Sudden Bilateral Visual Loss Research Articles

Bilateral Ocular Ischaemic Syndrome due to Carotid Artery and Cardiovascular Disease: A Case Report

Introduction : Ocular ischemic syndrome (OIS) is a rare but potentially blinding and fatal condition caused by carotid artery disease or other systemic condition results in ocular hypoperfusion.
 Case Illustration : A 62-year-old male with sudden bilateral vision loss, swelling, redness and pain of both eye for 7 days. There were dilated conjunctival and episcleral vessels, visual acuity of the right eye was hand movement and 0.05 for left eye, intraocular pressure (IOP) was 33 mmHg in right eye and 37 mmHgfor left eye. Anterior segment evaluation revealed rubeosis iris, mild anterior chamber reaction, and temporal angle neovascularization on gonioscopy. Both direct and consensual light reflexes were sluggish. Fundus examination showed normal optic disc, minimal hemorrhages at mid-periphery, narrowed arterioles, and minimal cotton wool spot. Macular OCT demonstrated discrete hyperreflectivity of inner retinal layers. From Macular Angiography OCT, ETDRS Central vessel density were 11.2% and 17.6% for the right eye and left eye, respectively. In both eyes, paracentesisof anterior chamber, intravitreal and intracameral injections of anti-VEGF were performed. Brain Magnetic Resonance Angiography Imaging revealed moderate stenosis of both distal carotid artery circulation. Percutaneous Coronary Angiography showed extensive stenosis in coronary artery, with low Ejection Fraction.
 Discussion : For the cardiovascular management, a pacemaker was implanted. One week after procedure, BCVA were 1/60 and 0.15, and IOPs of 17 and 18 mmHg, for the right and left eye, respectively. The patient was scheduled to have laser retinal photocoagulation.
 Conclusion : Quick clinical diagnosis, targeted workup for systemic associations, and prompt treatment might preserve life and sight in OIS.

Primary angiitis of the central nervous system presenting as sudden vision loss in a young patient

Primary angiitis of the central nervous system is a rare disorder that primarily affects the cerebral vessels and can prove to be a diagnostic challenge to the clinicians. It can present with a variety of clinical manifestations and lacks the evidence of any systemic disease. Digital subtraction angiography is often necessary to confirm the diagnosis of cerebral vasculitis but in cases where it may fail to do so, brain biopsy is eventually required. Obliviousness to this condition may lead to false management strategies and hence it is imperative to make an accurate diagnosis to facilitate proper treatment that mainly includes a combination of steroids and immunosuppressive agents. We report a case of a 27-year-old male with sudden bilateral vision loss who underwent extensive workup and was ultimately diagnosed with primary angiitis of the central nervous system. He was treated with steroids and responded well to it.
 

Cortical blindness: diagnostic issues in sudden bilateral visual loss

Cortical blindness is defined as bilateral visual loss due to disruption of the visual pathways beyond the lateral geniculate body. Visual disturbance as a result of cortical lesion can manifest in different ways. Anton's syndrome is one of the manifestations of cortical blindness, which presents as denial of loss of vision associated with confabulation in the setting of obvious visual loss. This case illustrates the challenges of diagnosing cortical blindness in the emergency setting.

267 - Syphilis presenting with sudden bilateral vision loss

267 - Syphilis presenting with sudden bilateral vision loss

Bilateral Posterior Ischemic Optic Neuropathy Due to Bilateral Anterior-Drainage Dural Carotid-Cavernous Fistulas: A Case Report

To report a case of bilateral posterior ischemic optic neuropathy (PION) due to bilateral anterior-drainage dural carotid-cavernous fistulas (CCFs). We report on a 62-year-old woman with a history of poorly controlled hypertension who presented with sudden bilateral visual loss and headache for 5 days. She denied a history of head trauma. On examination, her visual acuities were no light perception (NLP) with fixed pupils in both eyes. The ocular motility of both eyes was limited in all directions. Both eyelids were difficult to open. Anterior segment examination revealed bilateral chemosis and episcleral corkscrew vessels. Intraocular pressures were 45 and 48 mmHg in her right and left eyes, respectively. Gonioscopy revealed blood in Schlemm's canal at the nasal angle of the right eye. Fundus examination showed slightly dilated and tortuous retinal veins with normal-appearing optic discs in both eyes. The cup-to-disc ratios were 0.3 bilaterally. Other neurological examinations were unremarkable. Magnetic resonance imaging demonstrated dilation of the bilateral superior ophthalmic veins (SOVs), and marked orbital and periorbital congestion bilaterally. However, there was no compression or stretching of the bilateral optic nerves. Diffusion restriction on diffusion-weighted imaging, with corresponding reduced apparent diffusion coefficient, in the entire bilateral orbital segment of the optic nerves was revealed, consistent with bilateral PION. Magnetic resonance angiography revealed arterialization of the bilateral cavernous sinuses and SOVs. Cerebral angiography confirmed the diagnosis of bilateral anterior-drainage dural CCFs. Treatment with transvenous coil embolization was successful. Three months after embolization, ophthalmic examination demonstrated progressive improvement of aforementioned ophthalmic signs; however, her visual acuities remained NLP in both eyes. To our knowledge, this is the first reported case of bilateral PION due to bilateral anterior-drainage dural CCFs. In spite of its rarity, PION should be considered as a severe, irreversible ophthalmic complication of anterior-drainage dural CCF.

