Cases reported "Optic Nerve Diseases"

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1/9. Congenital intraorbital optic nerve cyst. Case report.

    Congenital cystic lesions of the optic nerve are exceedingly rare; only one case is reported in the world literature. The authors describe a case of congenital simple glial cyst in the intraorbital portion of the optic nerve with a brief review of the literature and comment on its histogenesis. A 45-day-old male infant was admitted to the hospital because of progressive proptosis and hypotropia in the left eye, which had been present since birth. magnetic resonance imaging of the left orbit revealed an ovoid, well-demarcated, homogeneous cystic mass in the intraconal retrobulbar area. The mass compressed the left eyeball with downward and lateral displacement. The wall of the cystic mass was very thin, and a needle puncture of the cyst released clear, colorless, watery fluid. The cystic wall was lined by loose astroglial nerve fibers with some scattered glial cells.
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2/9. A bad eye and a sore lip.

    A 48-year-old woman developed painful visual loss in the left eye, meningismus, and painful oral ulcers. magnetic resonance imaging of the brain with gadolinium demonstrated enhancement of the left optic nerve. Lumbar puncture showed a lymphocytic pleocytosis, and a biopsy specimen of one of the oral ulcerations was consistent with Behcet's disease. epidemiologic factors and diagnostic criteria for Behcet's disease are discussed.
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3/9. Linear magnetic resonance enhancement and optic neuropathy in primary angiitis of the central nervous system.

    A 38-year-old woman developed incoherent mentation, tremor, ataxia, and bilateral optic disc edema with mildly depressed visual acuity, nerve fiber bundle defects, and a left afferent pupillary defect. magnetic resonance imaging of the brain disclosed striking linear contrast enhancement radiating from the ventricular borders. Lumbar puncture showed a normal opening pressure with a lymphocytic pleocytosis and elevated protein. On the basis of these findings, the initial diagnosis was viral or post-viral meningoencephalitis and the patient was not treated. During the next 4 weeks, her condition worsened. A brain and meningeal biopsy disclosed findings typical of primary angiitis of the central nervous system. With aggressive treatment, her neurologic status and magnetic resonance imaging normalized and her optic neuropathy improved markedly. Optic neuropathy and linear magnetic resonance imaging enhancement should be recognized as features of primary angiitis of the central nervous system.
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4/9. Pars plana vitrectomy and lamina cribrosa puncture in absolute glaucoma.

    Two patients with refractory end-stage glaucoma who had no light perception underwent pars plana vitrectomy and lamina cribrosa puncture to relieve pain and decrease intraocular pressure. The patients presented with blind, painful eyes and high intraocular pressure (> 40 mm Hg). After the procedure, the pain was relieved and the intraocular pressure was lowered in both cases. The patients remained asymptomatic. Pars plana vitrectomy and lamina cribrosa puncture might be related to the decrease of intraocular pressure, probably by facilitating drainage of aqueous humor through the optic nerve.
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5/9. The clinical spectrum of amiodarone-associated optic neuropathy.

    PURPOSE: To describe the clinical spectrum of amiodarone-associated optic neuropathy. methods: Observational cases series and review. RESULTS: Of 55 cases, the median interval for onset of optic neuropathy was four months after initiating amiodarone; 88% occurred within 12 months. Seven (13%) patients were asymptomatic. Twenty-two (40%) patients presented with sudden visual loss, while 26 (47%) had insidious loss of vision. visual acuity ranged from 20/15 to light perception; 10 (18%) patients had legal blindness with visual acuity of 20/200 or worse. Visual field loss was present in 91% of cases. color vision loss was present in eight (40%) of 20 cases. Optic disc edema was present in 85% of cases, while eight (15%) patients had retrobulbar optic neuropathy, without evidence of disc edema. Optic disc edema resolved over a median time of three months. Five patients had raised intracranial pressure on lumbar puncture. CONCLUSION: We were able to classify amiodarone-associated optic neuropathy into five clinical categories with respect to temporal characteristics and optic nerve appearance: insidious-onset (43%), acute-onset (28%), retrobulbar (13%), increased intracranial pressure (8%), and delayed-progressive onset (8%). Most cases of optic neuropathy commenced within 12 months of initiating amiodarone, with the median onset being four months. Over 10% of patients will have no visual symptoms at the onset. Ophthalmologic examinations within the first 12 months--and particularly within four months of initiating amiodarone--should improve early detection of amiodarone-associated optic neuropathy.
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6/9. Optic neuropathy due to anaplastic large cell lymphoma.

    PURPOSE: To report a case of anaplastic large cell lymphoma (ALCL) of the central nervous system (CNS) producing an optic neuropathy. methods: Observational case report. RESULTS: A 29-year-old male presented with new onset headaches. Magnetic resonance imaging (MRI) of the brain revealed a large enhancing parietal lobe mass. Ocular exam at that time was normal. Initial diagnoses included possible bacterial cerebritis and fungal abscess. Serial lumbar punctures showed increased white blood cells but cytology was negative. A brain biopsy was non-diagnostic. The patient then presented with a left optic neuropathy. Repeat MRI of the brain and orbits revealed infiltration of the clivus and left orbital apex including the optic nerve. The patient had elevated liver function studies and an abdominal ultrasound disclosed two hypoechoic lesions. liver biopsy confirmed the diagnosis of ALK-1 positive ALCL. The patient was treated with chemotherapy but expired seven months after the initial presentation. CONCLUSION: ALCL should be considered to be a very rare but potential cause of optic neuropathy. To our knowledge, this is the first reported case of ALCL causing an optic neuropathy.
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7/9. optic nerve head drusen and pseudotumor cerebri.

    A 42-year-old woman presented with a history of headache. Results of funduscopic examination revealed elevated disc margins and bilateral optic nerve head drusen. Lumbar puncture, head computed tomography, and fluorescein fundus angiography results were consistent with the diagnosis of pseudotumor cerebri and coexistent disc drusen. Visual loss was demonstrated by formal perimetry. Headaches were unresponsive to a medical regimen that included prednisone, glycerol, acetazolamide, furosemide, and repeated lumbar punctures. A lumbar peritoneal shunt was performed, with immediate resolution of headache. Optic disc drusen can be associated with pseudotumor cerebri and can lead to diagnostic confusion.
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8/9. Recurrent acute myelomonoblastic leukaemia presenting as a red eye.

    A 68-year-old man was first diagnosed as having acute myelomonoblastic leukaemia on March 17, 1983. After two remissions with treatment, he suffered a further relapse, which caused him to present with a red eye, visual failure, and oedema of the right optic nerve head. Examination of cerebrospinal fluid that was obtained on lumbar puncture demonstrated an acute central nervous system relapse. Computed tomographic scanning led to the diagnosis of leukaemic infiltration of the optic nerve. Systemic and intrathecal treatment by appropriate chemotherapy and by orbital radiotherapy led to resolution of the clinical problem.
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9/9. Ophthalmological complications of cryptococcal meningitis.

    Two patients with cryptococcal meningitis associated with ophthalmological complications are described. One patient developed a cryptococcal fundal lesion which disappeared during chemotherapy. Chronically raised intracranial pressure was associated with a visual field defect. This resolved with repeated lumbar punctures. The second patient developed visual deficits secondary to papilloedema and responded to optic nerve decompression. In both cases CT scanning demonstrated swelling of the optic nerves. In the second patient this regressed after decompression. A review of the variety of the ophthalmological complications of cryptococcal meningitis and their prevalence is presented. The risk of developing severe visual disability is assessed.
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