visual deficits
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2022 ◽  
Vol 3 (3) ◽  

BACKGROUND During initial exposure and removal of craniopharyngioma in pediatric patients with severe visual field deficits, the authors have encountered severe deformation of the optic apparatus by taut anterior cerebral arteries as seen during both frontal craniotomy and transsphenoidal exposures. OBSERVATIONS The authors report two pediatric patients with craniopharyngioma whose severe preoperative visual deficits were associated not only with large suprasellar masses but also with severe optic nerve and chiasm compression by taut anterior cerebral arteries. In each patient, the optic nerves were partially cleft by these vessels’ indenting them. LESSONS The role of a taut anterior cerebral artery complex in compression of the optic apparatus in patients with suprasellar tumors has been reported previously, but the intraoperative images in these two cases dramatically reveal this phenomenon.


2022 ◽  
Vol 83 (01) ◽  
pp. e8-e12
Author(s):  
Charit Taneja ◽  
Pouneh K. Fazeli ◽  
Paul A. Gardner ◽  
Eric W. Wang ◽  
Carl H. Snyderman ◽  
...  

AbstractThis report describes a case of pituitary apoplexy with rapidly evolving hemorrhage in a 74-year-old female with coronavirus disease 2019 (COVID-19) disease. The patient presented with severe headache and mild respiratory symptoms, with laboratories concerning for pituitary hypofunction. Brain imaging demonstrated a sellar mass concerning for a pituitary adenoma with ischemic apoplexy. She subsequently developed visual deficits within 24 hours of presentation, and repeat imaging demonstrated evolving hemorrhage and new mass effect on the optic chiasm. She was successfully managed with urgent endoscopic endonasal surgery despite her COVID-19 positive status by taking special intraoperative precautions to mitigate SARS-CoV2 transmission risk. Only a handful of cases of pituitary apoplexy have been reported in association with COVID-19 disease, and even fewer reports exist of endonasal procedures in such cases. We discuss the potential implication of COVID-19 in the occurrence of pituitary apoplexy, in addition to the safety and success of endonasal surgery in this population.


Geriatrics ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. 5
Author(s):  
José Caamaño-Ponte ◽  
Martina Gómez Digón ◽  
Mercedes Pereira Pía ◽  
Antonio de la Iglesia Cabezudo ◽  
Margarita Echevarría Canoura ◽  
...  

Depression is one of the most prevalent pathologies in older adults. Its diagnosis and treatment are complex due to different factors that intervene in its development and progression, including intercurrent organic diseases, perceptual deficits, use of drugs, and psycho-social conditions associated with the aging process. We present the case of a 75-year-old woman (who lives in the community) with a diagnosis of major depression with more than 10 years of history, analyzing her evolution and therapeutic approach.


2021 ◽  
Vol 12 ◽  
pp. 617
Author(s):  
Tatsuya Kawano ◽  
Naoki Shinojima ◽  
Satoko Hanatani ◽  
Eiichi Araki ◽  
Yoshiki Mikami ◽  
...  

Background: Pituitary abscess (PA) can be fatal if diagnosed late. Rim enhancement is a typical radiological finding of PA on postgadolinium T1-weighted magnetic resonance imaging (MRI). Diffusion-weighted imaging is helpful in distinguishing PA from other sellar cystic lesions. Herein, we report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with an unusual organism, Moraxella catarrhalis. Case Description: A 77-year-old woman presented with headache, polyuria, polydipsia, and fatigue for a month before presenting to a local hospital. MRI showed pituitary enlargement with contrast enhancement. She had neither fever nor visual deficits and was followed up with hormonal replacement. Six months later, she complained of visual impairment, and MRI showed further pituitary enlargement with a thickened stalk compressing the optic chiasma. Neither rim enhancement nor diffusion restriction was observed. Endoscopic endonasal transsphenoidal surgery was performed based on the radiological diagnosis of lymphocytic hypophysitis or pituitary tumors. A thick, creamy yellow pus was drained from the sellar lesion. Intraoperative rapid histopathological findings revealed polymorphonuclear leukocytes infiltrating the pituitary gland. PA was diagnosed, and irrigation and open drainage of the abscess was performed. Bacterial culture of the pus detected M. catarrhalis by mass spectrometer, confirming the diagnosis. She underwent appropriate antibiotic administration, and her visual deficits improved. Conclusion: We report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with M. catarrhalis. Even if preoperative findings are not suggestive of PA, it should be considered as a differential diagnosis. Intraoperative rapid histopathological findings are useful for accurately diagnosing PA and initiating appropriate surgical treatment.


PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258678
Author(s):  
William E. A. Sheppard ◽  
Polly Dickerson ◽  
Rigmor C. Baraas ◽  
Mark Mon-Williams ◽  
Brendan T. Barrett ◽  
...  

Purpose Many people experience unilateral degraded vision, usually owing to a developmental or age-related disorder. There are unresolved questions regarding the extent to which such unilateral visual deficits impact on sensorimotor performance; an important issue as sensorimotor limitations can constrain quality of life by restricting ‘activities of daily living’. Examination of the relationship between visual deficit and sensorimotor performance is essential for determining the functional implications of ophthalmic conditions. This study attempts to explore the effect of unilaterally degraded vision on sensorimotor performance. Methods In Experiment 1 we simulated visual deficits in 30 participants using unilateral and bilateral Bangerter filters to explore whether motor performance was affected in water pouring, peg placing, and aiming tasks. Experiment 2 (n = 74) tested the hypothesis that kinematic measures are associated with visuomotor deficits by measuring the impact of small visual sensitivity decrements created by monocular viewing on sensorimotor interactions with targets presented on a planar surface in aiming, tracking and steering tasks. Results In Experiment 1, the filters caused decreased task performance—confirming that unilateral (and bilateral) visual loss has functional implications. In Experiment 2, kinematic measures were affected by monocular viewing in two of three tasks requiring rapid online visual feedback (aiming and steering). Conclusions Unilateral visual loss has a measurable impact on sensorimotor performance. The benefits of binocular vision may be particularly important for some groups (e.g. older adults) where an inability to complete sensorimotor tasks may necessitate assisted living. There is an urgent need to develop rigorous kinematic approaches to the quantification of the functional impact of unilaterally degraded vision and of the benefits associated with treatments for unilateral ophthalmic conditions to enable informed decisions around treatment.


eLife ◽  
2021 ◽  
Vol 10 ◽  
Author(s):  
Saumil Sethna ◽  
Wadih M Zein ◽  
Sehar Riaz ◽  
Arnaud PJ Giese ◽  
Julie M Schultz ◽  
...  

Usher syndrome type I (USH1) is characterized by deafness, vestibular areflexia and progressive retinal degeneration. The protein-truncating p.Arg245* founder variant of PCDH15 (USH1F) has an ~2% carrier frequency amongst Ashkenazi Jews accountings for ~60% of their USH1 cases. Here, longitudinal phenotyping in thirteen USH1F individuals revealed progressive retinal degeneration, leading to severe vision loss with macular atrophy by the sixth decade. Half of the affected individuals were legally blind by their mid-fifties. The mouse Pcdh15R250X variant is equivalent to human p.Arg245*. Homozygous Pcdh15R250X mice also have visual deficits and aberrant light-dependent translocation of the phototransduction cascade proteins, arrestin and transducin. Retinal pigment epithelium- (RPE) specific retinoid cycle proteins, RPE65 and CRALBP, were also reduced in Pcdh15R250X mice, indicating a dual role for protocadherin-15 in photoreceptors and RPE. Exogenous 9-cis retinal improved ERG amplitudes in Pcdh15R250X mice, suggesting a basis for a clinical trial of FDA approved retinoids to preserve vision in USH1F patients.


2021 ◽  
pp. 000841742110429
Author(s):  
Camille Dubé ◽  
Yu Jin ◽  
Brienne G. Powers ◽  
Ginny Li ◽  
Amélie Labelle ◽  
...  

