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1.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461994

RESUMO

A 26-year-old male driver presented with a history of pain in the neck for the past 1 week following trauma due to a road traffic accident. The patient had no neurological deficit. He had type 1 diabetes and was on regular oral hypoglycemics. After radiological investigations, the patient was diagnosed to have traumatic AO Spine Classification type C translational injury involving anterolisthesis of C6 over C7. After a detailed preoperative assessment, the patient was taken up for surgery. The patient underwent posterior stabilisation with instrumentation from C5 to T2. On extubation from anaesthesia, he immediately complained of complete painless loss of this vision in his left eye. Ophthalmological investigations attributed the cause to be due to central retinal artery occlusion. The patient was discharged with reassurance on the 20th postoperative day with minimal improvement in his vision and at 6-month follow-up, his vision improved to 1/60 and was advised for close follow-up.


Assuntos
Vértebras Cervicais/lesões , Complicações Pós-Operatórias/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Traumatismos da Coluna Vertebral/cirurgia , Transtornos da Visão/etiologia , Adulto , Vértebras Cervicais/cirurgia , Humanos , Masculino , Oclusão da Artéria Retiniana/diagnóstico , Traumatismos da Coluna Vertebral/diagnóstico , Transtornos da Visão/diagnóstico
2.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461997

RESUMO

Primary cardiac valve tumours are rare. This is a case report of a 32-year-old non-smoker man with a history of stroke 1 year prior and no other cardiovascular risk factors. The patient was admitted to our acute stroke ward for recurrent left hemiparesis, slurring of speech, facial asymmetry and central retinal artery occlusion. Initial laboratory investigations and ECG were normal. An urgent CT brain showed a large hypodense area at the right frontal, parietal, temporal, occipital region with effaced sulci and right lateral ventricle with midline shift and cerebral oedema in keeping with acute infarction. We proceeded with CT angiography of the cerebral and carotid on the following day, which revealed no evidence of thrombosis, aneurysm or arteriovenous malformation. There were no abnormal beaded vessels to suggest vasculitis. Transthoracic echocardiography revealed a large mobile mass in the left atrium. Meanwhile, MRI cardiac confirmed a large ill-defined mobile solid mass attached to the mitral valve's inferoseptal component suggestive of mitral valve myxoma. This case report highlights the significance of considering a cardiogenic source of emboli in patients with large cerebral infarcts and other cardiac embolic phenomena. Imaging modalities such as echocardiography and cardiac MRI will help detect treatable conditions, such as valvular myxoma and prevent further complications.


Assuntos
Ecocardiografia , Neoplasias Cardíacas/diagnóstico por imagem , Mixoma/diagnóstico por imagem , Oclusão da Artéria Retiniana/etiologia , Tomografia Computadorizada por Raios X , Adulto , Neoplasias Cardíacas/complicações , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/patologia , Mixoma/complicações , Oclusão da Artéria Retiniana/diagnóstico
4.
Middle East Afr J Ophthalmol ; 27(2): 139-141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874050

RESUMO

Paracentral acute middle maculopathy (PAMM) is an optical coherence tomography (OCT) finding seen in patients with retinal capillary ischemia. In this case report, we present a case of PAMM after a transient central retinal artery occlusion and the multifocal electroretinogram (mfERG) and other multimodal imaging findings. Clinical examination, OCT angiography, OCT en face, fluorescein angiography, and visual fields were performed at the baseline and follow-up examinations. As a result, we identified in this PAMM case evidence of hypoperfusion in both the choriocapillaris as well as the deep capillary plexus. To the best of our knowledge, the involvement of choriocapillaris has not been reported previously in the literature. Moreover, we concluded that mfERG constitutes a useful investigation in PAMM and this is the first mfERG findings to be presented for a PAMM case specifically.


