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1.
Ophthalmic Plast Reconstr Surg ; 38(3): e65-e67, 2022.
Article in English | MEDLINE | ID: covidwho-1691764

ABSTRACT

A young, morbidly obese woman with recent SARS-CoV-2 infection requiring hospitalization presented with visual and neurologic complications secondary to bilateral cerebral venous sinus thromboses. With elevated intracranial pressure and severe papilledema, she rapidly progressed to complete bilateral vision loss despite anticoagulation, therapeutic lumbar punctures with lumbar drain, bilateral optic nerve sheath fenestrations, and endovascular thrombectomy. It is possible that obese patients with a SARS-CoV-2 infection may be at greater risk of hypercoagulable cerebrovascular complications. It is impossible to know if an even more rapid response would have led to a different outcome, but we report this case in the hope that publishing this and similar cases may result in improved treatment protocols to preserve vision.


Subject(s)
COVID-19 , Obesity, Morbid , Papilledema , Sinus Thrombosis, Intracranial , Blindness/complications , Blindness/etiology , COVID-19/complications , Female , Humans , Obesity, Morbid/complications , Papilledema/diagnosis , Papilledema/etiology , SARS-CoV-2 , Sinus Thrombosis, Intracranial/complications , Sinus Thrombosis, Intracranial/diagnosis , Vision Disorders/etiology
2.
Medicine (Baltimore) ; 101(2): e28582, 2022 Jan 14.
Article in English | MEDLINE | ID: covidwho-1625304

ABSTRACT

RATIONALE: Multiple evanescent white dot syndrome (MEWDS) is an acute, usually unilateral, retinal disorder of unknown etiology that predominantly occurs in healthy young women. We report a case of bilateral asymmetric MEWDS that developed following the first vaccination for coronavirus-19 and worsened after a second vaccination. PATIENT CONCERNS: A 30-year-old Japanese woman was examined in an eye clinic for blurred vision in her left eye for 1 week duration. Thirteen days before her examination, she had received her first BNT162b2 mRNA SARS-CoV-2 vaccination. Her best-corrected visual acuity was 20/20 in both eyes. Fundus examination revealed multiple yellowish-white spots in the perifoveal area of both eyes. Visibility of the spots gradually decreased during the following week. She was then vaccinated with a second dose, and 3 days later, her vision worsened in her left eye. She was then referred to our hospital because of worsened vision and the appearance of white spots on other parts of the retina. Ophthalmological examination revealed a best-corrected visual acuity of 30/20 both eyes. DIAGNOSIS: The flare value in the anterior chamber was elevated in both the eyes. Fundus examination showed multiple white spots in the perifoveal area of both eyes, but they were more prominent in the left eye. Fundus fluorescein angiography revealed early hyperfluorescent spots located circumferentially around the fovea in both eyes. We concluded that the patient had MEWDS, which was most likely due to mRNA COVID-19 immunization. INTERVENTIONS: The patient was treated with topical betamethasone sodium phosphate/fradiomycin sulfate 0.1% thrice daily for 2 months. OUTCOMES: Two months after treatment, her blurry vision resolved with the disappearance of the fundus lesions. LESSON: Clinicians should be aware of potential adverse ocular events following similar vaccinations.


Subject(s)
/adverse effects , COVID-19/prevention & control , Vision Disorders/etiology , White Dot Syndromes/chemically induced , Adult , COVID-19 Vaccines/administration & dosage , Female , Fluorescein Angiography , Humans , RNA, Messenger , SARS-CoV-2 , Vaccination/adverse effects
3.
Eur J Neurol ; 28(10): 3289-3302, 2021 10.
Article in English | MEDLINE | ID: covidwho-1605352

