Spontaneous Venous Pulsations Research Articles

Pseudotumor cerebri and ciprofloxacin: a case report

IntroductionWe present a case of ciprofloxacin-associated pseudotumor cerebri in a 22-year-old African American woman. Withdrawal of ciprofloxacin in our patient resulted in complete resolution of ciprofloxacin-associated pseudotumor, as evidenced by a normal neuro-ophthalmic examination and a cerebrospinal fluid opening pressure of 140 mmH20.Case presentationA 22-year-old African American woman presented with a headache of two weeks duration, visual blurring and horizontal diplopia after starting ciprofloxacin for pyelonephritis. An ophthalmic examination revealed that she had left eye esotropia, and a picture of the fundus demonstrated bilateral disc swelling without spontaneous venous pulsations. Magnetic resonance imaging of the brain and a magnetic resonance venogram were normal. A diagnostic lumbar puncture demonstrated an elevated opening pressure of 380mmH2O in a supine position. Laboratory examinations, including a cerebrospinal fluid exam, were unremarkable.Conclusionciprofloxacin-associated pseudotumor can cause chronic disabling headache and visual complications. Therapy is sub-optimal, often symptomatic, insufficient and complicated by side effects. When ciprofloxacin-associated pseudotumor presents in an atypical population, an inciting agent must be suspected because prompt withdrawal of the agent may lead to complete resolution of symptoms and prevent recurrence of similar episodes.

Absence of spontaneous venous pulsations in children with pseudopapilledema

Absence of spontaneous venous pulsations in children with pseudopapilledema

Dynamic Association between Intraocular Pressure and Spontaneous Pulsations of Retinal Veins

Purpose: The amplitude of spontaneous retinal venous pulsations (SRVP) is known to be affected by intraocular pressure (IOP), retinal venous pressure, and intracranial pressure (ICP). This study characterized SRVPs adjacent to the disc and quantified changes in the amplitude of these pulsations during IOP manipulation in normal subjects.Methods: The study included 12 subjects (40 ± 15, 4 females, 8 males). Baseline IOP (range 10–25 mmHg) was measured and SRVP recorded using the dynamic retinal vessel analyzer (DVA). IOP was lowered using aproclonidine 0.5% and measured every 15 min, followed by dynamic recording of SRVP. Two subjects were also tested with timolol 0.5%, and three were treated with a placebo drop. Mean amplitude of SRVP was determined within each sample at the same site. Blood pressure and heart rate were tracked continuously.Results: Amplitude of SRVP decreased in all subjects with reduction of IOP with aproclonidine and timolol. Mean SRVP amplitude was 8.5 ± 6 μm at baseline and reduced to 2.5 ± 1.8 μm after 45 min (p < 0.0001). IOP fell from 14.4 ± 2.6 mmHg to 10.2 ± 2.9 mmHg over the same period (p < 0.001). Venous diameter, blood pressure, and heart rate did not change significantly from the baseline. Analysis of waveforms showed a slight phase shift only (150 ± 78.5 ms, p = 0.93) between disc veins and adjacent retinal vein.Conclusion: SRVPs in the peripapillary retina have similar waveform characteristics to those at the disc. SRVP amplitudes are reduced by manipulation of IOP downwards with pharmacological intervention. The relationship was consistent in all individuals tested for two classes of drugs and was independent of BP or heart rate changes.

Pearls &amp; Oy-sters: Spontaneous venous pulsation and its role in differentiating papilledema from pseudopapilledema

Spontaneous venous pulsation (SVP) of the optic disc can be used as a surrogate marker of intracranial pressure (ICP) in patients with discs of normal morphology. The presence of SVP can suggest an ICP within normal limits.1 Based on this premise, SVP is also referred to when differentiating anomalous pseudopapilledematous optic nerves from true papilledema. However, this application may be limited by the fact that anomalous discs are less likely to demonstrate SVP.2 The case detailed below supports this contention. A 48-year-old white woman presented to our hospital complaining of a recent onset of blurred vision. She was known to have migraine with aura and had a past ocular history of unilateral disc drusen (left eye only). On examination, the best-corrected visual acuity was 0.7 in the right and 0.5 in the left. Anterior segment examination was unremarkable in both eyes. Color vision was normal in the right and slightly reduced in the left (10/13 Ishihara) and there was a left relative afferent pupillary defect. Funduscopy revealed left optic nerve drusen with a clearly …

