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Optic Neuropathies Associated with Systemic Disorders And Radiation-Induced Optic Neuropathy
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
GCA is a systemic vasculitis affecting large to medium-sized arteries. This disease shows preferential involvement of the ophthalmic artery and its branches, including the posterior ciliary arteries and the central retinal artery. Pathologically, GCA is characterized by granulomatous inflammation and narrowing (or occlusion) of extradural arteries with an internal elastic lamina (11–13). Giant cell arteritis is diagnosed predominantly in elderly adults, with cases under the age of 50 years being rare, and the incidence increasing with advancing age (13). The diagnosis is more common in females, with a threefold relative risk in women compared to men (13). Of note, GCA is more likely to affect Caucasians relative to other ethnic groups (13).
Arteropathies, Microcirculation and Vasculitis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Giant cell arteritis is the commonest vasculitis affecting patients over 50 years of age who develop a high erythrocyte sedimentation rate (ESR). The terms ‘temporal’ and ‘cranial’ arteritis should be avoided since it is usually more diffuse. Giant cell arteritis is a vasculitis that involves medium- and large-sized vessels. Typically presenting with localized headache, temporal artery tenderness, jaw claudication and ophthalmological complications, it can also affect large vessels, leading aorta and pulmonary vessels. There is focal granulomatous inflammation with giant cell at the internal elastic lamina which can be confirmed by temporal artery biopsy (Fig. 11.6). Chronic inflammation of the small vessels external to the temporal artery adventitia, including veins and vasa vasorum can occur in this condition.11 It is often associated with polymyalgia rheumatica. The major complications are blindness (from retinal artery involvement) and cerebral infarction. There is usually a good clinical response to steroids.
Diabetic Neuropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Vision loss with both forms of ischemic optic neuropathy usually occurs quickly over minutes to days, and is painless. With giant cell arteritis, additional symptoms include general malaise, headaches over the temples, muscle aches and pains, jaw claudication, pain when combing the hair, and tenderness over the temporal artery. These symptoms sometimes do not occur until vision is already lost. There is reduced visual acuity and an afferent pupillary defect. The optic disk swells and becomes elevated. Swollen nerve fibers obscure the thin surface vessels of the optic nerve. Hemorrhages may surround the optic disk in many cases. The disk is often pale in the arteritic form, but hyperemic in the nonarteritic form. With both forms, a visual field examination often reveals a central defect, an altitudinal defect, or both.
Causes and Outcomes of Patients Presenting with Diplopia: A Hospital-based Study
Published in Neuro-Ophthalmology, 2021
Nitin Kumar, Savleen Kaur, Srishti Raj, Vivek Lal, Jaspreet Sukhija
In our study cohort, out of 160 patients, 153 patients were managed medically (95.6%) and seven (4.3%) patients had surgical intervention. Medical management included counselling, fogged glasses, multi-vitamin tablets, and oral and intravenous corticosteroids. Corticosteroids were administered in patients with giant cell arteritis and orbital apex syndrome. Four patients were managed with prism correction and one patient was advised to use an aphakic contact lens for correction of diplopia. Corrective surgery in the form of anterior transposition of the inferior oblique muscle was performed in four patients (all diagnosed with superior oblique palsy), Knapp’s procedure was done in one patient and two patients underwent orbital floor repair. In patients who underwent corrective surgery, diplopia resolved in three but remained after surgery in four.
Is Kimura’s disease associated with juvenile temporal arteritis? A case report and literature review of all juvenile temporal arteritis cases
Published in Modern Rheumatology Case Reports, 2021
Takafumi Tomizuka, Hirotoshi Kikuchi, Kurumi Asako, Daisuke Tsukui, Yoshitaka Kimura, Yoshinao Kikuchi, Yuko Sasajima, Hajime Kono
A biopsy of the left temporal artery revealed eosinophil infiltration in all layers of the arterial wall, accompanied by stenosis of the lumen due to intimal thickening, thrombus formation, and fibrinoid degeneration. Capillary hyperplasia and fibrosis were seen around the artery, and eosinophil infiltration was observed. No morphological difference in eosinophils was observed between the Kimura’s disease lesion and the JTA lesion by optical microscopy. No granulomas were noted, but a few multinucleated giant cells were focally observed (Figure 4). IgG4-related disease was excluded by IgG4 staining. These findings are consistent with the diagnosis of JTA, although some multinucleated giant cells were observed. The patient was not diagnosed with giant cell arteritis because of the absence of systemic symptoms and increase in erythrocyte sedimentation rate; moreover, our histological findings did not match with those reported by Wakugawa et al. [5]. The patient was treated with 30 mg/day prednisolone followed by gradual tapering, which led to a decrease in size of the masses of the posterior auricle. No recurrence of JTA has been detected for 2 years to date.
Ocular Involvement in Systemic Lupus Erythematosus: The Experience of Two Tertiary Referral Centers
Published in Ocular Immunology and Inflammation, 2018
Rosanna Dammacco, Pasquale Procaccio, Vito Racanelli, Angelo Vacca, Franco Dammacco
The second patient experienced a central retinal artery occlusion (CRAO), an emergency condition that is considered the ocular analogue of cerebral stroke52 and has been described as possible initial manifestation of SLE.45,53 At the time of the first diagnosis of a severely active SLE, she complained of headache and dizziness associated with rapidly increasing, painless vision loss in her right eye, which eventually resulted in hand motion as BCVA. No signs and symptoms of giant cell arteritis of the temporal artery (such as fever, malaise, temporal tenderness, jaw claudication, shoulder and pelvic girdle pain) were present. Fundus examination was normal in the left eye, whereas retinal artery attenuation and whitening of the retina with a cherry-red spot in the fovea were observed in the right eye. SD-OCT of the same eye revealed marked edema of the macula and a delay in arterial filling at the early to late phase, but no emboli were detected by FFA. Cherry-red spots and a ground-glass retina became visible the next morning.