A case of bilateral cystoid macular edema after rituximab infusion

A 65-year-old man experienced sudden bilateral vision loss after rituximab infusion. Best corrected visual acuity was 1/10, and cystoid macular edema was identified. A bilateral rituximab-induced cystoid macular edema was diagnosed, and an intravitreal dexamethasone implant was applied. The exudative phenomena resolved, and the visual acuity rose to 8/10. Another rituximab infusion was followed by vision loss and recurrence of macular edema. A dexamethasone implant was reapplied, which showed great results. This is a rare case of rituximab-induced bilateral macular edema, which recurred after a second infusion. We also present an alternative treatment consisting of intravitreal dexamethasone implant.

Sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage - case report

BackgroundWe report a rare case of sudden bilateral vision loss due to third ventricular cavernous angioma with intratumoral hemorrhage.Case presentationA 45-year-old woman presented decreased visual acuity in both eyes. Her best corrected visual acuity was 0.1 in the right eye and 0.15 in the left eye. Goldmann perimetry showed bilateral central scotomas and bitemporal visual field defects. MRI demonstrated a lesion with mixed hypo- and hyperintensity at the optic chiasm, which was thought to be an intratumoral hemorrhage. The patient underwent bifrontal craniotomy. The tumor was exposed via an anterior interhemispheric approach, and histological evaluation of the mass led to a diagnosis of cavernous angioma. Six months after the surgery, her best corrected visual acuity was 0.9 in the right eye and 0.9 in the left, with slight bitemporal visual field defects.ConclusionThird ventricular cavernous angioma is considered in the differential diagnosis of chiasmal syndrome. Contrast-enhanced MRI and FDG-PET might be useful for differential diagnosis of cavernous angioma from other chiasmal tumors including glioblastoma.

Sudden bilateral vision loss as the sole manifestation of posterior reversible encephalopathy syndrome from acute uremia

Rationale:Posterior reversible encephalopathy syndrome (PRES) is a cliniconeuroradiological entity associated with vasogenic edema. Symptoms may include headache, seizures, altered mental status, and visual impairment. Patients with PRES generally present with neurological deficits.Patient concerns:Here, we report an unusual case of a 42-year-old man who presented with sudden bilateral vision loss without any other neurologic symptoms.Diagnoses:He was diagnosed with PRES secondary to acute uremia.Interventions and outcomes:Our patient experienced a dramatic improvement in visual acuity, blood chemistry values, and magnetic resonance imaging findings following repeated hemodialysis.Lessons:Sudden bilateral vision loss may be the sole manifestation of PRES, particularly in patient with risk factors for PRES. Awareness of this variation of the clinical symptoms of PRES is important to facilitate its recognition.

Malignant Posterior Reversible Encephalopathy Syndrome-An Exacting Challenge for Neurocritical Care Physicians.

We report a case of malignant posterior reversible encephalopathy syndrome (PRES) in a 62-year-old Caucasian female with a complex medical history and comorbidities admitted for bowel resection and lysis of iatrogenic bowel adhesions and enterocutaneous fistulas. Postoperatively, the patient developed sudden bilateral visual loss with no other neurologic deficits. Computed tomography scan showed very severe PRES-like changes, confirmed on magnetic resonance imaging (MRI). Systolic blood pressure remained around 170 mm HG. The patient was obtunded and remained unresponsive after MRI, with minimal response and a deteriorating clinical condition. The patient was given hyperosmolar therapy with a mannitol bolus. She recovered well with near resolution of imaging findings.

Success of Early Surgical Intervention in a Case of Idiopathic Intracranial Hypertension Presented with Nearly Total Vision Loss

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri is a condition of elevated intracranial pressure (ICP) without laboratory pathology or intracranial structural abnormalities in radiological imaging techniques. Here in, we report a 21 years old patient presented with sudden bilateral vision loss and was treated with vetriculo-peritoneal (VPS) surgery and cured with full recovery. Management of IIH ranges from conservative medical treatment to surgical intervention. Saving the vision and reducing the symptoms are the main goals of the treatment. Severeness of the symptoms and visual impairment are considered when planning the time and type of the treatment. Considering the severeness of the symptoms, early intervention is critical to prevent permanent function loss of visual system.

