Skin in the game.

A 23-year-old man with a history of migraine and focal seizures, developed painless visual loss in the left eye associated with optic disk edema. There was no recent history of cat exposure except for a cat that lives outside. Initial laboratory studies were negative. magnetic resonance imaging brain and orbits without and with fat suppression and intravenous contrast was normal. The patient admitted to routinely skinning, processing and consuming deer while not wearing gloves, and he also frequently had cuts on his hands while doing so. The serum Toxoplasma gondii IgG antibody returned at >400 (0-7.1 IU/mL) with the IgM at 10.4 (0-7.9 AU/mL).

Cerebral Venous Sinus Thrombosis following Ventriculoperitoneal Shunting for Idiopathic Intracranial Hypertension.

A 30-year-old woman with idiopathic intracranial hypertension experienced worsening headaches and decreasing vision in her left eye. She underwent an uncomplicated ventriculoperitoneal shunt procedure but the following day was found to have cerebral venous sinus thrombosis. Treatment included venous sinus thrombectomy and anticoagulation. She had a favourable clinical outcome. Extensive evaluation including testing for thrombophilia was unremarkable. Potential causes for this rare association are discussed.

Chronic recurrent multifocal osteomyelitis, central retinal artery occlusion and optic neuropathy: A new association.

PURPOSE: To report a patient with chronic recurrent multifocal osteomyelitis (CRMO) complicated by optic neuropathy and central retinal artery occlusion (CRAO). OBSERVATIONS: CRMO is a noninfectious, inflammatory bone disorder. It is thought to be an autoimmune condition related to an imbalance of pro- and anti-inflammatory cytokines. Retinal vasculitis has been reported in a patient with CRMO but not CRAO or optic neuropathy. CONCLUSIONS: We expanded the list of ophthalmic involvement of CRMO to include CRAO and optic neuropathy.

Disorders of the Fourth Cranial Nerve.

ABSTRACT: This review of disorders of the fourth cranial nerve includes discussion on anatomy, examination techniques, congenital and acquired etiologies, differential diagnosis, and management options. The findings of the superior oblique muscle on orbital MRI in patients with fourth nerve palsy have had a major impact on our understanding of this cranial neuropathy. In addition, briefly reviewed are rare disorders of the fourth nerve: superior oblique myokymia, Brown syndrome, and ocular neuromyotonia. It behooves the clinician to have a clear understanding of the role that the fourth cranial nerve plays in a variety of neuro-ophthalmic conditions.

Neuro-ophthalmic Manifestations of Wernicke Encephalopathy.

Wernicke encephalopathy (WE) is a life-threatening but reversible syndrome resulting from acute thiamine deficiency that is frequently overlooked and underdiagnosed. It is classically characterized by a triad of ocular dysfunction, ataxia, and altered mental status. However, less than 1/3 patients have the complete triad, so it is crucial to have a high index of suspicion. Awareness of the early signs of WE is essential to prevent clinical progression, as patients with the full triad already have a profoundly thiamine-deficient state. This review highlights the neuro-ophthalmic manifestations of WE to guide the clinician in identifying the condition. In addition, we provide an update regarding the clinical characteristics, pathophysiology, neuroimaging and laboratory findings, treatment options, and prognosis of WE.