ABSTRACT

BACKGROUND AND PURPOSE: The full spectrum of neurological sequelae in COVID-19 is beginning to emerge. SARS-CoV-2 has the potential to cause both direct and indirect brain vascular endothelial damage through infection and inflammation that may result in long-term neurological signs and symptoms. We sought to illuminate persistent neuro-ophthalmological deficits that may be seen following posterior reversible encephalopathy syndrome (PRES) due to COVID-19. METHODS: We identified three individuals with PRES due to COVID-19 in our hospital system. One patient was identified on presentation to our neuro-ophthalmology clinic. The other patients were identified through internal records search. These cases were compared to published reports of PRES in COVID-19 identified through systematic literature search of PubMed/LitCOVID. RESULTS: All three patients were hospitalized with severe COVID-19 and developed altered mental status with new onset seizures that led to the recognition of PRES through diagnostic imaging. During recovery, two patients had persistent visual dysfunction including visual field deficits. One patient also experienced hallucinatory palinopsia and visual hallucinations. Literature search identified 32 other cases of PRES in the context of COVID-19. Visual disturbances were described in 14 cases (40%), with only seven cases (50%) reporting full recovery by the time of publication. CONCLUSIONS: As we learn about enduring neurological complications of COVID-19, it is possible that complications may be underrecognized and underreported. Understanding the range of complications can help in postcare evaluation and management changes in the critical care setting to potentially allow intervention before persistent deficits occur due to COVID-19.


Subject(s)
COVID-19 , Posterior Leukoencephalopathy Syndrome , Critical Care , Humans , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , SARS-CoV-2 , Vision Disorders/etiology
4.
Ophthalmic Plast Reconstr Surg ; 38(3): 242-249, 2022.
Article in English | MEDLINE | ID: covidwho-1593635

ABSTRACT

PURPOSE: To correlate the clinical, radiological, and histopathological features in Covid-associated Rhino-orbito-cerebral mucormycosis cases presenting with acute visual loss. DESIGN: Cross-sectional study. METHODS: Covid-associated Rhino-orbito-cerebral mucormycosis cases with unilateral visual loss, planned for exenteration, underwent orbital and ophthalmological ocular examination. The available radiological sequences, doppler ultrasonography and histopathology findings were correlated with clinical manifestations. RESULTS: The median age was 51 years and the male: female ratio was 3:1. All except one presented with unilateral ophthalmoplegia. The ocular media were hazy in 2 eyes. In 8 eyes, retinal changes were suggestive of occlusion of CRA (6), combined occlusion of CRA and central retinal vein (1), and myopic degeneration with hypertensive retinopathy (1). The contralateral eye showed retinal ischemic changes in one patient. Radiological imaging showed orbital apex involvement in the 10 affected eyes and one contralateral eye. Ipsilateral cavernous sinus thrombosis, diffusion restriction on MRI of optic nerve, internal carotid artery narrowing/thrombosis, and cortical watershed infarcts were seen in 8, 4, 4, and 2 cases, respectively. The blood flow in CRA and ophthalmic artery was absent or reduced in all the 10 affected eyes and in 1 contralateral eye. On histopathology, orbital fat necrosis, fungal hyphae, acute inflammation, granuloma formation, ischemic thrombosis of ophthalmic artery was observed in 10 specimens. CRA was patent in 9 and thrombosed in 1 eye. Optic nerve was ischemic in 8 and viable in 2 eyes. CONCLUSION: Acute visual loss in ROCM cases is associated with orbital apex involvement and thrombotic ischemia of ophthalmic artery. Cessation of flow in CRA possibly occurs secondary to ophthalmic artery thrombosis.


Subject(s)
COVID-19 , Eye Infections, Fungal , Mucormycosis , Orbital Diseases , COVID-19/complications , Cross-Sectional Studies , Eye Infections, Fungal/complications , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/microbiology , Female , Humans , Male , Middle Aged , Mucormycosis/complications , Mucormycosis/diagnosis , Mucormycosis/microbiology , Orbital Diseases/etiology , Orbital Diseases/microbiology , Vision Disorders/diagnosis , Vision Disorders/etiology
7.
Semin Pediatr Neurol ; 40: 100922, 2021 12.
Article in English | MEDLINE | ID: covidwho-1386629

ABSTRACT

Primary intracranial hypertension (PIH) is characterized by clinical signs of increased intracranial pressure, papilledema, elevated opening pressure, and absence of mass lesion, hydrocephalus, or meningeal enhancement on neuroimaging. Visual changes are a common presenting feature and if untreated there is risk of irreversible vision loss. There have been recent proposed changes to the criteria for PIH along with studies looking at the differences in imaging characteristics between adult and pediatric PIH. The presence of transverse sinus stenosis alone was highly sensitive and specific for pediatric PIH. The Idiopathic Intracranial Hypertension Treatment Trial was an adult, multicenter study that examined the use of acetazolamide and weight loss on the course of PIH. The study confirmed many previously held beliefs including the most common presenting symptom in PIH is headache. Most patients present with bilateral papilledema with 58.2% of patients having symmetric Frisen scale grading and within one grade in 92.8%. Although diplopia is a common reported symptom, very few have evidence of cranial nerve palsy. Male gender, high-grade papilledema, and decreased visual acuity at presentation are risk factors for treatment failure. Acetazolamide use is associated with mild metabolic acidosis. During acetazolamide treatment, monitoring for hypokalemia or aplastic anemia is not recommended. Monitoring transaminases in the titration phase of treatment should be considered due to a case of transaminitis and pancreatitis with elevated lipase. Newer case reports have also seen associations of secondary intracranial hypertension with concurrent COVID-19 infection and MIS-C.


