Optic disc edema and visual loss from paracentral acute middle maculopathy mimicking optic neuritis

ABSTRACT Optic neuritis is an important cause of unilateral and acute visual loss in young adults, but other differential diagnoses should be considered, especially when the disease has an atypical presentation. This report presents the case of a young woman with reduced visual acuity in her right eye, associated with optic disc edema and a relative afferent pupillary defect, that was initially misdiagnosed as optic neuritis and subsequently found to have paracentral acute middle maculopathy, possibly secondary to subtle impending central retinal vein occlusion. This case emphasizes the need to remember that retinal vascular diseases can occasionally mimic optic neuritis. Detailed anamnesis and ophthalmic examination can avoid unnecessary interventions.

Optic nerve sheath fenestration: A second lease at sight

Purpose: To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods: Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results: Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was ?1.9789 ± 1.46270, which improved to ?0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from ?1.3378 ± 1.50107 to ?1.0667 ± 1.33813 (p < 0.05). Conclusion: Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.

Recognition and progress of idiopathic intracranial hypertension / 中国医师杂志

Idiopathic intracranial hypertension (IIH) is a syndrome of unexplained increased intracranial pressure with normal cerebrospinal fluid and without organic brain lesions. The etiology and pathogenesis of IIH remain unclear, and IIH patients may develop irreversible visual impairment. At present, there are no guidelines and expert consensus on diagnosis and treatment of IIH in China. This review aims to introduce the pathogenesis, diagnosis and treatment of IIH, in order to help clinicians improve their understanding of the disease and to identify, diagnose and treat IIH as early as possible, and improve the prognosis of patients.

Papiledema bilateral por síndrome do pseudotumor cerebral em paciente com achado fortuito de microadenoma hipofisário / Bilateral papilledema by cerebral pseudotumor syndrome in a patient with a fortuitous finding of pituitary microadenoma

RESUMO O presente relato descreve um raro caso de papiledema bilateral decorrente da síndrome do pseudotumor cerebral relacionado com achado de microadenoma hipofisário. Relatamos um caso de paciente do sexo feminino, 21 anos, referindo baixa acuidade visual para longe, associada à cefaleia de início há 2 meses. Ao exame oftalmológico, a fundoscopia mostrou presença de papiledema bilateral significativo. A ressonância magnética de encéfalo evidenciou imagem nodular na hipófise, medindo 7 mm, sem qualquer evidência de compressão intracraniana, insuficiente para causar os sintomas do quadro clínico. Após diagnóstico de síndrome do pseudotumor cerebral, instituiu-se tratamento clínico com acetazolamida e orientou-se perda de peso, com evolução satisfatória. A descrição de ambas as patologias presentes de forma mútua foi citada apenas uma vez durante extensa revisão da literatura. Dessa forma, chamamos a atenção para essa ocorrência incomum, enfatizando as características de ambas as patologias, a fim de facilitar o diagnóstico diferencial, bem como elucidar a melhor abordagem terapêutica. Ressaltamos que o achado de pequenos adenomas hipofisários não deve confundir o diagnóstico etiológico em pacientes com queixas visuais e papiledema bilateral.

ABSTRACT The present report describes a rare case of bilateral papilledema due to cerebral pseudotumor syndrome (CPT) related to an occasional finding of pituitary microadenoma. We report the case of a 21-year-old female patient presenting low far visual acuity, associated with headache beginning 2 months ago. On ophthalmological examination, fundoscopy showed significant bilateral papilledema. Magnetic resonance imaging of the brain showed symmetrical and normal-sized ventricles, besides a nodular imaging in the pituitary, measuring 7 mm, without any evidence of intracranial compression, insufficient to cause the symptoms of the clinical presentation. After the diagnosis of cerebral pseudotumor syndrome, clinical treatment with acetazolamide was instituted and weight loss was advised, with satisfactory evolution. The description of both pathologies mutually present was mentioned only once during extensive literature review. Thus, we call attention to this unusual occurrence, emphasizing the characteristics of both pathologies in order to facilitate the differential diagnosis, as well as to elucidate the best therapeutic approach. We emphasize that the finding of small pituitary adenomas should not confuse the etiological diagnosis in patients with visual complaints and bilateral papilledema.

