الملخص
ABSTRACT Susac's syndrome, or microangiopathy of the retina, inner ear, and brain, is a rare condition characterized by the clinical triad of encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss. The complete triad has been documented in 85% of reported cases. At clinical onset, the most common manifestations are central nervous system symptoms, followed by visual symptoms and hearing disturbances. Although the clinical course of Susac's syndrome is usually self-limiting, fluctuating, and monophasic, clinical polycyclic and chronic courses have also been described. Likewise, recurrences of the full triad after more than 10 years of remission have been reported. We describe a 21-year-old woman who presented with branch retinal artery occlusions and magnetic resonance imaging findings compatible with Susac's syndrome without objective hearing loss. After 10 years of remission, the patient complained of visual field loss due to new retinal ischemia. Neither other symptoms nor neuroimaging or audiometry pathologic findings were found during the clinical course.
RESUMO A síndrome de Susac, ou a micro angiopatia da retina, do ouvido interno e do cérebro, é uma condição rara caracterizada pela tríade clínica de encefalopatia, oclusão de ramo da artéria retiniana e perda de audição neuro-sensorial. A tríade completa é documentada em 85% dos casos registrados. No início dos sinais clínicos, a manifestação mais comum relaciona-se ao sistema nervoso central, seguida por sintomas visuais e distúrbios auditivos. Apesar do curso clínico da síndrome de Susac ser usualmente auto limitante, variável e monofásico, cursos clínicos policíclicos e crônicos têm sido também descritos. Do mesmo modo, recorrências da tríade completa após mais de 10 anos de remissão têm sido relatadas. Descrevemos o caso de uma mulher de 21 anos que apresentava oclusões de ramos da artéria retiniana e imagens por ressonância magnética compatíveis com a síndrome de Susac, sem comprometimento objetivo da audição. Dez anos após a remissão, a paciente queixou-se de perda de campo visual devido a uma nova isquemia da retina. Nenhum outro sintoma, ou neuroimagem ou achado audiométrico patológico foi observado durante o curso clínico.
الموضوعات
Humans , Female , Young Adult , Retinal Artery Occlusion/pathology , Retinal Artery Occlusion/diagnostic imaging , Susac Syndrome/pathology , Susac Syndrome/diagnostic imaging , Recurrence , Time Factors , Vision Disorders/etiology , Magnetic Resonance Imaging , Fluorescein Angiography/methods , Retinal Artery Occlusion/complications , Susac Syndrome/complicationsالملخص
ABSTRACT A 22-year-old man complained of low visual acuity and pain in his left eye for five days. His ophthalmological examination revealed 2+ anterior chamber reaction and a white, poorly defined retinal lesion at the proximal portion of the inferotemporal vascular arcade. There were retinal hemorrhages in the inferotemporal region extending to the retinal periphery. In addition, venous dilation, increased tortuosity, and ischemic retinal whitening along the inferotemporal vascular arcade were also observed. A proper systemic work-up was performed, and the patient was diagnosed with ocular toxoplasmosis. He was treated with an anti-toxoplasma medication, and his condition slowly improved. Inferior macular inner and middle retinal atrophy could be observed on optical coherence tomography as a sequela of ischemic injury. To our knowledge, this is the first report of combined retinal branch vein and artery occlusion in toxoplasmosis resulting in a striking and unusual macular appearance.
RESUMO Um paciente do sexo masculino, com 22 anos de idade, queixou-se de redução da acuidade visual no olho esquerdo por 5 dias. O exame oftalmológico mostrou reação de câmara anterior 2+ e uma lesão retiniana esbranquiçada, pouco definida, na porção proximal da arcada vascular temporal inferior. Foram observadas hemorragias retinianas na região temporal inferior estendendo-se à periferia, assim como ingurgitamento venoso, aumento da tortuosidade e palidez isquêmica da retina no mesmo quadrante. Exames laboratoriais corroboraram o diagnóstico de toxoplasmose ocular. O paciente melhorou lentamente após tratamento apropriado. Foi evidenciada atrofia da retina macular inferior interna e média à tomografia de coerência óptica, como sequela da isquemia retiniana. Para nosso conhecimento, este é o primeiro relato de oclusão retiniana combinada de ramo arterial e venoso em toxoplasmose ocular, levando a um aspecto fundoscópico atípico e peculiar.
الموضوعات
Humans , Male , Young Adult , Retinal Vein Occlusion/etiology , Retinal Vein Occlusion/pathology , Retinal Artery Occlusion/etiology , Retinal Artery Occlusion/pathology , Toxoplasmosis, Ocular/complications , Toxoplasmosis, Ocular/pathology , Retinal Vein Occlusion/diagnostic imaging , Fluorescein Angiography , Retinal Artery Occlusion/diagnostic imaging , Visual Acuity , Toxoplasmosis, Ocular/diagnostic imaging , Tomography, Optical Coherence , Fundus Oculi , Macula Lutea/pathology , Macula Lutea/diagnostic imagingالملخص
A 48-year-old man presented following an episode of sudden onset simultaneous inferior altitudinal visual loss in his left eye and visual obscuration with shimmering in the inferonasal quadrant of the right eye. Clinical examination demonstrated left superior hemiretinal artery occlusion and an area of focal dynamic spasm along the right superior temporal branch retinal artery, the arteriolar spastic cycle was about 2 sec in duration. Hematological (including complete blood count, thrombophilia screen, vasculitic screen and serum magnesium), carotid, and cardiac investigations were normal. He was given acetazolamide 500 mg orally, timolol maleate 0.5% eye drops once daily and sublingual amyl-nitrate 0.8 mg, and maintained on felodipine 10 mg/day and aspirin 100 mg/day. The area of focal arteriolar spasm in the right eye resolved over two months. To our knowledge there are no prior reports of photographically documented dynamic focal retinal vascular spasm on a MEDLINE and PUBMED search.
