Bilateral Optic Nerve Swelling Research Articles

Characteristics and Incidence of Inpatient Ophthalmology Consultations to Screen for Papilledema

Abstract Objective A frequent reason for ophthalmology consultation is to rule out papilledema. The purpose of this study is to evaluate the incidence of consultations to screen for papilledema in an acute inpatient setting and determine the frequency and factors associated with a positive diagnosis of bilateral optic nerve swelling. Methods A retrospective chart review was performed of consecutive adult and pediatric inpatient ophthalmology consultations at a tertiary hospital system to “rule out papilledema” from September through November 2016. All patients had a detailed neuro-ophthalmology examination including a dilated fundus exam. Results A total of 36 consults—13 males and 23 females—with a mean age of 19.8 (range: 3–71) years were called to screen for papilledema. The most common service to request the consult was pediatrics (44%), followed by neurosurgery (42%), medicine (8%), and neurology (6%). The most frequent reason for consultation was headache (61%), followed by visual changes (30.5%) and nausea/vomiting (25%). A positive diagnosis of bilateral optic nerve swelling occurred in 14% (5/36) of consults. Of these five consults, four of them were sent into the hospital by an ophthalmologist who noted the bilateral optic nerve swelling and one was noted by an emergency room pediatrician. Conclusion No new cases of bilateral optic nerve swelling were found in screening consults to “rule out papilledema.” All of the positive diagnoses in our study had been previously identified by another physician and known to the primary team prior to ophthalmology consultation. Screening consultations for optic nerve swelling may not be an effective way to rule out papilledema.

Lyme disease associated neuroretinitis — Case report

We describe a rare case of Lyme disease complicated by unilateral neuroretinitis in the right eye. We report a case of a 27-year-old woman with blurred vision on her right eye. Because of the suspicion of optic neuritis (multiplex sclerosis) neurological examination was ordered. Surprisingly, computer tomography of the brain revealed incomplete empty sella, which generally results not monocular, but bilateral optic nerve swelling. Opthalmological examination (ophthalmoscopy and optical coherence tomography) indicated not only monocular optic nerve, but retinal oedema next to the temporal part of the right optic disk. Visual evoked potentials (VEP) demonstrated no P100 latency delay and mild differences between the amplitudes of the responses of the left and right eye. Optical coherence tomography (OCT) demonstrated the swelling of the optic nerve head and oedematous retina at the temporal part of the disk. Suspicion of an inflammatory cause of visual disturbance blood tests was ordered. Doxycycline treatment was ordered till the result of the blood test arrived. The Western blot and ELISA test were positive for Borrelia burgdorferi sensu lato. Following one week corticosteroide and ceftriaxone treatments, the patient displayed a clinical improvement. Unilateral neuroretinitis with optic disk swelling due to neuroborreliosis is a rare complication and in many cases it is difficult to distinguish between inflammatory and ischemic lesions. Further difficulty in the diagnosis can occur when intracranial alterations such as empty sella is demonstrated by CT examination.

Bilateral Panuveitis following Intravesical BCG Immunotherapy for Bladder Carcinoma

Purpose: To report a case of bilateral panuveitis following local treatment with Bacille Calmette-Guérin (BCG) immunotherapy for superficial bladder carcinoma.Design: Case report and literature review.Methods: A 70-year-old female presented with severe bilateral anterior chamber inflammation 5 days after intravesical BCG instillation. Despite topical steroids and mydriatics, inflammation worsened and bilateral optic nerve swelling developed.Results: Oral corticosteroids settled the ocular inflammation, and optic nerve function recovered. A trial of steroid cessation caused rebound uveitis, so she remains on maintenance doses of oral corticosteroid.Conclusions: Ocular inflammations following BCG therapy for bladder cancer are rare, and little is known about the management of such cases. This is the first report of bilateral panuveitis with optic nerve edema following such treatment.

Adult nasal glioma presenting with visual loss

We report a rare case of a nasal glioma found incidentally in an adult, presenting with visual loss, optic nerve oedema and proptosis. A 41-year-old woman presented with bilateral proptosis, impairment in visual acuity (6/60 bilaterally) and loss of colour vision. Computed tomography and magnetic resonance imaging showed proptosis, bilateral optic nerve swelling and a heterogeneous mass occupying the left nasal cavity and extending through a skull base defect into the anterior cranial fossa. Biopsy confirmed a nasal glioma. Treatment with intravenous dexamethasone resolved the proptosis, and the patient's visual acuity recovered to 6/9 bilaterally. At the multidisciplinary team meeting, it was felt that the nasal glioma probably represented an incidental finding and was not directly responsible for the patient's proptosis and transient visual loss. To our knowledge, this is the first report in the English language literature of adult nasal glioma presenting with visual loss. The management of nasal gliomas in adults is contentious and the relevant literature is reviewed. This case was managed conservatively with regular follow up.

Hypertensive optic neuropathy and choroidopathy in an 18-year-old woman with renal failure.

