Subject(s)
Exanthema , Adult , Blindness/diagnosis , Blindness/etiology , Exanthema/diagnosis , Exanthema/etiology , Humans , Male , Vision Disorders/diagnosis , Vision Disorders/etiologyABSTRACT
Bilateral carotid-cavernous fistulas (CCFs) are rare. In this paper, we report the case of an 88-year-old woman who presented with a two-month history of worsening visual symptoms and was subsequently found to have bilateral Barrow grade D CCFs. Cannulation and complete embolization of the offending vessels during angiography proved unsuccessful, and so the patient underwent adjuvant radiosurgery as salvage therapy with a good clinical outcome. This case adds to the limited but growing literature on the multi-modal management of CCFs.
ABSTRACT
OBJECTIVE: To examine the tolerability and adverse events reported in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT). METHODS: Randomized, double-masked, placebo-controlled clinical trial. Trial participants (n = 165) with mild visual loss concurrently receiving low-sodium weight-reduction diet plus the maximally tolerated dosage of acetazolamide (up to 4 g/d) or placebo for 6 months. MAIN OUTCOMES MEASURES: adverse events (AEs), assessment of clinical and laboratory findings at study visits. RESULTS: Thirty-eight of 86 participants randomized to the acetazolamide group (44.1%) tolerated the maximum allowed dosage of 4 g/d. The average time to achieve maximum study dosage in the acetazolamide group was 13 weeks (median 12 weeks; range 10-24 weeks). A total of 676 AEs (acetazolamide, n = 480; placebo, n = 196) and 9 serious AEs (acetazolamide, n = 6; placebo, n = 3) were reported. Notably, the percentages of participants reporting at least 1 AE in the nervous, gastrointestinal, metabolic, and renal organ systems were significantly higher in the acetazolamide group (P < 0.05). The odds of paresthesia (OR 9.82; 95% CI 3.87-27.82), dysgeusia (OR ∞; 95% CI 3.99-∞), vomiting and diarrhea (OR 4.11; 95% CI 1.04-23.41), nausea (OR 2.99; 95% CI 1.26-7.49) and fatigue (OR 16.48; 95% CI 2.39-702.40) were higher in the acetazolamide group than in the placebo group. CONCLUSION: Acetazolamide appears to have an acceptable safety profile at dosages up to 4 g/d in the treatment of idiopathic intracranial hypertension. The majority of participants in the Idiopathic Intracranial Hypertension Treatment Trial were able to tolerate acetazolamide above 1 g/d for 6 months.
Subject(s)
Acetazolamide/therapeutic use , Carbonic Anhydrase Inhibitors/therapeutic use , Diet, Sodium-Restricted , Pseudotumor Cerebri/diet therapy , Pseudotumor Cerebri/drug therapy , Acetazolamide/adverse effects , Adolescent , Adult , Carbonic Anhydrase Inhibitors/adverse effects , Combined Modality Therapy , Double-Blind Method , Female , Humans , Intracranial Pressure/drug effects , Male , Maximum Tolerated Dose , Middle Aged , Papilledema/physiopathology , Pseudotumor Cerebri/physiopathology , Quality of Life , Vision Disorders/drug therapy , Vision Disorders/physiopathology , Visual Fields/drug effects , Visual Fields/physiologyABSTRACT
OBJECTIVES: Determine potential risk factors for progressive visual field loss in the Idiopathic Intracranial Hypertension Treatment Trial, a randomized placebo-controlled trial of acetazolamide in patients with idiopathic intracranial hypertension and mild visual loss concurrently receiving a low sodium, weight reduction diet. METHODS: Logistic regression and classification tree analyses were used to evaluate potential risk factors for protocol-defined treatment failure (>2 dB perimetric mean deviation [PMD] change in patients with baseline PMD -2 to -3.5 dB or >3 dB PMD change with baseline PMD -3.5 to -7 dB). RESULTS: Seven participants (6 on diet plus placebo) met criteria for treatment failure. The odds ratio for patients with grades III to V papilledema vs those with grades I and II was 8.66 (95% confidence interval [CI] 1.65-∞, p = 0.025). A 1-unit decrease in the number of letters correct on the ETDRS (Early Treatment Diabetic Retinopathy Study) chart at baseline was associated with an increase in the odds of treatment failure by a factor of 1.16 (95% CI 1.04-1.30, p = 0.005). Compared with female participants, the odds ratio for male participants was 26.21 (95% CI 1.61-433.00, p = 0.02). The odds of treatment failure were 10.59 times higher (95% CI 1.63-116.83, p = 0.010) for patients with >30 transient visual obscurations per month vs those with ≤30 per month. CONCLUSIONS: Male patients, those with high-grade papilledema, and those with decreased visual acuity at baseline were more likely to experience treatment failure. All but one of these patients were treated with diet alone. These patients should be monitored closely and be considered for aggressive treatment of their idiopathic intracranial hypertension.
