Torsional Nystagmus Associated with Palatal Tremor in Vertebral Artery Dolichoectasia (.pdf)

"A 50 year-old woman presented with three-month history of oscillopsia. This accompanied with gait disturbance. Her previous medical history was significant for right-side hemiparesis for the last year, DM type2 and essential hypertension. She denied any history of drug abuse.On examination, BCVA was 20/20 in both eyes. Anterior segment and fundus exam were unremarkable. Binocular conjugated pure counter-clockwise torsional nystagmus synchronizing with palatal tremor was observed. The amplitude and frequency of nystagmus were similar in all gazes. Null point was absent. Ocular alignment was orthotropic. Extraocular muscles function, saccadic velocity and smooth pursuit eye movement were all within normal limit. Neurological examination showed rightsided hemiparesis and hyper-reflexia. Celebellar functions were impaired on the right-side including wide-base gaits, dysdiadokonesia and impaired Finger-to-Nose test. Thin slice axial T2 weighted MRI with fat suppression and Apparent Diffusion Coefficient(ADC) images show dolichoectatic left vertebral artery, exerting pressure effect to the left medulla. A hypersignal intensity T2 change with increased diffusion on the ADC image at the left medulla is also depicted. 3D Time of Flight (TOF) MRA of the posterior circulation reveals dolichoectatic left vertebral artery with redundancy to the right. Hypoplasia of the right vertebral artery is noted. To our knowledge, this is the first case of torsional nystagmus with palatal tremor in vertebral artery dolichoectasia.

Optical coherence tomography use in idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) is a condition in which elevated pressure in the cerebrospinal fluid can lead to optic nerve head (ONH) dysfunction and subsequent visual impairment. Physicians are currently limited in their ability to monitor and manage this condition, as clinical symptoms and exam findings are often delayed in response to changes in intracranial pressure. In order to find other biomarkers of disease, researchers are using imaging modalities such as optical coherence tomography (OCT) to observe microscopic changes in the eye in this condition. OCT can create 2-dimensional and 3-dimensional high definition images of the retina of the ONH and has been used to study various conditions such as glaucoma and multiple sclerosis. Numerous studies have used OCT in IIH as well, and they have shown that certain retinal layers and the ONH change in thickness and shape in both the short and long term with intracranial pressure changes. OCT is a promising modality for clinical and scientific evaluation of IIH as it is a noninvasive and practical tool to obtain in depth images. This review will discuss how OCT can be used to assess a patient with IIH, both before and after treatment, along with its limitations and future applications

Concurrent CRAO with Arteritic AION in Eosinophilic Granulomatosis with Polyangiitis

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic necrotizing vasculitis characterized by peripheral neuropathy, pulmonary involvement, and eosinophilia. EGPA has been associated with a number of ocular conditions, including retinal vascular occlusion, ocular motor cranial neuropathy, and optic neuropathy. We describe a case report of a concurrent central retinal artery occlusion(CRAO) with arteritic anterior ischemic optic neuropathy(AION)

The Impact of Acetylcholine Receptor Antibody Titers in Acetylcholine Receptor Antibody-Positive Ocular Myasthenia Gravis: Generalization, Presence of Thyroid Autoimmune Antibodies, and Thymoma

The importance of acetylcholine receptor(AChR) antibody titers in ocular myasthenia gravis(OMG) is scarcely studied. Therefore, we aim to evaluate the association between AChR antibody titers and conversion to generalized myasthenia gravis(GMG), presence of thyroid autoimmune antibodies, and presence of thymoma in subjects with positive AChR antibody OMG

MOG-IgG Versus AQP4-IgG Positive Optic Neuritis in Thailand: Clinical Characteristics and Long-Term Visual Outcomes Comparison

To compare demographic data, clinical and radiological characteristics, treatment and long-term visual outcomes between myelin oligodendrocyte glycoprotein autoantibody positive optic neuritis (MOG-IgG + ON) and aquaporin-4 autoantibody positive optic neuritis (AQP4-IgG + ON) in Thailand

