Uveitis associated with Primary Angiitis of the Central Nervous System.

BACKGROUND: In Primary Angiitis of the Central Nervous System (PACNS), disease is typically limited to the brain and spinal cord although other organs may be affected. Uveitis is occasionally seen in systemic vasculitides but is not a recognized manifestation of PACNS. We describe two patients who developed PACNS following the onset of uveitis. CASE DESCRIPTIONS: Case 1--a 47-year-old male suffered multiple TIAs and left pontine stroke shortly after two episodes of diffuse uveitis. A cerbral angiogram demonstrated multiple caliber changes within several intracranial vessels. Cyclophosphamide was added after his stroke occurred during pulse methylprednisolone therapy. Case 2--a 35-year-old male suffered a spinal cord TIA followed by hemispheric and brainstem infarctions two months after an episode of uveitis and Bell's palsy treated with oral prednisone. A cerebral angiogram demonstrated multiple caliber changes within several intracranial vessels. He was successfully treated with oral prednisone and cyclophosphamide. CONCLUSIONS: Uveitis should be considered a recognized feature of PACNS. Combination immunosuppressive therapy with prednisone and cyclophosphamide may be necessary for successful treatment.

Permanent vision loss in one eye following administration of local anesthesia for a dental extraction.

Prilocaine Plain, an amide local anesthetic (LA), is somewhat less potent than lidocaine and considerably less toxic after injection into peripheral tissues. Clinically, it produces less vasodilation and is similar to other amide LA in relative freedom from allergic reactions. It is reliably used in a plain solution for cardiac patients receiving short procedures. In this report a patient with a known diagnosis of bacterial endocarditis suffered permanent visual loss in the left eye immediately following dental extraction surgery prior to mitral valve surgery. The clinical implications indicate that the delivery of LA must be done with aspiration before and during the injection. This will possibly prevent intravascular injection, which can lead to fluid emboli occluding the ophthalmic artery with the devastating result of vision loss.

Co-occurrence of multiple sclerosis and myasthenia gravis in British Columbia.

We describe eight patients with associated multiple sclerosis (MS) and myasthenia gravis (MG). Patients were less than 50 years old at the time of onset, and seven were female. The clinical course of both MS and MG was mild in most patients. To our knowledge, this represents the largest reported series. We provide further evidence for a nonrandom association of these two diseases and discuss common mechanisms of pathogenesis.

Optic disk edema associated with peripapillary serous retinal detachment: an early sign of systemic Bartonella henselae infection.

PURPOSE: To describe optic disk edema associated with peripapillary serous retinal detachment as an early sign of systemic Bartonella henselae infection. METHODS: Multicentered, retrospective case series. RESULTS: Five women and two men presented with optic disk edema producing peripapillary serous retinal detachment. Each patient had a markedly elevated serum anti-B. henselae antibody titer. Patient age ranged from 11 to 44 years, with a mean and median of 26.6 and 28 years, respectively. The time from the onset of systemic symptoms to the onset of visual symptoms varied from 3 days to 1 month. The peripapillary serous retinal detachment resolved within 1 to 3 weeks in each case, producing a macular star in four of seven patients. Initial vision was 20/200 or worse in five of seven patients and improved in four of these five patients to 20/30 or better. CONCLUSIONS: Systemic B. henselae infection should be considered in patients who develop optic disk edema associated with a peripapillary serous retinal detachment, even in the absence of classic neuroretinitis with a macular star.

Creation and testing of a practical visual function assessment for use in Africa: correlation with visual acuity, contrast sensitivity, and near vision in Malawian adults.

AIM: To develop and test a practical visual function assessment for use in developing countries. METHODS: Using focus group discussions and interviews with eyecare workers and low vision specialists in Malawi, 13 questions related to visual characteristics of activities of daily living were designed. Patients presenting to an eye clinic were recruited and interviewed. Visual acuity, near vision, and contrast sensitivity were measured. Analysis sought to determine the degree of correlation between the vision indices and visual function. RESULTS: The visual function questionnaire was easy to administer. Visual function correlated with visual acuity, contrast sensitivity, near vision, and patient reported visual problem. People with a higher frequency of "not applicable" responses had lower visual function scores. Multivariate modelling revealed that visual acuity and number of questions felt to be applicable were independently associated with visual function. Reducing the questionnaire to nine questions did not affect the degree of correlation with any of the visual indices. CONCLUSION: The authors' visual function assessment correlates well with different measures of visual acuity. People with reduced vision for a prolonged period may no longer consider doing certain tasks and the number of questions considered appropriate by an individual may be an additional measure of visual function. Assessment of visual function by health workers may be a valuable tool in improving surgical uptake by encouraging both health personnel and patients to recognise that they have difficulties undertaking activities of daily living as well as a measure of monitoring and evaluating cataract outcomes.

POEMS syndrome: an unusual cause of bilateral optic disk swelling.

PURPOSE: To alert ophthalmologists to POEMS syndrome as an unusual cause of optic disk swelling. METHOD: Case report. A 25-year-old white woman developed scotomata and optic disk swelling, and systemic signs and symptoms of POEMS syndrome. RESULTS: Bone marrow biopsy disclosed multiple myeloma. Despite treatment with corticosteroids, radiation, and marrow transplantation, the patient died from multi-organ failure. CONCLUSION: Because POEMS syndrome typically affects older male patients, this is an unusual case of multiple myeloma in conjunction with POEMS syndrome.