Blindness Of Left Eye Research Articles

Blast injury with foreign body in maxillary sinus: A case report

Abstract BACKGROUND. Foreign bodies of paranasal sinuses are very rare in ENT clinical practice. CASE REPORT. We will discuss the case of a 38-year-old gentleman who showed up at our Emergency Room with loss of vision in his left eye following a blast injury. The initial physical examination identified a ruptured globe in the left eye, which caused left-eye blindness. An immediate plain X-ray revealed a metallic object lodged in the left maxillary sinus, reaching up to the left sphenoid sinus. The external approach was used to manage the patient surgically, with no intra- or postoperative complications. CONCLUSION. Inadequate managing of foreign bodies in the paranasal sinuses might result in significant morbidity. They must be removed surgically, either endoscopically or via an external method.

Globe Salvage and Vision Preservation by Neoadjuvant Darovasertib and Crizotinib in Uveal Melanoma

To report the effective use of neoadjuvant darovasertib and crizotinib in a patient with a large uveal melanoma (UM) in his only functional eye. Case report. One patient with T4b UM. Neoadjuvant darovasertib and crizotinib, followed by plaque brachytherapy. Objective tumor response and conversion from planned enucleation to placement of fovea- and optic nerve-sparing plaque brachytherapy. A patient with a history of left eye blindness from retinal artery occlusion presented with rapidly declining right eye vision due to a primary UM measuring 18 mm in maximal diameter and 16.5 mm in maximal thickness. To salvage vision, neoadjuvant treatment was initiated using darovasertib and crizotinib. After 6 months of neoadjuvant treatment, which included intraocular lens replacement for tumor-associated cataract, the tumor regressed to 14.1 mm in maximal diameter and 2.6 mm in maximal thickness, enabling treatment with plaque brachytherapy rather than enucleation. The combination of darovasertib and crizotinib for UM is an effective neoadjuvant strategy that warrants further investigation as an approach to improve visual outcomes from the treatment of primary UM. The other authors have no proprietary or commercial interest in any materials discussed in this article.

FRI310 Massive Gonadotropin-Secreting Adenoma In A Young Man: A Challenging Differential Diagnosis Of A Sellar Mass

Abstract Disclosure: C. Nava Suarez: None. J. Prater: None. N. Blocher: None. S. Sathi: None. Introduction: Gonadotropin-secreting adenomas are usually nonfunctioning representing 90% of silent pituitary masses. However, functioning gonadotropin-secreting adenomas (FGA) are rare, with unknown incidence given their infrequent recognition. FGA usually presents with high FSH and variable sex hormone levels. Usually misdiagnosed, these tumors present with late mass effect symptoms. Neuroimaging usually shows a sellar mass with extrasellar extension and compression of nearby structures. We present a case of a man with a massive FGA with craniopharyngioma features on imaging. Case: A 33-year-old male with left eye blindness for 3 years presented for evaluation of acute headache and right eye blurriness but no other symptoms. Ophthalmologic evaluation demonstrated left optic atrophy, right optic disc edema, and temporal field cut from optic chiasm involvement. Hormonal workup showed a markedly elevated FSH at 36.8 mIU/ml (<12 mIU/ml), normal total testosterone at 835 ng/dL (250-1000 ng/dL), and mildly elevated prolactin at 28.6 ng/dL (<29.4 ng/dL), all other pituitary hormones were normal. Brain MRI demonstrated a multilobulated, heterogeneously enhancing solid-cystic mass in the sellar and suprasellar area. It was T1 iso-hypointense, T2/FLAIR isointense, and had a few calcifications. There was mass effect on the optic chiasm, left frontal and temporal lobes, and left lateral ventricle causing obstructive hydrocephalus. Craniopharyngioma was the initial diagnosis given radiographic features. The patient required an extended left frontotemporal craniotomy for tumor debulking. Pathology reported pituitary macroadenoma with positive FSH immunostaining. He is planned for radiation therapy given the presence of residual tumor. Discussion: This case illustrates the late presentation of gonadotrophin pituitary adenoma. Up to 90% of silent pituitary adenomas stain for FSH or LH, but are not clinically active. A minority of these secrete functioning hormones which can result in clinically relevant effects with FSH elevation more commonly seen than LH elevation. In our case one would have expected low testosterone in the setting of high FSH as seen in primary hypogonadism, but testosterone levels can range from low to high in FGA. Men usually complain of erectile dysfunction and decreased libido. Our case is particularly interesting because of the imaging features (mixed cystic-solid components with calcifications) suggestive of craniopharyngioma. Radiologic features have over 90% accuracy in distinguishing craniopharyngioma from pituitary adenomas. An accurate pre-operatively diagnosis is important as it may affect the surgical approach and prognosis. Clinicians should have a high level of suspicion for FGA in patients with neurological and visual symptoms, especially when associated with sexual dysfunction, although the last is not always present. Presentation: Friday, June 16, 2023

