Delayed Onset Cranial Nerve Palsies After Endovascular Coil Emboization of Direct Carotid-Cavernous Fistulas

Late recurrence of carotid-cavernous fistula with associated visual symptoms, including diplopia, is quite uncommon and raises concern for new or recurrent fistula formation. However, in the absence of a new or recurrent fistula, the mechanism by which diplopia recurs is not clear

Delayed Onset Cranial Nerve Palsies After Endovascular Coil Embolization of Direct Carotid-Cavernous Fistulas

Late recurrence of visual symptoms associated with carotid-cavernous fistula (CCF), including diplopia, is uncommon and raises concern for new or recurrent fistula formation. We report 2 patients with traumatic CCFs, where cranial nerve paresis resolved after endovascular CCF treatment only to reappear years later. No evidence of recurrent or new fistula formation was found. Both were treated successfully with strabismus surgery. Although the cause of delayed onset diplopia after successful treatment is still unknown, theories include late compression of cranial nerves within the cavernous sinus due to coil mass that can cause chronic ischemia, delayed inflammation due to a thrombophilic nidus created by the coil mass, or injury to the cranial nerves that manifests later due to decompensated strabismus

Neuro-Ophthalmic Manifestations Post-COVID-19 Infection or Vaccination

Initially reported neurologic manifestations of the coronavirus disease 2019 (COVID-19) infection range from nonspecific symptoms (headache, dizziness) to acute cerebrovascular disease.[1] Subtle post- and para-infectious and vaccination neurological and ophthalmologic manifestations have been underreported. We hereby present a series of four neuro- ophthalmic conditions concomitant with a COVID-19 infection: visual snow syndrome, optic neuritis, cranial nerves palsy and ocular myasthenia gravis as well as a case of optic neuritis post Pfizer-BioNTech vaccine

Severe Heavy Eye Syndrome With Esotropia and Hypertropia in a Female With Congenital Monocular Anophthalmia

Heavy eye syndrome, (HES) known as myopic strabismus fixus is a cause of acquired esotropia in the setting of high axial myopia.[1,2] Patients present with esotropia due inferior shifting and compression of the lateral rectus against the orbital wall, leading to reduced abduction and increased infraduction.[3] They often present with accompanying hypotropia secondary to nasal displacement of the superior rectus.[3] We hereby present a case of HES presenting with esotropia and hypertropia rather than hypotropia in the only eye of a female with congenital monocular anopthalmos

Sialidosis Type 1 Without Cherry-Red Spot

Sialidosis is an autosomal recessive lysosomal storage disease caused by mutations in the neuraminidase 1 (NEU1) gene located on 6p21.33 chromosome leading to low levels of alpha-N-acetylneuraminidase (sialidase) and accumulation of sialyloligosaccharides

Unusual presentations of anti-MuSk-antibody-positive ocular myasthenia gravis

Myasthenia gravis is an autoimmune disease that affects the neuro-muscular junction resulting in variable muscle weakness and fatigability. Antibodies to a muscle-specific receptor tyrosine kinase (MuSK) have been found in approximately 40% of patients with generalized myasthenia gravis who are seronegative for the antiacetylcholine receptor antibody but anti-MuSK antibodies where never detected in seropositive myasthenia gravis

Congenital Lymphocytic Choriomeningitis Virus in a Member of a Twin Pregnancy

© Copyright 2017 by Georg Thieme Verlag KG, Stuttgart New York. We report a male infant, twin A of a dichorionic pregnancy, with a fetal ultrasound and subsequent MRI at 29 weeks of gestation revealing a small cranium (26 cm, \u3c 3rd percentile for gestation) and marked ex vacuo ventriculomegaly. Twin B had normal ultrasound and brain MRI. Newborn exam was unremarkable and his weight and head circumference were both at 5th percentile. Placental pathology findings included focal acute vasculitis and chronic villitis. Postnatal brain MRI showed significant cerebral volume loss with extensive large cystic parietal encephalomalacia and diffuse cerebral cortical dysplasia (polymicrogyria). Common congenital infectious diseases investigation on maternal serum was normal. Twin A was admitted for bronchiolitis and possible seizure at 3 months of age. At this time, he had microcephaly and was not tracking light. Ophthalmology exam showed markedly abnormal macula with diffuse pigment changes and scarring that extended between the full arcades bilaterally. Congenital lymphocytic choriomeningitis virus (LCMV) infection was confirmed with negative IgM titer and highly positive IgG titer of greater than 1:256. Serologic tests for LCMV should be considered in infants who have central nervous system and retinal involvement but negative TORCH studies

Congenital Lymphocytic Choriomeningitis Virus in a Member of a Twin Pregnancy

© Copyright 2017 by Georg Thieme Verlag KG, Stuttgart New York. We report a male infant, twin A of a dichorionic pregnancy, with a fetal ultrasound and subsequent MRI at 29 weeks of gestation revealing a small cranium (26 cm, \u3c 3rd percentile for gestation) and marked ex vacuo ventriculomegaly. Twin B had normal ultrasound and brain MRI. Newborn exam was unremarkable and his weight and head circumference were both at 5th percentile. Placental pathology findings included focal acute vasculitis and chronic villitis. Postnatal brain MRI showed significant cerebral volume loss with extensive large cystic parietal encephalomalacia and diffuse cerebral cortical dysplasia (polymicrogyria). Common congenital infectious diseases investigation on maternal serum was normal. Twin A was admitted for bronchiolitis and possible seizure at 3 months of age. At this time, he had microcephaly and was not tracking light. Ophthalmology exam showed markedly abnormal macula with diffuse pigment changes and scarring that extended between the full arcades bilaterally. Congenital lymphocytic choriomeningitis virus (LCMV) infection was confirmed with negative IgM titer and highly positive IgG titer of greater than 1:256. Serologic tests for LCMV should be considered in infants who have central nervous system and retinal involvement but negative TORCH studies

Extraocular Muscle Enlargement in Acromegaly

Acromegaly is a disorder resulting from the hypersecretion of growth hormone (GH), usually by a pituitary adenoma. Ophthalmic manifestations can include visual field defects, cranial nerve palsies, and extraocular muscle (EOM) enlargement. The limited case reports on EOM enlargement in acromegaly tend to focus on qualitative descriptions and lack quantitative data. This study aims to determine the frequency and extent of EOM enlargement in acromegaly

Retinal findings in membranoproliferative glomerulonephritis

Purpose: To assess the evolution of retinal findings in patients with membranoproliferative glomerulonephritis (MPGN) by funduscopy, intravenous fluorescein angiography and optical coherence tomography. Observations: Three women and one man were followed for a period of 1.5–37 years. Four patients (8 eyes) had drusen detected at first fundus exam at age 24, 29, 50 and 55. Three patients (6 eyes) had diffuse thickening of Bruch's membrane, and two patients (3 eyes) had detachment of the retinal pigment epithelium with serous retinal detachment. Drusen tended to widen over a period of 10-year follow-up in one case. Conclusions and importance: Drusen remain the ocular stigmata for MPGN occuring at an early age. The retinal disease is progressive with gradual thickening of Bruch's membrane and occurrence of retinal pigment epithelium detachment