, were normal, too. Ophthalmologic examinations showed that visual acuity of the right eye was good, while the visual acuity in the left eye decreased to the point of finger counting at a distance of 20 cm. The left eye Marcus gunn test was positive (3+); anterior and posterior eye segments were normal. The patient was evaluated by brain MRI with gadolinium and a pathologic enhancement in the left cavernous was seen which had a pressure effect on the optic nerve. She was treated by intravenous methylprednisolone followed by rituximab. Conclusion: Reporting orbital mass in a patient who had GPA can be supposed as granuloma which needs a biopsy to confirm a diagnosis. In our case, the imaging manifestation was heterodox for granuloma, while neurosurgical consultation recommended drug treatment for pachymeningitis.

Download Full-text

Recurrence of Primary Breast Lymphoma Presenting as Bilateral Vitreoretinal Lymphoma

Ocular Oncology and Pathology ◽

10.1159/000515560 ◽

2021 ◽

pp. 1-5

Author(s):

Karishma Habbu ◽

Roshan George ◽

Miguel Materin

Keyword(s):

Brain Mri ◽

B Cell Lymphoma ◽

Intrathecal Chemotherapy ◽

Primary Breast Lymphoma ◽

Blurred Vision ◽

Breast Lymphoma ◽

Central Nervous System Penetration ◽

Vitreoretinal Lymphoma ◽

The Right ◽

Vitreous Biopsy

Purpose: This report describes a case of relapsed primary breast lymphoma (PBL) presenting as vitreoretinal lymphoma (VRL). Methods: We describe the clinical and hematopathologic findings in a patient with relapsed PBL involving the vitreous of both eyes. Results: A 59-year-old woman was treated for PBL with systemic and intrathecal chemotherapy 5 years prior to presentation. Three years later, she presented to an outside clinic with blurred vision in both eyes and bilateral vitritis. She was referred to our clinic with concern for ocular lymphoma. On presentation, the patient’s best-corrected visual acuity was 20/40 in the right eye and 20/25 in the left eye with 3+ vitreous cells in the right eye and 2+ vitreous cells in the left eye. Vitreous biopsy of the right eye revealed CD5-negative/CD10-negative B-cell lymphoma cells on flow cytometry. She had no evidence of disease on brain MRI, lumbar puncture, bone marrow biopsy, or full-body CT scans. She was treated with a regimen of rituximab, methotrexate, procarbazine, and vincristine for central nervous system penetration as well as multiple intraocular injections of methotrexate and rituximab with improvement in vision and ocular inflammation bilaterally. Conclusion: Relapsed PBL can present as bilateral VRL.

Download Full-text

Submacular Cysticercosis Successfully Treated through Conservative Management: Case Report

Case Reports in Ophthalmology ◽

10.1159/000508030 ◽

2020 ◽

Vol 11 (2) ◽

pp. 315-321

Author(s):

Renata García Franco ◽

Alejandro Arias Gómez ◽

Juvenal Guzman Cerda ◽

Marlon García Roa ◽

Paulina Ramirez Neria

Keyword(s):

Visual Acuity ◽

Medical Management ◽

Central Nervous System Involvement ◽

Vitreoretinal Surgery ◽

Visual Outcome ◽

Clinical Findings ◽

Ophthalmological Examination ◽

Blurred Vision ◽

Elevated Lesion ◽

The Right

Appropriate medical management can be an alternative in those patients with submacular cysticercosis in whom achieving good visual outcome with vitreoretinal surgery is not possible. We report the case of a 25-year-old female who presented complaining of blurred vision in her left eye associated with photopsias and metamorphopsias of 3 months duration. Initial visual acuity in the right eye was 20/20 and 20/100 in the left eye. Upon indirect ophthalmoscopy in the left eye, a yellow-white, dome-shaped, elevated lesion with foveal involvement was observed. The rest of the ophthalmological examination proved normal. With clinical findings and images, submacular cysticercosis was diagnosed, and vitreoretinal surgery was suggested. Nevertheless, the patient did not accept the treatment; therefore, medical management was initiated. Central nervous system involvement was ruled out, and treatment with praziquantel and systemic prednisolone was initiated. Cysticercosis was resolved with significant improvement of her symptoms and visual acuity.