Streptococcus constellatus-Induced Blindness in a 10-Year-Old Boy: A Case Report

AbstractIn this article, we report a 10-year-old boy with acute bacteremia and left eye blindness. Culture from abscess drainage was positive for Streptococcus constellatus. Infection caused by S. constellatus is rare among children, and to our knowledge, this is the first report of this pathogen causing blindness. The rapidness of progression in this case is alarming. We also summarize other cases of S. constellatus infection.

Stroke Due to Orthognathic Surgery: Case Report of a Rare Complication

Summary:Le Fort I osteotomy is a frequent surgical procedure used in orthognathic surgeries to treat severe malocclusions and is associated with relatively rare surgical complications. Here, the authors report a case of thrombotic ischemic stroke as a result of this procedure, a complication still not described in the literature. A 19-year-old man with class II malocclusion and retrognathia underwent orthognathic surgery for aesthetic purposes. The surgery included a Le Fort I maxillary osteotomy with vertical impaction, bilateral sagittal split ramus osteotomy for mandibular advancement, and genioplasty. Postoperatively, the patient developed left eye blindness, headache, somnolence, aphasia, and right hemiplegia. Medical imaging showed the Le Fort I line of fracture extending from the maxillary osteotomy to the left optic canal and to the left carotid canal, with osseous fragments impinging the petrous segment of the internal carotid artery, left carotid artery occlusion and associated to an ischemic stroke at the left middle cerebral artery territory. Treatment required decompressive craniectomy and later focused on clinical stabilization, infection management, orthognathic care, neurorehabilitation, and cranioplasty. The hemiplegia and aphasia partially recovered during 12 months, and final dental occlusion was appropriate. Our report demonstrates that an unfavorable Le Fort I fracture trajectory can lead to ischemic stroke and severe neurological deficits.

CASE REPORT: HELLP-LIKE SYNDROME IN A 19-YEAR-OLD WOMAN WITH NOT WELL - CONTROLLED HYPERTENSION

Objective: We report a young woman with malignant hypertension (HTN) and multiorgan damage due to microangiopathy. Design and method: A 19-year old woman with previously recognized HTN and family history of HTN developed acute symptoms related to long-standing not well-controlled HTN. The patient presented with high blood pressure (BP), vomiting, epigastric pain, jaundice, impaired consciousness, tonic-clonic seizures, complete left eye blindness and partial right eye blindness. On admission, the patient was conscious but obtunded, with marked cognitive dysfunction, BP 255/143 mm Hg, heart rate 130 bpm, breathing rate 34/min, temperature 36,9C, SpO2 95%. Following admission, a transient loss of consciousness with eyes turning to the left was observed upon sitting up, without any arrhythmia seen in ECG monitoring. Neurological examination was unremarkable. Fundoscopy showed grade IV changes with papilledema, numerous hemorrhages and cotton wool spots. Results: Pregnancy test was negative. Laboratory test abnormalities included macrocytic anemia (Hb 10.25 g/dL, Hct 33.6%, MCV 103 fL), elevated leukocyte count (17.1x10 3 /L), low platelet count (69x10 3 /L), elevated serum bilirubin (10.4 mg/dL) and creatinine (4.2 mg/dL), and slightly elevated AspAT and troponin I. Brain CT showed chronic vascular brain damage. BP was gradually normalized using intravenous/oral antihypertensive drugs. Clinical symptoms and laboratory abnormalities resolved, except for left eye blindness and serum creatinine (2.47 mg/dL at discharge). Secondary HTN was excluded. The final diagnosis was malignant HTN, acute hypertensive encephalopathy with seizures, acute liver damage, chronic kidney disease, acute hemolytic anemia due to hypertensive microangiopathy, and permanent left eye blindness. Due to hemolysis and low platelet count, differential diagnosis included hemolytic-uremic syndrome which was excluded. The clinical presentation resembled that of HELLP syndrome in pregnant women with eclampsia, with evidence of target organ damage, low platelet count, liver and kidney dysfunction, and hemolytic jaundice. Conclusions: Young patients with essential HTN rarely present with such fulminant malignant HTN manifesting with neurological symptoms, with evidence of multiorgan damage due to microangiopathy. Similarly, microangiopathic hemolytic anemia rarely complicates malignant HTN. Initial clinical presentation was challenging due to neurological symptoms and evidence of multiorgan failure.

