Headaches And Diplopia Secondary To Ipilimumab Treatment For Stage III Melanoma

Diplopia and headaches is an ominous sign for intracranial spread in patients with malignancy. However, it is important for clinicians to review chemotherapy medications as a potential cause of symptoms

Functional MRI of Dynamic 3D Visual Object Recognition

The pattern of visual motion perceived during observer self-movement contributes to sense of direction and visuospatial orientation.GVSfunctionalneuro-imagin

Presentation of Giant Cell Arteritis with Normal Inflammatory Markers

Giant cell arteritis (GCA) can be challenging to diagnose when patients have mild symptoms, normal inflammatory markers, or subtle pathological abnormalities

Idiopathic Intracranial Hypertension in the Setting of Hypertensive Emergency

Idiopathic intracranial hypertension (IIH) is typically slowly progressive allowing good response to treatment. Rarely, patients present with fulminant IIH in which vision loss is rapidly progressive. Fulminant IIH has been reported in association with malignant hypertension. Here we describe a case of fulminant IIH in a male patient with hypertensive emergency

Ganglion Cell Complex Analysis as a Potential Indicator of Early Neuronal Loss in Idiopathic Intracranial Hypertension

Reliable visual field testing is the gold standard in identifying future vision loss in patients with Idiopathic Intracranial hypertension (IIH). However, when field performance is unreliable, GCC analysis may be useful. We evaluated IIH patients over three visits: initial visit, follow-up visit and a third visit, almost 1 year later. We evaluated mean deviation (MD), GCC and RNFL at presentation and the second visit and compared it to the mean deviation (MD) on fields at the third visit. As early as the second visit, GCC loss correlated with visual field results seen at the third visit

Ganglion Cell Complex Loss in Chiasmal Compression by Brain Tumors

Background: Patterns of ganglion cell complex (GCC) loss detected by optical coherence tomography provide an objective measure of optic nerve injury. These patterns aid in early diagnosis and localization of chiasmal lesions. Methods: Twenty-three patients with chiasmal compression seen between 2010 and 2015 were imaged with the Cirrus high-definition optical coherence tomography macular cube 512 +/- 128, retinal nerve fiber layer (RNFL) scan protocols and automated (30-2 Humphrey) visual fields (VFs). Age-matched controls were included for comparison. Generalized estimating equations were performed comparing RNFL and GCC thicknesses between patients and their controls. Effect size (d) was calculated to assess the magnitude of difference between patients and controls. The average GCC and RNFL thicknesses also were correlated with VF mean deviation (MD). Pre operative average GCC thickness was correlated to post operative VF MD. Results: Patterns of GCC thinning corresponded to VF defects. The average GCC thickness was 67 +/- 9 mu m in patients and 86 +/- 5 mu m in controls (P < 0.001). The effect size was the greatest for GCC thickness (d = 2.72). The mean deviation was better correlated with GCC thickness (r(2) = 0.25) than RNFL thicknesses (r(2) = 0.15). Postoperatively, VF MD improved in 7 of 8 patients with persistent nasal GCC thinning. Six patients had no VF defect and showed statistically significant loss of GCC compared with controls (P = 0.001). Conclusions: Distinct patterns of GCC loss were identified in patients with chiasmal compression. Binasal GCC loss was typical and could be seen with minimal or no detectable VF loss. Thinning of the GCC may be detected before loss of the RNFL in some patients. After decompression, the majority of patients showed improvement in VF despite persistent GCC loss. Patients with less GCC loss before decompression had better postoperative VFs. Therefore, GCC analysis may be an objective method to diagnose and follow patients with chiasmal lesions. (C) 2016 by North American Neuro-Ophthalmology Societ

The Heidenhain Variant of Creutzfeldt-Jakob Disease

"Creutzfeldt-Jakob disease (CJD) presents with ataxia, dementia, and myoclonus prior to ophthalmologic symptoms. The Heidenhain variant is different. Below are two cases presenting with initial visual symptoms emphasizing the critical role of ophthalmology.