Abducens Nerve Palsy as a Presenting Symptom of Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic disorder characterized by demyelination of the central nervous system. It often presents in women aged 18-35 with neurological symptoms such as visual loss, paresthesia, focal weakness, and ataxia. Demyelination in the brainstem can result in internuclear ophthalmoplegia causing binocular horizontal diplopia. Our report details a patient with horizontal diplopia from an isolated abducens (sixth) nerve palsy as the initial symptom of MS. While rare, this demonstrates the importance of including MS in the differential diagnosis for an isolated abducens nerve palsy, especially in younger patients with no known vascular risk factors.

Idiopathic Intracranial Hypertension: A Case Study of Patient Engagement in the Treatment of a Chronic Disease.

Idiopathic intracranial hypertension is a rare neurological disorder characterized by increased intracranial pressure, which can lead to visual loss and headaches. While medical therapy exists, weight loss is the only disease-modifying treatment. Weight loss is the only therapy that leads to sustained resolution of papilledema. Involving the patient in their disease management through patient engagement is a way to improve disease outcomes, and strengthen the therapeutic relationship. This feature discusses an overview of the disease, a patient's experience, and a physician's perspective.

Unilateral Papilledema in Idiopathic Intracranial Hypertension: A Case Series.

Idiopathic intracranial hypertension (IIH) typically presents with bilateral papilledema; however, highly asymmetric and rare unilateral cases have been reported. We report three cases of IIH meeting modified Dandy criteria presenting with unilateral papilledema. Magnetic resonance imaging (MRI) demonstrated bilateral distention of the optic nerve sheaths and computed tomography (CT) of the orbits demonstrated a smaller diameter of the optic canal in the unaffected eye in two cases. Papilledema fully resolved in all with acetazolamide. Of postulated mechanisms, we suspect that differences in bony optic canal diameter, compliance of the lamina cribrosa, and optic nerve sheath anatomy may contribute to asymmetry.

Congenital Herniation of the Gyrus Rectus Resulting in Compressive Optic Neuropathy.

We report a 34-year-old male with a previously uninvestigated lifelong blindness of the right eye from compressive optic neuropathy secondary to congenital herniation of the gyrus rectus (HGR). His past medical history was otherwise unremarkable, with no history of prior head or ocular trauma. On examination, he had no light perception in the right eye, right relative afferent pupillary defect (RAPD), and primary optic atrophy. His left eye had normal visual acuity, color vision, and a healthy optic disc. There was a sensory exotropia in the right eye; however, extraocular movements were intact and the remainder of his neurological exam was normal. MRI revealed compression of the prechiasmatic right optic nerve from HGR and atrophy of the right optic nerve and optic chiasm (Figures 1 and 2), without any parenchymal mass lesions. There were no signal abnormalities in the optic nerves or the chiasm.

Silent Post Cataract Bilateral Sequential Nonarteritic Anterior Ischaemic Optic Neuropathy.

Nonarteritic anterior ischaemic optic neuropathy (NAION) has been reported as a rare occurrence following cataract surgery. Bilateral sequential NAION following cataract surgery is extremely rare. We report an 83-year-old male who developed bilateral sequential NAION within 5 and 3 weeks of undergoing uneventful cataract surgeries in each eye. A brief review of the literature on this topic is provided. This case serves to add to the ongoing debate about the association between cataract surgery and NAION.

Optic nerve sheath meningocele.

Optic nerve sheath meningocele, also called dural ectasia of the optic nerve, is a benign dilation of the optic nerve sheath. We report two interesting cases of primary optic nerve sheath meningocele. Etiology, clinical features, and management options are discussed.

Multivariable prediction model for suspected giant cell arteritis: development and validation.

PURPOSE: To develop and validate a diagnostic prediction model for patients with suspected giant cell arteritis (GCA). METHODS: A retrospective review of records of consecutive adult patients undergoing temporal artery biopsy (TABx) for suspected GCA was conducted at seven university centers. The pathologic diagnosis was considered the final diagnosis. The predictor variables were age, gender, new onset headache, clinical temporal artery abnormality, jaw claudication, ischemic vision loss (VL), diplopia, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and platelet level. Multiple imputation was performed for missing data. Logistic regression was used to compare our models with the non-histologic American College of Rheumatology (ACR) GCA classification criteria. Internal validation was performed with 10-fold cross validation and bootstrap techniques. External validation was performed by geographic site. RESULTS: There were 530 complete TABx records: 397 were negative and 133 positive for GCA. Age, jaw claudication, VL, platelets, and log CRP were statistically significant predictors of positive TABx, whereas ESR, gender, headache, and temporal artery abnormality were not. The parsimonious model had a cross-validated bootstrap area under the receiver operating characteristic curve (AUROC) of 0.810 (95% CI =0.766-0.854), geographic external validation AUROC's in the range of 0.75-0.85, calibration pH-L of 0.812, sensitivity of 43.6%, and specificity of 95.2%, which outperformed the ACR criteria. CONCLUSION: Our prediction rule with calculator and nomogram aids in the triage of patients with suspected GCA and may decrease the need for TABx in select low-score at-risk subjects. However, misclassification remains a concern.