Background. Unrecognized visual deficits (VDs) following an acquired brain injury (ABI) may impact clients’ rehabilitation. Little is known about evaluation tools used in vision rehabilitation. Purpose. To systematically explore the literature describing evaluation tools used for VD on adults with ABI. Method. Using a scoping review methodology, we searched in MEDLINE(Ovid), Embase, CINAHL, PsycINFO, and the grey literature from inception to 2020. Quantitative and thematic analyses were performed. Findings. Of the 83 studies reporting on 86 evaluation tools, 47% used multiple tools to assess VD. Tools were mostly used by occupational therapists and psychologists to evaluate intermediate, intermediate to high, and high-level visual skills. Clinicians tend to select specific tools that focus on different levels of the hierarchy of visual skills. Implications. Future research should investigate the optimal timeframe for assessment of VD and the psychometric properties of tools to ensure comprehensive VD evaluation.


Author(s):  
Steven M. Doettl ◽  
Kandace L. Turner ◽  
Patrick N. Plyler ◽  
Nina Thomas ◽  
Allyson Lambert ◽  
...  

Purpose Falls in adults with intellectual and developmental disabilities (IDDs) are a challenge for the organizations responsible for their management and care. This study represents the initiation of a program to identify, manage, and rehabilitate individuals at risk for falls in this population. Method A retrospective analysis of an active database was provided by the East Tennessee Regional Office of the Department of Intellectual and Developmental Disabilities. The data from 1,652 reportable falls from state-contracted support agencies over the calendar years of 2016–2018 were analyzed using chi-square and decision tree analyses for a dependent variable of serious injury and independent variables consisting of hearing deficits, impaired mobility including balance and vestibular deficits, enrollment in current physical therapy services for impaired mobility, staff instructions present for individuals at risk for falls, staff instructions followed, falls training for the supporting staff, current fall prevention plan in place, aggressive or compulsive behaviors, history of falls, medical conditions, visual deficits, familiar environments, adaptive equipment, intrinsic and extrinsic factors, medication change/side effects, obesity, and repeat falls. Results Significant factors included age, aggressive/compulsive behaviors, physical therapist (PT) services, balance deficits, and intrinsic factors. Post hoc analysis also indicated individuals receiving PT with a history of falls increased their risk of serious injury in unfamiliar environments. Individuals not receiving PT and exhibiting aggressive behaviors increased their risk of serious injury with visual deficits. For individuals not receiving PT services and not exhibiting aggressive behaviors, intrinsic factors increased the risk of serious injury. Conclusions These results describe the characteristics that can predict an increased risk for serious injury from a fall in an adult community-dwelling population with IDDs. These data can be used to implement changes to reduced injury from falls, including improved identification of undiagnosed vestibular deficits and assessment for the need for vestibular rehabilitation.


2021 ◽  
Vol 19 (3) ◽  
pp. 321-326
Author(s):  
Kavitha Andiappan ◽  

Objectives: Anton’s syndrome is a rare clinical phenomenon characterized by acquired cortical blindness without the self-awareness of blindness. Patients with this syndrome tend to deny their visual deficits. The literature on the rehabilitation of individuals with Anton’s syndrome is sparse. Methods: We describe a 26-year-old patient who developed Anton’s syndrome in the background of anterior visual tract damage and multiple intracranial bleedings after traumatic brain injury. He presented with visual agnosia and confabulations that were only detected 2 months after trauma. He received 4 months of multidisciplinary rehabilitation care as an outpatient. His comprehensive program consisted of (a) compensatory strategies, (b) restorative strategies, and (c) counseling sessions. Although he showed significant improvement in terms of functional gain with rehabilitation, he still had visual deficits with occasional visual anosognosia that required 24-h supervision. Conclusion: Anton’s syndrome in traumatic brain injury should not be overlooked. A prompt diagnosis is vital to initiate appropriate rehabilitation measures.


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