PURPOSE: We report two patients diagnosed with a sinus thrombosis with papillary edema. CASE SUMMARY: Case 1 was a 27-year-old male who presented with complaints of headache and vomiting for 2 months and blurred vision in both eyes. The best-corrected visual acuity (BCVA) was 1.0 in the right eye and 1.0 in the left eye. A visual field (VF) examination revealed a binocular peripheral VF defect and optical coherence tomography (OCT) and a fundus examination indicated optic disc swelling in both eyes. Brain magnetic resonance imaging (MRI) showed no specific finding but magnetic resonance venography revealed filling defect signs in the transverse sinus and a cerebrospinal fluid examination indicated elevated intracranial pressure (ICP). Case 2 was a 54-year-old female who came to our hospital with suspicion of bilateral optic disc swelling. The BCVA was 0.9 in the right eye and 1.0 in the left eye. A VF examination revealed an inferior-temporal VF defect and blind spot enlargement in the right eye. OCT and a fundus examination showed optic disc swelling in both eyes. Brain MRI showed no specific finding but magnetic resonance venography revealed a decrease in blood flow in the transverse sinus, sigmoid sinus. A cerebrospinal fluid examination indicated elevated ICP. CONCLUSIONS: In the case of optic disc swelling in both eyes, a secondary cause of ICP elevation and the possibility of optic disc swelling due to sinus thrombosis should be considered, and brain MRI and venography are needed to distinguish these possibilities.
Adult ; Brain ; Cerebrospinal Fluid ; Colon, Sigmoid ; Edema ; Female ; Headache ; Humans ; Intracranial Hypertension ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Optic Disk ; Optic Nerve Diseases ; Papilledema ; Phlebography ; Sinus Thrombosis, Intracranial ; Telescopes ; Tomography, Optical Coherence ; Visual Acuity ; Visual Fields ; Vomiting

PURPOSE: The aim of the study was to describe the clinical features and characteristics of optic neuritis patients compared with those of patients enrolled in the Optic Neuritis Treatment Trial (ONTT). METHODS: We retrospectively included consecutive patients diagnosed with optic neuritis between 2006 and 2015. The inclusion criteria were the same as those of the ONTT; an acute or subacute unilateral visual symptom ≤8 days in duration, a relative afferent pupillary defect, and a visual field defect in the affected eye. RESULTS: The 41 patients (14 females, 27 males) were of mean age 32.7 years. The incidence of papilledema was 58.5%, thus higher than that of ONTT patients (p = 0.004), and the incidence of ocular pain was 75.6%, lower than that of ONTT patients (p = 0.002). Six months after intravenous methylprednisolone therapy, 29 of 32 eyes (90.6%) recovered visual acuity of ≥1.0 or better, and only one eye exhibited poor visual acuity (≤0.5). Orbital magnetic resonance imaging (MRI) was performed on 34 patients, and most (91.2%) exhibited optic nerve enhancement. The three patients who did not exhibit enhancement reported no pain. CONCLUSIONS: The clinical features of Korean optic neuritis patients differed from those of patients of the ONTT. Most patients exhibited optic nerve MRI enhancement associated with ocular pain. If enhancement of the optic nerve is lacking, diseases other than optic neuritis should be suspected because most optic nerves with neuritis exhibit enhancement on MRI.
Adult ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging ; Methylprednisolone ; Neuritis ; Optic Nerve ; Optic Neuritis ; Orbit ; Papilledema ; Pupil Disorders ; Retrospective Studies ; Visual Acuity ; Visual Fields

PURPOSE: We report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) following acute angle-closure crisis (AACC). CASE SUMMARY: A 76-year-old female visited our clinic because of a 1-day history of ocular pain and vision loss in both eyes. The visual acuity was 0.02 in both eyes and her intraocular pressure (IOP) was 52 mmHg in the right eye (RE) and 50 mmHg in the left eye (LE). She had corneal edema and a shallow anterior chamber in both eyes, with 4 mm fixed dilated pupils. After decreasing the IOP with intravenous mannitol, laser iridotomy was performed. However, 2 days later, visual acuity was further reduced to finger counting at 10 cm RE and at 50 cm LE, and her optic disc was swollen. Bilateral NAION following AACC was diagnosed. One month later, visual acuity slightly improved to 0.02 RE and 0.04 LE, and the optic disc edema resolved. A small cup-disc ratio, optic disc pallor, and atrophy were observed. Humphrey visual fields demonstrated superior and inferior altitudial visual field defects in the LE, and almost total scotoma in the RE. CONCLUSIONS: AACC can be a predisposing factor for NAION, so the relative afferent pupillary defect, papilledema, and presentation of other risk factors are important clues to a diagnosis of NAION.
Aged ; Anterior Chamber ; Atrophy ; Causality ; Corneal Edema ; Diagnosis ; Edema ; Female ; Fingers ; Glaucoma, Angle-Closure ; Humans ; Intraocular Pressure ; Mannitol ; Optic Neuropathy, Ischemic ; Pallor ; Papilledema ; Pupil ; Pupil Disorders ; Risk Factors ; Scotoma ; Visual Acuity ; Visual Fields

