Sudden Onset Blindness Research Articles

ALL-408 Unveiling the Shadows: Thiamine Deficiency Manifesting As Sudden-Onset Blindness in a Patient With Leukemia

ALL-408 Unveiling the Shadows: Thiamine Deficiency Manifesting As Sudden-Onset Blindness in a Patient With Leukemia

Unveiling the Shadows: Thiamine Deficiency Manifesting as Sudden-Onset Blindness in a Patient With Leukemia

Unveiling the Shadows: Thiamine Deficiency Manifesting as Sudden-Onset Blindness in a Patient With Leukemia

Demographics of a Large International Population of Patients Affected by Leber’s Hereditary Optic Neuropathy

To study the demographics of Leber's hereditary optic neuropathy (LHON) using a large international database of people affected by LHON. Cross-sectional study. One thousand five hundred seventeen people affected by LHON with a known pathogenic genetic mutation. Self-reported genetic and demographic data were collected. The data were de-identified and then analyzed. Leber's hereditary optic neuropathy mutation, gender, age at vision loss onset, and geographical region. The data showed that both females and males can experience symptom onset at any age. We found a 3:1 male-to-female ratio. Interestingly, at younger than 5 years and older than 45 years, the male-to-female ratio of those becoming affected was approximately 1:1. A dramatic peak in age at onset of vision loss was found among males between 14 and 26 years of age. Disease onset in females occurred across all age groups, without any comparable dramatic peak of onset age. This study found that 10% of individuals become affected with LHON after 50 years of age. According to the literature, we found that the m.11778, m.14484, and m.3460 mutations were the most common LHON point mutations in both males and females, with a similar age at onset distribution. This was the largest study of LHON demographics to date. It showed that women carrying an LHON mutation are at higher risk of losing vision than is generally expected. Unlike the traditional 5:1 male-to-female ratio commonly reported in the literature, we found a 3:1 male-to-female ratio. Earlier studies may have harbored an ascertainment bias of overemphasizing the confirmation of this being a disease of young men. However, our data suggest that LHON is a disease that affects both females and males of all ages. This should prompt physicians to conduct genetic testing for LHON in all patients who meet the clinical criteria, regardless of whether they fit the demographics traditionally associated with the disease. Counseling about LHON should be offered to all maternal bloodline relatives, females and males of all ages, because they are at risk of sudden-onset legal blindness.

Varicella Zoster Meningitis, Optic Neuritis Preceding the Development of Posterior Outer Retinal Necrosis, and Central Retinal Artery Occlusion in a HIV Patient

Varicella-zoster virus (VZV) has been known to cause various eye disorders in both immunocompetent and immunocompromised patients. We present a case of a forty-nine-year-old female patient with acquired immunodeficiency syndrome (AIDS) who presented with headache, fever, and blurred vision. Cerebrospinal fluid (CSF) analysis was consistent with VZV meningitis. Magnetic resonance imaging (MRI) of the brain showed enhancement of the right optic nerve indicative of optic neuritis. She responded well to acyclovir and steroids and discharged on the same. Four weeks after discharge, she presented with sudden onset blindness in the left eye. A cerebral angiogram revealed left retinal artery occlusion and was treated with tissue plasminogen activator (tPA). Funduscopic examination showed patchy areas of necrosis in the periphery which were rapidly progressive, diagnostic of posterior outer retinal necrosis (PORN). She was started on ganciclovir and cidofovir and experienced significant improvement in her visual acuity.

Reversible Blindness Secondary to Severe Diabetic Ketoacidosis

We present a case of sudden-onset reversible blindness secondary to severe diabetic ketoacidosis. The exact mechanism is not fully understood but is postulated to be due to uncoupling of retinal electrical transmission in a severe acidic environment. This report adds to the small number of reported cases of reversible blindness secondary to severe diabetic ketoacidosis and serves to raise awareness of this unusual diagnosis. It should be considered in patients who present with acute-onset reversible bilateral blindness only after other causes are excluded via detailed retinal examination and cranial imaging.