Assuntos
Isquemia/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Artéria Retiniana/patologia , Capilares/patologia , Corioide/irrigação sanguínea , Eletrorretinografia , Angiofluoresceinografia , Humanos , Isquemia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Retina/fisiopatologia , Oclusão da Artéria Retiniana/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica
5.
J Stroke Cerebrovasc Dis ; 29(9): 105002, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807420

RESUMO

BACKGROUND: Retinal artery occlusion (RAO) can cause acute, painless, and irreversible loss of vision. Using a large sample population database, we investigated the possible impact of RAO and numerous other clinical and non-clinical factors on the risk of developing a subsequent cerebrovascular accident. METHODS: Cases of RAO were obtained from the National Inpatient Sample (NIS) database between 2002 and 2013 using ICD-9 codes. Associated morbidities and procedures were assessed in these cases with a primary hospital admitting diagnosis of stroke. Univariate and multivariate logistic regression analyses were carried out in RAO cases to determine risk factors for stroke. The Bonferroni correction method was applied. RESULTS: The RAO group consisted of 19,809 cases that were separated into stroke (n=1,157, 55% male, mean age: 69±0.4 years) and non-stroke (n=18,652, 55% male, mean age: 68±0.1) cohorts. Age groups associated with reduced risk of stroke with respect to were 20-39 (OR: 0.391), 40-59 (OR: 0.842), and 60-79 (OR: 0.837). No cases of stroke were present for ages < 20. Other factors associated with a reduced stroke risk were carotid stenosis (OR: 0.187), transient ischemic attack (OR: 0.064), coronary artery disease (OR: 0.788), cardiac catheterization (OR: 0.481), and septicemia (OR: 0.333). Factors associated with an increased risk of stroke included hypertension (OR: 1.418), tobacco use (OR: 1.568), valvular disease (OR: 1.359), hyperlipidemia (OR: 1.298), and non-stroke cerebrovascular disease (OR: 2.985). CONCLUSIONS: A large patient population was used to determine that RAO patients with a history of hypertension, hyperlipidemia, tobacco usage, valvular disease, or non-stroke cerebrovascular disease had an increased risk of stroke. Patients below the age of 40 had significantly reduced the odds of stroke. Carotid stenosis, coronary artery disease, transient ischemic attacks, cardiac catheterization, and septicemia were all independently associated with a decreased risk of stroke development in RAO patients.


Assuntos
Oclusão da Artéria Retiniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Prognóstico , Oclusão da Artéria Retiniana/diagnóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
9.
Medicine (Baltimore) ; 99(16): e19875, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32312013

RESUMO

INTRODUCTION: Systemic lupus erythematosus (SLE) is a multisystem, chronic, autoimmune disease which can affect any organ system including the eye. About one-third of the patients can be diagnosed with SLE-related eye involvement which is usually indicative of disease activity. Retinopathy is one of the most vision-threatening complications that can be associated with the disease. PATIENT CONCERNS: An 11-year-old girl was hospitalized with complains of repeated swelling and pain in her extremities for 1 month, chest pain for 24 days, rash for 5 days and proteinuria for 1 day. On the morning of her fourth day in hospital, she suddenly complained of sudden, painless vision loss in the left eye. The ophthalmologist found that she had obstruction of central retinal vein and artery with diffuse retinal hemorrhages and macular edema. DIAGNOSIS: The patient was diagnosed with systemic lupus erythematosus, lupus nephritis, and lupus retinopathy through her clinical manifestations and laboratory tests. INTERVENTIONS: After diagnosis, she received steroid therapy, retinal laser photocoagulation, and intravitreal injection of dexamethasone (OZURDEX, Allergan Pharmaceuticals, Dublin, Ireland) early in her course. OUTCOMES: At the latest follow-up, her vision improved partially. However, she still has the possibility of subsequent neovascular glaucoma and bleeding in the future. CONCLUSIONS: An early diagnosis and the prompt therapeutic measures are necessary to prevent sight-threatening consequences, especially in pediatric patients with SLE.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Doenças Retinianas/etiologia , Doenças Retinianas/terapia , Transtornos da Visão/etiologia , Criança , Dexametasona/administração & dosagem , Dexametasona/uso terapêutico , Feminino , Glaucoma Neovascular/epidemiologia , Glaucoma Neovascular/etiologia , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Hemorragia , Humanos , Injeções Intravítreas , Fotocoagulação a Laser/métodos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/patologia , Nefrite Lúpica/complicações , Nefrite Lúpica/diagnóstico , Edema Macular , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/etiologia , Doenças Retinianas/patologia , Oclusão da Veia Retiniana/diagnóstico , Oclusão da Veia Retiniana/etiologia , Resultado do Tratamento
10.
Acta Diabetol ; 57(7): 861-866, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32114640

