Susac syndrome: The importance of an early diagnosis.

A 38-year-old man who attended the emergency department with headache, accompanied by vomiting, bradypsychia and gait instability, for which he was admitted to Neurology for study. During his admission, he began to present bilateral hearing loss and blurred vision in the left eye, with areas of arterial occlusion and hyperfluorescence of the arterial wall being observed in the ophthalmological examination. As a result, he was diagnosed with Susac syndrome. He was treated with systemic corticosteroids, as well as with rituximab and subsequently, with intravenous immunoglobulins and mycophenolate mofetil. The patient managed to preserve visual acuity, with gait instability and bilateral hearing loss as sequelae. Early diagnosis of Susac syndrome is important, because a delay in the start of treatment can lead to irreversible sequelae such as deafness, blindness or neurological involvement.

Síndrome de Susac: la importancia de un diagnóstico precoz / Susac syndrome: The importance of an early diagnosis

Varón de 38 años que acude a urgencias con cefalea, acompañada de vómitos, bradipsiquia e inestabilidad de la marcha, por lo que ingresa en neurología para estudio. Durante el ingreso, comienza con hipoacusia bilateral y visión borrosa en el ojo izquierdo, apreciándose en la exploración oftalmológica áreas de oclusión arterial e hiperfluorescencia de la pared arterial, por lo que es diagnosticado de síndrome de Susac. Se realiza tratamiento con corticoides sistémicos, así como con rituximab, y posteriormente con inmunoglobulinas intravenosas y micofenolato de mofetilo. El paciente consigue preservar la agudeza visual y presenta como secuelas, inestabilidad de la marcha y pérdida de audición bilateral. El diagnóstico precoz del síndrome de Susac es importante, porque un retraso en el inicio del tratamiento puede dar lugar a secuelas irreversibles como sordera, ceguera o afectación neurológica (AU)

A 38-year-old man who attended the emergency department with headache, accompanied by vomiting, bradypsychia and gait instability, for which he was admitted to Neurology for study. During his admission, he began to present bilateral hearing loss and blurred vision in the left eye, with areas of arterial occlusion and hyperfluorescence of the arterial wall being observed in the ophthalmological examination. As a result, he was diagnosed with Susac syndrome. He was treated with systemic corticosteroids, as well as with rituximab and subsequently, with intravenous immunoglobulins and mycophenolate mofetil. The patient managed to preserve visual acuity, with gait instability and bilateral hearing loss as sequelae. Early diagnosis of Susac syndrome is important, because a delay in the start of treatment can lead to irreversible sequelae such as deafness, blindness or neurological involvement (AU)

Fibrin glue as agent for sealing corneal and conjunctival wound leaks.

PurposeTo describe a novel use of fibrin glue in managing leaking blebs and leaking wounds following trauma or surgery.MethodsInterventional case series.ResultsWe report eight patients, including three where intra-operative or immediate post-penetrating keratoplasty recalcitrant leaks from the graft-host junction and/or openings created by the needle pass, were noted. All three had thin recipient beds in the sector of leak. This was managed by intra-cameral injection of fibrin glue in the affected quadrant. This stopped the leak and allowed the defect to heal. One patient of Descemets-stripping-endothelial-keratoplasty had leak from the surgical wound, which was also sealed with fibrin glue. Two patients with leaking glaucoma-surgery-related blebs were treated with intra-bleb injection of fibrin glue to stop the leak. One patient with a penetrating corneal injury with a metal wire had a brisk leak upon removal of the wire. This was sealed with fibrin glue. Another patient of chemical burn with spontaneous leaks was managed by glue injection in the perforations. Transient rise of intraocular pressure in one patient with a leaking bleb was the only adverse event recorded.ConclusionThis novel adaptation of the application of fibrin glue can help to deal with persistent intra-operative, post-operative and traumatic aqueous and air leaks.