Unilateral Edema Research Articles

Unilateral papilledema: illustrative case.

Idiopathic intracranial hypertension is caused by an elevation of intracranial pressure and can present with slowly progressive visual deterioration from bilateral papilledema. Unilateral papilledema is an exceedingly rare phenomenon, and the mechanisms underlying asymmetric optic nerve involvement remain unknown. A 42-year-old woman presented with acute left-eye blurred vision and extraocular pain. Examination revealed unilateral left optic disc edema with an enlarged blind spot, while the right optic disc appeared flat. Neuroimaging examination was suggestive of intracranial hypertension, characterized by flattening of the posterior globes and narrowing of bilateral distal transverse sinuses. Increased intracranial pressure was confirmed by lumbar puncture. Acetazolamide and weight loss yielded initial improvement, but recurrence prompted cerebral arteriography, revealing a transstenotic gradient in the right distal transverse sinus and hypoplastic left sigmoid and transverse sinuses with extensive collateralization to the left cavernous sinus. Stenting of the right transverse sinus successfully alleviated the optic disc swelling. This case highlights the intricate interplay between venous sinus dynamics and unilateral papilledema, underscoring the importance of tailored interventions. https://thejns.org/doi/10.3171/CASE24385.

Very asymmetric disc edema in fulminant idiopathic intracranial hypertension: A rare and an unusual clinical finding

Fulminant idiopathic intracranial hypertension (IIH) can present as a rapid and severe vision-threatening condition, particularly in young females. We present a distinctive case of fulminant IIH characterized by asymmetrical vision loss with unilateral disc edema with loss of vision in the eye without disc edema. The patient exhibited an unusual serial sequence of radiological signs of raised intracranial pressure, emphasizing the need for emergent treatment. Resolution of the radiological signs was achieved following theco-peritoneal shunt placement. This case highlights the occurrence of fulminant IIH in unilateral disc edema and cause–effect relation between raised intracranial pressure and radiological signs and educative emphasis on the pathophysiology of the condition.

Factors Predicting Treatment Adherence in Outpatients with Cancer-Related Edema: Decision Tree Analysis.

This study aimed to determine the combination of factors associated with continuity of care in outpatients with cancer-related edema six months after the initial visit. A total of 101 outpatients were divided into two groups: continuation (n=65) and non-continuation (n=36) groups. Details regarding age, body mass index, sex, affected extremities (upper or lower), site of edema (unilateral or bilateral), International Society of Lymphology (ISL) classification, presence of distant metastasis, and overall score on the lymphedema quality of life questionnaire (LYMQOL) were obtained before initial lymphedema care. In this study, we performed a decision tree analysis using a classification and regression tree (CART) to detect the combination of factors associated with the continuity of edema care for cancer-related edema. Significant differences were observed in the site of edema (unilateral or bilateral) and distant metastasis between the two groups. In the decision tree using CART analysis, the factors selected to influence the possibility of continuation were the side of edema as the first layer, and body mass index of 23.0 and distant metastasis (with/without) as the second layer. Outpatients with unilateral edema and a body mass index higher than 23.0 were most likely to be able to continue care. In contrast, outpatients with bilateral edema and distant metastasis had greater difficulty in continuing care. In this study, factors that were suggested to influence the continuity of cancer-related edema care were the side with edema, body mass index higher than 23.0, and distant metastasis. This information may be helpful for developing care strategies and improving patient adherence.

Delayed unilateral eyelid oedema following non-periocular hyaluronic acid injection: A case report and literature review

Delayed unilateral eyelid oedema following non-periocular hyaluronic acid injection: A case report and literature review

Sublabial transmaxillary approach to the inferior aspect of the orbit.

