Management of Abnormal Visual Developments

When human beings recognize the external world, more than 80% of the information come from visual function and visual system. Normal visual development and normal binocularity are the fundamental of good visual acuity and visual functions. Any abnormal visual experience would cause abnormality, such as refractive error, strabismus, amblyopia and other diseases. The patients with abnormal visual developments were reported to have abnormal, lonely, and other psycho problems. In this chapter, we will describe the normal developmental of visual function, summarize the abnormal developments and the correction or treatment.

Neuro-ophthalmology: Disorders of Visual Perception, Pupils, and Eyelids

Visual loss may develop acutely, subacutely, or insidiously. The course may be transient, static, or progressive. This chapter reviews the causes, diagnosis, and treatment of various disorders resulting in visual loss or abnormal visual perception. In addition, it reviews clinical disorders of the eyelids and pupils. Disorders of visual perception involve visual acuity, color perception, visual field defects, and other visual changes. Historical information and physical findings on examination can help to localize the problem and define the cause.

The clinical features of combined central and peripheral demyelination and antibodies against the node of Ranvier

Background: Combined central and peripheral demyelination (CCPD) is a disease of inflammatory demyelination that affects central and peripheral nerves simultaneously or temporally separated. Objectives: This study evaluated the clinical characteristics and the existence of antinodal/paranodal antibodies in patients with CCPD. Methods: We reviewed the clinical manifestations, laboratory tests, electrophysiological examinations, neuroimaging findings, treatment, and prognosis of 31 patients with CCPD. Using a live cell–based assay, we tested antinodal/paranodal antibodies. Results: The most common symptoms were motor weakness (83.3%), hyporeflexia (63.3%), and sphincter disturbance (58.1%). In total, 16.6% of patients had impaired vision symptoms, whereas 33.3% of patients had abnormal visual-evoked potentials (VEPs). A total of 21.1% (4/19) of patients were positive for anti-AQP4 (aquaporin 4) antibodies, 20.0% (2/10) of patients were positive for anti-NF155 (neurofascin-155) antibodies, and 10.0% (1/10) of patients were positive for anti-MAG (myelin-associated glycoprotein) antibodies. The effective rates of intravenous corticosteroids, intravenous immunoglobulins, and rituximab were 72.2%, 37.5%, and 100%, respectively. At the illness peak, 75% of patients with CCPD had an mRS (modified Rankin Scale) score of 4 or greater. In remission, 37.5% had an mRS score of 4 or greater. Conclusion: The clinical manifestations of patients with CCPD are highly heterogeneous. We recommend testing antinodal/paranodal antibodies for patients with CCPD.

Targeting the RNA-Binding Protein HuR as Potential Thera-Peutic Approach for Neurological Disorders: Focus on Amyo-Trophic Lateral Sclerosis (ALS), Spinal Muscle Atrophy (SMA) and Multiple Sclerosis

The importance of precise co- and post-transcriptional processing of RNA in the regulation of gene expression has become increasingly clear. RNA-binding proteins (RBPs) are a class of proteins that bind single- or double-chain RNA, with different affinities and selectivity, thus regulating the various functions of RNA and the fate of the cells themselves. ELAV (embryonic lethal/abnormal visual system)/Hu proteins represent an important family of RBPs and play a key role in the fate of newly transcribed mRNA. ELAV proteins bind AU-rich element (ARE)-containing transcripts, which are usually present on the mRNA of proteins such as cytokines, growth factors, and other proteins involved in neuronal differentiation and maintenance. In this review, we focused on a member of ELAV/Hu proteins, HuR, and its role in the development of neurodegenerative disorders, with a particular focus on demyelinating diseases.

Cervical neuromyelitis optica with thoracic ependymoma

Background: The occurrence of cervical neuromyelitis optica (NMO) in a patient with a thoracic ependymoma is uncommon. Here, we present a patient with a spinal ependymoma who developed the new onset of NMO 2 months later. Case Description: A 66-year-old male presented with right lower limb weakness. The magnetic resonance (MR) revealed an intramedullary spinal cord tumor at the T2-T4 level. It was surgically excised and proved pathologically to be an ependymoma. 2 months later, the patient presented with an acute partial quadriparesis and a high signal intensity cord lesion at the C2-C3 level attributed to seropositive NMO (i.e. additional diagnostic studies confirmed this diagnosis). Conclusion: Patients with intramedullary thoracic ependymomas may also develop NMO resulting in recurrent/ new neurological deficits. Critical studies utilized to diagnose NMO include brain and spine MRs showing unique intramedullary brain/cord lesions, aquaporin-4 positive serology, and classical abnormal visual studies. If the diagnosis of NMO is established, multiple additional medical therapies are warranted.