Effets secondaires neuro-ophtalmologiques du traitement par métronidazole chez l’enfant : à propos de deux cas

To report the onset of neuro-ophthalmological adverse effects in two children treated with metronidazole for amoebic dysentery. A 6-year-old child and his 8-year-old sister presented with sudden bilateral vision loss and diplopia associated with intense headache and vomiting. The medical history revealed amoebic dysentery 3 weeks before treated orally with metronidazole for 2 weeks. The ophthalmic examination was similar in the two children and revealed visual acuity of 3/10 bilaterally, binocular diplopia, normal oculomotor function, quiet anterior segment, altered afferent pupil light reflex associated with normal fundus examination, and most particularly absence of optic disc edema. The kinetic visual field showed restriction of isopters and blind spot enlargement and the Lancaster test showed discrete paresis of the lateral rectus muscle of the left eye. Orbitocranial computed tomography and magnetic resonance imaging were normal and visual evoked potential results were compatible with optic neuropathy. Clinical progression consisted in spontaneous resolution of general symptoms, total regression of diplopia, improvement of visual acuity, and normalization of visual evoked potentials after treatment interruption. Regression of symptomatology after interruption of the treatment allowed us to retain the toxic origin. Metronidazole may have neuro-ophthalmological side effects. These complications are rare but can be severe and are reversible after treatment interruption. Regular follow-up is necessary in children receiving this treatment.

Sudden Bilateral Choroidal Detachment in a Patient with Posterior Reversible Encephalopathy Syndrome

BACKGROUND: Pre-eclampsia is one of the most important causes of a rare cliniconeuroradiological entity called posterior reversible encephalopathy syndrome. The syndrome is characterized by headacke, visual disturbances, seizures, altered mental status and radiological findings of edema in the white matter of the brain areas perfused by the posterior brain circulation.CASE REPORT: Here we present a patient with sudden bilateral visual loss and deafness in early postnatal period without any other neurological deficits, but with affiliated ophthalmological pathology. The correct diagnosis was made 3 days after the Cesarean section.The patient was diagnosed with posterior reversible encephalopathy syndrome and bilateral choroidal detachment.CONCLUSION: Vascular changes in posterior reversible encephalopathy syndrome can cause visual disturbances not only by brain edema, but combined brain and ocular pathology.

Sudden bilateral vision loss and binasal campimetric involvement in an unusual case of lateral geniculate myelinolysis

AbstractPurpose Central pontine myelinolysis, a devastating demyelinating disease, is thought to be caused by an aggressive correction of a hyper‐ or hypo‐osmolar state. Lateral geniculate nucleus (LGN) has been incidentally found to be affected by an extrapontine demyelination on magnetic resonance imaging (MRI), although visual disturbances implicating both LGNs are unusual. We describe a campimetric involvement secondary to an intrageniculate damage.Methods A 40‐year‐old man, who was diagnosed with pancreatitis following cholecystectomy, complained of bilateral acute vision loss. His best corrected visual acuity (BCVA) was counting fingers in the right eye and 20/200 in the left eye. Optical coherence tomography (OCT) showed a slightly increased macular thickness in the nasal region of both eyes as well as an altered reflectivity of the retinal layers. Automated perimetry revealed a binasal hemianopsia and brain MRI confirmed symmetrical lesions within both LGNs. BCVA was gradually recovered, reaching 20/20 within 6 weeks.Results Lateral geniculate myelinolysis is an uncommon cause of acute bilateral vision loss which might cause retinal alterations by a retrograde way. Although MRI is the optimal imaging technique to confirm the diagnosis, OCT and visual field examination are able to detect subtle changes.Conclusion Binasal hemianopsia from intrageniculate myelinolysis has been described after rapid changes in serum sodium, following an emergency caesarean section or secondary to anaphylactic shock. To the best of our knowledge, this is the first case reported where it was induced by fluid and electrolyte imbalance in an acute pancreatitis.

Sudden Bilateral Choroidal Detachment in a Patient with Posterior Reversible Encephalopathy Syndrome

BACKGROUND: Pre-eclampsia is one of the most important causes of a rare cliniconeuroradiological entity called posterior reversible encephalopathy syndrome. The syndrome is characterized by headacke, visual disturbances, seizures, altered mental status and radiological findings of edema in the white matter of the brain areas perfused by the posterior brain circulation.CASE REPORT: Here we present a patient with sudden bilateral visual loss and deafness in early postnatal period without any other neurological deficits, but with affiliated ophthalmological pathology. The correct diagnosis was made 3 days after the Cesarean section.The patient was diagnosed with posterior reversible encephalopathy syndrome and bilateral choroidal detachment.CONCLUSION: Vascular changes in posterior reversible encephalopathy syndrome can cause visual disturbances not only by brain edema, but combined brain and ocular pathology.

