Bilateral Disc Edema Research Articles

Toxische Optikusneuropathie unter Cisplatin-Therapie: Eine Falldarstellung

Optic neuropathies presenting as bilateral disc oedema lead to a vast field of differential diagnosis; a toxic aetiology should be taken into consideration. A 55-year-old patient with a non-metastatic pleuramesothelioma received cisplatin as palliative chemotherapy. Due to a unilateral high myopia on the left eye the patient has a severe anisometropic amblyopia. The patient complained about visual loss and changed colour vision. Visual acuity was 0.1 on the right eye and counting fingers on the left eye. The anterior parts of the eyes were unremarkable, the optic nerve head showed bilateral disc oedema. The MRI was free of tumour or signs of elevated intracranial pressure. Colour vision test Panel D-15 revealed a pathologic colour perception affecting the tetartan-axis. Perimetry showed a cecocentral and superior bundle scotoma. The patient has been treated with methylprednisolone (Solu-Medrol) 500 mg i. v. 1 gr daily for three days, continued by 100 mg oral steroids successively reduced over a period of three weeks. After three weeks visual acuity increased to 0.3. Toxic neuropathies including disc oedema, retinal oedema and optic neuritis are rare, but have been described as occasional side effects of treatment with cisplatin.

Varicella Zoster Virus Optic Neuritis

A 13-year-old male presented with a corticosteroid-sensitive, varicella zoster virus (VZV)-related rapid loss of vision and bilateral disc edema after a febrile illness, and the case is reported from the University of Pittsburgh School of Medicine, Pittsburgh, PA.

Papilledema and abducens nerve palsy following ethylene glycol ingestion

A 34-year-old male with a long-standing history of polysubstance abuse and depression was admitted for acute renal failure and hemodialysis secondary to ethylene glycol ingestion that occurred two days prior. The patient was admitted with documented ethylene glycol levels of 41.2 mg/dl, which fell to 25.0 mg/dl after 8 hours and to 6 mg/dl after 12 hours. One week later the patient presented to the outpatient eye clinic complaining of headaches and diplopia. On exam, vision in both eyes was 20/20. No afferent papillary defect was present. The patient had a left abducens palsy. The remainder of the anterior segment exam was normal. On dilated fundus exam the patient was found to have 3+ disc edema with hemorrhages in both eyes. A lumbar puncture revealed elevated intracranial pressure. In our opinion, the patient developed a left abducens nerve palsy and bilateral disc edema secondary to a transient rise in intracranial pressure after ingestion of ethylene glycol.

Relapsing-remitting, corticosteroid-sensitive, varicella zoster virus optic neuritis

We report a 13-year-old male who presented with bilateral disc edema after a febrile illness. Rapid loss of vision prompted corticosteroids treatment, which reversed the visual loss and optic disc findings. Both his visual function and disc edema proved exceedingly sensitive to steroids, and he required increasingly slow and prolonged corticosteroids taper to avoid relapse over a period of 1 year. Ultimately, profound visual loss was reversed three times and only after exceptionally slow steroid weaning. Comprehensive systemic investigations and neuroimaging were initially unrevealing. Late in the course of disease, evidence of seroconversion was identified in his serum and cerebrospinal fluid with positive varicella zoster virus antibodies titers. Varicella zoster virus–related optic nerve pathology may present clinically with profound visual loss and disc edema and may reverse only with high-dose corticosteroids treatment. Physicians should carefully consider retesting with late varicella zoster virus titer in patients with relapsing-remitting, steroid-sensitive optic neuritides.

Disk edema subsequent to renal transplanation

A 12-year-old child was discovered (following successful renal transplantation) to have asymptomatic bilateral disk edema with preservation of optic nerve function. He had been maintained on cyclosporine, imuran and prednisone. Evaluation revealed normal intracranial imaging and normal CSF though under elevated intracranial pressure. The contributing possibilities to this papilledema are considered, and include a secondary pseudotumor cerebri syndrome of childhood and toxic effects of cyclosporine. The indications for treatment for pseudotumor cerebri are discussed, and clinicians are reminded to separate what we think about a case from how we behave in taking care of the patient.

Optic Nerve Compression from a Basal Encephalocele

A woman developed headaches, transient visual obscurations, anosmia, and decreased visual acuity. Ocular examination showed bilateral pulsatile proptosis and disc edema with choroidal folds. Standardized ophthalmic echography showed absence of bony orbital roofs, prominent dural pulsations, direct apposition of brain parenchyma and orbital tissues, and echographic signs suggesting bilateral optic nerve compression. CT and MRI showed a large defect in the floor of the anterior cranial fossa. The cribriform plate, both orbital roofs, and sphenoid bones were displaced by a large basal encephalocele. Clinical improvement followed reconstruction of the anterior cranial fossa and decompression of both optic nerves.