Radiographic Optic Nerve Findings and Their Clinical Implications in the Setting of Craniomaxillofacial Trauma

Purpose: Computed tomography (CT) scans obtained in the setting of facial trauma often report aberrations in neural anatomy, such as optic nerve stretching. While these findings have not yet been correlated with clinical findings, they raise concern for traumatic optic neuropathy (TON). This study aims to correlate radiographic optic nerve abnormalities with clinical findings in the setting of craniomaxillofacial trauma. Methods: Patient charts were queried based on ICD-9 codes for the presence of an orbital fracture. Patients were included if the CT report mentioned an anatomic abnormality of the optic nerve. Patients who expired within 24 hours of arrival, had an open globe injury, or who were not able to participate in a visual exam were excluded. An additional matched cohort of patients with orbital fractures and without optic nerve abnormalities was selected. The primary endpoint was a clinical diagnosis of TON, and secondary endpoints included the need for ophthalmologic intervention and the presence of abnormal visual acuity. Results: One-hundred and eight patients were included in the study (54 per group). Radiographic optic nerve stretching was not associated with an increased risk of TON (OR: 2.22, 95% CI: 0.71-7.02); however, it was associated with increased risk for abnormal visual acuity (OR: 2.24, 95% CI: 1.01-4.99). There was no increased need for any ophthalmologic intervention (OR: 1.93, 95% CI: 0.86-4.31). Conclusions: Alterations in orbital anatomy on CT are common after orbital fracture and may inappropriately raise concern for TON. This in turn may prompt interfacility transfer and/or emergent ophthalmology consultation. This study demonstrates that radiographic stretching of the optic nerve does not increase the odds for TON in the setting of orbital fractures. While patients with abnormal optic nerve findings did have a higher rate of abnormal visual acuity, this is a common, multifactorial finding in this setting.

Circumscribed Interest Modulates Attention to Eyes in Boys With and Without Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) exhibit abnormal visual attention, such as diminished attention to eyes and enhanced attention to high-autism-interest objects. We tested whether high-autism-interest objects would modulate the attention to eyes in boys with ASD and typically developing (TD) boys. Twenty-two ASD and 22 TD children were presented simultaneously with human eyes and high/low-autism-interest objects (HAI/LAI) while their eye movements were recorded. We found that visual preference for eyes was influenced by competing objects in children with and without ASD. Specifically, both children with and without ASD showed reduced overall and first looking preference when eyes were paired with HAI objects relative to LAI objects. Children with ASD also showed reduced sustained viewing preference to the eyes after first looking at the eyes and late looking preference to the eyes after first looking at the objects in the HAI condition than the LAI condition, but these effects were absent in the TD group. Our study not only helps us understand some factors that impact attention to eyes, but also has implications for interventions aiming at improving eye contact in children with ASD.

Optical Flow-Based Weighted Magnitude and Direction Histograms for the Detection of Abnormal Visual Events Using Combined Classifier

Movement information of persons is a very vital feature for abnormality detection in crowded scenes. In this paper, a new method for detection of crowd escape event in video surveillance system is proposed. The proposed method detects abnormalities based on crowd motion pattern, considering both crowd motion magnitude and direction. Motion features are described by weighted-oriented histogram of optical flow magnitude (WOHOFM) and weighted-oriented histogram of optical flow direction (WOHOFD), which describes local motion pattern. The proposed method uses semi-supervised learning approach using combined classifier (KNN and K-Means) framework to detect abnormalities in motion pattern. The authors validate the effectiveness of the proposed approach on publicly available UMN, PETS2009, and Avanue datasets consisting of events like gathering, splitting, and running. The technique reported here has been found to outperform the recent findings reported in the literature.