For many years, the pathophysiology of idiopathic intracranial hypertension (IIH) was interpreted as “secondary intracranial hypertension,” and IIH was considered to be caused by brain edema due to obstructive sleep apnea. Another theory proposed cerebrospinal fluid (CSF) absorption impairment due to excessive medication with vitamin A derivatives. Other reports pointed out the importance of obesity, which may cause an impairment of intracranial venous drainage due to elevated right atrial pressure. Patients with medically refractory IIH have traditionally undergone a CSF diversion. Venous outlet impairment on IIH has recently been reported as a causative or contributory cause, and thus focused venoplasty of the stenotic sinus with a stent has emerged as a new treatment strategy. We report the cases of two patients who presented with headache and papilledema with IIH. They successfully underwent stent placement at the stenosis of the transverse sinus and experienced complete resolution of symptoms.
Absorption ; Atrial Pressure ; Brain Edema ; Cerebrospinal Fluid ; Constriction, Pathologic* ; Drainage ; Headache ; Humans ; Obesity ; Papilledema ; Pseudotumor Cerebri* ; Sleep Apnea, Obstructive ; Stents* ; Vitamin A

PURPOSE: To report cases of a retinal, preretinal and vitreous hemorrhage due to retinoic acid syndrome and a papilledema caused by increased intracranial pressure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid (ATRA). CASE SUMMARY: (Case 1) A 48-year-old female visited our clinic with headache, dyspnea, and visual disturbance during ATRA medications for acute promyelocytic leukemia. Her visual acuity of both eyes was hand motion, and fundus examination revealed extensive retinal, preretinal, and vitreous hemorrhage. The laboratory test showed leukocytosis and computed tomography of brain and chest revealed subarachnoid hemorrhage and pulmonary alveolar hemorrhage. She was diagnosed with retinoic acid syndrome and was treated with vitrectomy in both eyes. (Case 2) A 17-year-old male, who had been treated with ATRA for acute promyelocytic leukemia, had headache and visual disturbance. His best-corrected visual acuity was 1.0 in both eyes, but the fundus examination showed papilledema and retinal hemorrhage in both eyes. Goldmann visual field examination revealed an enlarged blind spot in both eyes. He was diagnosed with papilledema caused by ATRA induced increased intracranial pressure, and was observed. CONCLUSIONS: Patients with acute promyelocytic leukemia treated with ATRA may have retinoic acid syndrome and increased intracranial pressure that could result in retinal hemorrhage, vitreous hemorrhage, and papilledema.
Adolescent ; Brain ; Dyspnea ; Female ; Hand ; Headache ; Hemorrhage ; Humans ; Intracranial Pressure ; Leukemia, Promyelocytic, Acute* ; Leukocytosis ; Male ; Middle Aged ; Optic Disk ; Papilledema ; Pseudotumor Cerebri* ; Retinal Hemorrhage ; Retinaldehyde ; Subarachnoid Hemorrhage ; Thorax ; Tretinoin* ; Visual Acuity ; Visual Fields ; Vitrectomy ; Vitreous Hemorrhage

PURPOSE: To report a case of rhino-orbito-cerebral aspergillosis successfully treated with a combination of amphotericin B, posaconazole and amphotericin B irrigation. CASE SUMMARY: A 59-year-old male with hypertension, diabetes mellitus and hyperlipidemia was admitted to our neurology department for left facial paresthesia, pain and consulted to ophthalmology for left eyeball pain. His visual acuity was no light perception in the left eye, and fundus examination showed papilledema and a cherry-red spot. Left exophthalmos and complete ptosis with ophthalmoplegia were also observed. Orbital computed tomography revealed left maxillary and ethmoid sinusitis, and nasal endoscopic examination revealed a black eschar adjacent to the middle turbinate. Subsequent biopsy suggested mucormycosis. The patient was immediately treated with a combination of amphotericin B and posaconazole. In addition, left endoscopic sinus surgery was performed and aspergillosis was histopathologically confirmed. The patient underwent amphotericin B irrigation for 5 days after canula insertion up to orbital apex. The patient survived for 18 months and is still alive. CONCLUSIONS: A combination of amphotericin B, posaconazole and amphotericin B irrigation using the canula through the orbital apex may be helpful in treating patients with rhino-orbito-cerebral aspergillosis who refuse orbital exenteration.
Amphotericin B* ; Aspergillosis* ; Biopsy ; Diabetes Mellitus ; Ethmoid Sinus ; Ethmoid Sinusitis ; Exophthalmos ; Humans ; Hyperlipidemias ; Hypertension ; Male ; Middle Aged ; Mucormycosis ; Neurology ; Ophthalmology ; Ophthalmoplegia ; Orbit ; Papilledema ; Paresthesia ; Turbinates ; Visual Acuity