History of Carotid Stroke

> [The] two branches which they call carotides or soporales, the sleepy arteries, because they being obstructed, or any way stopt we presently fall asleep. > > —Ambroise Pare (ca. AD 1510–1590)1 Current understanding of carotid artery disease begins in Ancient Greece. The term carotid is derived from the Ancient Greek karos (κάρος), meaning to stupefy. This first description is ascribed to Hippocrates (ca. 460–370 BC) but defined in the later accounts of Rufus of Ephesus (fl. ca. AD 100), who stated that the term was used because superficial compression of the vessels was known to induce stupefaction. The importance of the carotid arteries was even evident in the timeless art of the era. The 31st metope (a rectangular architectural element) from the south side of the Parthenon in Athens (Figure 1) depicts a centaur gripping the neck and compressing the left carotid artery of a Lapith (member of a mythological Thessalian people) during the legendary Centauromachy battle. Galen (ca. AD 131–201) attributed the loss of consciousness to compression not of the carotid arteries but of “sensitive nerves” located proximal to the vessels.2 Today cardiologists recognize a similar syndrome of carotid sinus syncope, tested for through carotid baroreceptor hypersensitivity. Figure 1. The 31st metope from the south side of the Parthenon in Athens. On display in the British Museum, the southern aspect metopes depict the battle between the centaurs (left) and the Lapiths (right) at the wedding of Peirithus, the king of the Lapiths. The left carotid artery of the Lapith is here being intentionally compressed to induce unconsciousness. Photograph courtesy of Colin Howley. Used with permission. The most devastating consequence of carotid artery disease is stroke, which was referred to during classical antiquity as apoplexy. Hippocrates and Galen were both aware that the hemiplegia often accompanying apoplexy resulted from a lesion in …

Retinopathy and optic neuropathy following closantel treatment of ewes

An outbreak of sudden onset blindness subsequent to dosing with oral closantel affecting 1 per cent of a six hundred ewe flock was investigated. Clinical examination and histopathology both revealed...

Clinical conundrum

A 21-year-old Domestic Shorthaired can presented with sudden onset blindness. The patient was also drinking, urinating and eating more, but had lost weight. Diagnosis and treatment of the underlying systemic hypertension and its cause are described.

Ocular emergencies in the dog and cat: part 2

In this second part of the article series we will consider traumatic ocular emergencies affecting both the globe and adnexa. Deep or melting corneal ulceration often requires intensive medication or surgery, and this article will consider methods to assess individual cases and provide appropriate treatment. Emergency management of lacerations of both the cornea and eyelids will significantly affect the prognosis for repair and retention of normal ocular function, and is discussed in some detail. Basic assessment and management of severe ocular and adnexal contusions is described to help provide a prognosis for owners, maintain comfort, and, where possible, preserve vision. Finally, we consider the differentials for sudden onset blindness with mention of treatments where they exist.

Sudden Onset Blindness in a Patient with Mixed Connective Tissue Disease

Sudden Onset Blindness in a Patient with Mixed Connective Tissue Disease

Ocular emergencies Part 2

ABSTRACT:Ocular emergencies are commonly encountered in general practice. Understanding the different disease processes of the most common conditions will help veterinary nurses to give adequate advice to the distressed owners and will ensure that the patients are cared for in the best possible way. The nurse's role during the conversation with the owner, particularly in view of recognising the seriousness of the condition, as well as owner education during the treatment period, should be emphasised. In this second of two articles, the management of ocular emergencies, including sudden onset blindness, corneal oedema and diabetic cataracts, are discussed.

Suprasellar tuberculoma presenting as sudden onset blindness in a patient of lupus

Tuberculosis can be an opportunistic infection complicating the course of patients receiving prolonged immunosuppression. In these patients, the tuberculosis can involve the central nervous system and can cause diagnostic difficulty due to atypical features. Often, the diagnosis of central nervous system tuberculosis in resource limited settings is indirect, like imaging. But anti-tubercular drugs, given even on empirical basis can be life saving. A case of a young female systemic lupus erythematosus patient (on prolonged steroids) with intracranial tuberculoma is presented here. She presented with blindness and headache and her computed tomography scan showed a calcified mass in the suprasellar location. However, she responded well to anti-tubercular drugs. The differential diagnoses of such lesions are also discussed.

Severe systemic hypertension in a cat with pituitary‐dependent hyperadrenocorticism

A seven-year-old Burmese cat was presented with sudden onset blindness. On physical examination, the cat had bilateral retinal detachment and severe systemic hypertension. Further clinical investigations revealed pituitary-dependent hyperadrenocorticism. Antihypertensive therapy was discontinued when the hypertension resolved after bilateral adrenalectomy. Systolic blood pressure remained normal until 19 months post-operatively when systemic hypertension recurred and was attributed to chronic kidney disease. The cat was euthanased 47 months after initial presentation. A pituitary adenoma was identified at post-mortem examination. This case illustrates that systemic hypertension can occur secondary to hyperadrenocorticism in the cat.