Download Full-text

Bilateral central serous chorio-retinopathy in pregnancy presenting with severe visual loss

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v6i2.11711 ◽

2014 ◽

Vol 6 (2) ◽

pp. 220-223 ◽

Cited By ~ 2

Author(s):

Chandana Chakraborti ◽

Swapan Kumar Samanta ◽

Khandakar Faiduddin ◽

Krittika Pal Choudhury ◽

Sheuli Kumar ◽

...

Keyword(s):

Visual Acuity ◽

Retinal Pigment ◽

Third Trimester ◽

Retinal Pigment Epithelial Detachment ◽

Serous Macular Detachment ◽

Macular Detachment ◽

Severe Visual Loss ◽

Finger Counting ◽

Funduscopic Examination ◽

The Right

Introduction: Bilateral central serous chorio-retinopathy is an unusual presentation. Objective: To report a case of pregnancy-induced bilateral central serous chorio-retinopathy. Case: A thirty-year-old woman complaining of reduced vision in both the eyes was referred for ophthalmoscopic evaluation in her third trimester of pregnancy. The best-corrected visual acuity was 6/60 in the right eye and finger counting at four meters in the left. The funduscopic examination revealed serous macular detachment with white sub-retinal exudates in both the eyes. Optical coherence tomography sections through the macula demonstrated serous elevation of the retina and retinal pigment epithelial detachment in both the eyes. The serous macular detachment resolved and the patient recovered to the visual acuity of 6/6 in both the eyes after twelve weeks of delivery. The OCT showed resolution of the sub-retinal fluid and disappearance of the sub-macular exudate in the right eye, but the resolution was partial in the left eye.Conclusion: Pregnancy is a risk factor for CSCR and it can present with severe bilateral visual diminution.DOI: http://dx.doi.org/10.3126/nepjoph.v6i2.11711Nepal J Ophthalmol 2014; 6(12): 220-223

Download Full-text

Giant hyperostosis after sphenoid ridge en plaque meningioma removal

Romanian Neurosurgery ◽

10.2478/romneu-2014-0063 ◽

2014 ◽

Vol 21 (4) ◽

pp. 471-476

Author(s):

Danil Adam ◽

Toma Papacocea ◽

Ioana Hornea ◽

Cristiana Moisescu

Keyword(s):

Brain Mri ◽

Growth Patterns ◽

Neurological Deficits ◽

X Rays ◽

Blurred Vision ◽

Orbital Cavity ◽

Orbital Wall ◽

The Central Nervous System ◽

The Right ◽

Sphenoid Ridge

Abstract Meningioma is in most cases a benign tumor of the central nervous system with two growth patterns: en masse and en plaque. Hyperostosis is associated in 13 - 49 % of the cases with en plaque meningioma. We describe the case of a 47 years old woman with meningotelial sphenoid ridge meningioma which was totally removed. At the first admission she presented with no neurological deficits, seizures and a mild right exophthalmos. This had an indolent growth. After 10 years, the patient was readmitted for headache, blurred vision and right exophthalmos. Skull X-rays and brain MRI revealed an important thickening of the right superior orbit wall and sphenoid ridge. She underwent a new surgery. There was no intradural tumor found. Instead, bones of the superior and lateral right orbit walls were very hiperostotic. A hole of 3/2 cm in the right superior orbital wall was drilled and the orbital cavity was decompressed. In the postoperative period, the symptoms were remitted and the exophthalmos reduced. We discuss the causes and management of hyperostosis associated with meningiomas.

