11/88. Central retinal artery occlusion and disc edema in a child.Obstruction of the retinal arterial system is most commonly associated with elderly patient populations. The major etiologic factor in adults has been attributed to emboli from atherosclerotic vascular disease of the carotid arteries, with about 75% of patients over the age of 40 years demonstrating this finding. Conversely, arterial obstruction in young patients is rarely secondary to atheromatous disease and has a variety of causative factors.(1) We describe an unusual case of a previously healthy 8-year-old boy who developed a unilateral central retinal artery occlusion in conjunction with marked optic disc edema. The etiology of these pathologic lesions was attributed to a viral-like syndrome. Vision rapidly deteriorated to no light perception and remained unchanged despite treatment.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
12/88. Cancer-associated retinopathy associated with invasive thymoma.PURPOSE: To report a case of cancer-associated retinopathy associated with invasive thymoma. DESIGN: Interventional case report. METHOD: A 41-year-old Japanese woman was observed between February 1998 and May 2001. Ophthalmologic examinations and systemic examinations were performed. The patient received treatment including corticosteroid pulse therapy, plasmapheresis, and thymectomy. RESULTS: The patient developed progressive visual dysfunction including bilateral visual acuity loss, concentric contraction of visual fields, and color vision loss. In both eyes, retinal vessel attenuation and retinal pigment epithelium degeneration were observed with fundus ophthalmoscopy and fluorescein angiography. Response in electroretinogram was reduced, suggesting both rod and cone dysfunction. Autoantibody against 23-kD cancer-associated retinopathy (CAR) antigen (antirecoverin antibody) was detected in the patient's serum. A mediastinal tumor that was histopathologically diagnosed as invasive thymoma was detected and was surgically resected. During more than 3 years of follow-up, no other malignancy was detected despite extensive systemic evaluation. The patient also suffered from subclinical myasthenia gravis. Although temporary improvement of visual function was observed after treatment with steroid pulse therapy and plasmapheresis' light perception of each eye was lost in the end. CONCLUSIONS: The patient was diagnosed as having CAR. Invasive thymoma was considered to be the causative tumor because there had been no evidence that suggested other systemic malignancy during more than 3 years of follow-up.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
13/88. eye-rubbing optic neuropathy.PURPOSE: To describe a patient whose "normal tension glaucoma" appears to have been produced by a long-standing habit of repetitive, bilateral eye rubbing. DESIGN: Observational case report. methods: A 46-year-old man presented with a "haze" over the left eye and had progressive bilateral optic neuropathy associated with bilateral normal intraocular pressure, pathological cupping of the optic disks, and nerve fiber bundle visual field defects. RESULTS: Over a 4-year period, vision in the left eye deteriorated to no light perception. Progressive deterioration in the right eye stopped only after the patient ceased a 20-year habit of forceful rubbing of his eyes. After that, the decline in vision was terminated and both visual acuity and visual field were stabilized over an 8-year follow-up. CONCLUSION: It may be appropriate to include "eye rubbing" in the differential diagnosis of unexplained progressive optic neuropathy in presumed normal tension glaucoma.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
14/88. Partial and significant reversal of progressive visual and neurological deficits in multiple sclerosis: a possible therapeutic effect.A 24-year-old woman developed over 18 months fluctuating and progressively increasing visual and cerebellar deficits, due to multiple sclerosis. The minimum visual acuities were 3/19 on the right and the perception of finger movement at 1 m on the left. She became able to walk only with a wide base and with support. Her condition deteriorated despite the use of methylprednisolone, prednisone and interferon beta-1b, so these were ceased. azathioprine, 25 mg daily increasing to 100 mg daily, reducing following abnormal liver function tests to 50 mg daily, and glatiramer acetate 20 mg daily were commenced. The visual acuities two months later were 3/7.5 on the right and 3/6 on the left and after 4 months 3/4.5 on the right and 3/3 on the left. She was able after 2 months to walk unaided on a narrow base and after 4 months to jog half a kilometre without difficulty. Progressive multiple sclerosis has been held to be irreversible. The response in the present case therefore raises the possibility of a drug effect. It indicates the need for trials of combined immunomodulatory and immunosuppressive therapies in progressive multiple sclerosis.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
15/88. Visual deficits in a patient with 'kaleidoscopic disintegration of the visual world'.We describe psychophysical, neuropsychological and neuro-ophthalmological studies of visual abilities in a patient who, following a right hemisphere stroke, had difficulty in combining parts of objects into a whole and in reading. Strikingly, her perceptual problems were accentuated when the objects moved or when she moved. Formal testing showed that her main deficits were in depth perception, various tasks of motion and object recognition of degraded stimuli. But low-level detection and discrimination of form and color were normal. Despite her deficits in visual motion and degraded static-object recognition, her visual recognition of 'biological motion' stimuli was normal. Structural magnetic resonance imaging revealed an infarct in the ventro-medial occipito-temporal region, extending ventro-laterally and leading to a 'kaleidoscopic disintegration of visible objects'.- - - - - - - - - - ranking = 1.3503349327985keywords = perception, discrimination (Clic here for more details about this article) |
16/88. A case of impaired auditory and visual speech prosody perception after right hemisphere damage.It is well established that vision plays a role in segmental speech perception, but the role of vision in prosodic speech perception is less clear. We report on the difficulties in prosodic speech perception encountered by KB after a right hemisphere stroke. In addition to musical deficits, KB was suspected of having impaired auditory prosody perception. As expected, KB was impaired on two prosody perception tasks in an auditory-only condition. We also examined whether the addition of visual prosody cues would facilitate his performance on these tasks. Unexpectedly, KB was also impaired on both tasks under visual-only and audio-visual conditions. Thus, there was no evidence that KB could integrate auditory and visual prosody information or that he could use visual cues to compensate for his deficit in the auditory domain. In contrast, KB was able to identify segmental speech information using visual cues and to use these visual cues to improve his performance when auditory segmental cues were impoverished. KB was also able to integrate audio-visual segmental information in the McGurk effect. Thus, KB's visual deficit was specific to prosodic speech perception and, to our knowledge, this is the first reported case of such a deficit.- - - - - - - - - - ranking = 10.091099483435keywords = perception, speech (Clic here for more details about this article) |