Subject(s)
Intracranial Hypertension/physiopathology , Intracranial Hypertension/therapy , Vision Disorders/physiopathology , Vision Disorders/therapy , Acetazolamide/therapeutic use , Adult , Diet, Reducing , Diet, Sodium-Restricted , Diuretics/therapeutic use , Female , Humans , Intracranial Hypertension/diagnosis , Intracranial Hypertension/epidemiology , Male , Papilledema/diagnosis , Papilledema/epidemiology , Papilledema/physiopathology , Papilledema/therapy , Prognosis , Randomized Controlled Trials as Topic , Risk Factors , Severity of Illness Index , Sex Factors , Treatment Failure , Vision Disorders/diagnosis , Vision Disorders/epidemiology , Visual AcuityABSTRACT
BACKGROUND: We present a retrospective review of all biopsy-positive cases of giant cell arteritis (GCA) presenting to a neuro-ophthalmology practice in Saskatoon, Saskatchewan. METHODS: Records of 141 consecutive patients who underwent temporal artery biopsy at the Saskatoon Eye Centre from July 1998 through June 2003 were reviewed. Patients that were biopsy-positive for GCA were studied and an estimated regional incidence was calculated. Study variables included age at diagnosis, sex, ethnicity, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level. RESULTS: Of 141 patients, 37 (26%) had a positive biopsy result for GCA; 11 underwent a second biopsy for a total of 152 biopsies. The average age of the biopsy-positive patients was 76.5 (SD 8.2) years, and the female-to-male ratio was 2.4:l. There were 35 patients (95%) of European descent and 2 patients (5%) of Aboriginal descent. Twenty-three patients had both ESR and CRP testing done before starting steroids. The ESR was elevated in 19 (83%) and the CRP in 22 (96%). The estimated incidence of GCA for Saskatoon and area was 9.4 per 100,000 for people over the age of 50 years. INTERPRETATION: GCA occurs primarily in people of European descent; however, it can affect North American people of Aboriginal descent. Sensitivity for the detection of GCA is higher in CRP than in ESR. The estimated incidence of GCA in Saskatoon and surrounding referral area is moderate compared with other northern areas.
Subject(s)
Giant Cell Arteritis/ethnology , Indians, North American/ethnology , White People/ethnology , Aged , Aged, 80 and over , Ambulatory Care Facilities , Biopsy , Blood Sedimentation , C-Reactive Protein/analysis , Female , Giant Cell Arteritis/blood , Giant Cell Arteritis/diagnosis , Humans , Incidence , Male , Middle Aged , Neurology , Ophthalmology , Retrospective Studies , Saskatchewan/epidemiology , Temporal Arteries/pathologySubject(s)
Giant Cell Arteritis/diagnosis , Ophthalmic Artery/pathology , Scalp/pathology , Skin Diseases/etiology , Aged , Diagnosis, Differential , Female , Functional Laterality , Giant Cell Arteritis/complications , Giant Cell Arteritis/drug therapy , Headache/etiology , Humans , Necrosis , Steroids/therapeutic use , Vision Disorders/etiologyABSTRACT
A patient who presented with symptoms of giant cell arteritis was found to have a right ophthalmic artery occlusion. One month after initial evaluation, the peripheral retina demonstrated multiple linear bands of chorioretinal atrophy known as Siegrist streaks. Although most commonly described in the setting of acute hypertension, Siegrist streaks also occur in patients with giant cell arteritis.