The objective was to demonstrate the surgical steps and outcomes of the sublabial transmaxillary microsurgical approach with endoscopic assistance to treat lesions in the inferior aspect of the orbit, as well as to describe the use of patient-specific 3D models to facilitate surgical preparation and improve experience with the technique. The authors' study evaluated data from patients who underwent an endoscope-assisted sublabial transmaxillary approach for inferior orbital lesions. For 2 patients, 3D models were created for preoperative planning and assessment of the approach. Surgical steps comprised osteotomy to access the maxillary sinus, bony resection of the orbital floor, opening of the periorbital fascia, and dissecting and removing the lesion, followed by closure. The neuroendoscope was used to inspect the surgical cavity between each step. The study included 5 patients with varying visual field defects and proptosis who underwent the sublabial transmaxillary microsurgical approach with endoscopic assistance. Complete resection was achieved in all, and all patients reported improvement in visual field defects and proptosis after the procedure. No complications were observed except for transient unilateral maxillary edema noted around the incision site in 3 patients during the early postoperative period, which resolved within a few days. Histopathological examination confirmed the diagnosis of cavernous malformation in all patients. The sublabial transmaxillary approach is a direct and safe method to resect cavernous malformations at the inferior aspect of the orbit. It reduces the risk of complications associated with lateral, transcranial, and transnasal approaches that may cross critical structures. The microsurgical approach provides the benefit of two-handed dissection for lesions embedded in orbital fat, which can be challenging because of adhesions to surrounding tissues. The use of 3D models can facilitate surgical planning and enhance familiarity with the approach.

Tailoring Management of May-Thurner Syndrome : Case Comparison

Background: May-Thurner syndrome (MTS) is a post-thrombosis syndrome (PTS) of the lower extremity. This disorder results from compression and/or irritation from adjacent crossing the right common iliac artery to the left iliac venous. In this report, we present two management comparisons of patients with left lower DVT with consideration of MTS. Case Illustration: The first patient is a 49-year-old male soldier presented with chronic unilateral left leg edema and a mild clinical presentation for 9 months. Previous Doppler ultrasonography (DUS) revealed a thrombus in the left venous femoralis. Anticoagulant was given for six months. DUS and CT venography following anticoagulant treatment revealed a thrombus in the left venous femoralis. Venography revealed entire blockage of the left common femoral and left iliac veins, with adequate collateral flow. PTV was attempted twice and failed both times. The patient was following a conservative therapy (walking exercise and stocking compression) that yielded positive outcomes. The second patient is a 53-year-old male soldier has had unilateral left leg edema for three years, which has increased during the previous three months with ulceration and active bleeding. Previous Doppler ultrasonography revealed a thrombus in the left iliac externa. Anticoagulants and compression stockings were given for eight months, but the symptoms persisted. CT and venography revealed a complete blockage from the left popliteal vein to the iliac vein. Femoral crossover bypass surgery yielded favorable results. Conclusion: Clinically moderate MTS demonstrated fair results with conservative treatment, whereas clinically severe MTS showed superior results with bypass surgery. Keyword: Anticoagulant, May-Thurner Syndrome, Palma Procedure.

Recurrent unilateral corneal edema in a 54-year-old patient after endurance sports in low temperature

Introduction: Corneal edema in endurance sports at low temperatures is a rare occurrence, and few reports can be found in the literature. Patient and Clinical Findings: A case of unilateral corneal edema in a 54-year-old man with a history of laser in situ keratomileusis surgery, cataract surgery, and vitrectomy is presented. Recurrent episodes of corneal edema were observed during endurance cycling in temperatures below 10 °C, with complete recovery observed the next day without any treatment. Diagnosis, Interventions, and Outcomes: Pathophysiology and therapeutic strategies were discussed. Local administration of hyperosmolar saline lacked of any effect as did administration of acetazolamide. A protection of the affected eye by contact lens was not successful, but ski goggles could effectively prevent the corneal edema. Conclusions: Some single reports in the literature described roughly similar corneal findings under different conditions. A systematic evaluation of this case could reveal a fateful combination of cold temperature, physical activity, and susceptibility of the corneal endothelium. Protection from cold wind by ski goggles was found to be an effective practical approach.

Papillophlebitis: A case series of a controversial diagnosis

Aims/Purpose: Papillophlebitis refers to an isolated optic disc oedema with venous engorgement in asymptomatic patients as defined by Walsh and Hoyt in 1969. We report a case series of 3 patients who developed papillophlebitis related to SARS‐CoV‐2 vaccination, type 2 diabetes or idiopathic. A literature review was also performed.Methods: Observational case report of 3 patients and a review of the literature covering papillophlebitis cases was performed using Pubmed, Embase and Web of Science. Cases presenting with visual loss, RAPD, visual field defect or retinal vascular occlusion were excluded.Results: We report the case of 3 patients who did not have any visual complain and presented a unilateral optic disc oedema found by chance. The 1st patient was 33 year‐old and her past medical history was significant for SARS‐Cov‐2 vaccination. The 2nd patient was 6 year‐old and in general good health. The 3rd patient was known for a type 2 diabetes with no complications. For all patients, the visual acuity was 1.0, the intraocular pressure was normal, the anterior segment was quiet and the fundus showed a unilateral optic disc oedema without any haemorrhage. The RNFL OCT confirmed the presence of an optic disc oedema. The visual field was normal. An extensive blood test was negative for auto‐immune, inflammatory and vascular disease. In our patients, the optic disc oedema decreased spontaneously after a couple of months without any treatment and they retain 1.0 vision. A diagnosis of papillophlebitis was made. In the literature, the term papillophlebitis is not well‐defined and controversial. No treatment is required, and the condition resolved spontaneously over time. The visual prognosis is excellent as patients keep a 1.0 vision with a normal visual function. No recurrence has been reported.Conclusions: Papillophlebitis is diagnosed after ruling out any inflammatory, infectious or auto‐immune disease in asymptomatic patients who present a spontaneous recovery without any treatment as reported in our cases.

A Case Series of May-Thurner Syndrome: An Anatomical Variation Leading to a Life-threatening Condition

May-Thurner syndrome is a rare clinical condition resulting from anatomical variation, where patients present with unilateral left lower limb swelling due to a thrombus in the left common iliac vein. This occurs as a result of compression of the left common iliac vein by the right common iliac artery. The condition is more commonly observed in females and can lead to life-threatening pulmonary thromboembolism. Early diagnosis and interventional management, such as stenting and placement of an Inferior Vena Cava (IVC) filter, can help prevent pulmonary embolism. In the present case series, four patients were included. Two of them presented with the classical clinical history of unilateral left lower limb oedema and calf muscle tenderness. One of these patients underwent stenting of the left common iliac vein and placement of an IVC filter. In the other two patients, abdominal complaints prompted the performance of Multidetected Computed Tomography (MDCT), and incidentally, left common iliac vein thrombus secondary to May-Thurner syndrome was detected.

Non-Arteritic Anterior Ischemic Optic Neuropathy (NA-AION): A Comprehensive Overview.

Non-arteritic anterior ischemic optic neuropathy (NA-AION) represents one of the most important causes of blindness or severely impaired vision in middle-aged and elderly people. Unilateral optic disc edema and abrupt, painless vision loss are its defining features. It is commonly assumed that NA-AION is caused by an ischemic infarction of the optic nerve head, and, although the exact pathogenesis is still unknown, several risk factors and comorbidities associated with its development have been found. NA-AION occurs generally in patients older than 50 years who have small optic discs and vasculopathy risk factors. Even though numerous treatment options have been proposed, no available effective medical or surgical therapy or prophylactic measure for NA-AION currently exists. The purpose of present-day therapeutic strategies is therefore to identify and possibly control any underlying modifiable risk factors, aiming to prevent the development of new NA-AION episodes in the affected and fellow eye. A thorough assessment of NAION, including its history, epidemiology, etiology, pathophysiology, risk factors, associated comorbidities, clinical findings, diagnostic tests, treatment choices, prognosis, and future research, is the goal of this work.

Charcot Foot: The Zebra You Need to Know

Charcot foot is a rare and debilitating disease that primarily affects patients with diabetes. Advanced neuropathy can mask the presence of this progressive and severe condition, resulting in it often being overlooked. Rare conditions such as Charcot foot are less common than they are underdiagnosed. The leading barrier to a prompt diagnosis of Charcot foot is the failure to include it in the differential diagnoses. Clinicians must consider Charcot foot when a patient with diabetes presents with unilateral inflammation, edema, and warmth. Alerting clinicians to consider this diagnosis earlier in presentation can positively impact clinical outcomes.

A Tissue Dielectric Constant Evaluation of Knee Edema: A Retrospective Intra-rater Reliability and Association Study of Repeated Measures.

This research compared the reliability and association of tissue dielectric constant (TDC) measures of knee edema to circumferential measurements of knee girth recorded as part of a physical therapy examination. Twenty adults having observable unilateral knee edema were enrolled. A single examiner measured edematous knee swelling with a TDC device and a tape measure across two visits. The presence of edema was recorded as a positive number in reporting side-to-side differences and a positive percentage in documenting change over time. Intra-rater reliability of the measures was assessed with an intra-class correlation coefficient (ICC). Percent change in edema was evaluated independently for both methods using a paired t-test, and the association between measures was assessed by a Pearson's statistic. Both measures were reliable (ICC ≥ 0.81), and both detected a significant percentage decrease (p < 0.05) in edema across visits. The TDC measure changed by 8.3%, an amount nearly four times larger compared to knee girth (2.4%). The subsequent follow-up comparison revealed an inverse relationship (p = 0.049; r = -0.44) between the two percent change measurements of edema. The two methods capture different physical attributes of edema. The TDC records the water content of the tissue, while the use of a tape measure records circumferential limb girth. The TDC measurement was reliable and more responsive in detecting a percentage decrease in knee edema in comparison to a circumferential measure of knee girth. The TDC method may have wider use in directly measuring edema in other tissue structures and regions of the body.

Anti-MOG antibody optic neuritis in AML – A case report

We report a unique presentation of anti-myelin oligodendrocyte (MOG) optic neuritis in a patient with AML in remission. An elderly man presented with diminished vision in the right eye associated with headache and jaw pain. Systemic investigations revealed no leukemic recurrence. The presence of anti-MOG antibodies and optic nerve enhancement suggested of unilateral optic neuritis. Steroid therapy resulted in the resolution of disc edema. We faced a diagnostic dilemma in a patient with unilateral disc edema in the background of multiple systemic diseases. A methodical approach to investigations helped us in accurate diagnosis, institution of prompt therapy, and minimizing visual morbidity. We present this case to highlight the importance of differentiating leukemic optic nerve infiltration from other causes of unilateral disc edema, as their therapeutic approaches are different.

Red vulvar plaque with unilateral edema

Red vulvar plaque with unilateral edema

Lingual abscess, an uncommon cause of tongue oedema: Case series

Lingual abscess is a rare but potentially life-threatening medical entity. Consequently, it requires high medical suspicion in order to prevent misdiagnosis. Unilateral tongue oedema constitutes the characteristic clinical feature.

Increased acute invasive fungal rhinosinusitis in COVID-19 patients

Aim: Acute invasive fungal rhinosinusitis (AIFRS) is a rare infection of the nose and paranasal sinuses that can be fatal. Infection may lead to tissue infarction, necrosis, and thrombosis and rapidly spread intracranially. The aim of this study is to highlight the increasing cases of AIFRS after covid-19 and to investigate the parameters affecting mortality.&#x0D; Material and Method: Total 11 patients diagnosed with AIFRS after COVID-19 were included in this study. Patient age, gender, comorbid diseases, initial symptoms, time between COVID-19 diagnosis and AIFRS diagnosis, intensive care hospitalization history, medical treatments, surgical findings, antifungal treatment, fungal species grown in culture, mortality, and the relationships of these parameters with mortality were also evaluated.&#x0D; Results: A total of 11 patients diagnosed with AIFRS after COVID-19 were included in the study. Among these patients, 81.8% were male, 18. 2% were female, and ages ranged from 57 years to 89 years. The mean time between COVID-19 infection and development of IFRS in patients was 26.09±18.04 days. The initial symptoms in 45.45% of the patients were unilateral periorbital edema, vision loss, and total ophthalmoplegia. The surgical approach was purely endoscopic in all patients. In our study, the mortality rate was 72.7% in COVID-19 related AIFRS patients.&#x0D; Conclusion: As a result, in our study, we found an increase in AIFRS incidence and mortality due to the systemic effects of COVID 19 and the treatments used for it. AIFRS should be suspected when a patient presents acute sinusitis symptoms after COVID-19 infection.

CT-peritoneography in diagnosis of patent processus vaginalis in peritoneal dialysis

Patent processus vaginalis is a congenital condition characterized by persistent communication between the scrotum and peritoneal cavity which is associated with pathologies like congenital hydrocele/hernias. Asymptomatic patent processus vaginalis may become clinically evident in patients undergoing peritoneal dialysis, who may present with unilateral scrotal edema following dialysis. Conventional plain computed tomography (CT) may be difficult to identify the communication, especially if small, and in such cases, CT peritoneography will be useful to detect the patent processus vaginalis.

A Rare Case of Diabetic Papillopathy Presenting with Pseudo-Foster Kennsedy Syndrome

Pseudo-Foster Kennedy syndrome (PFKS) is defined as unilateral disc oedema with contralateral optic nerve pallor, in the absence of intracranial pathologies. Diabetic papillopathy is a rare ocular manifestation of diabetes mellitus (DM). We report a rare case of PFKS secondary to diabetic papillopathy in a young patient with type 2 DM who had poor glucose control. There was optic disc swelling over the right eye and optic disc pallor over the left eye. His visual field assessment showed right inferior field defect and general depression in the left. Optical coherence tomography retinal nerve fibre layer showed normal thickness over the right eye and generalized thinning over the left eye. Neuroimaging and other laboratory investigations were unremarkable. With good glycemic control, the optic disc swelling over the right eye resolved. Visual field defect remained the same but retinal nerve fiber layer showed thinning in areas where the edema had resolved.

The Experience of Using Plain Balloon Percutaneous Venoplasty in Central Vein Stenosis in Hemodialysis Patient; Insight for Future Better Development Strategy

Background : Central vein stenosis is a most complication among hemodialysis patient who inserted catheter or access for dialysis. The proper management is still challenging because venoplasty as the main recommendation but it had potential complication. The comparable datas of plain vs drug coated balloon were still exist. In this case presentation we will discuss about the use of plain ballon venoplasty as an urgent strategy to relieved central vein stenosis in hemodialysis patient and it’s outcome after procedure in our hospital. Case : Female, 56 years old came to Saiful Anwar Hospital with unilateral upper extremity edema, she felt heavy to move her arm, a litte bit numbness, and no history of pain on her arm. She had been undergo routine hemodialysis and had history of AV shunt inserted for 3 months ago. She came with compos mentis, GCS 456, BP 160/92 mmHg, HR 68 bpm, RR 20 tpm, SpO2 98% RA, temp 36.4oC, Hb 8.0 mg/dL, Ur 53.6 mg/dL, Cr 5.4 mg/dL, eGFR 1.73. From physical examination we got good peripheral oxygen saturation, we suggested this patient with central vein stenosis. We performed venography resulted stenosis 95% at brachiocephalic vein and undergo plain balloon percutaneous venoplasty. After procedure her right upper extremity was getting better. We observes this patient, but in the next three months after procedure of plain balloon percutaneous venoplasty she complained that her right upper extremity became swollen again. We performed re-venography and resulted with restenosis of brachiocephalic vein. She underwent percutaneous venoplasty again and the evaluation untik now was better, the diameter of upper right extremity became smaller and she can do her daily activity. Conclusion : Central vein stenosis was one of the most complication after dialysis catheter insertion. We performed percutaneous venoplasty and observed the outcome of this patient. After 3 months, the symptom was recurrent and we performed percutaneous venoplasty again.

Clinical Profile of Mucormycosis during the Second Wave of COVID-19 in a Tertiary Care Center in India

Objective: To study the clinical profile and treatment outcome of mucormycosis associated with the second wave of COVID-19 pandemic.Methods: An observational study was conducted in a tertiary care center over a period of 12 months, including a 6-month post treatment follow up. Study included all COVID positive patients with a clinical and radiological evidence of rhino-orbito-cerebral mucormycosis during the second wave of COVID-19. All patients underwent further diagnostic workup and confirmed cases underwent surgical debridement and Amphotericin B was started.Results: A total of 59 patients presented with mucormycosis with the mean age being 52.7 years and unilateral facial and orbital edema as the most common symptoms (28.8%). All were diabetic with HbA1c &gt;7 in 54.2%. The mean duration of presentation was 20.7±7.9 days from the onset of COVID-19 infection. Unilateral involvement of the paranasal sinuses was the most common finding in MRI. Early administration of Amphotericin B with prompt surgical debridement was performed in all cases. Orbital exenteration was conducted in nine patients for better fungal load clearance. Patients showed a good response to surgical debridement and prompt medical treatment, with a mortality rate of 27%.Conclusion: COVID-19 associated mucormycosis is difficult to treat and often presents in late stage. Uncontrolled diabetes, immunocompromised state, and steroid-induced immunosuppression were important risk factors. A close surveillance for early identification and initiation of treatment is mandatory. Repeated surgical debridement to clear the dead tissue is effective to control fungal load.