Download Full-text

Pseudophacocele following a Bicycle Handle Injury: A Case Report

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v10i1.21724 ◽

2018 ◽

Vol 10 (1) ◽

pp. 94-97

Author(s):

Sahil Thakur ◽

Parul Ichhpujani ◽

Suresh Kumar

Keyword(s):

Visual Acuity ◽

Case Report ◽

Blunt Trauma ◽

Surgical Management ◽

Clinical Course ◽

Rare Complication ◽

Vitreous Haemorrhage ◽

Visual Outcomes ◽

Subconjunctival Space ◽

The Right

Background: Pseudophacocele is a rare complication of blunt trauma in pseudophakic eyes.Case: We present a case of 60-year-old male who presented with pseudophacocele after injury from a bicycle handle. On presentation, visual acuity in the right eye was perception of light (PL) in 2 quadrants (superior and temporal) and left eye was 20/20. A PCIOL was seen superonasally in the right subconjunctival space with total hyphaema. Ultrasound demonstrated vitreous haemorrhage with membranes in right eye. We describe the surgical management and further clinical course of the patient.Conclusion: It is imperative to surgically manage these challenging cases. Despite optimum care visual outcomes are guarded in patients with severe blunt trauma.

Download Full-text

Paediatric case of peripapillary choroidal neovascularisation associated with optic disc drusen treated with aflibercept

BMJ Case Reports ◽

10.1136/bcr-2018-228134 ◽

2019 ◽

Vol 12 (1) ◽

pp. bcr-2018-228134 ◽

Cited By ~ 1

Author(s):

Weh Loong Gan ◽

Vernon W Long

Keyword(s):

Visual Acuity ◽

Optic Disc ◽

Rare Complication ◽

Fundus Autofluorescence ◽

Choroidal Neovascularisation ◽

First Case ◽

Optic Disc Drusen ◽

Intravitreal Aflibercept ◽

The Right ◽

Subfoveal Fluid

Peripapillary choroidal neovascularisation (PPCNV) associated with optic disc drusen is a rare complication that can result in severe vision impairment in children. We report the first case of paediatric PPCNV secondary to optic disc drusen successfully treated with intravitreal aflibercept. A 6-year-old girl presented with a one week history of reduced vision in her right eye with best-corrected visual acuity of 20/500. Fundus examination revealed bilateral elevated discs with a peripapillary pigmentary lesion in the right eye. Optical coherence tomography of the right eye showed marked subfoveal fluid. Both B-scan ultrasonography and fundus autofluorescence demonstrated findings consistent with optic disc drusen. Diagnosis of PPCNV was further confirmed on fluorescein fundus angiography. The child received three intravitreal aflibercept injections with complete resolution of the subfoveal fluid. Her visual acuity improved to 20/25 with no recurrence at a 16-month follow-up. No adverse side effects were reported.

Download Full-text

Partly reversible central auditory dysfunction induced by cerebral vasospasm after subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2013.7.jns13674 ◽

2013 ◽

Vol 119 (5) ◽

pp. 1125-1128 ◽

Cited By ~ 5

Author(s):

Ester Ponzetto ◽

Marco Vinetti ◽

Cécile Grandin ◽

Thierry Duprez ◽

Vincent van Pesch ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Auditory Evoked Potentials ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Rare Complication ◽

Brain Mri ◽

Temporal Cortex ◽

Intraarterial Infusion ◽

Auditory Dysfunction ◽

The Right

The authors describe a rare case of central auditory dysfunction induced by cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). A 55-year-old woman who was admitted after aneurysmal SAH developed cerebral vasospasm on Day 3 affecting mainly the right middle cerebral artery (MCA) and partly the left MCA. The vasospasm became refractory to conventional therapy and was ultimately improved by intraarterial infusion of nimodipine in the right MCA and angioplasty. Severe auditory dysfunction was apparent from Day 10 as the patient was not reactive to speech or environmental sounds. Brain MRI on Day 17 demonstrated infarcted areas mainly in the right hippocampus, medial occipital lobe, and thalamus. The patient underwent further examination using audiometry, speech testing, auditory evoked potentials, functional MRI, and cerebral PET. The initial diagnosis was extended nonverbal agnosia and total pure word deafness. The central auditory dysfunction improved over 6 months, with persisting hyperacusis, tinnitus, and amusia. Central auditory dysfunction is a rare complication after SAH. While cortical deafness may be associated with bilateral lesions of the temporal cortex, partly reversible central auditory dysfunction was observed in this patient after prominently unilateral right temporal lesions. The role of the interthalamic connections can be discussed, as well as the possibility that a less severe vasospasm on the left MCA could have transiently impaired the left thalamocortical auditory pathways.