Cerebral Venous Sinus Stenting for the Treatment of Idiopathic Intracranial Hypertension in a Child / Angioplastia de Seio Venoso Cerebral para Tratamento de Hipertensão Intracraniana Idiopática em Criança

Idiopathic intracranial hypertension (IIH) is a disease characterized by an increase in the opening pressure of the cerebrospinal fluid (CSF) associated with symptoms of elevated intracranial pressure (ICP). The condition is more prevalent in women and typically managed clinically. Surgical treatment is reserved for select refractory cases. The well-established surgical procedures for the management of IIH are CSF shunting and fenestration of the optic nerve sheath. These procedures, however, are associated with high rates of complication and recurrence. More recently, venous sinus angioplasty with stents has been employed in cases with documented narrowing of the sigmoid-transverse sinuses. This technique is associated with a significant reduction in the venous pressure gradient at the stenosis site, alleviating the symptoms of intracranial hypertension. We report a case of a previously healthy 12-year-old patient who presented with 10-day history of headaches, blurring of vision, nausea and vomiting, which evolved with worsening of the visual acuity and papilledema. Imaging scans disclosed stenosis of the right transverse and sigmoid sinuses. The patient underwent stenting of the stenotic venous segments and showed good evolution, with significant clinical improvement within 24 hours of the procedure.

A hipertensão intracraniana idiopática (HII) é uma doença caracterizada pelo aumento da pressão de abertura do líquido cefalorraquidiano associado a sintomas de aumento da pressão intracraniana. É mais frequente em mulheres, sendo habitualmente tratada com medidas clínicas. O tratamento cirúrgico é reservado a uma minoria de casos que se mostram refratários. Os procedimentos cirúrgicos consagrados para este fim são a derivação liquórica e a fenestração de bainha do nervo óptico. Entretanto, eles estão associados a altos índices de complicações e recorrência. Mais recentemente, a angioplastia de seio venoso com uso do stent vem sendo utilizada em casos em que há redução documentada no calibre dos seios transverso-sigmoide com repercussão comprovada no gradiente pressórico. Essa técnica está associada a uma redução significativa no gradiente de pressão venosa no local da estenose. Consequentemente, resulta em alívio dos sintomas da hipertensão intracraniana. Neste trabalho, descrevemos o caso de um paciente de 12 anos de idade, sem doenças prévias, que apresentava quadro de cefaleia, turvação visual, náuseas e vômitos de início havia dez dias, tendo evoluído com piora da acuidade visual e papiledema. Realizou exame de imagem que identificou estenose dos seios transversos e sigmoide à direita. O paciente foi submetido a angioplastia dos segmentos venosos estenosados, apresentando boa evolução, com melhora clínica significativa já nas primeiras 24 horas após o procedimento.

Idiopathic intracranial hypertension: an illustrated guide for the trainee radiologist / Hipertensão intracraniana idiopática: um guia ilustrado para o residente de radiologia

Abstract Idiopathic intracranial hypertension is characterized by increased intracranial pressure, headache, and visual perturbations. Although the pathophysiology of idiopathic intracranial hypertension is obscure, several mechanisms have been proposed, such as increased cerebral blood volume, excessive cerebrospinal fluid volume (due to high production or impaired resorption), and inflammatory mechanisms as a likely cause of or contributor to impaired cerebrospinal fluid circulation. It predominantly affects women of reproductive age who are overweight or obese. The most common symptoms are daily headache, synchronous pulsatile tinnitus, transient visual perturbations, and papilledema with visual loss. The main neuroimaging findings are a partially empty sella turcica; flattening of the posterior sclera; transverse sinus stenosis (bilateral or in the dominant sinus); a prominent perioptic subarachnoid space, with or without optic nerve tortuosity; and intraocular protrusion of the optic nerve head. The main complication of idiopathic intracranial hypertension is visual loss. Within this context, neuroimaging is a crucial diagnostic tool, because the pathology can be reversed if properly recognized and treated early.