Spontaneous Venous Pulsation as a Barometer for Translaminar Pressure Fluctuation

Spontaneous Venous Pulsation as a Barometer for Translaminar Pressure Fluctuation

Interrelationship between optic disc edema, spontaneous venous pulsation and intracranial pressure

Interrelationship between optic disc edema, spontaneous venous pulsation and intracranial pressure

Relationship of Intraocular Pulse Pressure and Spontaneous Venous Pulsations

Relationship of Intraocular Pulse Pressure and Spontaneous Venous Pulsations

The Role of Spontaneous Venous Pulsations in the Diagnosis of Adult Chiari Malformation

Objective: To perform neuro-ophthalmologic evaluations in patients with symptomatic Adult Chiari Malformations (ACM).Methods: Observational case series of 56 patients with symptoms and neuro-imaging consistent with ACM. Comprehensive histories and complete neuro-ophthalmic examinations were performed. Findings: Sixteen men and forty women were evaluated. The mean age was 41 years old (range 8 - 73 years old). The most common visual complaint was transient visual obscurations lasting seconds (n= 34). Pain or fullness behind the eyes was present in 32 patients. Forty-eight patients had headaches. Other frequent symptoms included neck pain, dizziness, facial pain, and numbness. Fundus examination was remarkable for absent spontaneous venous pulsations in one or both eyes in 28 patients. Interpretation: Adult Chiari Malformation (ACM) presents with characteristic symptoms that may be overlooked or misdiagnosed. Neuro-ophthalmic evaluation is helpful in ruling out other entities and identifying characteristic absent venous pulsations.

Relationship of Intraocular Pulse Pressure and Spontaneous Venous Pulsations

To determine the influence of intraocular pulse pressure (IOPP) on the presence of spontaneous venous pulsations (SVP) in patients with normal intracranial pressure. Clinic-based cross-sectional study. Forty-seven patients without signs and symptoms of elevated intracranial pressure were recruited from a general ophthalmology clinic. Patients with glaucoma or retinal vascular disease were excluded from the study. IOP was determined by applanation, and IOPP was measured with the Pascal Dynamic Contour Tonometer (Ziemer Group, Port, Switzerland). SVP were assessed by undilated (direct) and dilated indirect ophthalmoscopy. Other variables assessed included age, cup-to-disc ratio, and refractive error (spherical equivalent). The main outcome measure was the presence of SVPs with normal IOPP. The incidence of SVPs declined with increasing age in a nonlinear manner. Dilated examinations yielded the greatest sensitivity for detecting SVPs, with 91.5% of subjects having SVPs. However, in subjects with IOPP of 1.2 mm Hg or more in at least one eye, the incidence of SVPs was 100%. A significant correlation exists between the amplitude of IOPP and the presence of SVPs, with SVPs detected in one or both eyes of all patients with IOPP of 1.2 mm Hg or more. When IOPP is 1.2 mm Hg or more, absent SVPs may be more predictive of elevated intracranial pressure than previously recognized.

Not a microvascular sixth nerve palsy

A 59-year-old man presented with a three-week history of double vision, worse on looking to the left. He also had non-insulin dependent diabetes mellitus, hypertension and hypercholesterolaemia. For the previous...

The Force Required to Induce Hemivein Pulsation Is Associated with the Site of Maximum Field Loss in Glaucoma

To determine the factors associated with central retinal vein pulsation changes in glaucoma and identify any hemiretinal vein pulsation changes and their association with sectoral visual field loss. One hundred twenty-six patients with glaucoma and 40 normal subjects had automated perimetry, blood pressure, and intraocular pressure measured. A hemifield sensitivity loss was calculated from the upper and lower halves of each field. Those without spontaneous venous pulsation on the optic disc had an ophthalmodynamometer applied, to measure the minimum ophthalmodynamometric force (ODF) necessary to induce venous pulsation. When ODF was restricted to the hemiveins, the force needed to induce pulsation in each hemivein was measured. Eighty-three patients with glaucoma had no spontaneous venous pulsation. The minimum ODF was strongly correlated with mean deviation (Spearman rank r = -0.475, P < 0.0001). Mixed linear regression analysis showed that mean deviation (P < 0.0001) and pulse blood pressure (P < 0.0001) were significantly associated with minimum ODF. There was a strong association between differences in hemifield sensitivity loss and in hemivein ODF (rank r = 0.369, P < 0.0001, n = 80). Multiple linear regression modeling demonstrated that lower hemivein ODF was independently associated with upper field loss (P = 0.003) and upper hemivein ODF with lower field loss (P < 0.0001). These venous pulsation findings in glaucoma are independent of blood pressure. The hemifield and hemivein association suggests that the major hemivein change is adjacent to the site of major disc damage.