A case of neuromyelitis optica spectrum disorder (NMOSD) and acute myositis following SARS-CoV-2 infection

Background and aims: Neurological manifestations of COVID-19 have been described. We report a case of seropositive NMOSD and acute myositis following SARS-CoV-2 infection. Methods: A previous healthy 35-years old man was admitted for NORB, a month after paucisymptomatic SARS-CoV-2 infection. Nasopharyngeal tests for SARS-CoV-2 was negative and serological IgG and IgM were positive. The neurological examination showed left eye blindness and myalgia. Blood examination showed elevated CK (>1000 UI/l), positive ANA (1:640) and anti-TPO (>1300 U/ml). Brain MRI showed T2/FLAIR left optic nerve hyperintensity with contrast enhancement. The EMG revealed signs of acute myogenic damage. He received intravenous methylprednisolone with poor recovery on vison but full recovery on muscle symptoms. Four months later he present NORB in contralateral eye;MRI showed optic chiasm hyperintensity, serum anti-AQP-4-antibodies were positive, EMG and CK were normalized. The patient received intravenous steroids and Immunoglobulins and started rituximab. Nevertheless, three months later he developed the area postrema syndrome, he was retreated with intravenous steroids and immunoglobulins and achieved a complete recovery. In March 2021, he underwent the second course of rituximab with clinical and radiological stability. Results: The patient was diagnosed with seropositive NMOSD, presented with recurrent NORB and area postrema syndrome, associated to acute myositis and autoimmune tiroiditis after SARS-CoV-2 infection. Conclusions: We supposed that SARS-CoV-2 may cause a post-infectious autoimmune response directed against AQP4 and other target (the muscle, the tiroid gland). Post-infectious autoimmunity is a potential mechanism in a subset of patients with COVID-19-related neurologic disease. Further research is needed to clarify this association.

Bed for three

IntroductionCharles Bonnet syndrome (CBS) is characterized by the presence of visual hallucinations without other sensory-perceptual disturbances or evidence of organic mental disorder nor functional psychosis.ObjectivesReview differential diagnosis of BCS, searching articles in Pubmed.Methods 62-year-old woman, undergoing treatment with Sertraline and psychotherapy for three months because of anxious-depressive synthoms. Pathological myopia and retinal detachment in 2012, blind left eye, retaining 33% vision in the right eye. She comes to the emergency room feeling really anxious, she says that for a year now she has had the feeling that her husband is cheating on her with another woman, and she claims with certainty that she sees a woman in her bed at night, as well as flashes of light evidencing her presence. She has also begun to hear voices through the telephone wires. She and her family deny memory loss or other cognitive impairments. We performed a Nuclear Magnetic Resonance with normal results. Family claims good conygal relation until these synthoms began and no signs of cognitive impairment.ResultsThe patient lives as real these hallucinations which haven´t appeared during admission. We started treatment with an antipsychotic and a benzodiazepine, with great improvement of anxiety and development of some insight. Executive impairment was observed.ConclusionsThe results obtained, make us think that, although our patient has an important visual loss, it is more a psychiatric pathology. Here lies the importance of a multidisciplinary approach among ophthalmologists, neurologists and psychiatrists in order to avoid misdiagnosis and that the patient can benefit from proper treatment.DisclosureNo significant relationships.