Sudden acquired retinal degeneration syndrome (SARDS)

Sudden acquired retinal degeneration syndrome (SARDS) is a disease of dogs causing sudden onset blindness. There is no treatment and it causes permanent blindness. This article aims to give an overview of the disease and its diagnosis.

Sudden onset blindness treated with pulse steroid therapy in a patient with microscopic polyangiitis

Abstract We report a 71-year-old male with microscopic polyangiitis (MPA) who developed sudden-onset, progressive, bilateral visual loss associated with a relapse of MPA symptoms. The patient was referred to our hospital, and treated with intravenous pulse steroid therapy and high-dose oral prednisolone. Although the right eye remained vision deficient, visual acuity in the left eye recovered. Ocular manifestations of MPA are quite uncommon. This case emphasizes the necessity of early detection and initiation of prompt therapy where ocular manifestations of MPA occur.

Feline systemic hypertension: Classification and pathogenesis

the increased availability of indirect blood pressure monitoring devices in clinical practice over the past decade has highlighted the significance of systemic hypertension in the feline population. Without routine monitoring and appropriate intervention, cats with undiagnosed systemic hypertension may first be presented with sudden-onset blindness as a consequence of either hyphaema or retinal detachment. the primary aim in the early diagnosis and treatment of systemic hypertension is prevention of hypertensive target organ damage (with respect to the eye, kidney, cardiovascular and central nervous systems, in particular). A prerequisite is a knowledge of the pathophysiological mechanisms and disease conditions that may contribute to the development of hypertension. This allows the clinician to determine those cases in which blood pressure assessment and longitudinal monitoring is essential and can assist in determining appropriate therapeutic strategies for control of blood pressure. Recent studies have also begun to explore the relationship that systemic hypertension may have with proteinuria and the progression of kidney disease. the geriatric cat appears most susceptible to the development of systemic hypertension, and monitoring of systolic blood pressure is often advocated as part of a routine health screen in cats over 9-12 years old. Consideration must also be given to cats suspected of having an underlying disease such as chronic kidney disease or hyperthyroidism, or which are receiving therapeutic agents, irrespective of their age. much of our understanding of the pathogenesis of feline hypertension is extrapolated from studies performed in experimental animal models or in human patients, and interspecies differences are often poorly understood.

An approach to sudden onset blindness

having suddenly gone blind? Rather than panic we should approach each case logically and work out how to do our best to help both patient and owner. Dogs and cats are brought in to see us from time to time with sudden onset blindness as the owner’s presenting complaint. In some situations the cause can be obvious rapidly maturing cataracts in an unstable diabetic dog, for example, but some can be more challenging and we shall address the more common causes in the following paragraphs.

Blindness as an initial presentation of rectal cancer with brain metastases

Sir, Brain metastases frequently occur after the diagnosis of systemic cancer. However, some patients with brain metastasis may be diagnosed before the primary tumor is found.[1] Colorectal cancer patients with brain metastasis have a poor prognosis because of the tendency of these patients to have a higher frequency of cerebellar metastases. Patients with brain metastasis as the only manifestation of an undetected primary tumor have a favorable prognosis with an overall median survival of 13.4 months. Patients with colorectal carcinoma tend to have a poorer prognosis. This may be due to the tendency of these patients to have a higher frequency of cerebellar metastases, which are associated with an adverse prognosis.[2] A 55-year-old woman presented with sudden-onset bilateral blindness and altered sensorium of 15 days duration. On ophthalmologic examination, both pupils were normal and direct and consensual reflexes were present. Fundoscopy revealed bilateral optic atrophy secondary to papilloedema. computed tomography (CT) scan of the brain showed a large lesion occupying left parietal space with perilesional edema [Figure 1]. Stereotactic biopsy of the brain lesion revealed metastatic adenocarcinoma. On further workup, the CT scan of the abdomen showed irregular circumferential wall thickening of the rectum with perirectal infiltration [Figure 2]. There were no metastases in liver and lung. She was treated with steroids, mannitol, and palliative cranial radiotherapy of 30 Gy of 10 fractions. Once her condition stabilized, colonoscopic-guided biopsy of rectal mass was performed. Histopathological examination revealed adenocarcinoma of the rectum [Figure 3]. She was treated with 5 Fluorouracil-lecovorin regimen and tolerated chemotherapy well, and her vision has improved marginally. She did not receive concurrent radiotherapy as her general condition was poor. She has finished four cycles of chemotherapy and is doing well. Figure 1 CT scan of the brain shows large left parietal space occupying lesion with perilesional edema Figure 2 CT scan of the abdomen shows rectal mass with perirectal infiltration Figure 3 Neoplasm composed of pleomorphic epithelial cells arranged in glandular pattern (H and E;×40) Metastatic brain mass is uncommon and frequently associated with metastatic disease elsewhere. Older estimates suggested that metastases constituted of 20–40%[1] of all intracranial tumors. In adults, the commonest sources of brain metastases are the lung, breast, gastrointestinal tract, genitourinary tract, and malignant melanoma. The best diagnostic test for brain metastases are contrast-enhanced magnetic resonance imaging (MRI) and CT scan. Other diagnostic measures being needed to establish the diagnosis firmly are angiog raphy and/or biopsy. Stereotactic biopsy has become the most convenient and safe approach to obtain a tissue diagnosis.[3] Untreated brain metastases are associated with a median survival time of about 4 weeks and poor prognosis.[4] At the time of diagnosis of colorectal carcinoma, 2–3% of patients are likely to be harboring brain metastases, and another 10% of patients will develop brain lesions during the course of their disease. Surgical removal of colorectal metastatic brain lesions in selected cases may result in a longer survival time. Increased awareness of the possibility of brain metastases, early diagnosis, and aggressive therapy can increase the survival of patients with colorectal cancer with brain metastases.[2]