Retinal venous pulsation in glaucoma and glaucoma suspects

Purpose To determine whether changes in central retinal vein pulsation characteristics occur in glaucoma, and how these are related to indices of glaucoma severity. Design A large, consecutive, prospective, case-controlled study. Participants Ninety-four consecutive glaucoma patients and 105 glaucoma suspects seen in a tertiary referral clinic were examined. Forty-one age-matched normal subjects also were examined. Methods The presence or absence of spontaneous venous pulsation was observed in these 3 groups. The ophthalmodynamometric force (ODF) required to induce venous pulsation at the optic disc was measured in those without spontaneous pulsation. Optic disc photographs were obtained and visual field testing was performed for all subjects. Main outcome measures The prevalence of spontaneous venous pulsation between these 3 groups was compared. The relationship between ODF and visual field mean deviation, neuroretinal rim area, age, intraocular pressure (IOP), gender, and diagnosis of glaucoma was investigated using linear mixed models fitted by Gibb's sampling. Results Significantly fewer (chi-square, 27.7; P<0.001) glaucoma patients (54%) were observed to have spontaneous venous pulsation than suspects (75%) or normals (98%). A worse visual field mean deviation was shown to be the most significant predictor of a higher ODF ( P<0.000), with younger age ( P<0.000) also predictive of a higher ODF. A strong relationship between ODF and mean deviation was found in the glaucoma patients ( r = 0.59; n = 52; P<0.001). Conclusions Spontaneous venous pulsation is less common in glaucoma. The ODF required to induce venous pulsation is increased in glaucoma, and this ODF is greater in those with more severe field loss.

The effect of optic disk edema on spontaneous venous pulsations

PurposeWe evaluated the effect of optic disk edema on spontaneous venous pulsations (SVP) in patients without elevated intracranial pressure (ICP). DesignProspective, cross-sectional comparison in an institutional setting. MethodsTwenty consecutive patients with unilateral optic disk edema due to anterior ischemic optic neuropathy (AION, n = 11) or optic neuritis (n = 9) were evaluated. The proportion of subjects with SVP in both eyes, the involved eye only, the uninvolved eye only, or neither eye was determined. Comparisons were made using the Exact McNemar Test. ResultsThere was a significant difference in the proportion of uninvolved and involved eyes with SVP (60% [12/20] vs 5% [1/20], P < .005). Spontaneous venous pulsations were present in the uninvolved eye of 12 patients and the nonedematous portion of the optic disk in 1 patient with segmental edema from AION. ConclusionsOptic disk edema may cause SVP cessation without ICP elevation.

Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), Fort Lauderdale, Florida, May 5-10, 2002.

Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO), Fort Lauderdale, Florida, May 5-10, 2002.

