Acute bilateral vision loss after endovascular treatment of an intracranial aneurysm.

Acute bilateral vision loss (ABVL) is a rare and challenging diagnostic issue that is most often caused by a neurological disorder. Since it can be the presenting symptom of potentially life-threatening diseases, priority should be given to excluding such diagnoses. Special caution is required if ABVL symptoms result after an intracranial intervention. This article reports on a diagnostic approach for a patient suffering from ABVL due to vitreous hemorrhage related to a subarachnoid hemorrhage (SAH) after endovascular intracranial aneurysm treatment. This case study highlights the importance of imaging interpretation and its consequences.

Idiopathic Orbital Pseudotumor: A Rare Case Report.

Orbital pseudotumor is a rare inflammatory condition affecting the orbit of the eye. It has diverse clinical manifestations. Although its exact etiology remains unknown, it is believed to involve an immune-mediated response. A 42-year-old male presented to the ophthalmology clinic with progressively worsening symptoms in his left eye, including pain, swelling, and blurry vision. He had no history of trauma or recent illness. Initial discomfort had escalated over three weeks. The patient had controlled hypertension but no known allergies. Examination showed eyelid edema, erythema, and mild anterior chamber cell, and flare in the left eye. Magnetic resonance imaging revealed orbital soft tissue enhancement, extraocular muscle thickening, and optic nerve involvement. Laboratory results showed elevated inflammatory markers. A diagnosis of orbital pseudotumor was made. The patient was treated with oral corticosteroids, resulting in symptom improvement and regression of inflammatory changes on follow-up. Orbital pseudotumor is a complex condition with diverse clinical manifestations. Its diagnosis requires a comprehensive approach involving clinical evaluation, imaging studies, and laboratory investigations.

Not just any headache.

A 40-year-old man with a history of traumatic retinal detachment in the left eye treated with scleral buckle and migraine with aura presented to clinic for persistent blurry vision of the right eye following an episode of migraine with aura. The patient had experienced migraines with visual auras starting as a teenager, which normally resolve within an hour except for the most recent episode. Humphrey visual field showed right superior homonymous quadrantanopia. Computed tomography of the head without contrast showed acute ischemia in the left occipital lobe. Magnetic resonance imaging of the brain confirmed an ischemic infarct of the left occipital lobe. There were no significant abnormalities in complete blood count, metabolic panel, coagulation studies, and infectious testing. Echocardiogram and transthoracic echocardiography were normal as well, but further work up by cardiology revealed a patent foramen ovale on transesophageal echocardiogram. This case illustrates a rare case of migrainous infarction, which should be considered as a possible complication of migraine with aura, presenting with persistent visual changes.

Renal Crisis as the Initial Manifestation of Scleroderma.

We report the case of a young Hispanic woman who was originally admitted to the emergency department following hypertensive urgency and right-sided blurry vision. The patient did not carry a diagnosis of scleroderma at the time of the visit. However, upon further evaluation, the patient was found to have a scleroderma renal crisis. An angiotensin-converting enzyme (ACE) inhibitor was initiated promptly with subsequent normalization of the blood pressure and creatinine level. Scleroderma renal crisis is a rare, highly feared complication of scleroderma that if left untreated can be life-threatening. Therefore, it is important to identify this condition early and initiate therapy without delay.

An Uncharacteristic Presentation of Evans Syndrome Following Treatment With Dupilumab.

Evans syndrome is a rare autoimmune disorder where patients develop autoimmune hemolytic anemia (AIHA), immune thrombocytopenia (ITP), and less commonly immune neutropenia. Patients typically present with fatigue, pallor, jaundice, petechiae, or epistaxis. A 27-year-old man with a history of atopic dermatitis for which he recently began treatment with dupilumab presented to the emergency department with a headache and blurry vision. Multiple Roth spots were seen on fundoscopic examination. Laboratory studies were consistent with warm AIHA, confirmed by a positive direct antiglobulin test (DAT), and severe thrombocytopenia. He was diagnosed with Evans syndrome. He was treated with corticosteroids, rituximab, and intravenous immunoglobulin (IVIG). His recovery was prolonged with the slow improvement of anemia and thrombocytopenia. This is an atypical presentation of Evans syndrome with isolated symptoms of new-onset blurry vision and headache along with the finding of Roth spots. Another interesting feature in the case is the recent use of dupilumab. Dupilumab is a monoclonal antibody that inhibits the T-helper cells type 2 (Th2) signaling pathway by blocking interleukin (IL)-4 and IL-13 binding. This alteration in the immune response could have a role in the development of Evans syndrome.

A Novel Association between Oxybutynin Use and Bilateral Acute Angle Closure Glaucoma: A Case Report and Literature Review.

We are reporting a case of a 62-year-old male presenting with headache and blurry vision. His condition resolved with cessation of the presumed offending medication and urgent bilateral laser peripheral iridotomies since he failed medical therapy. This case presents a novel association between oxybutynin and bilateral acute angle-closure glaucoma (AACG).

Paraneoplastic frosted branch angiitis as first sign of relapsed Hodgkin lymphoma.

Frosted branch angiitis (FBA) is a rare form of retinal vasculitis with typical perivascular edema taking the shape of frost on a tree branch. It was reported only twice as the initial presentation of Hodgkin lymphoma (HL). Here, we present the first case of paraneoplastic FBA as the initial sign of HL relapse in an elderly female.

Long-acting Injectable Risperidone Use in an 11-Years-Old Bipolar Child.

Early-onset bipolar disorder is difficult for child psychiatrists in terms of both diagnosis and treatment. The proper diagnostic evaluation is negatively impacted by the atypical clinical manifestation and rapid cycling pattern of the disease, together with common comorbidity with attention-deficit hyperactivity disorder and anxiety disorder. In addition to poor insight, nonadherence to treatment, poor family coping skills, and insufficient child psychiatric inpatient units make clinicians unsuccessful in following up and treating such patients. Risperidone is a commonly used atypical antipsychotic it has been approved for the treatment of manic and mixed episodes of bipolar disorder even in 10-17-year-old patients, and it is commonly used. It has a long-acting injectable formulation. Studies on its long-acting form in younger children are limited. In this case presentation, the diagnostic procedure in an 11-year old child with bipolar disorder will be presented. Long-acting injectable risperidone use in the case of nonadherence to treatment and observed side effects will be discussed.

Elderly male with blurry vision / 世界急诊医学杂志（英文）

@#We present a case of an elderly gentleman who was punched in the face and subsequently diagnosed by an emergency physician with acute angle closure glaucoma secondary to a posterior lens dislocation. Slit lamp evaluation, ocular ultrasound, and computed tomography (CT) imaging, can identify a dislocated lens. A rare complication of a lens dislocation includes secondary acute angle closure glaucoma. Treatment of lens dislocation includes prosthetic lens placement or reattachment in cases of a partial lens dislocation.

Clinical characteristics of patients with conjunctivochalasis.

PURPOSE: To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh). METHODS AND MATERIALS: This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded. RESULTS: The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60%) eyes with grade 1 CCh; 15 (30%) eyes with grade 2 CCh; and five (10%) eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90%) eyes, and in the remaining five (10%) CCh was located in the superior bulbar conjunctiva. Ten (33.3%) patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6%) patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients. CONCLUSION: Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora.