Bilateral simultaneous inferior altitudinal hemianopia due to ischemic optic neuropathy

A sixty-year-old patient developed a bilateral symmetrical inferior altitudinal hemianopia in the span of an hour. The ophthalmoscopic and fluorescein angiographic findings were typical of anterior ischemic optic neuropathy (AION). This disease usually begins in one eye and as rule involves the fellow eye after an interval of days or years. Simultaneous bilateral onset of AION in a patient is very rare although not unknown. This case suggests that symmetrical and simultaneous bilateral defects of visual fields may be due to a prechiasmal lesion of the visual pathways.

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Sommario Vierte descritto il caso di un paziente di 60 anni che presentò improvvisamente una emianopsia altitudinale inferiore, bilaterale, omonima e perfettamente simmetrica. I reperti oftalmoscopici e fluoroangiografici erano tipici per una diagnosi di neuropatia ottica ischemica anteriore. Tale malattia di solito inizia in un occhio e tende tipicamente al coinvolgimento dell'altro occhio in un 'elevata percentuale di casi con un intervallo variabile (da alcuni giorni ad alcuni anni). Un'insorgenza bilaterale e simultanea, come nel caso qui riportato è un evento eccezionalmente raro, soprattutto se si considera la simmetricità dei difetti campimetrici che avrebbe potuto suggerire una localizzazione post-chiasmatica della lesione.

     

Bilateral anterior ischemic optic neuropathy after liposuction.

A 30-year-old woman had bilateral anterior ischemic optic neuropathy after undergoing large-volume liposuction. Visual function remained stable over a four-month follow-up, with decreased visual acuity and marked constriction of the visual fields. To our knowledge, this is the second reported case of ischemic optic neuropathy in this setting.     

Bilateral and simultaneous ischemic optic neuropathy following hip replacement surgery

Ischemic optic neuropathy, is an exceptional complication of surgery. Moreover, bilateral and simultaneous visual deficit in ischemic optic neuropathy is very rare. We describe two patients who suffered bilateral and simultaneous ischemic optic neuropathy after elective total hip replacement. Anemia and hypotension are the most likely risk factors.     

Bilateral non-arteritic anterior ischemic optic neuropathy following second-trimester spontaneous abortion-related haemorrhage

Bilateral anterior ischemic optic neuropathy is a rare complication of massive haemorrhage and related hypotension and anaemia in young individuals. We report a 34-year-old woman with bilateral non-arteritic ischemic optic neuropathy (NAION) after a massive spontaneous abortion-related haemorrhage who presented with sudden painless visual loss in her left eye. Visual acuity was 20/20 in the right eye with only hand motion discernible in the left eye. There was a left relative afferent papillary defect (RAPD). Fundus examination revealed bilateral swollen, hyperaemic optic discs and nerve fiber layer haemorrhages. Brain MRI and magnetic resonance venography were normal. The diagnosis of bilateral NAION was made and intravenous pulse corticosteroid therapy (1000 mg/day) was administered for three days. On the sixth day, optic disc oedema regressed bilaterally and on the third week, the visual acuity improved to 20/80 in the left eye. The visual field showed only a small spared area in the nasal region, and persistent RAPD was present. After two months, fundus examination showed a small and crowded optic disc on the right and a pale optic disc on the left. Severe acute haemorrhage is an important risk factor for NAION in healthy young individuals. In addition to correction of hypotension and anaemia, intravenous high dose corticosteroid might be beneficial for treatment.     

Migrainous ischemic optic neuropathy

Anterior ischemic optic neuropathy (AION) is a stroke syndrome of the eye seen in isolation or as a manifestation of underlying disease. A case of migrainous AION is reported, and the implications of anterior visual pathway migraine discussed.     

Choroidal and optic nerve infarction in hepatitis C-associated polyarteritis nodosa.

A 39-year-old man presented with headache, weight loss, bilateral subdural hematomas, pansinusitis, and visual loss. The neuro-ophthalmologic examination disclosed deep choroidal lesions and bilateral optic disc edema. Orchiectomy for testicular torsion showed acute vasculitis consistent with polyarteritis nodosa (PAN). Polymerase chain reaction (PCR) testing revealed hepatitis C. This is the first reported case of PAN due to hepatitis C with early findings of choroidal and optic nerve infarction.     

Bilateral optic neuropathy associated with multiple myeloma.

A 51-year-old man had reduced vision and bilateral optic disc swelling as the initial clinical manifestation of multiple myeloma. Brain imaging failed to disclose any abnormalities. Before any therapy was begun, visual function began to improve substantially. Three months after chemotherapy was started, visual function and optic disc appearance returned to near normal. There were no features to suggest polyneuropathy-organomegaly-endocrinopathy-M protein-skin changes (POEMS) syndrome. Visual loss in myeloma is usually caused by compression or infiltration of the optic nerves by tumor. The mechanism of the optic neuropathy in this case remains unknown.     

Interferon-alpha-associated bilateral simultaneous ischemic optic neuropathy.

The authors describe one patient with essential thrombocytosis and one with chronic hepatitis C infection who developed bilateral simultaneous anterior ischemic optic neuropathy within 3 months of starting treatment with interferon-alpha. One patient had several typical risk factors for conventional AION; the other did not. These cases are the fourth and fifth reported examples of this phenomenon. Interferon-alpha treatment may cause or aggravate the risk of developing anterior ischemic optic neuropathy. Vulnerable patients should be advised of this potential complication, assisted in reducing risk factors, and monitored for optic nerve and retinal vascular complications.     