Retinal Ependymoma: A Rare Extra-Axial Presentation

Abstract Introduction/Objective Ependymomas are well-demarcated and slow-growing neuroepithelial neoplasms that comprise 3–9% of primary CNS tumors. The vast majority of ependymomas arise either intracranially, mostly in children, or in the spinal cord and are associated with ependymal lining. Histologic hallmarks are perivascular pseudorosettes, ependymal rosettes and alternating zones of nuclear crowding and nuclear free zones composed of coarse cell processes. In high grade ependymomas increased mitoses, necrosis and nuclear pleomorphism may be seen. Methods We present the case of a 63-year-old woman in with a past medical history of retinopathy of prematurity, glaucoma and right eye enucleation. She presented with a painful blind left eye refractory to medical treatment and subsequently underwent left eye enucleation. Results On histologic examination, an incidental retinal ependymoma was identified. The neoplastic cells were fusiform and had long coarsely fibrillar cell processes. Characteristic periodicity of nuclear crowding and scarcity was observed. In places, neoplastic cell processes extended radially to delicate and sometimes hyalinized blood vessels, forming so-called perivascular pseudorosettes. Definite ependymal rosettes were not recognized in the examined sections. Stigmata of chronicity were found, such as ischemic type necrosis, blood vessels with dystrophic calcifications and foci of ossification replete with fibroadipose tissue in the marrow spaces. The neoplastic cells labeled with antibodies against glial fibrillary acidic protein (GFAP), thus confirming glial lineage in the neoplastic cell. Additionally, there was scattered intracytoplasmic expression of epithelial membrane antigen (EMA) in a dot-like or circular pattern. The latter is well described in ependymomas and often used to support the diagnosis. Conclusion Ependymomas rarely occur at extracranial sites, such as the chest, abdomen and pelvis. We are presenting the fourth case of retinal ependymoma reported in literature. The tumor had classical immunomorphologic findings.

The importance of follow-up and re-diagnosis of patients with demyelinating syndrome suspicion - a case study of a conversion from radiologically isolated syndrome to clinically definite multiple sclerosis

Introduction. Radiologically isolated syndrome (RIS) is a term to describe criteria of diagnosis for the individuals, who underwent brain MRI because of other reasons than multiple sclerosis (MS) suspicion, but turned out to have white matter lesions similar to those present in patients with diagnosed MS. RIS is a separate entity with the presence of MR detected lesions strongly suggestive of MS in patients with no neurological manifestations. Although RIS is not the first stage of MS in every individual, 30-45% of them will present clinical symptoms later. There is a consensus, that about 1/3 of RIS patients will convert to clinically definite MS (CDMS) within 5 years of follow-up. There are some significant predictors of conversion, such as: age (< 37 when diagnosed), male sex and presence of lesions in spinal cord.Case report. We describe a case of a 35-year-old female patient who was initially diagnosed with RIS after MRI performed due to migraine. After about year and a half of follow-up she presented first clinical manifestation (temporary left eye blindness) followed by second episode (in the second eye), a progression in MRI and appearance of oligoclonal bands in cerebrospinal fluid.Discussion. Among individuals with incidentally found lesions in MRI, only few happen to have white matter findings similar to demyelinating lesions in patients with CDMS. Non-specific MRI white matter lesions are much more often than than those fulfilling 2017 MAGNIMS criteria.There is more research needed to determine significant risk factors for conversion from RIS to CDMS. In RIS patients watchful neurological supervision is indispensable.

Bilateral rostral temporomandibular luxation with bilateral coronoid fracture in a Welsh pony

Temporomandibular joint (TMJ) luxation in the horse is a rare condition. There are few reports of unilateral luxation with successful reduction; bilateral luxation with concurrent bilateral coronoid fracture has not...

Lens

“The surgery won’t cost you anything at all, Mrs. Wilson. In fact, you’ll get paid for your time and inconvenience,” the doctor was talking to my mother, but leaning over me, his light shone into my mostly blind left eye. “And even though there are no guarantees she’ll be able to see, it’s unlikely to do any harm. Her brain has rewired itself to ignore this eye, so aside from the lens being experimental, we’ll also have to work at reqiring the brain to pay attention to the messages coming from this eyeball.”[…]

P1452 A rare case of embolic blindness in an adult patient with univentricular heart after fontan operation