RESUMO

AIMS: Hyperreflective foci (HF), detected in the retina of diabetic patients, suggest the presence of microglial activation and migration, while controversies still remain for the origin of HF to be precursors of hard exudates. We investigated the presence of HF and their association with dyslipidemia in serous retinal detachment (SRD)-type diabetic macular edema (DME). METHODS: Forty-two eyes in 42 patients with diabetic retinopathy (DR) and 22 eyes in 22 patients with branch retinal vascular occlusion (BRVO) showing macular edema were included in this study. The medical records and OCT findings were retrospectively reviewed in patients with SRD-type DME and compared with those with BRVO. The mean number of HF, the mean choroidal thickness, and lipid profiles were analyzed and compared between groups. RESULTS: The mean number of HF was significantly higher in DR group compared to BRVO group. Significant correlation of HF was noted with triglycerides (r = 0.523, P = 0.002). Triglycerides were significantly associated with HF by linear regression (ß = 0.012, 95% CI 0.001-0.024, P = 0.034) and remained significantly associated by multiple linear regression (ß = 0.014, 95% CI 0.003-0.025, P = 0.014). CONCLUSIONS: HF on OCT of DME patients could be indicative of activated microglia. HF are associated with dyslipidemia, especially high triglycerides, suggesting inflammatory reaction from dyslipidemia in diabetic retina.


Assuntos
Retinopatia Diabética/complicações , Dislipidemias/complicações , Edema Macular/complicações , Microglia/patologia , Retina/patologia , Descolamento Retiniano/complicações , Adulto , Idoso , Movimento Celular , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/patologia , Dislipidemias/diagnóstico , Dislipidemias/patologia , Feminino , Humanos , Edema Macular/diagnóstico , Edema Macular/patologia , Masculino , Microglia/fisiologia , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/fisiopatologia , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/patologia , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/patologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
12.
Mult Scler Relat Disord ; 37: 101436, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32173001

RESUMO

Susac's syndrome (SuS) is a rare disorder with a clinical triad of encephalopathy, sensorineural hearing loss, and branch retinal artery occlusions. We report a 7-year-old girl who presented with chronic, progressive sensorineural hearing loss, who, years later, presented with encephalopathy and vision loss. Such prolonged period between symptoms is unusual and to our knowledge, this is the longest interval between onset of hearing loss and completion of the full triad in SuS. In addition, she had a protracted disease course, requiring multiple immune therapies for disease control.


Assuntos
Perda Auditiva Neurossensorial/fisiopatologia , Oclusão da Artéria Retiniana/fisiopatologia , Síndrome de Susac/fisiopatologia , Transtornos da Visão/complicações , Encefalopatias/complicações , Criança , Feminino , Angiofluoresceinografia/métodos , Perda Auditiva Neurossensorial/complicações , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Oclusão da Artéria Retiniana/diagnóstico , Síndrome de Susac/complicações , Síndrome de Susac/diagnóstico
13.
J Fr Ophtalmol ; 43(4): 294-297, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32107025

RESUMO

Factor V is a pro-coagulant cofactor required for the transformation of prothrombin into thrombin. Thrombin activates factor V, which is then deactivated by protein C. A mutation in factor V is responsible for the formation of factor V Leiden, resistant to activated protein C. The association of this mutation with venous thromboses has been established. Its association with arterial occlusions is still controversial. We report the case of a central retinal artery occlusion associated with a non-arteritic anterior optic neuropathy associated with a Leiden mutation of factor V (FVL). The presence of FVL has been associated with lack of reperfusion and rapid progression to neovascularization. It seems that FVL intervenes mainly during the reperfusion phase after the occurrence of arterial thrombosis.


Assuntos
Resistência à Proteína C Ativada/diagnóstico , Fator V/genética , Mutação , Neuropatia Óptica Isquêmica/diagnóstico , Oclusão da Artéria Retiniana/diagnóstico , Resistência à Proteína C Ativada/complicações , Resistência à Proteína C Ativada/genética , Angiofluoresceinografia , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Neuropatia Óptica Isquêmica/complicações , Neuropatia Óptica Isquêmica/genética , Oclusão da Artéria Retiniana/complicações , Oclusão da Artéria Retiniana/genética , Tomografia de Coerência Óptica
17.
Graefes Arch Clin Exp Ophthalmol ; 258(2): 303-310, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31863398