Download Full-text

EMERGENCY TREATMENT FOR CENTRAL RETINAL ARTERY OCCLUSION ( CRAO )

The Avicenna Medical Journal ◽

10.15408/avicenna.v1i2.20122 ◽

2021 ◽

Vol 1 (2) ◽

pp. 7-8

Author(s):

Nida Farida

Keyword(s):

Visual Acuity ◽

Emergency Treatment ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Blurred Vision ◽

Retinal Artery ◽

Ocular Chamber ◽

The Right

Central retinal artery occlusion (CRAO) is a blinding event but not considered as a common emergency problem. Since awareness of the case is low, patients usually come to the ophthalmologist later than the golden period and havingthe worst prognosis. We report the case of patient with a central retinal artery occlusion that had visual improvement after emergency treatment.A 47-year-old woman with no comorbidities presented with symptoms of a sudden blurred vision, no pain or redness in the right eye (RE). Best-corrected visual acuity in the RE was 1/60. A relative afferent pupillary defect was observed in the RE. Ocular fundus examination of RE was suggestive of CRAO. Emergency treatment were performed, including rebreathing of expired CO2, ocular massage and ocular chamber paracentesis. One week later, the visual acuity was improved.This case highlights that fast and accurate response in acute management of CRAO should be conducted, especially within the golden hours which is less than 6 hours after the accident, to prevent permanent visual loss of thepatient.

Download Full-text

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

Klinische Monatsblätter für Augenheilkunde ◽

10.1055/a-1068-2506 ◽

2020 ◽

Vol 237 (04) ◽

pp. 458-463 ◽

Cited By ~ 1

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.

Download Full-text

Active iris vascular tufts bleeding successfully treated with argon laser photocoagulation

European Journal of Ophthalmology ◽

10.5301/ejo.5001021 ◽

2018 ◽

Vol 28 (2) ◽

pp. 241-242 ◽

Cited By ~ 2

Author(s):

Ambreen Sarmad ◽

Fadi Alfaqawi ◽

Monali Chakrabarti ◽

Arijit Mitra ◽

Bushra Mushtaq

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Case Report ◽

Laser Photocoagulation ◽

Argon Laser ◽

Active Bleeding ◽

Blurred Vision ◽

Argon Laser Photocoagulation ◽

The Right ◽

Effective Use

Purpose: Iris vascular tufts (IVT) are rare biomicroscopic capillary outgrowths from the pupillary margins. Patients are usually asymptomatic until presenting with blurred vision due to spontaneous hyphema or with raised intraocular pressure. Case report: A 61-year-old woman presented to eye casualty with left eye (LE) blurred vision and discomfort for 1 day. Her external ocular examination was unremarkable and visual acuity was 6/6 in the right eye (RE) and 6/9 in the LE. Biomicroscopic examination revealed a 2-mm hyphema in her LE and bilateral multiple small IVT and active bleeding from IVT at the pupillary margin of the LE at the 5 o’clock position. Diagnosis of LE active bleeding from IVT was made and she underwent argon laser photocoagulation directed at the source of bleeding. The bleeding stopped immediately after the second burn. She was followed up for 3 months; her visual acuity was 6/5 and 6/6 in the RE and LE, respectively, with no further problems. Conclusions: Iris vascular tufts are benign and recurrent hemorrhages are unlikely. Therefore, definitive argon laser photocoagulation or surgical treatment are reserved to arrest further episodes of hyphema. Our case demonstrates the effective use of argon laser photocoagulation to completely arrest active bleeding from IVT and excellent recovery of hyphema with no further problems for 5 years.

Download Full-text