Self-Assessment MCQ Questions Vol.1 No.2

(A Evans &amp; M Taylor) · Diabetic Ketoacidosis 1. Only occurs in patients with a history of Insulin-treated Diabetes 2. Can be precipitated by Acute Pancreatitis 3. The diagnosis is excluded by a blood glucose less than 14 mmol/l 4. Has a higher mortality than Hyper-Osmolar Non-Ketotic coma 5. Patients with newly diagnosed Diabetes Mellitus rarely present with Diabetic Ketoacidosis · The Sliding Scale Insulin Regimen 6. 50 units of isophane insulin should be mixed in 50 mls of N/Saline and commenced at 6 units/hour 7. If there is a delay in commencing the intravenous sliding scale 10 units of soluble insulin should be given sub-cutaneously 8. Blood glucose falls of greater than 5 mmol/hour should be avoided 9. When the blood glucose falls to less than 5 mmol/l then the insulin infusion should be stopped 10. If the blood glucose remains above 20mmol/l additional bolus injections of insulin should be administered · Cerebral oedema in DKA 11. Is more common in children than adults 12. Typically occurs 4-12 hours after the start of treatment 13. If suspected clinically a CT scan should be performed prior to treatment with mannitol 14. Should be treated with mannitol 0.5g/kg 15. Intubation and hyperventilation may be required (AP Williams, T Krishna &amp; AJ Frew) · The following statements are true of Anaphylaxis 16. Anaphylaxis results from generation of specific IgG antibody directed against an allergen 17. Biphasic reactions affect fewer than 5% of patients 18. Intravenous adrenaline is the treatment of choice 19. Bronchodilators such as salbutamol may be useful 20. Intravenous hydrocortisone will provide rapid relief from symptoms (G R Jones) · Regarding the antibiotic treatment of cellulitis 21. Aspiration of the lesion yields a pathogen in over 80% of cases 22. Cellulitis resulting from a bite injury may be due to an unusual pathogen 23. Oral agents may be as effective as vancomycin in treating MRSA cellulitis 24. 80% of patients are suitable for outpatient intravenous antibiotic therapy 25. Combination of gentamicin with penicillin enhances streptococcal killing (S Fletcher) · Indicators of life threatening asthma requiring immediate ICU admission are 26. PEFR &lt; 200 l/min 27. Cyanosis despite high inspired FiO2 28. Generalized audible inspiratory and expiratory wheeze 29. Hypertension and tachycardia 30. Altered level of consciousness or confusion · CPAP and Non Invasive Ventilation 31. Has no place in the management of the asthmatic patient 32. May reduce the inspiratory work of breathing 33. May reduce air trapping 34. CPAP &gt; 10 cm/H2O is most beneficial 35. Can be usefully combined with a heliumoxygen mix · Mechanical ventilation of asthmatic patients is 36. A straightforward therapeutic manoeuvre 37. Intubation is associated with severe acute complications 38. Requires a careful balancing act between high inspiratory flow and prolonged expiratory time 39. May not aim for normocapnoea 40. Is well tolerated (C Borland) · Pulmonary embolism 41. Is associated with a mortality of less than 5% 42. Is the most frequent cause of maternal death 43. Nowadays is rarely an unsuspected post mortem finding 44. Is found in a minority of patients undergoing perfusion lung scanning 45. Is usually due to genetic factors · For pulmonary embolism in women 46. The pill is a major risk factor 47. Warfarin may be safely given in pregnancy provided control is optimum 48. Warfarin may be safely given during breast feeding 49. Thrombolysis is indicated for massive post partum pulmonary embolism 50. Spiral CT is the imaging method of choice in pregnancy · In treatment of pulmonary embolism 51. Low molecular weight heparin is no more effective than unfractionated heparin 52. Warfarin can be started at diagnosis 53. Thrombolysis has not been shown to reduce mortality in hypotensive patients 54. Alteplase is preferred to streptokinase or urokinase 55. Inferior vena caval filters double the risk of deep vein thrombosis (P J Francis &amp; B Edmunds) · Regarding direct ophthalmoscopy 56. The macula is located temporal to the optic disc 57. Blurring of the temporal margin of the optic disc can be a normal finding 58. To examine the red reflex, the patient is instructed to fixate over the examiner’s shoulder 59. Myopic examiners should set the dial on the ophthalmoscope on a minus lens (unless wearing their glasses) 60. Viewing the fundus of a myopic patient is challenging because the image is magnified · Regarding papilloedema 61. Visual loss occurs early in the disease 62. Unilateral swelling of the ONH excludes the diagnosis 63. Spontaneous venous pulsation will be absent 64. The presence of spontaneous venous pulsation excludes the diagnosis 65. The optic nerve head (ONH) swells because axoplasmic flow is interrupted