To describe hypertensive optic neuropathy and choroidopathy caused by renal failure in an 18-year-old woman. The clinical and angiographic findings of a young patient with hypertensive optic neuropathy and choroidopathy caused by hypertensive emergency secondary to renal failure are described. The patient's visual acuity, bilateral optic nerve swelling, and macular edema improved with blood pressure control. Several small areas of exudative retinal detachment remain. Accelerated or malignant hypertension is a common cause of bilateral optic nerve swelling and exudative retinal detachments. Treatment of systemic hypertension is essential in reversing the ocular manifestations of the condition.

Cells, Cells, and More Cells

A 64-year-old woman presented with bilateral optic nerve swelling, vitreous cells, and cerebrospinal fluid monocytic pleocytosis. A chest radiograph and computed tomography demonstrated a lesion in the left lung, which histologically was confirmed to be a small-cell lung carcinoma. The serum was positive for the anti-CV2 (anti-CRMP-5) antibody. Following treatment with chemoradiation the optic nerve swelling and vitritis resolved. The differential diagnosis of uveal-meningeal diseases is discussed and the pathophysiology and clinical manifestations of paraneoplastic syndromes reviewed.

Papilledema Associated with Dialysis Disequilibrium Syndrome

The purpose of this paper is to report a case of dialysis disequilibrium syndrome as an unusual cause of papilledema. A 38-year-old woman with type 1 diabetes mellitus presented with decreased visual acuity and bilateral optic nerve swelling associated with systemic signs and symptoms of dialysis disequilibrium syndrome. Repeated lumbar punctures revealed elevated intracranial pressures. She was placed on acetazolamide with some improvement in symptoms. After renal transplantation, the patient had complete resolution of headaches, nausea and the papilledema. Our conclusion is that patients with visual disturbance and focal neurological symptoms during and after hemodialysis should be suspected of having dialysis disequilibrium syndrome (DDS). DDS is thought to occur as a result of a rapid reduction in plasma osmolality during dialysis. As the shift of urea from cerebral spinal fluid (CSF) is delayed, the relative increase in CSF osmolality draws fluid into the brain. The ensuing cerebral edema is responsible for the characteristic neurological symptoms. We report the association of papilledema with this syndrome, and caution as to the possible concurrent risk of permanent visual impairment.

Optic Neuritis, Preretinal Hemorrhage, and Retinal Vasculitis as Ocular Manifestations of Brucellosis

A young woman with severe visual loss, diplopia, bilateral optic nerve swelling, subhyaloid hemorrhage, and vasculitis was diagnosed with brucellosis. Clinical and ocular findings, except optic disc atrophy, improved within 3 months after antibrucellar treatment. These findings expand the ocular manifestations of brucellosis, and should be considered in the differential diagnosis of optic neuritis, subhyaloid hemorrhage, vasculitis, and optic disc atrophy.

ДВУСТОРОННИЙ ОТЁК ДИСКА ЗРИТЕЛЬНОГО НЕРВА ПОСЛЕ ТИРЕОИДЭКТОМИИ С ПОСЛЕДУЮЩИМ КУРСОМ РАДИОЙОДТЕРАПИИ

The most common cancer of the endocrine system is thyroid cancer, representing 1.0-1.5 % all newly diagnosed cases of cancer. According to the cancer society of Russia, the thyroid cancer in children is much rarer than in adults. Thyroid cancer in children and adolescents is characterized by an adverse clinical course and a high risk of developing metastases in the lymph nodes. The main method of treatment for pediatric thyroid cancer is total thyroidectomy with central neck lymph node dissection followed by radioactive iodine therapy. In foreign and domestic literature, complications of the organ of vision, namely, changes of the optic disc, after surgical treatment for thyroid cancer are poorly understood. The risk of transient hypocalcemia and hypothyroidism increases after thyroidectomy. In the literature, there are two reported cases of the optic nerve swelling combined with hypoparathyroidism and hypocalcemia. While hypocalcemia intracranial hypertension and swelling of the optic nerves are often recorded. In this article, the authors present their own clinical observation of a 13-year-old patient after thyroidectomy and radioactive iodine therapy with detailed analysis of the clinical data and study results. According to the survey of the patient, bilateral swelling of the optic disc was revealed, which could occur due to hypothyroid state. Objective: to identify the cause of the development of bilateral optic nerve swelling in a patient after thyroidectomy and treatment course with radioactive iodine.

Unilateral Papilledema in Pseudotumor Cerebri

Pseudotumor cerebri is a condition of uncertain pathogenesis characterized by increased intracranial pressure in the absence of a mass lesion or hydrocephalus and normal cerebrospinal fluid composition. This disorder is associated with numerous conditions, although many cases may have no identifiable cause. The typical clinical picture of pseudotumor cerebri is that of an obese young woman who presents with headaches that are worse in the morning, transient visual obscurations, and bilateral optic nerve swelling. We report a case of pseudotumor cerebri with unilateral papilledema. Report of a Case. —An obese 46-year-old Hispanic woman was seen for evaluation of headaches. Her medical history was significant for hypertension and deep vein thrombosis. On examination, her visual acuity was 20/20 OU. She had normal pupillary responses and color vision. Extraocular motions were full. Anterior segment examination results and intraocular pressure were normal. A dilated fundus examination revealed marked disc edema with dilated capillaries,