A Case of Purtscher's Retinopathy Responsive to High-dose Steroid Therapy

PURPOSE: To report a case of high dose steroid-responsive Purtscher's retinopathy which was developed after operation for diaphragmatic laceration sustained in motorcycle accident. CASE SUMMARY: A 68-year-old man came to our hospital with complaining of decreased visual acuity in the right eye after diaphragmatic laceration operation. Best corrected visual acuity was 0.1 in the right eye. Anterior segment was nonspecific. However, afferent pupillary defect was observed. Superficial intraretinal hemorrhage, numerous cotton-wool spots, peripapillary hemorrhage, and macular edema were detected on fundus examination. Fluorescein angiography revealed capillary nonperfusion and fluorescein filling defect due to retinal hemorrhage in arteriovenous phase and fluorescein leakage from the macula and capillary nonperfusion area in the late venous phase. Accordingly, Purtscher's retinopathy was diagnosed and the patient was observed without specific treatment. After 2 weeks of observation, symptoms and fundus findings were not changed. High-dose steroid therapy was begun with injection of one gram of methylprednisone for three days, switched to oral prednisolone, and then slowly tapered in period of 3 weeks. 7 days after the treatment, visual acuity was improved to 0.2 in the right eye but afferent pupillary defect was still observed. Cotton-wool spots slightly decreased, peripapillary hemorrhage was absorbed but macular edema was remained. 14 days after the treatment, visual acuity greatly improved to 0.63 and afferent pupillary defect was not observed. Cotton-wool spots and macular edema were decreased but fluoroscein leakage from capillary nonperfusion area was remained. CONCLUSIONS: In the case of Purtscher's retinopathy, high-dose steroid therapy can be a useful management method for the improvement of visual acuity and other symptoms.

Clinical Characteristics of Inflammtory Pseudotumor of the Orbit / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Inflammatory pseudotumor is not malignant, but similar to malignancy lesions with respect to its clinical and radiological manifestations. It is well-known to opthalmologists and neurosurgeons, but unfamiliar to otolaryngologists. The objective of this study is to determine the diagnosis and treatment of inflammatory pseudotumor of the orbit. SUBJECTS AND METHOD: We reviewed 17 patients who visited Kangnam St. Mary's hospital and were diagnosed with inflammatory pseudotumor with clinical manifestations and radiological studies between September, 1994 and December, 2006. RESULTS: Seventeen patients were treated with high dose steroid, and of these, 12 showed clinical improvement, although 7 of these patients later showed recurrence. Of the five patients who initially showed no clinical improvement, one received radiation therapy but did not show improvement whereas two patients showed no improvement. One patient's symptoms improved after surgical decompression. CONCLUSION: Our study suggests that the initial treatment of inflammatory pseudotumor should be high dose steroid treatment without improvement and the second treatment should be radiation therapy or surgical treatment.

A Case of Terminal Ileal Ulcer of Henoch-Sch?nlein Purpura Treated with High Dose Steroid / 대한소화기학회지

Henoch-Schonlein purpura (H-S purpura) is a systemic small-vessel vasculitis involving skin, joint, gastrointestinal tract, and kidney. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement. All of these clinical findings can occur in any order and at any time over several days to weeks. Gastrointestinal manifestations such as abdominal pain, melena, or hematochezia occur in 45-85% and preceed skin lesions upto 40% in H-S purpura. However, endoscopically proven gastrointestinal lesion is rare because majority of involved sites are small intestine. We report a case of Henoch-Schonlein purpura with terminal ileal ulcer, healed after treatment with high dose steroid, proven by colonoscopy.

Use of High-dose Steroid in a Case of Scrub Typhus with Acutely Progressive Local Neurologic Symptoms / 감염

Scrub typhus, which is caused by Orientia tsutsugamushi, is systemic illness that causes generalized vasculitis. The central nervous system (CNS) is the most crucial target in scrub typhus as in other rickettsial disease. A 54-year-old woman, who was receiving doxycycline under the diagnosis of scrub typhus, developed rapidly progressive neurologic symptoms. During the treatment, abnormal mental function, abnormal lateral gaze, paralysis in upper extremities and dysphasia occurred in the patient. To investigate CNS involvement in the patients, CSF profile (cell count and levels of protein and glucose) and brain radiologic image (brain CT, brain MRI) were concurrently examined. And ampicillin and high-dose steroid were empirically added to her treatment with doxycycline. With use of high-dose steroid, the initial neurologic symptoms such as restlessness and irritability and other disorders like abnormal lateral gaze and paralysis in upper extremities were recovered. And also any other neurologic sequelae did not appear. We could observe the clinical improvements of abnormal neurologic symptoms and signs after use of high-dose steroid in the Orientia tsutsugamushi infected patients. A further intensive study about the steroid therapy in Orientia tsutusgamushi infected patients with focal neurologic symptoms is required.

High Dose Steroid and Optic Canal Decompression in the Treatment of Traumatic Optic Neuropathy

We compared the result of 6 patients[group A]treated with high dose steroid only with the result of 14 patients[group B]treated with optic canal decompression after at least 24 hours of high dose steroid therapy without improvement. 4 of 6 patients[66%]in group A and 7 of 14 patients[50%]in group B improved in visual acuity.But 1 of 6 patients[17%] in group A and 6 of 14 patients[43%]in group B had marked improvement in visual function[above 0.02].Of 5 patients with optic canal fracture in orbit CT in group B, all had improved visual function and 4 had marked improvement in visual function. If CT demonstrates bony fragments impinging on intracanalicular optic nerve, or if vision deteriorates or fails to improve during the first 24 hours of high dose steroid and initial visual acuity is no light perception, optic canal decompression is considered effective and valid treatment modality in TON.

Clinical and MRI Findings of Acute Disseminated Encephalomyelitis Associated with Preceding Infections Confirmed Serologically

PURPOSE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system. The pathogenesis is not well known, but it is thought to be an immune-mediated disease and may follow a viral infection or vaccinations. MRI demonstrates decreased signal on T1 weighting and increased signal on T2-weighted image. We report clinical features and characteristic MRI findings in seven patients with ADEM who confirmed the preceding infections serologically. METHODS: Patients admitted to the Department of Pediatrics at Asan Medical Center as having ADEM were evaluated for the preceding infections : CSF findings, MRI findings, effects of high-dose steroids and follow-up on changes of neurological symtoms and MRI findings. RESULTS: The onset of neurological symptoms from preceding infection was between 1-3 weeks. The etiologies were Epstein-Barr virus in two, mycoplasma pneumoniae in three, and measles virus in two cases. All lesions found in MRI were cerebral white matter lesions of which there were subcortical white matter in three, corpus callosum in three, deep white matter in two, periventricular white matter in one, internal capsule in one, and cerebral peduncle in one case. There were a total of 3 cases with gray matter lesions. Two cases were treated with high- dose methyl prednisolone, one which showed a good clinical response with much improved lesions on follow-up T2-weighted image, but no clinical response in the other with aggravated MRI lesions. There was 1 patient with gadolinium enhancement lesion in acute phase and the lesion was completely resolved after steroid treatment. CONCLUSION: MRI shows various features in ADEM and may be useful in diagnosis and evaluation of clinical course.