Abstract Background Thromboembolic complications following Fontan procedure are one of the major causes of mortality and morbidity among patients with univentricular heart. We may classify thromboembolic complications into two groups: systemic- and nonsystemic. We present a case of a patient with a manifestation of both. Case report 24-year old female, foreign student was admitted to Ophthalmology Department due to sudden blindness of the left eye. Performed studies revealed embolus in the left central retinal artery. Because the patient had the history of congenital heart defect she was referred to our department. Analysis of medical documentation showed that the patient has combined congenital heart defect including right ventricle hypoplasia, tricuspid atresia, pulmonic stenosis, ventricular septal defect, atrial septal defect and persistent ductus arteriosus. She had a history of two surgeries: modified left-side Blalock-Tausing connection (in 4th month of life) and total cavo-pulmonary connection with the closure of Blalock-Tausing and excision of interatrial septum (in 2,5 year of life). On admission she presented with left-eye blindness. She had no dyspnoea or palpitations. However she reported very severe migraines from a few days preceding the admission to hospital. Echocardiography revealed tricuspid atresia, hypoplastic right ventricle, preserved systolic and diastolic function of left ventricle, atrial septal defect with no restriction. We observed enlarged diameter of vena cava inferior with no respirophasic variations and massive thrombus in inside with very low flow. The connection between inferior vena cava and right pulmonary artery was working properly with no visible fenestration. We also observed a winding vessel between ascending aorta and truncus pulmonalis/pulmonary artery with continuous flow of blood from left to right side. Computer tomography confirmed the diagnosis of massive thrombosis of vena cava inferior. Patient had anticoagulation started. Two days later we the flow in inferior vena cava returned – we did not observe any thrombus. Patient was referred to catheterization and had chronic anticoagulation initiated. Three months follow-up revealed no changes in clinical condition of a patient. Discussion The palliative Fontan operation predispose to the increased risk of thromboembolic complication. Despite the risk factors of such complications have been identified, there are no guidelines about prophylactic anticoagulation in that group of patients. As a result, chronic anticoagulation is initiated in patients who have other indications e.g. atrial fibrillation. It seems that it would be beneficial to define the group of patients after Fontan procedure with indications to chronic anticoagulation therapy despite arrhythmias.

NEUROFIBROMATOSIS TYPE 1 INVOLVING THE UPPER MAXILLA, CASE REPORT

Von Recklinghausen disease or neurofibromatosis type 1 (NF1) is an autosomal dominant disease with a wide clinical expression, with manifestations ranging from multiple café-au-lait spots to severe functional and aesthetic complications affecting bone tissue and nerve. Oral manifestations of NF1 are rare. The relevance of this case lies in the fact that the disease rarely occurs in oral cavity. The patient was a 12-year-old boy with facial asymmetry caused by a swelling around the upper left jaw causing deformation. Intraorally, a tumor that completely occupies the vestibule was identified. Excisional biopsy of the lesion was performed, and results indicated neurofibroma plexiform and S-100 positivity. At the control, a favorable healing is observed, and the result is correlated with a clinical history: glaucoma causing blindness of left eye, palpebral fibroids, bilateral frontal neurofibromas, multiple periocular neurofibromas, and Von Recklinghausen disease diagnosis. The treatment of NF1 patients is difficult, which may be increased by the complications derived from deformations (and its resulting psychological problem), gliomas of the optic nerves (blindness), or the high risk of malignant transformation. Von Recklinghausen disease or neurofibromatosis type 1 (NF1) is an autosomal dominant disease with a wide clinical expression, with manifestations ranging from multiple café-au-lait spots to severe functional and aesthetic complications affecting bone tissue and nerve. Oral manifestations of NF1 are rare. The relevance of this case lies in the fact that the disease rarely occurs in oral cavity. The patient was a 12-year-old boy with facial asymmetry caused by a swelling around the upper left jaw causing deformation. Intraorally, a tumor that completely occupies the vestibule was identified. Excisional biopsy of the lesion was performed, and results indicated neurofibroma plexiform and S-100 positivity. At the control, a favorable healing is observed, and the result is correlated with a clinical history: glaucoma causing blindness of left eye, palpebral fibroids, bilateral frontal neurofibromas, multiple periocular neurofibromas, and Von Recklinghausen disease diagnosis. The treatment of NF1 patients is difficult, which may be increased by the complications derived from deformations (and its resulting psychological problem), gliomas of the optic nerves (blindness), or the high risk of malignant transformation.