A case of optic neuritis associated with anticardiolipin antibodies]

We reported a case of optic neuritis with the persistence of severe visual loss and central scotoma in a 26-year-old woman who was proven to have biologic false positive test for syphilis, and the elevated serum titres of IgG and IgM anticardiolipin antibodies. C.S.F. findings showed the absence of oligoclonal bands and the presence of IgM anticardiolipin antibody. She was treated twice at intervals of two weeks with methylprednisolone 1000 mg intravenously daily for three days (pulse therapy), and was started on oral prednisolone 60 mg daily which tapered gradually. After the second treatment of the pulse therapy, her visual acuity was improved remarkably and the titre of anticardiolipin antibodies became normal. Her clinical course seemed to be different from that of the optic neuritis of multiple sclerosis, in which many of patients recover near normal visual acuity after a first attack. We suggested that antiphospholipid antibodies might play a role in the etiology of her optic neuritis.     

Diagnostic pitfalls: posterior ischemic optic neuropathy mimicking optic neuritis

In young people, the most frequent cause of isolated monocular visual loss due to an optic neuropathy is optic neuritis. We present the case of a 27 year old woman who presented monocular visual loss, excruciating orbital pain and unusual temporal headache. The initial diagnosis of optic neuritis revealed later to be a posterior ischemic optic neuropathy (PION). In this case, PION was the first unique presentation of a non-traumatic carotid dissection, and it was followed 24 h later by an ischemic stroke.Sudden monocular visual loss associated with a new-onset headache are clinical symptoms that should immediately prompt to a carotid dissection.     

Prolonged premonitory optic disc signs in anterior ischemic optic neuropathy.

A patient displayed a pink mass on the right optic disc and normal visual function that was diagnosed as a capillary hemangioma. Seven months later, he developed typical features of nonarteritic anterior ischemic optic neuropathy (NAION) in that eye. Such a long latency between "preeruptive" and "eruptive" disc edema has not been well documented in NAION.     

Pathogenesis of nonarteritic anterior ischemic optic neuropathy.

Based on histopathology, electron microscopic corrosion cast studies, optic nerve blood flow studies, and clinical data, the pathogenesis of idiopathic nonarteritic ischemic optic neuropathy includes the following features: (1) structurally crowded optic discs are predisposed; (2) laminar and retrolaminar regions are the most common locations for infarction; (3) there is flow impairment in the prelaminar optic disc during the acute phase; (4) lack of consistent choroidal flow impairment and the retrolaminar location of infarcts suggest vasculopathy within or distal to the paraoptic branches of the posterior choroidal arteries; (5) diabetes is the most consistently identified vasculopathic risk factor; (6) impaired autoregulation of the disc circulation by atherosclerosis, with a possible contribution from serotonin and endothelin-mediated vasospasm, may play a role; and (7) progression may be caused by secondary cell death after the initial ischemic insult or compression from cavernous degeneration and mechanical axonal distortion.     

Anterior ischemic optic neuropathy associated with viagra.

A 42-year-old male presented with acute onset of an inferior visual field defect OD after sildenafil citrate use. Examination revealed a right relative afferent pupillary defect and a swollen disc with a 0.1 cup-to-disc ratio and a prominent disc hemorrhage. Anterior ischemic optic neuropathy (AION) is associated with acute episodes of hypotension in patients with structurally crowded discs. Sildenafil citrate may cause episodes of hypotension and was temporally related to the onset of symptoms in this patient. Because patients are often reluctant to volunteer their history of sildenafil citrate use, the physician may need to ask specifically about use of this medication. Physicians should counsel patients with crowded optic discs and a history of nonarteritic anterior ischemic optic neuropathy in one eye that use of sildenafil citrate might increase their risk of ischemic optic neuropathy in the fellow eye.     

Reduced anticardiolipin antibodies in first episode and chronic schizophrenia

The objective of this study was to measure anticardiolipin antibodies (aCL) in major psychiatric diseases. In Experiment 1, 96 subjects were evaluated: 20 first episode schizophrenia patients, [SCZ1] 20 chronic schizophrenia patients in acute exacerbation [SCZ2], l9 bipolar patients, 20 schizoeffective patients and 17 healthy age matched controls. In Experiment 2, 97 subjects were studied: 20 first episode schizophrenia patients [SCZ1], 60 chronic schizophrenia patients in acute exacerbation [SCZ2] and 17 healthy matched controls. Diagnosis was performed according to DSM-IV. Serum samples were tested for aCL in parallel by enzyme-linked immunosorbent assay in the presence of bovine serum. Five positive control samples with high levels of aCL were run in parallel. Background binding to wells uncoated with cardiolipin (CL) was also measured. In Experiment 1, aCL levels were similar in the control, bipolar and schizoeffective groups. In contrast, aCL levels in the SCZ1 and SCZ2 groups were significantly lower than in controls. In Experiment 2, Significantly lower levels of aCL antibodies were found in all schizophrenic patients versus controls. Interestingly, background levels in both experiments were higher in the schizophrenic groups than in controls. Serum aCL levels are lower in schizophrenic patients, and especially in first episode cases, than in controls. One possible explanation for the lower levels of aCL in schizophrenic patients is the consumption of these antibodies in the acute phase and exacerbation of the disease. The higher background levels in schizophrenic patients may indicate a high level of antibodies to some serum component in schizophrenic patients that is still unclear and needs further elucidation.     

Posterior ischemic optic neuropathy after minimally invasive prostatectomy.

Two patients developed postoperative ischemic optic neuropathy (ION) after laparoscopic radical prostatectomy. One operation was robotically assisted; the other was performed with the conventional laparoscopic technique. These new minimally invasive techniques offer many advantages, but they require steep supine head-flexed (Trendelenburg) positioning. Until they are mastered by surgeons, operative times may be prolonged beyond those associated with the traditional technique. As a result, ION may occur more frequently.