Painful Multiple Cranial Neuropathies due to Lyme Disease as Opposed to Tolosa-Hunt Syndrome

Painful cranial neuropathy is sometimes attributed to inflammatory idiopathic disorder called Tolosa-Hunt syndrome which often responds to steroids. In case of steroid poor response alternative infectious or inflammatory etiology should be investigated. Sarcoidosis, Tuberculosis, and Lyme are only a few conditions that can present with painful cranial neuropathies

Arteritic AION and Central Retinal Artery Occlusion With Coincident Giant Cell Arteritis and Polyartertitis Nodosa

While giant cell arteritis (GCA) is a well-known cause of severe vision loss, other large and medium vessel vasculitides such as polyarteritis nodosa (PAN) have very rarely been reported to have such devastating ophthalmic manifestations

Anterior Ischemic Optic Neuropathy in End Stage Renal Disease

Ischemic optic neuropathy was described in patients with end stage renal disease (ESRD). They usually suffer from chronic anemia and fluctuating blood pressure. These patients are vulnerable to ischemic complications including ischemic optic neuropathy. The pathophysiology arises from interruption of the posterior ciliary artery blood supply to the prelaminar optic nerve due to atherosclerosis, and is exacerbated by episodic hypotension and severe anemia. Although this is a form of non-arteritic ischemic optic neuropathy (NAION), they lack the general features including the disc at risk appearance. They are often misdiagnosed as giant cell arteritis (GCA), or idiopathic intracranial hypertension (IIH). Ischemic optic neuropathy in ESRD is an important entity to recognize as it influences the management of these medically fragile patients

Severe Intracranial Hypertension as a Result of Topical Isotretenoin

Secondary intracranial hypertension occurs in patients taking oral isotretinoins and tetracyclines. In a small percentage of patients, this can be severe enough to cause irreversible optic nerve damage. It was previously thought that these medications had no cross-reactivity, thus patients with intracranial hypertension secondary to drug use have been prescribed medications from alternate drug classes. However, two cases demonstrate synergistic action between tetracycline and isotretinoin, even after the initial medications were withdrawn and visual function was recovered

Chiasmal Optic Neuritis Presenting as Bilateral Blurred Vision And Ataxia

Chiasmal optic neuritis is an urgent condition that may lead to blindness in both eyes. It is a rare condition associated with inflammatory demyelinating disorders, most commonly Multiple Sclerosis. We report a rare case of optic chiasm neuritis in a patient who presented with bilateral blurred vision and ataxia

Anesthesia Dolorosa of Trigeminal Nerve as an Early Presentation of Orbital Tumor (.pdf)

Anesthesia dolorosa is a syndrome of numbness and pain in the same sensory distribution. This combination of symptoms is thought to be caused by an injury to the first order neurons with spontaneous firing of the second order neurons. It has been described in association of injuries related to surgery or radiation, but may present as an early sign of cancer

Unilateral Disc Edema as the First Presentation of CML

Papilledema has previously been reported as the initial presentation of chronic myeloid leukemia (CML). Reported cases of CML have demonstrated bilateral, symmetrically edematous optic nerves attributed to poor CSF absorption given the hyperviscosity induced by an elevated white blood cell (WBC) count. We report an interesting case of unilateral optic disc edema as the first presentation of CML approximately one year prior to substantial elevation of WBC count

Intracranial hypertension associated with topical tretinoin use

Purpose: To report cross-reactivity between topical vitamin A derivatives and tetracycline-class antibiotics. Observations: A 19-year old woman with a remote history of resolved secondary intracranial hypertension due to minocycline use developed intracranial hypertension while using topical tretinoin alone. Examination demonstrated bilateral optic nerve edema, a right sixth cranial nerve palsy, along with characteristic features of markedly elevated intracranial pressure on imaging. Lumbar puncture opening pressure was 60 cmH2O. Cessation of topical tretinoin use ensued complete resolution of symptoms and optic nerve swelling in both eyes. Conclusions and importance: Our findings substantiate the need to avoid topical vitamin A derivatives and alternate drug classes known to be associated with drug-induced intracranial hypertension

Epidemic Bhutanese Optic Atrophy

Beginning in the early 1990's, tens of thousands of ethnic Nepali Bhutanese were forced out of Bhutan as a result of the Bhutanese; government's policy of "one nation and one people." A majority of these persons resided, for up to twenty years, in camps along the; Eastern Nepal border with Bhutan before resettlement in third-party countries. Vitamin B12, among other micronutrient; deficiencies, was common in these camps. More than 100,000 individuals have been resettled, with over 80% coming to the United; States, with less than 3,000 Bhutanese refugee arriving in Vermont. A number of patients from the local Bhutanese refugee population were evaluated in the neuro-ophthalmology clinic at our academic medical center and found to have optic atrophy (OA) without identifiable cause. To better understand the scale and potential etiology of this problem, all cases of OA, from this group, referred to the neuro-ophthalmology clinic, were reviewed

Reversible Unilateral Visual Field Defect as the Presentation of a Pituitary Adenoma and Cerebral Aneurysm

Bitemporal hemianopsia is a well known sequelae of compression of the optic chiasm, oftentimes by a pituitary tumor. Here we present a case of a patient with unilateral visual symptoms as the presenting sign of a pituitary adenoma and a large cerebral aneurysm