الموضوعات
Arterioles/drug effects , Arterioles/pathology , Drug Administration Schedule , Follow-Up Studies , Fundus Oculi , Humans , Male , Middle Aged , Migraine Disorders/complications , Migraine Disorders/physiopathology , Photography , Retinal Artery Occlusion/etiology , Retinal Artery Occlusion/pathology , Retinal Vessels/drug effects , Retinal Vessels/pathology , Vasoconstriction/drug effects , Vasodilator Agents/administration & dosageالملخص
We report a case of branch retinal artery occlusion (BRAO) in a healthy young girl. An eight-year-old girl presented with sudden loss of vision in her left eye. She had a pale retina with macular edema consistent with extensive BRAO. A thorough workup was performed to determine any etiologic factor. All test results were within normal limits. Her visual acuity improved from finger counting to 20/40 over two weeks, on immediate treatment with intravenous steroids (methyl prednisolone). This case suggests that BRAO can occur in healthy children without any detectable systemic or ocular disorders and a dramatic improvement may be achieved with prompt treatment with intravenous steroids.
الموضوعات
Child , Female , Humans , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/pathology , Retinal Artery Occlusion/therapyالملخص
Os autores relatam o caso de um paciente com insuficiência coronariana que desenvolveu quadro de oclusão de artéria central da retina após ser submetido a cateterização cardíaca por via braquial e realização de cineangiocoronariografia. Este procedimento pode desencadear fenômenos embólicos oculares consistentes com o quadro descrito.
The authors report a case of a patient with coronary insufficiency who developed central retinal artery occlusion following cardiac catheterism through the brachial artery and cineangiocoronography. This procedure can lead to embolic phenomena like that which was reported.
الموضوعات
Humans , Male , Middle Aged , Coronary Angiography/adverse effects , Cardiac Catheterization/adverse effects , Retinal Artery Occlusion/etiology , Brachial Artery , Coronary Angiography/methods , Embolism/etiology , Retinal Artery Occlusion/pathologyالملخص
Carotid cavernous fistulas are a rare entity occurring as result of head trauma and also spontaneously. The authors report a rare case of central retinal artery occlusion complicating traumatic carotid-cavernous fistula, resulting in severe visual acuity loss. Spontaneous closure of the fistula was observed. The possible mechanisms responsible for this complication are discussed.
Fístulas carótido-cavernosas são raras e ocorrem como resultado de trauma cefálico e também espontaneamente. Os autores relatam um caso raro de oclusão de artéria central da retina complicando fístula carótido-cavernosa traumática, resultando em perda grave da acuidade visual. Fechamento espontâneo da fístula foi observado. Os possíveis mecanismos responsáveis por esta complicação são discutidos.
الموضوعات
Adult , Humans , Male , Carotid-Cavernous Sinus Fistula/etiology , Head Injuries, Closed/complications , Retinal Artery Occlusion/etiology , Carotid-Cavernous Sinus Fistula , Fluorescein Angiography , Retinal Artery Occlusion/pathology , Tomography, X-Ray Computed , Visual Acuity/physiologyالملخص
The retinal vasculature is a unique site where the microcirculation can be noninvasively imaged in vivo. This presents an opportunity to study otherwise inaccessible structural features of the microcirculation. Recently, a number of population-based studies have developed quantitative methods of measuring these retinal signs, and investigated how these signs relate to metabolic disorders such as diabetes, hypertension, obesity, and metabolic syndrome. These studies have reported fairly consistent associations of retinopathy lesions, arteriolar narrowing and venular dilation with these metabolic disorders, suggesting a microvascular component in either the pathogenesis or manifestation of these disorders. Further, several of these signs have been associated with future risk of cardiovascular outcomes, such as coronary heart disease and stroke, independently of traditional risk factors. This review will examine in detail the evidence linking retinal vascular signs with metabolic disorders and discuss their implications for research and clinical practice.
A vasculatura retiniana apresenta uma oportunidade única de observação não-invasiva da microcirculação e de suas estruturas in vivo. Recentemente, uma série de estudos populacionais desenvolveu métodos quantitativos de observação destes sinais retinianos e suas relações com distúrbios metabólicos, tais como diabetes, obesidade, hipertensão arterial e síndrome metabólica. Esses estudos demonstraram associações das lesões retinianas, entre elas estreitamento arteriolar e dilatação venular, com essas alterações metabólicas, sugerindo um componente microvascular na patogênese ou na manifestação destes distúrbios. Ainda, vários destes sinais foram associados com risco de doença cardiovascular, tais como doença arterial coronariana e acidente vascular cerebral independente dos fatores de risco clássicos. Esta revisão discute em detalhes as evidências entre os sinais retinianos e os distúrbios metabólicos e suas possíveis implicações na pesquisa e na prática clínica.