Resumo A hipertensão intracraniana idiopática é caracterizada por aumento da pressão intracraniana, cefaleia e manifestações visuais. Apresenta fisiopatologia incerta, porém, alguns mecanismos já foram propostos, como o aumento do volume sanguíneo cerebral, o excesso de líquor por aumento da produção ou a redução da reabsorção, e mecanismos inflamatórios como fator causal ou mesmo determinando limitação na circulação do líquor. Predomina em mulheres obesas em idade reprodutiva. Os sintomas e sinais mais comuns são cefaleia diária, zumbido síncrono ao pulso, obscurecimentos visuais transitórios e papiledema com perda visual. Os principais achados em neuroimagem são: sela turca vazia, achatamento posterior do globo ocular/esclera, estenose do seio transverso bilateral ou do seio dominante, distensão do espaço liquórico perióptico com ou sem tortuosidade do nervo óptico e protrusão intraocular da cabeça do nervo óptico. A principal complicação da hipertensão intracraniana idiopática é a perda visual. Nesse contexto, o papel da neuroimagem no diagnóstico é fundamental, pois a doença pode ser revertida se devidamente reconhecida e precocemente tratada.

Papilledema and abducens nerve palsy associated with vitamin B12 deficiency

Papilledema is defined as optic disc swelling that is secondary to elevated intracranial pressure. Vision is usually well preserved with this condition. The optic discs appear blurred in papilledema. Elevation in intracranial pressure is due to variety of reasons of which intracranial hemorrhageis the most common. We present a case in which our patient developed papilledema due to vitamin B12 deficiency. Lateral rectus muscle palsy occurs due to abducens nerve palsy. The lateral rectus muscle is responsible for lateral movement of the eyeball, specificallyabduction. Its palsy results in sudden onset of horizontal double vision, which is worse when the patient looks to the affected side. There is also limited outward movement of the affected eye. Abducens nerve palsy can occur due to ischemia injury, stroke, infection, brain tumour, elevated intracranial pressure, or inflammation of the nerve. In our patient the abducens nerve palsy was due to homocysteinemia secondary to dietary vitamin B12 deficiency. Homocysteine is a potent atherosclerotic risk factor and can cause ischemic nerve palsy, as seen in our patient.

Clinical profile and ophthalmological manifestations of idiopathic intracranial hypertension in adults at a tertiary care center in India: A cross-sectional study

Purpose: Our aim was to describe the clinical profile of patients with idiopathic intracranial hypertension (IIH), assess ophthalmological manifestations, and correlate grade of papilledema with optic nerve sheath diameter (ONSD) and cerebrospinal fluid (CSF) opening pressure. Methods: This was a prospective cross?sectional study. Patients between 18 and 60 years, diagnosed with IIH using modified Dandy criteria were included. Demographic details, ocular symptoms and signs were noted and papilledema graded. Ocular investigations such as B?scan ONSD and perimetry findings were noted for analysis. Results: The study included 32 patients of mean age 35.25(±9.57) years with a predominantly female population (96.9%). Mean BMI was 28.12(±5.32) kg/m2. Common presenting complaint was headache (87.5%). The most common gynecological disorder was dysmenorrhea (15.6%). Vitamin D deficiency (46.9%) was a biochemical abnormality seen. Most patients had BCVA 6/6 (62.5%). Lateral rectus palsy was present in 12.5%. Papilledema was present in 81.3% eyes with 31.3% Grade I. There was visual field loss in 53.1%, with 20.3% Grade I. Mean CSF opening pressure was 376.3(±191.51) mmH2O. MRI showed empty sella (34.4%) and tortuous optic nerve (18.8%). MRV showed transverse sinus stenosis (52.4%) as common abnormality. There was significant correlation between grade of papilledema and B?scan ONSD. No correlation was seen between CSF opening pressure and ONSD, grade of papilledema and grade of visual field defect and CSF opening pressure with BMI. Conclusion: Clinical profile of patients with IIH was an overweight female of child?bearing age with headache. Visual field examinations are essential in management and follow?up. B?scan ONSD is useful to quantify raised ICP.