Subject(s)
Acetazolamide/administration & dosage , COVID-19/diagnosis , Carbonic Anhydrase Inhibitors/administration & dosage , Headache/diagnosis , Intracranial Hypertension , Papilledema/diagnosis , Vision Disorders/diagnosis , Weight Loss , Acetazolamide/adverse effects , Adolescent , Adult , COVID-19/complications , Carbonic Anhydrase Inhibitors/adverse effects , Child , Combined Modality Therapy , Diagnosis, Differential , Female , Headache/etiology , Humans , Intracranial Hypertension/complications , Intracranial Hypertension/diagnosis , Intracranial Hypertension/therapy , Magnetic Resonance Imaging , Male , Middle Aged , Multicenter Studies as Topic , Papilledema/etiology , Pseudotumor Cerebri/complications , Pseudotumor Cerebri/diagnosis , Pseudotumor Cerebri/etiology , Pseudotumor Cerebri/therapy , Randomized Controlled Trials as Topic , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosis , Tomography, Optical Coherence , Vision Disorders/etiology , Young Adult
11.
Inflamm Res ; 70(9): 931-933, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1258184

ABSTRACT

Long-term and rare adverse effects of COVID-19 vaccines are unknown. Hence, it is important to report them to improve the safety profile of the vaccines and enhance their use worldwide. Here, we describe a case of acute visual impairment after Pfizer-BioNTech vaccine second dose.


Subject(s)
COVID-19 Vaccines/adverse effects , Vision Disorders/etiology , Visual Acuity/drug effects , Visual Fields , Humans , Male , Middle Aged , Vaccination/adverse effects
12.
Indian J Ophthalmol ; 69(6): 1625-1627, 2021 06.
Article in English | MEDLINE | ID: covidwho-1236852

ABSTRACT

A 40-year-old woman presented with headache, bilateral optic disc edema, and visual loss. She had been diagnosed with COVID-19 (coronavirus disease 2019) 15 days ago. Her cerebrospinal fluid opening pressure was 410 mmH2O, and cranial imaging was normal. She had obesity as a risk factor but had not experienced any ophthalmic complaints before. COVID-19 could be a causative or precipitating factor for intracranial hypertension especially in high-risk groups even in the late phases of the disease and has not been discussed in the literature as such. This should be studied further and kept in mind to prevent permanent loss of vision.


Subject(s)
COVID-19 , Intracranial Hypertension , Papilledema , Adult , Female , Humans , Intracranial Hypertension/complications , Intracranial Hypertension/diagnosis , Papilledema/diagnosis , Papilledema/etiology , SARS-CoV-2 , Vision Disorders/diagnosis , Vision Disorders/etiology
13.
J Neuroophthalmol ; 41(2): 166-169, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1231059

ABSTRACT

OBJECTIVES: Affection of the central nervous system and the eyes is increasingly recognized as manifestations of a SARS-CoV-2 infection (COVID-19). This review aims at summarizing and discussing recent advances concerning causes and locations of impaired vision because of an infection with SARS-CoV-2. METHODS: On a literature search through PubMed and ScholarOne, all available publications about COVID-19 patients with impaired vision were retrieved. RESULTS: Visual impairment in SARS-CoV-2-infected patients may be due to infection of lacrimal glands (dacryoadenitis), conjunctivitis, tonic pupils, vitritis, central retinal artery/venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy, optic nerve stroke, optic neuritis, optic perineuritis, or occipital ischemic stroke. Visual impairment may be the initial manifestation of SARS-CoV-2. CONCLUSIONS: This mini review shows that impaired vision may be the initial manifestation of COVID-19, that all sections of the visual tract may be affected and causative for visual impairment in COVID-19 patients, and that SARS-CoV-2 manifests along the visual tract with ischemia, focal infection, and immunological reactions.