Posterior Reversible Encephalopathy Syndrome in a Woman With Behcet’s Disease: Case Report

Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by the presence of variable neurological symptoms and reversible edema typically affecting the posterior white matter on brain MRI studies. It has been described in association with autoimmune diseases and with the use of chemotherapy and immunosuppressive drugs. We report a case of a 58-year-old woman with Behcet’s disease treated with methotrexate, adalimumab and low-dose prednisone who presented with sudden bilateral visual loss, together with radiological findings and clinical course suggesting PRES. PRES may appear associated with Behcet’s disease, from whose neurological complications should be differentiated, since management and prognosis differ significantly. J Med Cases. 2014;5(3):177-179 doi: http://dx.doi.org/10.14740/jmc1442w

Posterior Reversible Encephalopathy Syndrome in a Woman With Behcet’s Disease: Case Report

Posterior reversible encephalopathy syndrome (PRES) is an entity characterized by the presence of variable neurological symptoms and reversible edema typically affecting the posterior white matter on brain MRI studies. It has been described in association with autoimmune diseases and with the use of chemotherapy and immunosuppressive drugs. We report a case of a 58-year-old woman with Behcet’s disease treated with methotrexate, adalimumab and low-dose prednisone who presented with sudden bilateral visual loss, together with radiological findings and clinical course suggesting PRES. PRES may appear associated with Behcet’s disease, from whose neurological complications should be differentiated, since management and prognosis differ significantly. J Med Cases. 2014;5(3):177-179 doi: https://doi.org/10.14740/jmc1442w

Sudden Bilateral Vision Loss and Brain Infarction Following Cosmetic Hyaluronic Acid Injection

Sudden Bilateral Vision Loss and Brain Infarction Following Cosmetic Hyaluronic Acid Injection

Plötzlicher beidseitiger Visusverlust bei posteriorem reversiblem Enzephalopathiesyndrom

We describe the case of a patient from the emergency ophthalmic clinic who presented with sudden, bilateral visual loss, headache and dizziness. The magnetic resonance imaging (MRI) showed bilateral parieto-occipital vasogenic edema of the white and grey brain matter consistent with the diagnosis of posterior reversible encephalopathy syndrome (PRES). This is a rare cause of sudden bilateral visual loss which describes a condition with bilateral edema of primarily the white but also the grey matter. The edema is usually detectable with MRI but not always with the less sensitive computed tomography (CT). Further clinical signs may be headache, seizure, nausea, character changes and reduced consciousness. Arterial hypertension, drugs inducing hypertension or drug side effects may cause PRES but sometimes the reason remains unknown. In most cases the symptoms resolve simultaneously with the edema but may also lead to severe complications. In suspected cases of PRES the blood pressure should be measured and a MRI performed, followed by intensive care and treatment of the hypertension, other symptoms and complications.

A Case of Bilateral Corneal Wound Dehiscence With Iris Prolapse After Coronary Bypass Surgery

Purpose: To report a case of bilateral corneal wound dehiscence with iris prolapse after coronary artery bypass surgery. Case summary: A 65-year-old woman complained of sudden bilateral vision loss. Slit lamp microscope examination showed bilateral corneal wound dehiscence, collapse of the anterior chamber and iris prolapse. The patient had a history of bilateral cataract surgery one-month earlier and a coronary artery bypass surgery one-day previously. The authors resutured the corneal wound and performed an emergency iris repositioning. Postoperative 1 day, the best corrected visual acuity (BCVA) was 0.3 in the right eye and hand motion in the left eye. Total hyphema was observed in the left eye. At postoperative 2 months, the right eye had a BCVA of 0.63 with a sutured state of the corneal wound, and the left eye had a BCVA of light perception with a clotted hemorrhage in the anterior chamber. Conclusions: When a patient with a history of a previous sutureless cataract surgery has a coronary bypass surgery under general anesthesia, corneal wound dehiscence and iris prolapse may occur. For those patients, the authors recommend suturing the corneal wound instead of sutureless cataract surgery.

Sudden Bilateral Visual Loss Developed Connected to PRES

Posterior Reversibl Ensefalopati Sendromu (PRES) mental durum bozuklugu, nobet, bas agrisi, gorme kaybindan bilinc bozukluluguna kadar cesitlilik sunan ve genellikle geri donusumlu norolojik sendrom olarak aciklanir. Bu yazimizda intramuskuler analjezik uygulanmasi sonrasi gelisen bilateral gorme kaybi ve nobet sonrasi getirildigi acil servisimizde klinik ve nororadyolojik bulgulari ile PRES tanisi konulan 59 yasindaki hipertansif kadin hastaya ait olgu literatur esliginde sunulmustur