Idiopathic intracranial hypertension leading to bilateral optic atrophy in a patient with recent COVID-19 infection: a case report

Neurologic complications are common in patients hospitalisedwith COVID-19 infection. Most common complications are myalgias, headaches, encephalopathy and dizziness. Uncommon complications are stroke, motor and sensory deficits, seizures, ataxia and movement disorders. Multiple neuro-ophthalmological manifestations have also been reported in association with COVID-19. These complications may be the result of a range of pathophysiological mechanisms like hypoxic neuronal injury during active COVID-19 infection, RAS dysfunction, immune dysfunction and direct injury by the virus etc throughout the course of the disease. Here we reported a case of neuro-ophthalmic complication of Idiopathic intracranial hypertension (IIH) followed by bilateral optic atrophy in a middle-aged man with recent COVID-19 infection. He presented to the emergency with complaints of headache, dizziness and sudden painless bilateral diminution of vision for 3 days. His fundus examination was suggestive of bilateral papilledema, his MRI brain was normal and opening pressure of CSF was raised on lumbar puncture. His MRV was normal, there was no evidence of CSVT. He was started on steroids and acetazolamide. His headache improved but there was no improvement in visual acuity. Repeat fundus showed pale disc and MRI orbit was suggestive of bilateral optic atrophy.

A rare presentation of Guillain-Barre syndrome with GQ1b positivity: A case report

Rationale: To report a case of cervicobrachial variant of acute inflammatory demyelinating polyneuropathy presenting with papilledema and GQ1b positivity. Patient concern: A 35-year-old female, 68 days postpartum, presented with headache, vomiting, and gait difficulty in swallowing with bilateral upper limb weakness and difficulty in walking, 13 days after ChAdOx1 nCoV-19 vaccination. Diagnosis: Guillain-Barre syndrome with GQ1b positivity. Intervention: Five cycles of plasmapheresis were given. Outcome: The patient's clinical condition improved. Palatal weakness improved and she could walk without support. There were mild sensory symptoms involving upper limbs which gradually improved. Lessons: AIDP should be considered in case of weakness following ChAdOx1 nCoV-19 vaccination. Albumino-cytological dissociation and anti-GQ1b positivity are needed to confirmed the diagnosis.

An uncommon case of brucellosis with ocular presentation / Um caso incomum de brucelose com apresentação ocular

ABSTRACT We report an unusual case of brucellosis presented with headache, diminished vision, papillitis and multiple peripapillary hemorrhages accompanied by subretinal fluid extending up to macula. Diagnosis of brucellosis was made based on positive polymerase chain reaction of cerebrospinal fluid sample for Brucella species DNA, accompanied by a raised titer of anti-brucella antibodies. Patient showed remarkable improvement on triple drug therapy in form of doxycycline, rifampicin and ceftriaxone.

RESUMO Relatamos um caso incomum de brucelose apresentada com cefaleia, visão diminuída, papilite e múltiplas hemorragias peripapilares acompanhadas por fluido sub-retinal, estendendo-se até a mácula. O diagnóstico de brucelose foi feito com base na reação em cadeia da polimerase positiva de amostra de líquido cefalorraquidiano para DNA de espécies de Brucella, acompanhada por um título elevado de anticorpos antibrucela. O paciente apresentou melhora notável com a terapia tripla com drogas na forma de doxiciclina, rifampicina e ceftriaxona.

Unilateral papilledema and peripapillary polypoidal choroidal vasculopathy as the presenting manifestations of intracranial hypertension / Papiledema unilateral e vasculopatia polipoidal da coroide peripapilar como sinais de apresentação de hipertensão intracraniana

ABSTRACT We have reported here the case of a 54-year-old woman with intracranial hypertension that presented with the unique features of unilateral papilledema and peripapillary polypoidal choroidal vasculopathy. Our investigations lead to the diagnosis of idiopathic intracranial hypertension and an incidental small right frontal meningioma. The patient was accordingly treated with oral acetazolamide, followed by three consecutive monthly intravitreal injections of bevacizumab, which resulted in the inactivation of the polypoidal choroidal vasculopathy, marked reduction of lipid exudation, and complete absorption of the subretinal fluid. This case serves as the first documentation of polypoidal choroidal vasculopathy associated with papilledema. It also demonstrates that choroidal vascular abnormalities may occur even when optic disk edema is unilateral, which is an uncommon manifestation of increased intracranial pressure. Prompt recognition of such findings and its appropriate management are essential for adequate treatment and prevention of irreversible visual loss.

