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Neuropathology Of Neuro-Ophthalmic Disorders
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Sarcoidosis is a systemic granulomatous disease of unknown etiology. The organs primarily involved in this disease are lungs and hilar lymph nodes, but any organ or system may be affected. The ophthalmic involvement by sarcoidosis may occur as part of neuro-sarcoidosis,8 although isolated orbital sarcoidosis has been rarely reported. Any structure within and around the eye can be involved independently.9–11 The neuro-sarcoidosis mainly presents as cranial neuropathy and involvement of basal meninges, and hypothalamus may also be noted. Uncommon manifestation of neurosarcoidosis such as a combination of cranial and extracranial structures are described in some patients.12 The optic neuropathy is seen in the form of optic nerve swelling, disc edema or optic atrophy. Additionally, posterior uveitis and periphlebitis are noticed in sarcoid optic neuropathy. Histologically, sarcoidosis shows well-formed epithelioid cell granulomas without significant lymphoid cuffing. The granulomas are discrete and devoid of caseation necrosis (Figure 25.6). The granulomas are associated with both Langhan's and foreign body type giant cells. The asteroid and Schaumann bodies may be present in giant cells but are not characteristic for diagnosis. It is essential to exclude any infective pathology particularly tuberculous (TB)/fungal granuloma, especially in cases with isolated orbital sarcoidosis.
Homonymous Hemianopia
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Visual field defects are common in patients with optic atrophy irrespective of the underlying cause. Following papilloedema, for example, it is common to find that the blind spot is enlarged and the peripheral field of vision has constricted; a condition like retinitis pigmentosa may also be associated with marked constriction of visual field. In organic diseases, constricted visual field enlarges as the distance between the test object and the patient increases. If the constriction of visual field does not change with the distance of the visual test stimulus from the eye, it is often referred to as 'tunnel vision'. Tunnel vision may be seen in conditions like hysteria where there are no abnormal findings on fundoscopy.
Ophthalmology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
These are rare hereditary neurological disorders with optic atrophy that usually present during the first decade of life. They may be Behr (recessive), Friedreich ataxia (recessive), Charcot–Marie–Tooth disease (dominant, X-linked), adrenoleukodystrophies (two types – X-linked recessive and autosomal recessive) or cerebellar ataxia type I (dominant).
Bilateral Vision Loss and Visual Hallucinations in Subacute Sclerosing Panencephalitis: A Case Report
Published in Neuro-Ophthalmology, 2023
Ravi Uniyal, Ravindra Kumar Garg, Hardeep Singh Malhotra, Neeraj Kumar, Shweta Pandey, Imran Rizvi, Amita Jain, Nidhi Tejan, Rupesh Singh kirar
Bilateral acute vision loss occurs due to any disease process that involves either bilateral or optic nerves optic chiasm, bilateral optic radiation, or bilateral occipital cortex. Common conditions include bilateral optic neuritis, sellar, or parasellar tumour; infarcts, inflammatory granuloma, or tumours involving the occipital cortex. Colour desaturation can occur due to maculopathies and optic neuritis; however, flashes of light (phosphenes) on ocular movements are more suggestive of optic neuritis.2,3 Patient did not have pain in ocular movements. Pain during ocular movement occurs due to traction at the origins of the superior and medial recti on the inflamed optic nerve sheath. This is commonly associated with retrobulbar optic neuritis; however, it is uncommon in papillitis (inflammation of the optic nerve head).4 Fundus examination shows disc oedema in papillitis, whereas the optic disc remains normal in early retrobulbar optic neuritis. However, optic atrophy may ensue in retrobulbar optic neuritis depending upon the severity of involvement. Severe vision loss and fundus examination findings in this patient suggest papillitis.
Disease modifying drugs in idiopathic sclerosing orbital inflammatory syndrome
Published in Orbit, 2022
Farzad Pakdel, Anousheh Haghighi, Niloofar Pirmarzdashti
The lesions showed mild to moderate enhancement, after contrast injection. Enhancement pattern was either speckled (Figures 1B and 2B) (case 1 and 2) or diffuse and uniform (Figure 3B) (case 3). There was narrowing of the optic nerve in mid and apical parts of the orbit (cases 1,2 and 4) (Figures 1D and 2B), tenting of optic nerve (cases 1 and 2) (Figures 1D and 2B) and optic nerve displacement (case 1,2,3,4). These findings correlated with clinical finding of progressive visual loss and optic atrophy in four of the patients (case 1,2,3 and 4). Enlargement and enhancement of recti muscles (superior and lateral recti muscles in cases 2 and 3; lateral rectus in case 5; four recti muscles in case 1 and 4) were seen. Muscle changes were especially prominent in the vicinity of the orbital mass (Figure 3A-C). The Lacrimal gland was enlarged in four of the cases (case 2,3,4 and 5). Comparing pre- and post-treatment, we could not spot any remarkable changes in MRI.
Viral Kerato-Uveitis with Choroidal Vitiligo
Published in Ocular Immunology and Inflammation, 2021
Ankush Kawali, Padmamalini Mahendradas, Srinivasan Sanjay, Rohit Shetty
One-eyed 54-year-old Asian Indian lady, known case of right HZO with corneal involvement, treated elsewhere 4 months prior, presented with the recurrence of kerato-uveitis in OD. The patient also had a history of left sided carotico-cavernous fistula embolization done 2 years ago. Examination revealed stromal keratitis, granulomatous KPs, 1+ cells in anterior chamber, posterior synechiae, clear vitreous, and MHCL in OD (Figure 3Figure 3a,Figure 3b). Other eye examination revealed optic atrophy. Indocyanine green angiography was normal except for few pigment epithelial detachments (PEDs) (Figure 3c). OCT scan confirmed PEDs and ruled out choroidal lesions (Figure 3d). Patient was treated vide supra and the inflammation resolved. Patient had another relapse with dendritic ulcers after 5 months due to inadvertent use of topical cyclosporine. Fundus lesions remained status quo without any evidence of vitritis and other eye examination revealed no evidence of MHCL (Figure 3Figure 3e). Dermal vitiligo post HZO was evident on patient’s right forehead(Figure 3f). Follow-up after detection of MHCL and the total follow-up was 8 months.