A case report of disseminated nocardiosis with ocular involvement in a myasthenia gravis patient and literature review

BackgroundNocardiosis is a rare and life-threatening opportunistic infection in immunocompromised patients. Myasthenia gravis (MG) patients are potentially at risk of nocardia infection because of the use of immunosuppressive agents. To date, only 7 patients with MG have been reported to have nocardiosis. Disseminated nocardiosis with ocular involvement has not been reported in MG patients.Case presentationA 66-year-old man with MG who was receiving treatment with methylprednisolone and azathioprine was found to have a respiratory infection. He also had heterogeneous symptoms with skin, brain and ocular manifestations. Nocardia bacteria verified by the culture of puncture fluid, and a diagnosis of disseminated nocardiosis was made. Except for left eye blindness, the patient completely recovered from the disease with combination antibiotic therapy. To further understand nocardiosis in patients with MG, we reviewed the previous relevant literature. According to the literature, this is the first report of disseminated nocardiosis with ocular involvement in an MG patient.ConclusionsMG patients with immunosuppressant treatments are potentially at risk of a rare nocardia infection, and a favourable prognosis can be achieved through early diagnosis and appropriate antibiotic therapy.

Severe Vitamin a Deficiency After Biliopancreatic Diversion (P12-051-19)

ObjectivesIntroduction: Biliopancreatic diversion (BPD) is a surgical procedure that causes weight loss via volume restriction and malabsorption. It is now rarely performed due to the risk of severe nutritional deficiencies including Vitamin A (1). MethodsCase Description: A 68-year-old female status-post BPD in 1987 was referred for vitamin A deficiency. She initially had diminished night vision that progressed to left eye blindness by the time of her diagnosis in 2013. She was treated with oral vitamin A 100,000 IU daily; however, levels did not normalize, and her retinopathy progressed. She was later treated with intramuscular vitamin A and developed injection site rashes (Figure 1) thought to be due to an injection site reaction versus type IV hypersensitivity. Over time her vitamin A levels improved but her vision did not. ResultsVitamin A deficiency is a preventable complication of BPD and can lead to permanent vision loss. A study of 376 BPD patients found that 1 year after surgery vitamin A levels were low in 52% and 4 years this increased to 69% despite supplementation compliance (2). Vitamin A injection site rashes have been reported in one case series of 3 patients (3), and skin testing revealed sensitivity to polysorbate 80. This is an emulsifier found in injectable vitamin A palmitate, other parental medications and some vaccines (3). ConclusionsVitamin screening is important in post-bariatric surgery patients. Rash following intramuscular vitamin A is uncommon and should be closely monitored for progressive allergic reaction and potential for reactions to other medications that contain similar components. Funding SourcesNone. Supporting Tables, Images and/or Graphs▪

Case Report: Hyperprolactinemia and growth hormone deficiency associated with Morning Glory Syndrome; with a review of the literature

Morning Glory Syndrome (MGS) is a rare congenital malformation of the optic nerve that is caused by a failure of the closure of the choroidal embryonic fissure in utero. The syndrome is usually seen in association with midline cranial defects, such as transsphenoidal and basal encephaloceles. Although MGS usually presents as an isolated ocular finding, it can be associated with endocrinological abnormalities. We report a case of a 32 year old female with MGS with hyperprolactinemia and growth hormone (GH) deficiency. She was diagnosed with MGS at the age of three and her past medical history was significant for left eye blindness, hyperprolactinemia and GH deficiency. She has received GH replacement and oral contraceptive pills in the past. Our investigations revealed elevated prolactin levels (63mg/l) and borderline low GH levels. Magnetic resonance imaging revealed an abnormality involving the optic chiasm, left optic nerve and compression of the pituitary gland by a basal encephalocele. Genetic studies were positive for a mutation in Paired box 6 gene (PAX6). She is being currently treated with cabergoline for her hyperprolactinemia. Our aims of this report are to highlight the hormonal manifestations of MGS and to review the etiopathogenesis of this rare disorder.