17/88. Complications of general anesthesia using nitrous oxide in eyes with preexisting gas bubbles.PURPOSE: To present the visual and anatomical outcomes for patients with intraocular gas placed during vitreoretinal surgery who subsequently underwent surgery wherein general anesthesia with nitrous oxide was used. methods: The authors reviewed the charts of patients who had undergone vitreoretinal surgery where a long-acting gas tamponade had been used. These patients underwent additional surgery for a variety of reasons at five different institutions and had nitrous oxide used during general anesthesia. The authors reviewed the preoperative and postoperative findings for patients receiving nitrous oxide following vitreoretinal surgery with gas tamponade. RESULTS: The authors reviewed findings for five eyes of five patients. All eyes that underwent general anesthesia using nitrous oxide had significant preexisting intraocular gas bubbles ranging from 40% to 90%, and the surgical procedures lasted from 1 to 4 hours. These eyes were followed from 2 months to 9 years (median follow-up, 4 years). Four of five eyes had a final vision of 20/200 or worse and significant optic atrophy at the time of the last follow-up examination. Three eyes had no light perception. CONCLUSION: The use of nitrous oxide during general anesthesia in gas-filled eyes may have disastrous visual results caused by gas expansion and elevated intraocular pressure. patients must be advised of the potentially catastrophic results of undergoing general anesthesia before their intraocular gas bubble has resorbed. The use of nitrous oxide for patients with intraocular gas should be avoided. It may be prudent for patients with intraocular gas to wear notification bracelets warning anesthesiologists about the presence of intraocular gas lest emergency surgery be needed by a patient unable to advise anesthesia personnel about the potential danger.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
18/88. Fomepizole therapy for reversal of visual impairment after methanol poisoning: a case documented by visual evoked potentials investigation.PURPOSE: To illustrate the safety and efficacy of fomepizole in a case of methanol poisoning with initial visual impairment. DESIGN: Interventional case report. methods: A 60-year-old man was admitted with blurred vision and changes in color perception 18 hours after ingesting 100 ml methanol. Fomepizole was chosen for antidotal therapy in combination with hemodialysis. Flash electroretinogram (fERG) and flash visual evoked potentials (fVEPs) examinations were obtained at the bedside 2 hours after admission and on days 1 and 8. The monocular pattern-reversal visual evoked potentials (pVEPs) were investigated on days 1 and 8. RESULTS: A complete reversal of visual impairment was achieved within 20 hours. An abnormal b-wave amplitude and an increased peak III latency at VEPs were present on admission and recovered within 24 hours. CONCLUSIONS: Fomepizole appeared safe and effective for a patient who had severe methanol poisoning presenting with visual impairment.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
19/88. A case of acute loss of binocular vision and stereoscopic depth perception. (The misery of acute monovision, having been binocular for 68 years).PURPOSE: There are few personal reports in the literature, by knowledgeable vision scientists, of the loss of binocular vision. This case is reported. CASE REPORT: This 68 year old retired pediatric ophthalmologist suffered an almost total loss of vision, OD, as a result of a sudden massive hemorrhage into the vitreous body from a bridging retinal vessel, which remained after repair of a spontaneous large horseshoe retinal tear. This caused significant problems with both remaining monocular vision, cognition, and space perception. It was surprisingly disabling. A diary is included. RESULT: The author now appreciates better: 1. that the overlap and cross compensation of monocular vision is quite significant; 2. that monocular depth perception may be impaired by any type of intervening optical media; 3. that a two dimensional world is very different and vastly inferior to a three dimensional world. comment: Such problems are not ordinarily expected or described in these circumstances, but considering what is in the literature, they may be more common and serious than assumed by eye care professionals, and should be taken into consideration in rendering eye care in similar situations. Loss of binocular vision results in a significant handicap even when the vision remaining in the good dominant eye is normal. It is truly remarkable to this victim that so many mature patients are willing to accept this situation in the form of surgical or optical monovision to avoid spectacles for presbyopia.- - - - - - - - - - ranking = 6keywords = perception (Clic here for more details about this article) |
20/88. Bilateral optic nerve sheath enhancement from giant cell arteritis.An 83-year-old man presented with acute bilateral visual loss to no light perception (NLP) OD and 20/50 OS. His fundus examination showed moderate bilateral pallid disc edema. A sedimentation rate was 60 mm/h. magnetic resonance imaging of the brain and orbits with gadolinium revealed marked bilateral enhancement of the optic nerve sheaths and adjacent orbital fat. He underwent biopsies of the optic sheath OD and bilateral temporal arteries. Histopathology of the optic nerve sheath area revealed fibroadipose tissue containing numerous arteries with intimal thickening, and mild mural inflammation consisting predominantly of lymphocyte with occasional giant cells. The bilateral temporal artery biopsies revealed focal disruption of the elastic lamina with rare giant cells. His vision had since stabilized on IV methypdnisolone therapy. The biopsies of the nerve sheath suggest that the radiologic finding of optic nerve sheath enhancement in giant cell arteritis is caused by tbe same pathophysiology, and therefore may be a manifestation of this systemic disease.- - - - - - - - - - ranking = 1keywords = perception (Clic here for more details about this article) |
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