Subject(s)
COVID-19/complications , Vision Disorders/etiology , COVID-19/epidemiology , Humans , Incidence , Pandemics , SARS-CoV-2 , Vision Disorders/epidemiology
14.
J Clin Neurosci ; 88: 108-112, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1174389

ABSTRACT

The novel human coronavirus disease (COVID-19) has been associated with vascular and thrombotic complications, some of which may result from endothelial dysfunction, including the posterior reversible encephalopathy syndrome (PRES). We report a case series of 8 patients with COVID-19 and PRES diagnosed at two academic medical centers between March and July of 2020. The clinical, laboratory and radiographic data, treatment, and short-term outcomes were retrospectively analyzed. The mean age was 57.9 ± 12 years, and 50% were women. Four patients had previous vascular comorbidities. All the patients suffered from severe pneumonia, requiring intensive care unit admission. Five patients were not hypertensive at presentation (all SBP < 127 mmHg). Neurologic symptoms included seizures in 7 patients; impaired consciousness in 5 patients; focal neurological signs in 3 patients; and visual disturbances in 1 patient. All patients underwent brain magnetic resonance imaging which indicated asymmetric T2 prolongation or diffusion changes (50%), extensive fronto-parieto-occipital involvement (25%), vascular irregularities (12.5%) and intracranial hemorrhage (25%). Four patients were treated with tocilizumab. Three patients were discharged without neurologic disability, 2 patients had persistent focal neurologic deficits and 2 expired. One patient's prognosis remains guarded. Together, these data support the relationship between PRES and endothelial dysfunction associated with severe COVID-19. In patients with severe COVID-19, PRES can be triggered by uncontrolled hypertension, or occur independently in the setting of systemic illness and certain medications. Like other infectious processes, critically ill patients with COVID-19 may be at greater risk of PRES because of impaired vasoreactivity or the use of novel agents like Tocilizumab.


Subject(s)
COVID-19/complications , Posterior Leukoencephalopathy Syndrome/etiology , Adult , Aged , Brain/diagnostic imaging , Comorbidity , Consciousness Disorders/etiology , Critical Care/statistics & numerical data , Critical Illness , Cytokine Release Syndrome/epidemiology , Cytokine Release Syndrome/etiology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Pneumonia/etiology , Pneumonia/therapy , Retrospective Studies , Seizures/etiology , Vision Disorders/etiology
16.
Clin Neurol Neurosurg ; 201: 106440, 2021 02.
Article in English | MEDLINE | ID: covidwho-1059540

ABSTRACT

BACKGROUND AND IMPORTANCE: Additional time is needed to determine the exact impact of COVID-19 on acute cerebrovascular disease incidence, but recently published data has correlated COVID-19 to large vessel occlusion strokes. CLINICAL PRESENTATION: We report the first case of central retinal artery occlusion (CRAO) as the initial manifestation of COVID-19 infection. Subsequent neuroimaging revealed a large thrombus extending into the internal carotid artery. CONCLUSION: This case illustrates the need to suspect COVID-19 infection in patients presenting with retinal arterial occlusion, including individuals who are asymptomatic or minimally symptomatic for COVID-19 infection.


Subject(s)
COVID-19/diagnostic imaging , Retinal Artery Occlusion/diagnostic imaging , Vision Disorders/diagnostic imaging , Vision, Monocular/physiology , COVID-19/complications , Diagnosis, Differential , Humans , Male , Middle Aged , Retinal Artery Occlusion/etiology , Vision Disorders/etiology
17.
Neurosci Lett ; 742: 135531, 2021 01 18.
Article in English | MEDLINE | ID: covidwho-966786

ABSTRACT

Multiple neuro-ophthalmological manifestations have been described in association with COVID-19. These symptoms and signs may be the result of a range of pathophysiological mechanisms throughout the course from acute illness to recovery phase. Optic nerve dysfunction, eye movement abnormalities and visual field defects have been described.


Subject(s)
COVID-19/complications , Cytokine Release Syndrome/etiology , Nervous System Diseases/etiology , Vision Disorders/etiology , COVID-19/diagnosis , COVID-19/metabolism , Cytokine Release Syndrome/diagnosis , Cytokine Release Syndrome/metabolism , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/metabolism , Vision Disorders/diagnosis , Vision Disorders/metabolism
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