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Case Reports in Ophthalmology ; 13(1):185-190, 2022.
Article in English | ProQuest Central | ID: covidwho-1823840


Coronavirus disease-19 (COVID-19) patients are at an increased risk of cerebral venous sinus thrombosis (CVST). Rapid diagnosis and treatment are vital to ensure a favorable outcome for CVST, so clinicians need to be aware of all its potential presentations. We describe a unique case where transient visual obscurations (TVOs) from papilledema were the presenting symptoms of COVID-19-related CVST. A 43-year-old woman, who had tested positive for severe acute respiratory syndrome coronavirus-2 1 month earlier, developed holocephalic headache, TVOs, and bilateral disc edema. She did not seek medical attention until she developed TVOs. Visual acuity was 20/20 and Humphrey visual field testing showed enlarged blind spots in both eyes. She was diagnosed with papilledema and underwent magnetic resonance imaging and magnetic resonance venography of the brain, which revealed right transverse sinus thrombosis. Lumbar puncture was performed, showing elevated opening pressure and normal cerebrospinal fluid contents. Her optic disc edema resolved and visual function remained normal 6 weeks following warfarin and topiramate therapy. Recanalization of the right transverse sinus occurred after 3 months. Although rare, TVOs are important presenting symptoms of COVID-19-related CVST. Ophthalmologists, who may be the first physicians to assess patients with this presentation, should be aware of TVOs as potential presenting symptoms of CVST, so diagnoses can be made in a timely manner.

Can J Neurol Sci ; : 1-2, 2021 Jul 29.
Article in English | MEDLINE | ID: covidwho-1331345
Can J Neurol Sci ; : 1-2, 2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1267979
J Neuroophthalmol ; 41(4): e761-e763, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1232245


ABSTRACT: It is recommended that every patient with a new third nerve palsy undergo urgent neuroimaging (computed tomography angiography or magnetic resonance angiography) to exclude a posterior communicating artery aneurysm. Because of the novel coronavirus (COVID-19) pandemic, our institution noted a significant decline in the number of patients with aneurysmal subarachnoid hemorrhage presenting to the hospital. We report one such example of a patient who developed new-onset severe headache and vomiting and did not seek medical attention because of COVID-19. Two months later, she was noted to have ptosis during a routine follow-up and was found to have a complete, pupil-involving third nerve palsy. Computed tomography angiography was performed and revealed an irregular bilobed saccular aneurysm (7 × 9 × 5 mm) of the right posterior communicating (PComm) artery, but no acute hemorrhage was visible on CT. On MRI, immediately adjacent to the aneurysm, there was a small subacute hematoma in the right medial temporal lobe with surrounding vasogenic edema. This case had a fortunate and unique outcome as she had a contained hematoma adjacent to the ruptured PComm aneurysm and did not experience severe morbidity from the subarachnoid hemorrhage nor did she rebleed in the interval in which she did not seek care. This case highlights the importance of providing neuro-ophthalmic care even during a pandemic.

Aneurysm, Ruptured/diagnostic imaging , COVID-19/complications , Intracranial Aneurysm/diagnostic imaging , Oculomotor Nerve Diseases/diagnostic imaging , Aged , Aneurysm, Ruptured/complications , Cerebral Angiography , Female , Humans , Intracranial Aneurysm/complications , Magnetic Resonance Angiography , Oculomotor Nerve Diseases/complications
Can J Neurol Sci ; 47(5): 598-603, 2020 09.
Article in English | MEDLINE | ID: covidwho-325627


OBJECTIVE: To outline features of the neurologic examination that can be performed virtually through telemedicine platforms (the virtual neurological examination [VNE]), and provide guidance for rapidly pivoting in-person clinical assessments to virtual visits during the COVID-19 pandemic and beyond. METHODS: The full neurologic examination is described with attention to components that can be performed virtually. RESULTS: A screening VNE is outlined that can be performed on a wide variety of patients, along with detailed descriptions of virtual examination maneuvers for specific scenarios (cognitive testing, neuromuscular and movement disorder examinations). CONCLUSIONS: During the COVID-19 pandemic, rapid adoption of virtual medicine will be critical to provide ongoing and timely neurological care. Familiarity and mastery of a VNE will be critical for neurologists, and this article outlines a practical approach to implementation.

Betacoronavirus , Coronavirus Infections/therapy , Neurologic Examination/standards , Pneumonia, Viral/therapy , Practice Guidelines as Topic/standards , Telemedicine/standards , Video Recording/standards , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Neurologic Examination/methods , Neurologists/standards , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/methods