Neuro-Ophthalmology最新文献

Purpose: To evaluate the near reflex components, including accommodation, convergence, and binocular fusional vergences in patients with multiple sclerosis (MS).

Material-method: MS patients under 35 years of age without visual evoked potential (VEP) abnormalities (MS Group) and age-matched healthy individuals of (Control Group) were included in the study. Fusional vergence amplitudes, the amplitude of accommodation (AA), stereopsis measurements, near-object fixation and near point of convergence (NPC) measurements, Convergence Insufficiency Symptoms Survey (CISS) results, and the presence of nystagmus were recorded retrospectively from the files of the cases. Statistical comparison was made between the groups.

Results: The mean age was 28.04 ± 3.7 years in the MS group (20 females, 4 males) and 27.16 ± 3.1 years in the control group (20 females, 5 males) (p = .763). There was no statistically significant difference between groups in stereopsis (p = .395), mean convergence (p = .666), and divergence amplitudes (p = .773) at a distance, and mean convergence and (p = .836) divergence amplitudes (p = .877) at near, and NPC measurements (p = .908). The mean AA was 5.31 ± 0.7 D in the MS group and 6.1 ± 0.8 D in the control group (p < .001). CISS results were lower in the control group (p < .001). In addition, gaze-evoked nystagmus was statistically significantly higher in the MS group (p < .001).

Conclusion: Compared to the healthy control group, MS patients under 35 who did not have optic neuritis had lower accommodation amplitude and more signs in favor of convergence insufficiency symptoms. In addition, gaze evoked nystagmus was observed at a higher rate in the MS group. These findings may guide us in understanding the asthenopia findings of MS patients without optic neuritis.

Lemierre syndrome is an extremely rare but life-threatening condition, characterized by septic thrombophlebitis of the internal jugular vein. There is usually a preceding oropharyngeal infection, and the culprit pathogen is usually Fusobacterium necrophorum. We present an unusual case of Lemierre syndrome caused by Streptococcus pyogenes. The patient initially presented to ophthalmology with multiple cranial nerve palsies and cavernous sinus thrombosis. He was successfully treated with antibiotics in a timely fashion. This is the first report to show this pathogen causing severe ophthalmic complications from Lemierre syndrome.

Non-arteritic ischemic optic neuropathy (NAION) is a common cause of sudden, painless vision loss, often triggered by inadequate blood supply. Dialysis, essential for end-stage renal disease (ESRD), can precipitate intradialytic hypotension, potentially leading to dialysis-associated NAION (DA-NAION). Our protocol was prospectively registered on PROSPERO (CRD42023464202). On 12 December 2023, five databases were searched: PubMed, Scopus, Web of Science, Google Scholar, and Cochrane. We have included all primary studies reporting NAION post-dialysis. Data about baseline characteristics, dialysis types, and NAION were extracted. From 250 identified papers, 24 studies involving 36 patients were included. Patients with DA-NAION presented at a younger age compared to non-dialysis NAION cases. Patients on continuous peritoneal dialysis (CPD) were significantly younger by about 17 years compared to those on hemodialysis. Visual outcomes were generally poor, with an average best corrected visual acuity (BCVA) of 1.33 logMAR (20/428 Snellen). Bilateral involvement was more common in CPD patients (100%) compared to hemodialysis patients (37.5%) (p = .002). Progressive NAION was observed in 33.3% of cases, and 16.7% experienced recurrent episodes. Systemic comorbidities were common, with 47.2% of patients having systemic diseases and 55.6% suffering from cardiovascular diseases (CVD). This systematic review highlights that dialysis, particularly CPD, is associated with the development of NAION. Younger age and systemic comorbidities may be notable risk factors. Bilateral involvement and poor visual outcomes are more common in DA-NAION compared to non-dialysis NAION.