Sudden onset blindness as a presenting feature of chronic subdural haematoma: case report

We present a rare case report of a patient with chronic subdural haematoma presenting with sudden onset blindness secondary to severe acute bilateral papilloedema. Following prompt surgical evacuation, the patient’s visual acuity returned back to almost normal. Previous reported cases in the literature of blindness following subdural haematomas were related to bilateral homonymous hemianopia due to compression of the posterior cerebral artery following tentorial herniation. These patients were either left blind or developed significant visual deficit despite surgical evacuation. Our case is the first in the literature where the blindness was reversible and due to severe acute papilloedema. There was also no evidence of posterior cerebral artery territory ischaemia. We discuss the importance of visual symptoms in subdural haematoma and emphasize the importance of prompt early intervention. CLINICAL PRESENTATION A 21 years old man was transferred as an emergency from the regional district general hospital after he presented with sudden onset of complete blindness in both eyes in the early hours of the day of transfer. Prior to this, he has been complaining of severe progressive headache with episodic visual blurring over the previous seven weeks. There was nothing of note in previous background history. On examination, he was alert, confused and obeying commands. He was eye opening spontaneously and there were no lateralizing signs. He was completely blind in both eyes and there was evidence of gross papilloedema bilaterally. CT (computerized axial tomography) scan showed a significant left sided acute on chronic subdural haematoma with 1 cm midline shift and also a left middle fossa arachnoid cyst. These findings were confirmed on MR (magnetic resonance) imaging (Fig 1) with MRA (magnetic resonance angiography) ruling out an underlying vascular abnormality. Figure 1 Fig 1: MRI scan showing chronic subdural haematoma causing midline shift. There is also a left temporal arachnoid cyst Considering the papilloedema and scan appearances, he underwent emergency burrhole drainage of subdural haematoma on the evening of transfer. He had significant recovery of his vision within 24 hours of his surgery. Visual acuity has been recorded as 6/9 right eye, 6/12 left eye with good fields in Goldman perimetry but with enlarged blind spots bilaterally. He was subsequently discharged home and at the time of discharge, he was self caring, alert, oriented and had not suffered any deficits a result of the surgery. On review in the outpatient clinic in 6 weeks time, his visual acuity in the right eye was 6/6+2 and left eye 6/9+1. Repeat CT scan (Fig 2) showed that the Sudden onset blindness as a presenting feature of chronic subdural haematoma: case report 2 of 4 subdural haematoma had resolved and the arachnoid cyst was unchanged.

Sudden onset blindness in sickle cell disease due to retinal artery occlusion

Central retinal artery occlusion (CRAO) is a rare and potentially devastating cause of acute blindness in sickle cell disease (SCD) that is unique compared to classic sickle retinopathy. Few details related to this complication in SCD are known, including its risk factors, pathogenesis, presentation, treatment and outcomes. We present three patients with SCD and retinal artery occlusion. The overall variability in clinical presentation, treatment and prognosis reported in the literature underscores the need for a greater understanding of these factors as they relate to this complication in SCD.