RESUMO Relatamos um caso de uma paciente de 54 anos com hipertensão intracraniana que apresentava achados atípicos de papiledema unilateral e vasculopatia polipoidal da coroide peripapilar. A investigação levou ao diagnóstico de hipertensão intracraniana idiopática e de um pequeno meningioma incidental. A paciente foi tratada com acetazolamida por via oral, seguida de três injeções intravítreas mensais de bevacizumabe, resultando em inatividade da vasculopatia polipoidal da coroide, redução da exsudação e completa absorção do líquido subretiniano. A apresentação deste caso serve para documentar pela primeira vez vasculopatia polipoidal da coroide associada a papiledema. Ele também demonstra que podem ocorrer anormalidades vasculares da coroide mesmo quando o edema do disco óptico é unilateral, uma manifestação incomum do aumento da pressão intracraniana. O reconhecimento imediato desses achados e seu manejo adequado são essenciais para o tratamento adequado e para prevenção da perda visual irreversível.

Alterações retinianas em pacientes com leucemia linfocítica aguda (lla): discussão de tema a partir de relato de caso / Retinal changes in patients with acute lymphocytic leukemia (all): discussion of topic from a case report

RESUMO A Leucemia Linfocitica Aguda (LLA) é uma doença caracterizada por uma alta taxa de sobrevida, porém o número absoluto de crianças que morrem por ela representa uma grande parcela dos casos de óbitos infantis por câncer. A morbidade decorrente de seu tratamento pode deixar sequelas em pessoas com grande expectativa de vida, tornando-se extremamente necessário o entendimento da patogênese desta doença, possibilitando o desenvolvimento de novos tratamentos e diminuição de sequelas provocadas pela doença. O diagnóstico precoce é importante para se evitar complicações oculares que possam levar a baixa de acuidade visual em longo prazo e para avaliação de recaídas de tratamento sendo determinante no direcionamento de condutas.

ABSTRACT The Acute Lymphocytic Leukemia (ALL) is a disease characterized by a high survival rate, but the absolute number of children who die from it represents a large proportion of cases of infant deaths from cancer. The morbidity resulting from its treatment can leave sequelae in people with high life expectancy, making it extremely necessary to understand the pathogenesis of this disease, enabling the development of new treatments and reduction of sequelae caused by the disease. This early diagnosis is important to avoid ocular complications that may lead to low long-term visual acuity and to evaluate treatment relapses and determine the conducts.

Viagem espacial: Um desafio sob o ponto de vista da oftalmologia / Space travel: A challenge from the point of view of ophthalmology

RESUMO No final do século vinte, com o surgimento de novas tecnologias e de novos programas espaciais, a medicina aeroespacial ganhou destaque no meio científico uma vez que os estudos relacionados às alterações da fisiologia humana no espaço tornaram-se cada vez mais necessário para a manutenção da saúde de cosmonautas. Os olhos são considerados uma das estruturas mais sensíveis do corpo às alterações vasculares, estruturais e bioquímicas provocadas pela microgravidade e radiação cósmica. Nesse sentido, essa revisão narrativa busca identificar e explicar as principais alterações morfológicas e funcionais que ocorrem no sistema visual em decorrência de missões espaciais.

ABSTRACT At the end of the twentieth century, with the emergence of new technologies and new space programs, aerospace medicine gained prominence in the scientific community since studies related to changes in human physiology in space have become increasingly necessary for the maintenance of cosmonaut health. The eyes are considered one of the most sensitive structures in the body to vascular, structural and biochemical changes caused by microgravity and cosmic radiation. In this sense, this narrative review seeks to identify and explain the main morphological and functional changes that occur in the visual system as a result of space missions.