A 51-year-old female sanitation worker in China developed bilateral neuroretinitis due to scrub typhus. Initially diagnosed with 'scrub typhus infected pneumonia', her symptoms subsided within seven days of chloramphenicol treatment. However, two weeks later, she experienced acute bilateral vision loss. Fundoscopy revealed swollen optic discs, exudates, and a small macular pigment epithelial detachment. Diagnosed with scrub typhus-related neuroretinitis, her vision improved after methylprednisolone treatment. This represents the first reported case of such in southern China, suggesting a delayed immune response to scrub typhus. Early diagnosis and proper treatment are crucial for vision prognosis.

We present two cases of a rare thymic tumor presenting with ocular myasthenia gravis. Patient A was a male in his 40s who presented with bilateral diplopia. Investigations revealed negative myasthenic antibodies and positive jitter on single fiber electromyography. Patient B was a female in her 20s who presented with bilateral and fluctuating ptosis and diplopia, and was found to have positive acetylcholine receptor antibodies. Both patients demonstrated thymic hyperplasia on computed tomography chest and underwent robotic thymectomy. Pathology of the excised thymic tissue confirmed thymolipoma. We discuss the incidence, presentation, and management of thymolipomatous myasthenia gravis and present robotic thymectomy as a minimally invasive surgical treatment for thymolipoma.

A 68-year-old man described a progressive, painless, and bilateral reduction of visual acuity, with greater difficulties in central vision, over a period of 3 years. His past medical history was unremarkable, and he admitted a long exposure to tobacco smoking and moderate daily alcohol intake. The first ophthalmological evaluation confirmed a bilateral reduction of visual acuity, without other major findings. Visual fields showed a central scotoma in the right eye and a temporal pseudo-hemianopia in the left eye. The neurological examination was unremarkable. A slight cobalamin deficiency was detected after the first panel of investigations, and he was diagnosed and treated for the cause that seemed most obvious. Surprisingly, nutritional optic neuropathy was not his final diagnosis. This case shows how the paraclinical findings may help to address the correct diagnosis, summarizing a comprehensive approach to patients with progressive and bilateral visual loss and highlighting the main differential diagnosis.

Non-paralytic pontine exotropia (NPPE) is a rare condition characterized by internuclear ophthalmoplegia associated with exotropia in the contralateral eye. We report a case of an 82-year-old woman with acute onset of right eye exotropia and adduction deficit of the left eye. Magnetic resonance imaging showed areas of restricted diffusion in the left paramedian midbrain, left precentral gyri, and right superior parietal gyri. She recovered after 3 days. On the seventh day after onset, the left eye appears with an esotropia, a finding never described before in NPPE. For a better understanding of the pathophysiology and recognition of NPPE, more reports like this are essential to encourage more publications on the topic and the creation of guidelines for this type of ophthalmoplegia.

The history of the European Neuro-Ophthalmology Society (EUNOS) dates to 1993, when the first biennial meeting was held in Zurich, Switzerland. Fifteen more meetings followed in the years thereafter, and during these 31 years EUNOS developed into a thriving professional society serving its members and fulfilling the vision of both its funders Alfred Huber and Adolphe Neetens.

SUNCT is a rare and disabling type of headache. Here, we present a patient with pituitary adenoma and 2-years history of chronic SUNCT accompanied by unusual, disabling photophobia. Past medical records revealed acromegaly and pituitary adenoma resection in 2009, with recurrence in 2015, further invading the ipsilateral cavernous sinus and dura mater. Pharmacotherapy and multiple cranial peripheral nerve blocks were partially effective. After endoscopic endonasal trans-sphenoidal tumor resection, attacks ceased completely. Our findings suggest that dural invasion of the pituitary adenoma in the left cavernous sinus was the primary cause of the ipsilateral SUNHA, as evidenced by the cessation of symptoms following complete tumor resection. We advocate investigating and treating secondary causes in SUNCT patients. The presence of photophobia in various types of headaches suggests a crosstalk between visual and pain pathways. The proposed pathophysiology of photophobia and headache due to pituitary adenoma is discussed.