Decreased Vision and Junctional Scotoma from Pituicytoma

Pituicytomas are rare neoplasms of the sellar region. We report a case of vision loss and a junctional scotoma in a 43-year-old woman caused by compression of the optic chiasm by a pituitary tumor. The morphological and immunohistochemical characteristics of the tumor were consistent with the diagnosis of pituicytoma. The tumor was debulked surgically, and the patient's vision improved

Isolated presumed optic nerve gumma, a rare presentation of neurosyphilis

Purpose The incidence of syphilitic infections continues to rise and represents a major public health concern, particularly in patients co-infected with human immunodeficiency virus (HIV). The infection has a multitude of clinical presentations and is often referred to as the ‘great imitator.’ We present a rare case of an isolated presumed syphilitic optic nerve gumma and characterize it using newer imaging modalities. Observations A 36-year-old HIV-positive man, compliant with treatment, presented with a five day history of decreased vision in the left eye. On examination his visual acuity was 20/30 with mild dyschromatopsia and an inferior altitudinal field defect in the left eye. Funduscopy demonstrated small cup to disc ratios bilaterally and a swollen and hyperemic left optic disc. Following five months of stable vision, the patient's vision in the left eye declined to 20/60, associated with diffuse visual field loss and continued swelling of the left optic disc. Subsequent magnetic resonance imaging with contrast demonstrated enhancement of the left optic nerve, and his serologies were positive for syphilis. Fluorescein angiography and optical coherence tomography were used to better characterize the lesion being most consistent with a syphilitic optic nerve gumma. Conclusions and importance Gummas of the central nervous system are a rare presentation of neurosyphilis and the last reported gumma of the optic nerve was in 1990. Such lesions have not been characterized using newer imaging modalities including optical coherence tomography and fluorescein angiography, both of which may assist in the diagnosis of this rare entity. With the increased prevalence of syphilis and remarkable response to therapy, syphilitic gummas should be considered in at-risk patients presenting with an optic neuropathy

Isolated Bilateral Fourth Cranial Nerve Palsies as the Presenting Sign of Hydrocephalus

Midbrain lesions leading to bilateral fourth nerve palsies are typically accompanied by other brainstem symptomatology. Here we report a case of a 29-year-old man with hydrocephalus and significant third ventricle dilation applying pressure on the dorsal midbrain and having as only manifestation isolated, bilateral fourth cranial nerve palsies. This finding, reported now for the first time, could be attributed to a partially working ventriculoperitoneal shunt previously placed to this patient, which was able to sporadically relieve the increases of the intraventricular pressure on the midbrain that would normally lead to other manifestations

A Rod-Sparing Retinopathy in Bardet-Biedl Syndrome

Bardet-Biedl syndrome is a continuum of disorders characterized by systemic and ocular findings. Retinal abnormalities typically present as diffuse photoreceptor degeneration. Here, we report a novel case that suggests a rod-sparing variant of Bardet-Biedl syndrome

Optic Chiasmal Glioma in an Adult Associated with a Good Long-Term Prognosis: A Case Report and Review of the Literature

To report a case of a glioma of the optic chiasm that presented in an adult and was associated with an excellent long-term prognosis

Comparison of AO Hardy-Rand-Rittler and Richmond Products Color Plates

AOHRR pseudoisochromatic plates are used to recognize acquired dyschromatopsia for diagnosing optic neuropathy. They contain blue-yellow and red-green discriminations, providing a simple, sensitive, selective test. The AOHRR plates have been out of print since 1957. We investigated whether RP plates are an equivalent replacement for AOHRR

Laser-induced Optic Neuropathy as A Model to Study Neuro-protection

Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) is believed to result from insufficient blood flow to the optic nerve head. However, the precise mechanism of ischemia remains unclear. A successful experimental animal model would help us better understand the pathophysiology of the disease. The purpose of our study is to develop a novel version of the photodynamic model of rodent optic neuropathy currently used, which will give us results with high reproducibility

Demographic, Systemic and Ocular Features of Non-Arteritic Anterior Ischemic Optic Neuropathy in a Large US Claims Beneficiary Database (.pdf)

The etiology of non-arteritic ischemic optic neuropathy (NAION), the most common acute neuropathy in older adults, is poorly understood. We assessed demographic, systemic and ocular factors associated with NAION to gain insight into the pathogenesis of the disease