Uncommon progression of toxoplasmic papillitis: patient perception and case report / Papilite por toxoplasmose ocular com evolução incomum: percepção do paciente e relato de caso

ABSTRACT Ocular toxoplasmosis frequently presents as necrotizing retinochoroiditis and, less often, as peripapillary chorioretinitis and/or papillitis. The progression from papillitis to peripapillary retinochoroiditis has been rarely described. We report the case of a 52-year-old patient living in southern Brazil, who developed papillitis in the right eye and was treated with systemic corticosteroids (prednisone 0.6 mg/kg/day and pulse therapy with methylprednisolone 15 mg/kg/day, for 3 days). After 14 days, the patient developed peripapillary retinochoroiditis with vitritis and decreased visual acuity (20/60), and was immediately initiated on the classic oral treatment for toxoplasmosis, consisting of pyrimethamine (50 mg/day), sulfadiazine (4 g/day), folinic acid (15 mg every 3 days) and prednisone (0.6 mg/kg/day). The visual acuity of the right eye normalized after treatment (20/20), which lasted approximately 70 days, but scotomas were detected on visual field examination, especially in the lower nasal quadrant. Although two studies mentioned this presentation, our report emphasizes the possible manifestation of ocular toxoplasmosis as papillitis in the initial phase, with progression to peripapillary retinochoroiditis and permanent visual field defects, which justifies early treatment for toxoplasmosis in suspected cases, especially in endemic regions.

RESUMO A toxoplasmose ocular manifesta-se com maior frequência por um quadro de retinocoroidite necrotizante e, com menor frequência, por coriorretinite justapapilar e/ou papilite. A evolução de papilite para retinocoroidite justapapilar raramente foi descrita. Apresenta-se o relato de caso de uma paciente de 52 anos, habitante da Região Sul do Brasil, que iniciou com quadro de papilite em olho direito, sendo tratada com corticoides sistêmicos (prednisona 0,6/mg/kg ao dia e pulsoterapia com metilprednisolona 15mg/kg ao dia, por 3 dias), mas, após 14 dias, evoluiu para retinocoroidite justapapilar, com vitreíte e diminuição de acuidade visual (20/60), sendo imediatamente instituído o tratamento via oral clássico para toxoplasmose, com pirimetamina (50 mg ao dia), sulfadiazina (4 g ao dia) e ácido folínico (15 mg a cada 3 dias), e mantida a prednisona (0.6 mg/kg/dia). A acuidade visual do olho direito normalizou após o tratamento (20/20), que durou em torno de 70 dias, porém desenvolveu escotomas ao exame de campo visual, sobretudo de quadrante nasal inferior. Embora tenham sido encontrados dois trabalhos que mencionam essa forma de apresentação, o presente relato destaca-se por enfatizar a possibilidade de manifestação da toxoplasmose ocular por meio de papilite na fase inicial, que evolui com retinocoroidite justapapilar, causando defeito permanente de campo visual, justificando que se avalie a instituição de tratamento precoce para toxoplasmose dos casos suspeitos, sobretudo em região endêmica.

Optic disc drusen in children: a diagnostic challenge / Drusas de disco óptico em criança um desafio diagnóstico

Abstract In children, optic disc drusen (ODD) are often mistaken for papilledema, this being the prin-cipal differential diagnosis. This report describes the case of an 11-year old patient with ODD, in which the condition was initially diagnosed as papilledema, and the patient referred for pulse therapy. Fundoscopic examination is important because it is the first examination conducted by the ophthalmologist that is capable of revealing some characteristics of ODD that will aid in the differentiation between this disease and papilledema. In cases of ODD, the optic disc presents blurred margins and elevation of the disc borders, with clearly defined vessels at the papilla border. The differential diagnosis of ODD in children is challenging and requires appropriate management and follow-up to avoid iatrogenesis.

