Malaria retinopathy and cerebellitis in a 9-year-old boy in the United States.

Malarial retinopathy is characterized by retinal whitening, vessel change, and hemorrhages usually associated with a white center. We present the case of a 9-year-old boy who presented with a systemic Plasmodium falciparum infection, hemorrhagic cerebellitis and malarial retinopathy characterized by "fire flare" hemorrhages (scleral icterus with subconjunctival hemorrhages), Roth spot-like hemorrhages, and subhyaloid hemorrhage. To our knowledge, this is the first reported case of hemorrhagic cerebellitis secondary to P. falciparum infection in the United States.

Transarterial Onyx Embolization of an Orbital Solitary Fibrous Tumor.

Solitary fibrous tumor (SFT) is an uncommon mesenchymal neoplasm sometimes found in the orbit. We report a case of an aggressive orbital SFT with enlarged feeding vessels that was successfully resected immediately after transarterial embolization with Onyx (ethylene vinyl alcohol copolymer). To our knowledge, this is the first report showing the histopathology of Onyx embolization material in an orbital SFT.

Visual hallucinations (Charles Bonnet syndrome) associated with neurosarcoidosis.

The Charles Bonnet syndrome (CBS) refers to lucid and complex visual hallucinations in cognitively normal patients with acquired vision loss. It can be associated with any type of vision loss including that related to macular degeneration, corneal disease, diabetic retinopathy, and occipital infarct. Neurosarcoidosis, a multi-systemic inflammatory granulomatous disease affecting both the central and peripheral nervous systems, is rarely associated with CBS. We report a patient with biopsy-confirmed neurosarcoidosis who experienced visual hallucinations following the development of a right seventh-nerve palsy, right facial paresthesia, and bilateral progressive visual loss. This case highlights the importance of recognizing that the CBS can occur in visual loss of any etiology.

Late-onset Leber hereditary optic neuropathy.

BACKGROUND: While Leber hereditary optic neuropathy typically causes bilateral visual loss in the second through fourth decades, we highlight visual loss from Leber hereditary optic neuropathy in older patients to characterize the clinical features of this cohort. DESIGN: Retrospective case series. PARTICIPANTS: Patients seen between January 2003 and July 2012 at Baylor College of Medicine and between April 2010 and July 2012 at The Methodist Hospital in Houston, Texas. METHODS: Patients with visual loss from genetically confirmed Leber hereditary optic neuropathy were identified via retrospective chart review. MAIN OUTCOME MEASURES: Clinical courses of patients. RESULTS: Five patients with visual loss from genetically confirmed Leber hereditary optic neuropathy were greater than 60 years of age at the time of visual loss (range 62-70 years, mean 66.4 ± 3.0). CONCLUSION: This series reinforces the importance of including Leber hereditary optic neuropathy in the differential diagnosis of patients of any age with optic neuropathy.

A pox upon your house.

Herpes zoster ophthalmicus (HZO) is a common viral infectious disorder affecting the ophthalmic division of the trigeminal nerve. A small subset of HZO patients present with the ophthalmic symptoms, but without an accompanied rash, a condition described as Herpes zoster sine herpete. Although HZO is well known to be associated with other central nervous system abnormalities, encephalitis and cerebral infarction are atypical and uncommon. We report an unusual case of presumed unilateral Herpes zoster ophthalmicus sine herpete that presented with trigeminal pain and uveitis and then progressed to encephalitis and bilateral cerebral infarctions despite treatment with acyclovir and corticosteroids. The diagnosis of HZV was confirmed by polymerase chain reaction testing on the cerebrospinal fluid.

Neuroimaging in ophthalmology.

In the past three decades, there have been countless advances in imaging modalities that have revolutionized evaluation, management, and treatment of neuro-ophthalmic disorders. Non-invasive approaches for early detection and monitoring of treatments have decreased morbidity and mortality. Understanding of basic methods of imaging techniques and choice of imaging modalities in cases encountered in neuro-ophthalmology clinic is critical for proper evaluation of patients. Two main imaging modalities that are often used are computed tomography (CT) and magnetic resonance imaging (MRI). However, variations of these modalities and appropriate location of imaging must be considered in each clinical scenario. In this article, we review and summarize the best neuroimaging studies for specific neuro-ophthalmic indications and the diagnostic radiographic findings for important clinical entities.

Sub-tenon atracurium injection in rabbit eyes;a histopathologic study.

PURPOSE: To evaluate early and late histopathologic changes following posterior sub-Tenon injection of atracurium in the rabbit eye. METHODS: This study was performed on 39 healthy white New Zealand rabbits which received sub-Tenon injection of 0.05-0.08 mg/kg atracurium diluted in 0.5 ml normal saline (N/S) in the left and 0.5 ml N/S in the right eyes. Bilateral enuclation was performed one hour after the injection to evaluate early changes in 19 rabbits and one week later to determine late changes in the remaining 20 animals. After enucleation, the rabbits were euthanized. Enucleated eyes were sent in 10% formalin solution for histopathologic examination. After processing, the specimens were evaluated by light microscopy following staining with hematoxylin and eosin, and trichrome. RESULTS: Congestion was more common in the control group 1 hour after injection.Liquifaction necrosis was seen in both groups but was significantly increased one week after the injection in the atracurium group. CONCLUSION: Congestion is a transient complication related to injection which disappears after one week, but necrosis seems to be an important late complication of atracurium injection.