Optic disk edema with cotton-wool spots

A 43-year-old man with high blood pressure developed visual loss in his left eye. He was found to have bilateral disk edema with cotton wool spots present in the temporal arcades and peripapillary hemorrhages. The presence of the cotton wool spots in the arcades is highly suggestive of hypertension as the etiology of the disk edema. The pathophysiology of cotton wool spots (inner retinal ischemic spots) due to focal ischemia from occlusion of terminal retinal arterioles is discussed.

Fourth nerve palsy in pseudotumor cerebri

A 13-year-old white female with a past medical history of facial acne treated with minocycline presented with headaches, normal visual acuity, bilaterally enlarged blind spots on visual field testing due to bilateral disc edema, and a right fourth nerve palsy. Neuroimaging studies were normal and a lumbar puncture revealed an elevated opening pressure but normal cerebrospinal fluid contents. The diagnosis of pseudotumor cerebri was made and the patient was treated with acetazolamide. The papilledema improved over several weeks and the fourth nerve palsy resolved completely. Fourth nerve palsy is an uncommonly reported nonlocalizing sign in pseudotumor cerebri.

Bilateral Visual Loss and Disc Edema in a 15-Year-Old Girl

Bilateral Visual Loss and Disc Edema in a 15-Year-Old Girl

Macular Hole Following Severe Hypertensive Retinopathy

Macular holes occur most commonly in predominantly healthy women in their seventh decade of life.1We followed up a young patient for 6 years who developed a full-thickness macular hole following an episode of hypertensive retinopathy. We propose a multifactorial cause of this macular hole. Report of a Case. A 21-year-old black Haitian woman presented with decreased visual acuity and floaters of 4 months' duration. She was receiving hemodialysis support three times per week for chronic renal failure with biopsy-proven membranoproliferative glomerulonephritis and seronegative systemic lupus erythematosus. Her visual acuity was 20/400 OU. The slit-lamp examination findings were normal. She had a minor vitreous hemorrhage in her left eye. Her fundus showed bilateral disc edema with diffuse retinal edema and hard exudates (Figure 1). There was no retinal neovascularization or serous retinal detachment. Cystoid macular edema was not noted and fluorescein angiography was not performed. The patient's blood pressure

Bilateral visual loss and disc edema in a 15-year-old girl

A 15-year-old girl with a ventriculoperitoneal shunt for congenital hydrocephalus presented with bilateral visual loss and disc edema. Although a CT scan showed no change in ventricular size, subsequent evaluation revealed elevated intracranial pressure and shunt malfunction. Initial visual loss was secondary to chronic papilledema. The rapid reduction of longstanding elevated intracranial pressure may have contributed to worsening of visual function after shunt revision. Subsequent optic nerve sheath fenestration did not improve visual function. In patients with treated hydrocephalus and symptoms of signs of raised intracranial pressure, shunt malfunction should be suspected even if neuroimaging proves unremarkable.

Disc swelling in an adult diabetic patient

A patient with insulin dependent adult onset diabetes presented with bilateral disc edema and minimal visual dysfunction. Initial work-up excluded an intracranial lesion, and a lumbar puncture revealed a normal opening pressure. The patient developed proliferative retinopathy, for which she received photocoagulation therapy. She subsequently developed an exacerbation and change of her disc swelling, associated with raised intracranial pressure. The differential diagnosis of diabetic papillopathy and papilledema is discussed.

PERIPAPILLARY SUBRETINAL NEOVASCULARIZATION IN PERIPHERAL UVEITIS

A 29-year-old white female with peripheral uveitis developed bilateral disc edema and unilateral peripapillary subretinal neovascularization which was successfully treated with argon laser photocoagulation. To our knowledge, this is the first reported case of peripapillary subretinal neovascularization complicating the course of peripheral uveitis.

Bilateral Retinal Hemorrhages and Disk Edema in Migraine

A 27-year-old patient with severe migraine developed bilateral disk edema and retinal hemorrhages during a prolonged attack of his illness, lasting at least two months. The combination of bilateral disk edema and diffuse superficial retinal hemorrhages was considered to be a manifestation of prolonged valsalva efforts accompanying the migraine attack and of not persistent raised intracranial pressure.