Prognostic Factors for Visual Outcomes Following the First Episode of NMOSD-Related Optic Neuritis

Acute-onset neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) tends to present with severe visual loss. Early treatment not only preserves better visual outcomes, but also prevents further morbidity and mortality. Only a few previous studies have identified prognostic factors regarding disease outcomes following treatment for neuromyelitis optica spectrum disorder (NMOSD). However, the authors did not report the prognostic factors for visual outcomes following the first episode of NMOSD-ON per eye. Therefore, our study aim to identify prognostic factors for visual outcomes following a first episode of NMOSDON in affected eyes

Painful Horner Syndrome as a Presentation of Nasopharyngeal Carcinoma: A Carotid Dissection Mimicking Lesion

Horner syndrome refers to a set of clinical presentations resulting from disruption of sympathetic innervation to ocular and adnexa.; Classically, clinical triad consists of ipsilateral blepharoptosis, pupillary miosis and facial anhidrosis. The lesion responsible for Horner syndrome can occur anywhere along ocular sympathetic pathway. Ocular sympathetic denervation may signify the life-threatening causes such as carotid dissection, brainstem infarction and malignancies. A patient with painful oculosympathetic denervation, timely accurate investigation and diagnosis are essential

Isolated Optic Neuritis with Abnormal Trigeminal Nucleus on Imaging: Rare Complication of Herpes Zoster Ophthalmicus

Herpes zoster ophthalmicus (HZO) is related to reactivation of the latent varicella zoster virus (VZV) involving ophthalmic branch of the trigeminal nerve. Optic neuritis (ON) is a rare ocular complication following HZO. Most of the previous cases occurred simultaneously with other ocular complications, especially orbital apex syndrome. Moreover, detailed magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) of optic nerve and trigeminal nucleus in HZO-related ON are scarcely documented

Isolated optic neuritis with a concurrent abnormal trigeminal nucleus on imaging: case report of a rare complication of herpes zoster ophthalmicus

Abstract Background Herpes zoster ophthalmicus (HZO) is an inflammation related to reactivation of the latent varicella zoster virus (VZV), involving the ophthalmic branch of the trigeminal nerve. Optic neuritis (ON), a rare ocular complication following HZO, has been reported in 1.9% of HZO-affected eyes. Most previous cases occurred simultaneously with other ocular complications, especially orbital apex syndrome. Moreover, detailed magnetic resonance imaging (MRI) with diffusion weighted imaging of the optic nerve and trigeminal nucleus in HZO-related ON has been rarely reported. We report a case of postherpetic isolated ON with a concurrent abnormal trigeminal nucleus on imaging. Case presentation A healthy 58-year-old female presented with sudden painful visual loss in her right eye for 2 days. Four weeks before the presentation, her right eye was diagnosed with HZO, and she received intravenous acyclovir for 10 days. Ophthalmic examination revealed a visual acuity of light perception and 20/20 in the right and left eyes, respectively. A relative afferent pupillary defect was present in the right eye. Neurological examination was significant for hypoesthesia in the area of the HZO. A clinical diagnosis of HZO-related right retrobulbar ON was made, and other causes of atypical ON were excluded. MRI showed enhancement and restricted diffusion of the right-sided optic nerve with linear hyperintense T2 of the right-sided spinal trigeminal nucleus and tract (STNT) along the brainstem. She received 14 days of intravenous acyclovir and 5 days of methylprednisolone. Both were switched to an oral route for 2 months. After the completion of treatment, the visual acuity was counting fingers and 20/20 in the right eye and left eye, respectively. Stable brainstem STNT abnormalities and resolution of ON were found radiologically. Conclusions Isolated ON is a rare ocular complication following HZO. An abnormal high signal of STNT on a T2 weighted image may be present, which may be a clue for VZV-associated complications, such as HZO-related ON, especially in cases lacking an obvious history of HZO or other concomitant ocular complications. Prompt treatment with both acyclovir and corticosteroids should be started. Restricted diffusion of the optic nerve may be a predictor for poor visual recovery