Neurosyphilis in a suspected case of giant cell arteritis

A 67-year-old man had a few month history of deteriorating visual acuity. He had originally presented to ophthalmology with right-sided visual blurring. This subsequently progressed to involve the left eye. At this point, he was empirically treated with high-dose glucocorticoids, both orally and intravenously, with the suspicion that giant cell arteritis was causing acute visual deterioration of his left eye. Unfortunately, his symptoms did not improve. During an admission to hospital for a pneumonia, he underwent further investigations for this bilateral visual loss. He was diagnosed with left neuroretinitis and right vitritis. A thorough workup revealed positive syphilis serology and cerebrospinal fluid was positive on venereal disease research laboratory testing. He was diagnosed and treated for neurosyphilis with intravenous benzylpenicillin 4 million units 4 hourly for 14 days. His left-sided vision improved but he still suffers from severe visual impairment in his right eye.

Transient visual blurring during a sexual intercourse in a young woman with surgically corrected myopia and unrecognized pigmentary glaucoma: A rare case report

Purpose: To present a rare case of unilateral visual loss episodes occurred during sexual intercourse in a young patient affected by unrecognized pigmentary glaucoma and previously undergone myopic refractive surgery. Case description: The patient presented surgically flattened corneas and markedly asymmetric pigmentary glaucoma. Conclusions: Previous refractive surgery, sexual intercourse, and athletic lifestyle might be risk factors for acute pigment dispersion and chronic progression of pigmentary glaucoma in young myopic patients. During their ophthalmic examination prior to refractive surgery, greater attention should be paid to detect early signs of pigmentary dispersion, and awareness of these dangerous situations should be raised in affected patients.

Object identification difficulty can be predicted based on disfluencies and eye-movements in connected speech

To reveal the underlying cause of disfluency, several authors use a network task, where participants describe the route taken by a marker through visually presented networks of objects. To be able to disentangle disfluency related to word preparation from other factors, we combined this task with eye-tracking. We asked whether delays in the earliest stages of picture naming elicit disfluency. We therefore used visual blurring which hinders visual identification of the items and thereby slows down selection of a lexical concept. This manipulation did not lead to more disfluency on average and viewing times decreased with blurred pictures. However, multivariate pattern analyses revealed that a classifier could predict, from the pattern of disfluency, whether each participant was about to name blurred or control pictures. Impeding the conceptual generation of a message therefore affected the pattern of disfluencies of each participant individually, but this pattern was not consistent from one participant to another.

Symptomatic Giant Virchow-Robin Spaces: A Rare Cause of Spastic Quadriparesis in 43-Year-old Ethiopian Patient: A Case Report

BACKGROUND: Virchow-Robin Spaces (VRS) are perivascular spaces that surround small arteries and arterioles. These normal anatomical structures are thought to be involved in the drainage of interstitial fluid and also to play an immunomodulatory role by hosting macrophages. Rarely, it becomes giant and symptomatic resulting in mass effect on adjacent neuronal structures and ventricular system causing different neurological disorders.CASE PRESENTATION: We report a 43-year-old, Ethiopian woman who presented with progressive weakness of all her extremity over the period of seven years. She had associated speech difficulty, visual blurring and pseudo-bulbar affect. Neurologic examination revealed spastic quadriparesis with increased deep tendon reflexes and up going plantar bilaterally. She had horizontal nystagmus, dysarthria and reduced bilateral visual acuity, otherwise normal cognition and cranial nerves examination. Brain MRI showed T1 hypointense, T2 hyperintense and non-enhancing multiple cystic lesions of different size, mainly in bilateral basal ganglia area with mass effect on adjacent internal capsule and lateral ventricles. Considering her clinical presentation and typical radiological features, diagnosis of symptomatic dilated Virchow-Robin spaces was made, and the patient was treated symptomatically.CONCLUSION: Commonly, dilation of Virchow-Robin spaces are not symptomatic, but giant Virchow-Robin spaces, as in our patient may result in spastic quadriparesis, causing great disability on the patient. Thus, we recommend considering symptomatic Virchow- Robin spaces as a potential differential diagnosis of progressive quadriparesis, as early neurosurgical intervention may reduce the neurological complications, such as spastic quadriparesis.

An Ayurvedic approach to the Treatment of Ataxia – A case study

Progressive Cerebellar Ataxia inherited by autosomal dominant transmission is known as ‘Spinocerebellar Ataxia’ (SCA) which is a neurological disorder. The global prevalence of ataxia is 0.3 – 2 per 1,00,000 population. The prevalence varies significantly depending on the race, place of birth and founder effect. The symptoms and signs of ataxia consists of gait impairment, unclear speech, visual blurring due to nystagmus, poor co – ordination and tremors with the movements. This leads to the dependency of the patient on the others for routine work. In the present study, a case previously diagnosed as spinocerebellar ataxia treated with Ayurvedic treatment is reported. A 55years old female patient having complaints of imbalance while walking, giddiness, unclear speech, poor co-ordination and tremors was treated with Shalishashtik Pinda Sweda over extremities, Nasya with Ksheerbala Taila, Shirodhara and Padabhyanga with Tila Taila and Baladi Niruha Basti (enema) for 28days. Along with these karma, internal medicines were also given.

