Unilateral Blastomyces dermatitidis optic neuropathy case report and systematic literature review.

Objective: To describe the clinical and histopathologic findings of a unique case of isolated optic nerve Blastomyces dermatitidis infection and to summarize the ophthalmic blastomycosis literature.

Design: Case report and systematic literature review.

Methods: A 70-year-old healthy man experienced impaired vision in his left eye.

Wegener granulomatosis presenting as bilateral loss of vision.

We describe a man presenting with bilateral loss of vision secondary to a branch retinal artery occlusion and ischemic optic neuropathy, in turn related to underlying Wegener granulomatosis (WG). This case is unusual, because the simultaneous development of branch retinal artery occlusion and anterior ischemic optic neuropathy has, to our knowledge, not been reported in WG. Furthermore, only rarely does WG cause bilateral vision loss.

MR imaging of primary trochlear nerve neoplasms.

We present the clinical, anatomic, and MR imaging findings in six patients with seven primary trochlear nerve neoplasms, as well as the MR and clinical criteria that serve to establish the diagnosis of these rare cranial nerve neoplasms. Three patients had a history of neurofibromatosis and five patients had clinical evidence of a trochlear nerve palsy. Six of seven neoplasms produced localized, fusiform enlargement of the proximal cisternal segments of the trochlear nerves.

Delayed visual loss due to trauma of the internal carotid artery.

The group of six patients in this study experienced delayed visual loss following head trauma. Visual loss occurred from 1 day to 13 years after the initial injury. All patients suffered indirect trauma to the internal carotid artery resulting in formation of either an aneurysm or pseudoaneurysm or a carotid-cavernous fistula.

Spinocerebellar ataxia, hypogonadotropic hypogonadism, and choroidal dystrophy (Boucher-Neuhäuser syndrome).

We describe two families (including one previously reported) in which cerebellar or spinocerebellar ataxia, hypogonadotropic hypogonadism, and choroidal dystrophy result from abnormal function of an autosomal recessive gene. Review of the literature adds one other family with this disorder. These three examples confirm the existence of this traid as a specific, pleiotropic, single-gene syndrome.

Recurrent scintillating scotoma and homonymous hemianopia due to metastatic melanoma.

Acute left homonymous hemianopia and recurrent scintillating scotoma occurred in a 43-year-old woman due to metastases from a cutaneous malignant melanoma that had been resected 5 years previously. Computed tomography initially demonstrated small, probably embolic, areas of occipital lobe infarction. Five months after the onset of her visual symptoms, massive cerebral hemorrhage occurred from a large right occipital lobe tumor that had not been present initially.

Optic atrophy and the Wyburn-Mason syndrome.

A 14-year-old girl developed impaired vision and optic atrophy of the left eye as a manifestation of an orbital and parachiasmal arteriovenous malformation. Despite the lack of a retinal arteriovenous malformation, this condition appears to be a variant of the Wyburn -Mason syndrome, representing a vascular dysgenesis of the orbit and midbrain resulting in focal arteriovenous communications without interposed capillaries.

Occurrence of anti-retinal ganglion cell antibodies in patients with small cell carcinoma of the lung.

This report describes a patient with small-cell carcinoma of the lung associated with blindness. The serum of this patient was tested for immunoreactivity with retinal sections because there was no evidence of tumor metastasis to the central nervous system and because neuroendocrine cells of the lung share common antigens with retinal neurons. The immunoglobulins in the sera from this patient, from two other patients with small-cell carcinoma, from two patients with multiple sclerosis and from three controls were reacted with 8 micrometers thick sections of retina.

Diplopia in autoimmune thyroid disease.

Diplopia without obvious exophthalmos, caused by infiltrative endocrine ophthalmopathy, developed in 12 patients with clinical and laboratory confirmation of autoimmune thyroid disease. In eight patients, the diplopia alone prompted medical attention, which led to the diagnosis of autoimmune thyroid disease. A hypotropia secondary to restrictive tightening of the inferior rectus muscle, producing vertical diplopia, was the most common manifestation of the disorder.

Ischemic oculopathy. A manifestation of carotid artery disease.

Six patients experienced ischemic oculopathy, a condition in which there is ischemia in both the anterior and posterior segments of the eye caused by occlusive carotid artery disease. The abnormalities in the anterior segment include episcleral vascular congestion, anterior chamber flare and cells, a mid-dilated, sluggish, or unreactive pupil, rubeosis iridis, and abnormal intraocular pressure. The posterior segment abnormalities include ischemic insults to the retina or optic nerve, venous-stasis retinopathy, and low ophthalmodynamometry values.