ANTERIOR IRIS ENCLAVATION OF A BLACK INTRAOCULAR LENS FOR LEUKOCORIA

A 32-year-old black woman was evaluated due to the cosmetic appearance of her blind left eye, with exotropia and leukocoria, which were interfering with her professional, social and personal life. The eye showed a clear cornea, quiet anterior chamber, normal iris and a white pupillary reflex due to white cataract and fibrotic retinal detachment. The Artisan® pupil occluder was enclavated retropupillary, keeping the cataract intact. After incision suture, strabismus was corrected. Despite the uneventful immediate post-operative course, two weeks after surgery the patient presented with posterior dislocation of the pupil occluder by release of one of the haptics, which induced cataract subluxation. Intracapsular cataract extraction was performed and the pupil occluder was repositioned anterior to the iris. At one year follow-up the eye remains quiet. The exotropia was corrected and the pupil occluder is well centered with an excellent cosmetic appearance. The patient is extremely satisfied with the result.

PP.LB01.02] CASE REPORT

Objective: We report a young patient with malignant hypertension (HTN) and multiorgan damage due to microangiopathy. Design and method: A 26-year old previously healthy man with family history of HTN developed acute symptoms related to long-standing unrecognized HTN. The patient presented with impaired consciousness, tonic-clonic seizures, high blood pressure (BP), jaundice, epigastric pain, vomiting, complete right eye blindness and partial left eye blindness. On admission, the patient was conscious but obtunded, with marked cognitive dysfunction, BP 240/130 mmHg, heart rate 120 bpm, breathing rate 30/min, temperature 37°C, oxygen saturation 94%. Following admission, a transient loss of consciousness with eyes turning to the left was observed upon sitting up, without any arrhythmia seen in ECG monitoring. Fundoscopy showed grade IV changes with papilledema, numerous hemorrhages and cotton wool spots. Neurological examination was unremarkable except for increased reflexes and triple flexion response on the right side. Results: Laboratory test abnormalities included elevated leukocyte count (14.7 × 103/μL), macrocytic anemia (Hb 12.87 g/dL, Hct 36.9%, MCV 100 fL), low platelet count (73 × 103/μL), elevated serum bilirubin (9.76 mg/dL) and creatinine (3.03 mg/dL), and slightly elevated AspAT and troponin I. Brain CT was unremarkable. BP was gradually normalized using intravenous/oral antihypertensive drugs. Clinical symptoms and laboratory abnormalities resolved, except for left eye blindness and serum creatinine (2.27 mg/dL at discharge). Secondary HTN was excluded. The final diagnosis was malignant HTN, acute hypertensive encephalopathy with seizures, acute liver damage, acute hemolytic anemia due to hypertensive microangiopathy, chronic kidney disease, and permanent left eye blindness. Due to hemolysis and low platelet count, differential diagnosis included hemolytic-uremic syndrome which was excluded. The clinical presentation resembled that of HELLP syndrome in pregnant women with eclampsia, with evidence of target organ damage, liver and kidney dysfunction, hemolytic jaundice, and low platelet count. Conclusions: Young patients with essential HTN rarely present with such fulminant malignant HTN manifesting with neurological symptoms, with evidence of multiorgan damage due to microangiopathy. Similarly, microangiopathic hemolytic anemia rarely complicates malignant HTN. Initial clinical presentation was challenging due to neurological symptoms and evidence of multiorgan failure.

Intraventricular Neurilemmoma (Schwannoma): Shall GFAP Immunostaining Be Regarded as a Histogenetical Tag or as a Mere Histomimetical Trait?

Neurilemmomas are benign neoplasms presumedly derived from Schwann cells which rarely originate within the central nervous system. Moreover, their intraventricular location has been seldom noticed with less than 30 cases reported worldwide. Here, we add another case study to the record as well as the fifth one in Latin American population. A 16-year-old boy without significant past clinical data debuted with headache and progressive left eye blindness during six months. Neuroimaging scans showed a bulky, multiloculated, intraventricular tumour emerging from the posterior horn of the left lateral ventricle. Microscopically, the lesion put on view the classical schwannian histology: spindle cells arranged in both compact and loosely textured areas. Verocay bodies were not present but vessel hyalinisation, pericellular reticulin, and senescent atypia were observed. The immunoperoxidase reactions were also consistent with neurilemmal differentiation; however, glial fibrillary acidic protein expression was widespread and unexpectedly seen. Traditionally conceived as “nerve sheath tumours” the dual immunophenotype herein demonstrated points to a different histogenetical pathway other than sheer Schwann cell derivation. As previously advised by some authors, neoplastic transformation from a multipotent stem cell may explain the occasional finding of these tumours in unconventional intracranial compartments.