Sudden Visual Disturbance Research Articles

Probable Posterior Ischemic Optic Neuropathy Associated with Acute Fungal Sinusitis

Purpose: We report a case of probable posterior ischemic optic neuropathy in a patient with acute fungal sinusitis.Case Summary: An 81-year-old male patient presented with sudden-onset visual loss in his left eye 3 weeks prior to presentation. His best corrected visual acuity was 0.6 in his right eye and light perception in his left eye. Pupillary size was 3 mm in both eyes, and a relative afferent pupillary defect was detected in his left eye. In fundus examination, diabetic retinopathy was found, and cup/disc ratios were increased in both eyes, but disc swelling and hemorrhage were not observed. Fluorescein angiography did not indicate filling delay, defects, or leakage of discs in either eye. Magnetic resonance imaging of the brain revealed multi-sinusitis in the sphenoid, ethmoid, and frontal sinuses. No bony defects or erosion were found around the optic canal or orbital apex during endoscopic surgery; however, histological examination revealed aspergillosis. The patient was diagnosed with posterior ischemic optic neuropathy caused by acute fungal sinusitis.Conclusions: When elderly patients with uncontrolled diabetes experience sudden visual disturbances without ocular pain, posterior ischemic optic neuropathy with fungal sinusitis should be considered as a differential diagnosis. Immediate imaging studies and appropriate treatment should be performed.

Cases with parietal and occipital lobe epilepsies

BackgroundFor seizures emerging from the posterior cortex it can be a challenge to differentiate if they belong to temporal, parietal or occipital epilepsies. Sensoric auras like visual phenomena may occur in all of these focal epilepsies. Ictal signs may mimic non- epileptic seizures.Case presentationsCase 1: Patient suffering from a pharmacoresistent focal epilepsy. Focal seizures with sudden visual disturbance, later during the seizure epigastric aura, vertigo-nausea, involvement to bilateral tonic-clonic seizures. MEG detected interictal spikes, source localization indicated focal epileptic activity parietal right.Case 2: Patient with focal pharmacoresistent epilepsy, semiology with focal unaware seizures, feeling that something like a coat is imposed from behind on him, then feeling cold over the whole body, goose bumbs from both arms to head, then block of motoric activity, later focal unaware seizures with stare gaze, blinking of eyes, clouding of consciousness, elevation of arms and legs, sometimes tonic-clonic convulsions. EEG/MEG source localization and MRI detected an epileptogenic lesion parietal left.Case 3: Patient with pharmacoresistent focal epilepsy, focal aware seizures, a dark spot occurring in the left visual field, sometimes anxiety during seizures (leading to the suspicion of non-epileptic psychogenic pseudo seizures). MRI demonstrated an atrophy occipito-temporal right after sinus vein thrombosis. Ictal video-EEG showed a focal seizure onset occipital right.ConclusionContribution of noninvasive and/or invasive confirmation of the localization of the underlying focal epileptic activity in posterior cortex is illustrated. Characteristics of posterior cortex epilepsies are ventilated.

Rare Cerebral Infarction in Patient with Type B Aortic Dissection

A 65 years old woman was admitted with sudden visual disturbance. She had a history of cerebral infarction which led to the diagnosis of type B aortic...

A Case of Phacoanaphylactic Uveitis Presenting as Endophthalmitis

Purpose: To report a case of phacoanaphylactic uveitis presenting as endophthalmitis. Case summary: A 77-year-old woman presented with sudden visual disturbance and painful red right eye. She did not have a history of trauma or surgery in her right eye. Her best corrected visual acuity was hand movement in the right eye and log MAR 0.22 in the left eye; intraocular pressure was 27 mm Hg in the right eye and 15 mm Hg in the left eye. Slit-lamp examination revealed corneal edema and prominent inflammation with hypopyon in the anterior chamber. B-scan showed vitreous opacity behind the lens. Based on the diagnosis of endophthalmitis, anterior chamber paracentesis and irrigation were performed. After irrigation, a hypermature cataract with intact anterior capsule was observed. Therefore, we performed extracapsular cataract extraction and intravitreal antibiotics injection. Gram staining of the aqueous humor revealed numerous macrophages filled with lens protein but no organisms. She was treated with hourly topical corticosteroid and an antibiotic agent. One month later, the anterior chamber is clear, and the cultures remained negative. Conclusions: We report a case of spontaneous phacoanaphylactic uveitis presenting as endophthalmitis in a patient with no history of eye trauma or surgery. J Korean Ophthalmol Soc 2016;57(9):1480-1483

A Case of Visual Loss Following Injection of Poly-(L)-Lactic Acid Filler into the Right Forehead

Purpose: We report a case of visual loss after the injection of poly-L-lactic acid filler into the right forehead area for cosmetic purposes. Case summary: A 46-year-old female patient visited our clinic due to sudden visual disturbance and dysesthesia on the right forehead and cheek. Her best corrected visual acuity was no light perception in the right eye and 20/20 in the left eye. Visual acuity in her right eye was not corrected. An afferent papillary defect in the right eye and paralysis of oculomotor muscles were observed. Fundus exam revealed a pale optic nerve and turbid retina on the posterior pole. The retinal vessels were narrowed. A papule 1 cm to the lateral margin of the right eyebrow due to the needle injection was found and no other visible skin abnormalities were observed. She had a cosmetic poly-L-lactic acid filler injection into the right forehead area immediately before the visual disturbance occurred. Fluorescent angiography showed occlusion of the right retinal artery and blood flow defects on the retina and choroid were present. The patient was followed up for 6 months and visual acuity and dysesthesia in her right forehead and cheek did not improve. Conclusions: Several cases of visual loss have occurred after injection of filler on the glabella and forehead for cosmetic purposes. However, most of the complications were observed after the use of hyaluronic fillers and not due to poly-L-lactic acid filler. This is the first case report of visual loss caused by poly-L-lactic acid filler in South Korea in a normal patient. Hence, consideration of complications when using this type of fillers is important. J Korean Ophthalmol Soc 2014;55(8):1253-1256