RESUMO

PURPOSE: Nonperfusion of retinal tissue due to arterial occlusion leads inevitably to mostly irreversible retinal damage. Until today no evidence-based treatment exists. Inhalation of 100% oxygen at high atmospheric pressure causes an increased solubility of oxygen in the blood that helps the retinal tissue to survive through diffusion in case of an artery occlusion till vascular recanalization occurs. Hence the purpose of this study is to compare the visual outcome in patients with retinal branch artery obstruction treated with hyperbaric oxygen versus patients treated with hemodilution only. METHODS: Non-randomized, monocentric, retrospective study. Patients with diagnosis of non-arteritic retinal branch artery occlusion (BRAO) treated with hyperbaric oxygen therapy between 1997 and 2017. Exclusion criteria were central retinal artery occlusion, presence of a cilioretinal artery and arteritic cases. The control group was matched based on visual acuity (VA) at admission, age, and delay between symptoms and beginning of clinical care. RESULTS: The control group and the matching oxygen group contained 14 patients each. Initial VA in the matched HBO group was 0.18 ± 0.19 and 0.23 ± 0.19 in the control group (p = 0.57). Final VA at discharge was 0.69 ± 0.29 in the matched oxygen group and 0.32 ± 0.23 in the control group (p = 0.0009). HBO-treated patients had a significant visual increase compared with the control group. The most common comorbidities were arterial hypertension and vascular sclerosis. CONCLUSION: HBO treatment appears to have a beneficial effect on visual outcome in patients with retinal branch artery occlusion. HBO treatment could be a rescue therapy at an early stage of BRAO, especially to bridge the time of a potential reperfusion. However, further, prospective, randomized clinical trials are required to verify this assumption.


Assuntos
Artérias Ciliares/patologia , Oxigenação Hiperbárica/métodos , Retina/patologia , Oclusão da Artéria Retiniana/terapia , Acuidade Visual , Idoso , Feminino , Angiofluoresceinografia/métodos , Seguimentos , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Oxigênio/metabolismo , Oclusão da Artéria Retiniana/diagnóstico , Oclusão da Artéria Retiniana/metabolismo , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento
18.
J Stroke Cerebrovasc Dis ; 29(2): 104446, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31837921

RESUMO

OBJECTIVE: In population-based studies asymptomatic retinal emboli occur in .32%-2.9% of people. Retinal artery occlusion (RAO) may occur concurrently with cerebral stroke but the frequency is unknown. No study has examined how commonly retinal emboli occur in the acute stroke population. We aimed to assess the prevalence of retinal emboli and RAO at the time of carotid territory ischemic stroke. METHODS: Patients were enrolled prospectively after onset of symptoms consistent with the diagnosis of carotid territory ischemic stroke. Every participant underwent pharmacologic dilation of both pupils and bedside funduscopic examination. Emboli were classified as cholesterol, calcific, platelet/fibrin, or other and categorized by the side of occurrence. Stroke was classified as atheroembolic, cardioembolic, embolic stroke of undetermined source, lacunar, or other. Acute RAO was diagnosed by direct visualization of ischemic retinal whitening. RESULTS: Sixty-five patients were enrolled with a mean age of 59.2 years; 23 were female (35.4%). Eleven of 65 subjects (16.9%) had retinal emboli visible on funduscopy; all were cholesterol emboli except a single platelet/fibrin embolus in a patient with atheroembolic source. Six patients (9%) had acute RAO and no RAO was seen in the lacunar or undetermined source subgroups. CONCLUSIONS: Retinal emboli occurred more than 10 times more frequently in the acute stroke patient than in large population-based studies. RAOs also occurred concurrently with ischemic stroke. Although emboli were seen in patients with atheroembolic and cardioembolic sources, all patients with carotid disease had emboli in the ipsilateral eye. Future studies are required to determine if the presence of retinal emboli or RAO may help elucidate an etiology in patients suffering from embolic stroke of undetermined source.


Assuntos
Isquemia Encefálica/epidemiologia , Embolia/epidemiologia , Oclusão da Artéria Retiniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Isquemia Encefálica/diagnóstico , Embolia/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oregon/epidemiologia , Projetos Piloto , Prevalência , Estudos Prospectivos , Oclusão da Artéria Retiniana/diagnóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Adulto Jovem
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