Optic disk vasculitis.

A 44-year-old woman developed progressive loss of vision associated initially with a swollen optic disk, and later with optic atrophy and a diffuse retinal vasculopathy, which caused extensive retinal hemorrhagagic. Histopathologic examination showed hemorrhagagic infarction of the retina, as well as infarction of the anterior optic nerve. In the optic nerve, the central retinal vessels showed extensive phlebitis and occlusion of many small arterioles.

Diabetic papillopathy.

A 13-year-old girl and a 20-year-old man with juvenile-onset diabetes mellitus developed transient bilateral optic disk edema with minimal impairment of optic nerve function and with minimal diabetic retinopathy. This conditions, termed diabetic papillopathy appears to be a local optic disk vasculopathy, and generally resolves without treatment. Diabetic papillopathy should not be mistaken for papilledema or for the optic disk neovascularization of diabetic retinopathy.

Meningiomatous changes in the optic canan: a polytomographic study.

Eleven patients who had unilateral insidious compression of the optic nerve but exhibited no detectable abnormality on plain skull radiographs or non-tomographic views of the optic canal were studied. Paracanalicular meningioma was proved surgically in 10. Complex-motion tomography demonstrated characteristic alterations in the bone forming the optic canal in all cases.

Ophthalmodynamometry: a reappraisal.

The accuracy of ophthalmodynamometry (ODM) was retrospectively analyzed in 36 patients who had ophthalmic examinations prior to carotid arteriography. In 75% of those patients, ODM correctly predicted the presence of absence of significant stenosis (ie, 50% or greater) or occlusion of the internal carotid artery. A 30% false-negative rate and 19% false-positive rate was found in this study.

Amaurosis and blood loss.

A 57-year-old alcoholic man sustained permanent bilateral blindness and optic atrophy as a complication of hemorrhage from peptic ulcer disease. Post-hemorrhagic visual loss occurs in middle-aged, debilitated persons a short time after repeated episodes of hemorrhage from any site.

Meningeal carcinomatosis with blindness.

A 53-year-old man had bilateral blindness secondary to meningeal carcinomatosis from pulmonary adenocarcinoma. Histopathologic examination of the visual system showed extensive infiltration of the arachnoid of the proximal optic nerves and chiasm, with minimal invasion of the optic nerves themselves. The visual pathways within the cerebral cortex were not affected.

Bilateral homonymous hemianopia.

Bilateral homonymous hemianopia occurred in 15 patients seen during a four-year period. Persons with this visual deficit had similarly shaped visual field defects on corresponding sides of the vertical midline for each eye, equal visual acuity which is generally normal, and normal pupil and fundus examinations. The most common causes of the bilateral posterior cerebral artery insufficency were arteriosclerosis (40%), uncalherniation (20%), and migraine (13%).

Raeder's paratrigeminal syndrome.

Three middle-aged patients, 2 of whom are females, with unilateral trigeminal pain and associated isolated oculosympathetic paralysis are presented as characteristic of the benign form of Raeder's paratrigeminal syndrome. Their nonprogressive course is representative of the fact that this syndrome is not likely to be caused by aneurysms or mass lesions, and suggests that neuroradiologic contrast studies are generally not initially required in the investigation of such patients. If atypical features are present, or the pain is protracted, further investigation may be warranted.

Anatomic considerations for computed tomography of the optic chiasm.

When the clinical distinction between lesions of the optic nerves or the chiasm is not apparent, computed tomographic scans should be performed at both 0 degrees and 25 degrees or 35 degrees to the orbital-meatal line (Reid's baseline). The former plane is preferable for the demonstration of the optic nerves or orbital structures, while the latter allows superior visualization of perichiasmatic structures.

Progressive multifocal leukoencephalopathy. A cause of visual loss.

A patient had been treated for chronic lymphocytic leukemia for five years before developing visual blurring as the manifestation of occipital lobe lesions of progressive multifocal leukoencephalopathy (PML). The disease is caused by an infection of the CNS oligodendrocytes by a papovavirus, whose replication is facilitated by an impairment of the host's cell-mediated immunologic system. The multiplying virus destroys the oligodendrocytes and causes extensive demyelination of the white matter of the brain.