No abstract available.
Headache ; Meningeal Carcinomatosis* ; Papilledema*

PURPOSE: To report a case of adult-onset Coats' disease which showed decreased retinal edema and improved visual acuity following intravitreal ranibizumab injection. CASE SUMMARY: A 21-year-old woman visited our hospital for decreased visual acuity in left eye from 3 months ago. Her best corrected visual acuity was 1.0 in the right eye, and 0.4 in the left eye. The intraocular pressure was 19 mmHg in the right eye and 16 mmHg in the left eye. At anterior segment examination, no abnormal findings were found. On fundus examination, subretinal exudates, superior retinal edema at posterior pole, and telangiectasia along superortemporal vascular arcade were observed in the left eye. Upon diagnosis as Coats' disease, intravitreal ranibizumab was performed, and laser photocoagulation was done around the retinal telangiectasia and nonperfusion area. Then, the second and third intravitreal ranibizumab injections were performed by a month, and her best visual acuity was improved to 0.8 and optical coherence tomography revealed decreased retinal edema. CONCLUSIONS: We report a case of adult-onset Coats' disease. Intravitreal ranibizumab injection is effective in rapid visual improvement and decrease of retinal edema as combination therapy with laser photocoagulation which was a generalized treatment of choice in Coats' disease.
Diagnosis ; Exudates and Transudates ; Female ; Humans ; Intraocular Pressure ; Light Coagulation ; Macular Edema ; Papilledema ; Ranibizumab* ; Retinaldehyde ; Telangiectasis ; Tomography, Optical Coherence ; Visual Acuity ; Young Adult

PURPOSE: To report a case of bilateral optic disc edema associated with hypocalcemia. CASE SUMMARY: A 48-year-old woman visited our ophthalmology department with decreased vision and disturbance of the visual field in the right eye, which began 2 days prior to presentation. The patient history indicated she had undergone total thyroidectomy 3 months prior and was given an oral calcium preparation. She had no eye pain, headache, tinnitus or diplopia. Her best corrected visual acuity of both eyes was 1.0, and color vision was normal in both eyes although a mild relative afferent pupillary defect was present in the right eye. Severe bilateral optic disc edema was present in the right eye. A Humphrey visual field test revealed an enlarged blind spot and peripheral nasal step scotoma in the right eye. The Cerebrospinal fluid (CSF) opening pressure was within the normal range and there were no abnormal findings regarding CSF. Additionally, there were no remarkable findings on brain magnetic resonance imaging nor neurologic tests. Her serum calcium was 5.9 mg/dL (normal range: total calcium 8.7-10.6 mg/dL), and an intravenous calcium supplement was started. Visual disturbance and optic disc edema improved 2 days after replacement and the optic disc edema completely dissolved 2 months later. CONCLUSIONS: Hypocalcemia may cause bilateral optic disc edema and can be recovered through adequate calcium supplementation, and it is necessary to prevent and promptly detect this rare complication.
Brain ; Calcium ; Cerebrospinal Fluid ; Color Vision ; Diplopia ; Edema* ; Eye Pain ; Female ; Headache ; Humans ; Hypocalcemia* ; Magnetic Resonance Imaging ; Middle Aged ; Ophthalmology ; Optic Disk ; Optic Nerve Diseases ; Papilledema ; Pupil Disorders ; Reference Values ; Scotoma ; Thyroidectomy ; Tinnitus ; Visual Acuity ; Visual Field Tests ; Visual Fields

Scrub typhus is an infective acute febrile disorder caused by the intracellular parasite Orientia tsutsugamushi. Neurological manifestations of scrub typhus are meningoencephalitis, cerebellitis, transverse myelitis, papilledema, and cranial nerve palsy. However, opsoclonus-myoclonus syndrome associated with scrub typhus has been rarely reported. A 59-year-old man developed vertigo, nausea, vomiting, and imbalance following scrub typhus infection for eight days. Examination showed eschar at the axilla, decreased mentality, and opsoclonus-myoclonus syndrome. Video-oculography disclosed opsoclonus with an amplitude of 15°–20° and a frequency of 6–8 Hz. The serum antibody titers to Orientia tsutsugamushi were 1:5,120, and cerebrospinal fluid analysis revealed pleocytosis. Brain magnetic resonance imaging was normal. Neurological symptoms and signs completely improved by systemic steroid and antibiotics treatment. Various mechanisms including direct disseminating inflammation or indirect immune modulation may give rise to neurological complications following scrub typhus.
Anti-Bacterial Agents ; Axilla ; Brain ; Cerebrospinal Fluid ; Cranial Nerve Diseases ; Encephalitis ; Humans ; Inflammation ; Leukocytosis ; Magnetic Resonance Imaging ; Meningoencephalitis ; Middle Aged ; Myelitis, Transverse ; Nausea ; Neurologic Manifestations ; Ocular Motility Disorders ; Opsoclonus-Myoclonus Syndrome ; Orientia tsutsugamushi ; Papilledema ; Parasites ; Scrub Typhus ; Vertigo ; Vomiting