Misleading Mydriasis

In this case, a middle-aged male presents to an emergency department (ED) with eye pain, visual blurring, and photophobia following trauma to the eye the previous day. It is some time before the patient is seen because the ED is extremely busy. Some drops are instilled in the eye for pain relief. When the physician finally gets to see the patient, he finds that the pupil of the affected eye is fixed and dilated—ominous signs but not consistent with the trauma the patient reports. After further investigation, it is determined that the patient had earlier received the wrong medication. Several biases can be identified in the case, as well as the likely error-producing condition rapid task switching.

Pseudotumor cerebri-Case report

An 46-year-old Caucasian woman was diagnosed with idiopathic intracranial hypertension (IIH) after presenting with papilledema and bilateral visual blurring. Lumbar puncture revealed an opening pressure of more than 550 mmH2O. Cerebral magnetic resonance imaging (MRI) showed bilateral flattening of the posterior sclera, enhancement of the prelaminar optic nerve, distension of the perioptic subarachnoid space, intraocular protrusion of the prelaminar optic nerve and empty sella. The main purpose of the treatment was to release the symptoms and preserve the vision. It was initiated the general treatment with Mannitol 20%, 250 ml/day, Acetazolamide 2x500 mg/day and B-vitamins. After discharge the patient followed a treatment with acetazolamide 2x250 mg/ daily doses and oral potassium supplements 30 mg bid/day. Key words: pseudotumor cerebri, idiopatic intracranial hypertension, papilledema,

Vogt-Koyanagi-Harada with Unilateral Clinical Presentation: A Case Report

Purpose: To report a case of acute Vogt-Koyanagi-Harada (VKH) disease with unilateral clinical manifestations followed by late fellow eye involvement. Case Report: This case report reviews the 12-month follow-up observation of a 44-year old woman who presented to the emergency department with unilateral progressive and painless visual blurring. Ophthalmoscopic findings, best-corrected visual acuity (BCVA), fluorescein angiography (FAG), enhanced-depth optical coherence tomography (EDIOCT), indocyanine green angiography, and response to treatment were evaluated. Her BCVA was 20/50 (logMAR: 0.4) in the right eye and 20/20 (logMAR: 0) in the left eye. Eye examination revealed optic disc swelling and multiple serous retinal detachments in the right eye and a normal left eye. She had headache, dysacusia, and mild hearing problems. Her past ocular and drug histories were unremarkable. Retinal imaging revealed characteristic features of VKH in the right eye. All laboratory testing results were inconclusive. VA and OCT findings significantly improved following the treatment with methylprednisolone 1 g/day continued by tapering dose of oral prednisolone. Two months after the presentation and during prednisolone tapering, VA of the left eye decreased and fundus examination revealed multiple serous retinal detachments in this eye. Conclusion: Ophthalmologists should recognize unilateral and asymmetrical VKH disease with subtle systemic involvement.

Strategies that reduce Stroop interference

A remarkable example of reducing Stroop interference is provided by the word blindness post-hypnotic suggestion (a suggestion to see words as meaningless during the Stroop task). This suggestion has been repeatedly demonstrated to halve Stroop interference when it is given to highly hypnotisable individuals. In order to explore how highly hypnotisable people manage to reduce Stroop interference when they respond to the word blindness suggestion, we tested four candidate strategies in two experiments outside of the hypnotic context. A strategy of looking-away from the target words, and a strategy of visual blurring demonstrated compelling evidence for substantially reducing Stroop interference in both experiments. However, the pattern of results produced by these strategies did not match those of the word blindness suggestion. Crucially, neither looking-away nor visual blurring managed to speed up incongruent responses, suggesting that neither of these strategies are likely underlying mechanisms of the word blindness suggestion. Although the current results did not unravel the mystery of the word blindness suggestion, they showed that there are multiple voluntary ways through which participants can dramatically reduce Stroop interference.

Symptoms related to the visual system in migraine

Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical migraine aura is not difficult to diagnose, patients with migraine may report several other visual symptoms, such as prolonged or otherwise atypical auras, “visual blurring”, “retinal migraine”, “ophthalmoplegic migraine”, photophobia, palinopsia, and “visual snow”. Here, we provide a short overview of these symptoms and what is known about the relationship with migraine pathophysiology. For some symptoms, the association with migraine is still debated; for other symptoms, recent studies indicate that migraine mechanisms play a role.