14-Year-Old Boy With Blurred Vision and Diplopia

14-year-old boy presented to our emergency depart­ ment because of neck stiffness, diplopia, and blurred vision. He reported that the symptoms had begun 2 weeks earlier with a stiff neck after he had slept in a chair. Four days before presentation, he had noted mildly blurred vi­ sion, a holocephalic headache, and neck stiffness. The headache was relieved with acetaminophen. The morning before presentation, he complained of intermittent diplopia, and his parents took him to an optometrist for evaluation. On funduscopic examination, the optometrist observed blurred disk margins bilaterally. The patient was then referred to an ophthalmologist, who obtained a head computed tomographic scan, findings of which were nor­ mal. The patient was subsequently referred to our institu­ tion for evaluation. On presentation, the patient's only complaint was diplopia on right and left lateral gaze. He denied having headache, neck tenderness, change invisual acuity, nausea, or emesis. The general examination revealed an obese ado­ lescent male in no distress, with normal vital signs. Funduscopic examination showed indistinct optic disk margins bilaterally, retinal hemorrhages at the nasal margin of the left optic disk, and an absence of spontaneous venous pulsations. Diplopia was present on right and left lateral gaze, with an inability of the patient's left eye to ab­ duct fully on left lateral gaze. On the cover test, the lateral­ most image on both right and left lateral gaze was eliminated by covering the abducting eye. Findings on the rest of the neurologic examination were normal, in­ cluding visual fields, visual acuity, deep tendon reflexes, motor strength, sensory function, and cerebellar func­ tion. After the neurologic examination, the patient had a

Bilateral Optic Disk Edema With Macular Exudates as the Manifesting Sign of a Cerebral Arteriovenous Malformation

To report that an unruptured arteriovenous malformation without hydrocephalus may manifest with bilateral optic disk edema and macular exudates. We examined an 11-year-old girl with an unruptured frontal lobe arteriovenous malformation who had decreased visual acuity, bilateral optic disk edema, and bilateral macular exudates. The arteriovenous malformation was treated with partial embolization. A ventriculoperitoneal shunt was placed, but the patient's visual function did not improve. Although optic disk edema with macular exudates may be caused by neuroretinitis, ophthalmologists should consider increased intracranial pressure as a cause of these ophthalmoscopic findings, especially when atypical features are present, such as bilaterality, lack of vitreous cells, lack of infectious risk factors, absent spontaneous venous pulsations, or no significant visual recovery.

Pseudotumor Cerebri Associated With Danazol Withdrawal

To the Editor. —Danazol is an androgenic compound used in the treatment of endometriosis, benign cystic breast disease, and some hematologic disorders. Danazol therapy has been implicated in the pathogenesis of pseudotumor cerebri in some patients. 1,2 We describe a patient who developed symptoms and signs of increased intracranial pressure (ICP) shortly after cessation of danazol. Report of Case. —A 36-year-old woman was prescribed 200 mg/d of danazol for endometriosis. She received the drug from December 1989 to July 1990. Two days after discontinuing danazol, she developed bifrontal headaches with nausea and tinnitus, accompanied by transient visual obscurations. She was examined 3 weeks later because of progressive worsening of her symptoms. Corrected visual acuity was 20/25 in each eye. Results of pupillary and slit-lamp examination and applanation tonometry were normal. Fundus examination showed bilateral papilledema, peripapillary hemorrhages, and absent spontaneous venous pulsations. The blind spots were enlarged on Goldmann visual

Choroidal Folds and Dural Cavernous Sinus Fistula

Dural cavernous sinus fistulas may undergo spontaneous resolution with transient worsening of clinical signs and symptoms. We report such a case and document the first association of choroidal folds with this vascular malformation. Report of a Case. —A 66-year-old woman was evaluated for sudden worsening of right eye redness that had been present for 6 weeks. Visual acuity was 20/30 OD and 20/25 OS. Pupils were normal. Examination of the right eye showed 5-mm proptosis, limited supraduction and infraduction, upper and lower eyelid edema, chemosis, and dilated episcleral vessels. Results of left eye examination were normal. Intraocular pressures were 36 mm Hg OD and 16 mm Hg OS. Spontaneous venous pulsations were absent on the right, but present on the left. The fundi were otherwise normal. Computed tomography demonstrated a prominent right superior ophthalmic vein and enlargement of the right extraocular muscles. A presumptive diagnosis of dural cavernous sinus fistula

Unilateral Papilledema in 'Benign' Intracranial Hypertension (Pseudotumor Cerebri)

Three patients with benign intracranial hypertension ([BIH], or pseudotumor cerebri) had verified increased CSF pressure and unilateral papilledema. One patient had slowly progressive loss of visual acuity until unilateral optic nerve sheathotomy was performed. One patient had spontaneous venous pulsation in the unaffected eye. The diagnosis of BIH must be considered even in the absence of bilateral papilledema.