Resumo As drusas de disco óptico (DDO) em crianças são frequentemente confundidas com papiledema, sendo este o principal diagnóstico diferencial. Este artigo relata o caso de uma paciente de 11 anos com DDO, no qual o quadro foi inicialmente diagnosticado como papiledema, e a paciente encaminhada para pulsoterapia. O exame fundoscópico é importante por ser o primeiro exame realizado pelo oftalmologista que é capaz de revelar algumas características das DDO que auxiliarão na diferenciação do papiledema. Nos casos de DDO, o disco óptico apresenta margens mal definidas e bordas elevadas, com vasos na margem da papila bem definidos. O diagnóstico diferencial das DDO em crianças é desafiador e requer conduta e seguimento adequados para evitar iatrogenias.

Uso terapéutico de la hialuronidasa y la triamcinolona en el pseudotumor orbitario / Therapeutic use of hyaluronidase and triamcinolone in orbital pseudotumor

RESUMEN El origen del pseudotumor orbitario no es del todo conocido. Se admite su naturaleza inflamatoria granulomatosa e inespecífica en diferentes localizaciones. El pseudotumor orbitario se define como una respuesta inflamatoria celular pleomórfica, que está usualmente confinado a estructuras de la órbita y tiene una evolución limitada. En este trabajo se presenta una paciente femenina de 16 años, con diagnóstico de pseudotumor orbitario corroborado por biopsia y tomografía axial computarizada, refractaria al tratamiento con esteroides sistémicos, por lo que se decide iniciar con la aplicación de hialuronidasa y triamcinolona en el espacio peribulbar. Los casos agudos casi siempre responden rápidamente al tratamiento con cortocoesteroides, como prednisona, pero debemos tener en cuenta que existen pacientes que son refractarios al tratamiento, por lo que es necesario buscar procedimientos alternativos. Una opción es el uso de hialuronidasa para destruir las uniones extracelulares, y difundir un esteroide de manera local, como la triamcinolona, más efectiva dentro del tejido inflamatorio para provocar un efecto localizado de este. A los tres meses del tratamiento hubo una regresión total del cuadro en esta paciente(AU)

ABSTRACT The exact etiology of orbital pseudotumor is unknown, but its granulomatous unspecific inflammatory nature at various locations has been recognized. Orbital pseudotumor is defined as a cellular pleomorphic inflammatory response of limited evolution often confined to orbital structures. A case is presented of a female 16-year-old patient diagnosed with orbital pseudotumor confirmed by biopsy and computerized axial tomography, refractory to treatment with systemic steroids, due to which it is decided to start treatment with hyaluronidase and triamcinolone in the peribulbar space. Acute cases often respond fast to treatment with corticosteroids such as prednisone. It should be borne in mind that there are patients who are refractory to treatment for whom alternative treatments should be sought. An option is the use of hyaluronidase to destroy extracellular junctions and locally spread a steroid such as triamcinolone, most effectively within the inflammatory tissue to ensure its localized effect. Total regression of the patient's status was observed at three months of treatment(AU)

Coexistence of papilledema and pseudopapilledema after remission of idiopathic intracranial hypertension by bariatric surgery / Coexistência de papiledema e pseudopapiledema após remissão de hipertensão intracraniana idiopática por cirurgia bariátrica

ABSTRACT A 37-year-old woman complained of headaches following bilateral visual loss in the past two years. She was obese and had undergone bariatric surgery three months earlier, followed by a considerable weight loss. Neuro-ophthalmic examination revealed a bilateral swollen optic disk. After a computerized analysis of the visual fields and magnetic resonance imaging of the brain and orbits, a diagnosis of idiopathic intracranial hypertension was made. At six months after the bariatric surgery, the patient reported no further headaches and exhibited better findings on computerized analysis of visual fields. However, fundus examination revealed persistent mild papilledema in both eyes. Ocular B-scan ultrasonography showed bilateral optic disk drusen. This report highlights the coexistence of true papilledema and pseudopapilledema due to optic disk drusen, following remission of idiopathic intracranial hypertension after a bariatric surgery.