Stellate figure in the macula: visualization in the Henle fiber layer on optical coherence tomography

Stellate figure in the macula: visualization in the Henle fiber layer on optical coherence tomography Shinji Makino, Meri Watanabe, Hironobu TampoDepartment of Ophthalmology, Jichi Medical University, Shimotsuke, Tochigi, JapanAbstract: A 21-year-old woman complaining of a sudden visual disturbance in her left eye was referred to our hospital. The best-corrected visual acuity (BCVA) in the left eye was 0.3. Fundus examination revealed tortuous retinal veins, soft exudates, and retinal edema. Optical coherence tomography showed that the macular thickness was increased to 685 µm. We diagnosed the condition as a central retinal vein occlusion. Systemic administration of an antiplatelet agent was initiated. The BCVA improved to 0.6, the retinal edema dramatically resolved, and the macular thickness was reduced to 318 µm 1 week later. Furthermore, the reduced retinal edema had transformed to many spokes in a wheel of exudates, a so-called “stellate figure”s, in the macula. On optical coherence tomography, hyper-reflective substances were detected in the Henle fiber layer. One month later, the BCVA improved to 1.0. Changes in microstructural findings and visual acuity were analogous during the recovery of macular edema in our patient.Keywords: stellate figure in the macula, Henle fiber layer, central retinal vein occlusion, macular edema, optical coherence tomography

The Feasibility of Central Retinal Artery Doppler Ultrasonography in Patients with Sudden Visual Disturbance that's Caused by Retinal Vascular Occlusion

Purpose: We evaluated the usefulness of central retinal artery Doppler ultrasonography for assessing the patients with sudden visual disturbance that’s caused by retinal vascular occlusion. Materials and Methods: The blood flow velocity and the resistive and pulsatile indexes were measured at the central retinal arteries of 65 patients with sudden visual disturbance. For all the subjects, the patient’s affected eye was compared with the non-affected eye. We investigated the efficacy of the Doppler ultrasonography parameters to predict a significant visual loss on the Snellen test (

Statistical observations of clinical cases with frontal, ethmoid and sphenoid sinus mucoceles

Ninety six patients with paranasal mucoceles (or pyoceles) were admitted and treated at Gunma University Hospital from 1977 to 1986 (age range 15-82 years; mean 46.4 years). We statistically investigated these cases paying a special attention to 25 patients with visual disturbance. 1) In 71 cases mucocele was located in the frontal or fronto-ethmoid sinus (FE group), in 12 it was found in the ethmoid sinus (E group), and in 13 it was situated in the sphenoid or spheno-ethmoid sinus (SE group). 2) Sixty three cases had histories of previous surgery of paranasal sinuses and 29 cases were considered to have primary mucoceles. 3) The mean age of patients with primary mucocele was 56.4, while that with postoperative mucocele was 41.2. 4) In the FE group recurrence was so frequent that some device for surgical treatment should be considered (i.e., mucous membrane grafting, prolonged insertion of silicon tubes). 5) Visual disturbance was frequently observed in both the E group (7/12) and the SE group (9/13). 6) Visual disturbance may occur when mucocele compress the optic nerve and the globe at retrobulbar portion as well as at the optic canal. Twelve cases out of 25 with visual disturbance belonged in the former type. 7) Optic atrophy was most commonly seen in the SE group, but was recognized in 1 case even in the E group and the FE group respectively. 8) In patients with sudden visual disturbance, if only they were operated within a week after the onset, their visual acuity was remarkably improved except for serious cases. 9) In the cases presented with gradually attacked or varying visual disturbance, there was no correlation between the recovery of the vision and the duration of the disturbance.

Neurotoxicity of methylmercury in squirrel monkeys. Cerebral cortical pathology, interference with scotopic vision, and changes in operant behavior.

Blood mercury was raised to levels exceeding 1,000 ng/gm by weekly oral doses of methylmercury hydroxide to squirrel monkeys. Operant behavior tests were employed and neurological signs were recorded on film. Sudden visual disturbance occured with subacute exposure. Prolonged exposure resulted in impaired coordination with impairment of scotopic vision and possibly also sensory disturbances. Scotopic vision was tested by determining the critical fusion intensity (cfi) at 10 cps. An increase in cfi was the earliest neurological sign appearing in some monkeys months before other signs could be detected. Poisoned monkeys exhibited typical cerebral cortical lesions. The visual cortex was invariably involved. Extension to adjacent cortical areas increased with increasing duration of exposure and increasing brain mercury. The microgram per gram brain tissue was the lowest concentration of methylmercury seen wiht morphological lesions.

Abscess formation in the pituitary fossa associated with a pituitary adenoma.

A pituitary adenoma with abscess formation is an extremely rare finding, only two eases having been found reeorded in the literature. Whalleyfl in 1952, reported the ease of a patient who presented a picture of fulminating meningitis, and who died before a diagnosis could be made. At autopsy an abseess in a pituitary adenoma was found as the cause of the acute meningitis. Asenjo 1 deseribed a ease in which the presence of an hypophysial adenoma with typieal elinieal and radiologieal findings was detected after the patient had been treated for acute sinusitis, and complained of sudden visual disturbance. Operative treatment was sueeessful. In the ease reported here, as in Whalley's 2 case, the presenting symptoms were those of acute intracranial pathology. The pituitary adenoma which was present was diagnosed only during the course of investigations which were performed in order to aseertain the cause of his acute illness. CASE REPORT