RESUMO Uma mulher de 37 anos queixou-se de cefaleia após perda visual bilateral nos últimos dois anos. Apresentava história de obesidade e havia sido submetida à cirurgia bariátrica três meses antes, seguida de considerável perda de peso. O exame neuro-oftálmico revelou um disco óptico inchado bilateral. Após uma análise computadorizada dos campos visuais e ressonância magnética do crânio e órbitas, foi feito um diagnóstico de hiper tensão intracraniana idiopática. Após seis meses da cirurgia bariátrica, a paciente não relatou mais cefaleia e foram descobertas melhoras na análise computadorizada dos campos visuais. No entanto, o exame de fundo de olho revelou papiledema leve persistente em ambos os olhos. A ultrassonografia ocular B-scan mostrou drusas do disco óptico bilateralmente. Este relato destaca a coexistência de papiledema verdadeiro e pseudopapiledema devido à drusa de disco óptico após remissão da hipertensão intracraniana idiopática após uma cirurgia bariátrica.

Clinical and Etiological Profile of Cerebral Venous Sinus Thrombosis

Introduction: Cerebral Venous Thrombosis is an importantcause of stroke in the young. The importance of recognisingthis condition is that it carries a good prognosis if recognisedand treated early. Study objective was to analyse the clinicaland etiological profile of Cerebral Venous Sinus Thrombosis.Material and Methods: Prospective cross sectional studyin patients attending OPD or emergency at a tertiary referralcentre in eastern Tamilnadu with history suggestive of CVTand in whom the diagnosis of CVT confirmed by imagingof brain (MRI and MRV) were included in the study aftermeeting the inclusion criteriaResult: Among the 33 patients included in the study, majorityaffected were young males, most common clinical presentationwas headache and most common sinus involved was superiorsagittal sinus. Pro thrombotic state was observed in 27% ofcases and alcohol addiction was found to highly prevalent inthe study population.Conclusion: Cerebral Venous Thrombois is found to besignificantly high in males and alcoholics. Compared to otherIndian studies there was not much disparity in clinical profileand risk factors.

Ultrastructural changes detected using swept-source optical coherence tomography in severe vitreopapillary traction: a case report / Alterações ultraestruturais detectadas pela tomografia de coerência óptica de fonte de varredura em tração vitreopapilar grave: relato de caso

ABSTRACT Vitreopapillary traction is an uncommon condition characterized by strong adhesion and the traction of the posterior hyaloid onto the optic disc and peripapillary retina, leading to optic disc elevation and visual loss. An 85-year-old man presented with a 6-month history of slow, progressive visual loss in the left eye along with optic disc edema. Swept-source optical coherence tomography B-scans revealed circumpapillary anterior-posterior persistent traction of dense vitreous strands onto the optic disc. Visual field examination demonstrated mild, generalized, diffuse sensitivity loss and blind-spot enlargement. A 25-gauge posterior vitrectomy was performed with posterior hyaloid separation from the optic disc, resulting in significant anatomical and visual improvement. In conclusion, swept-source optical coherence tomography aids in understanding the mechanism underlying visual loss in vitreopapillary traction. Moreover, posterior vitrectomy can effectively promote anatomical and visual improvements in these cases.

RESUMO A tração vitreopapilar é uma condição incomum caracterizada por forte adesão e tração da hialoide posterior no disco óptico e retina peripapilar, levando à elevação do disco óptico e à perda visual. Um homem de 85 anos apresentou uma história de 6 meses de perda visual lenta e progressiva no olho esquerdo, juntamente com edema do disco óptico. A tomografia de coerência óptica por fonte de varredura revelou tração persistente ântero-posterior peripapilar com traves vítreas densas sobre o disco óptico. Exame de campo visual demonstrou perda de sensibilidade difusa, generalizada, leve e aumento do ponto cego. Uma vitrectomia posterior de calibre 25 foi realizada com separação hialóide posterior do disco óptico, resultando em melhora anatômica e visual significativa. Em conclusão, a tomografia de coerência óptica por fonte de varredura auxilia na compreensão do mecanismo subjacente à perda visual na síndrome de tração vitreopapilar. Além disso, a vitrectomia posterior pode efetivamente promover melhorias visuais e anatômicas nesses casos.