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Radiology Case Reports Jul 2024To discuss a very rare presentation of lung malignancy which results in visual disturbance as first and only clinical manifestation. Case report. We report a case of...
To discuss a very rare presentation of lung malignancy which results in visual disturbance as first and only clinical manifestation. Case report. We report a case of otherwise asymptomatic 32-year-old, nonsmoker female presenting with painless loss of vision in the right eye and photophobia in the left eye, owing to secondaries in choroid from lung carcinoma. Patient was worked up after admission in our hospital to ascertain the cause of blindness and subsequently revealed lung malignancy with widespread metastasis involving multiple organ systems. Despite widespread malignant involvement patient was completely asymptomatic and active except for visual disturbances. This case further emphasized the necessity of prompt and priority-based evaluation of patients for lung carcinoma whenever doubtful intraocular lesions are noted, regardless of age or smoking status. It seems that these cases represent a distinct subset of lung malignancy.
PubMed: 38666143
DOI: 10.1016/j.radcr.2024.03.015 -
Journal of Clinical Medicine Feb 2024Visual snow syndrome (VSS) is a rarely diagnosed neurological phenomenon. It is a visual disorder characterised by the presence of numerous white, black, or translucent... (Review)
Review
Visual snow syndrome (VSS) is a rarely diagnosed neurological phenomenon. It is a visual disorder characterised by the presence of numerous white, black, or translucent dots in the visual field, resembling the 'snow' of an analogue TV set experiencing reception interference. According to The International Classification of Headache Disorders, 3rd edition, visual snow is defined as a pattern of continuous small dots across the visual field lasting >3 months and accompanied by at least two of the following four additional symptoms: palinopsia, increased entoptic phenomena, photophobia, and nyctalopia. These complaints are not consistent with a typical migraine with visual aura and cannot be better explained by another disorder. The authors present the case of a 39-year-old woman who was diagnosed with VSS. The symptoms appeared after a migraine attack and had not alleviated. The patient reported a sensation of constant 'TV screen snow'. A neurological examination found no signs of focal damage to the nervous system. The results of the ophthalmological examination, MRI of the brain with contrast, MRI of the eye sockets, and EEG were normal. VSS is a phenomenon that is still not fully understood, different from migraine aura and associated with a number of additional symptoms. VSS is very difficult to treat. In this case, a lot of drugs were used without improvement. Further research must be conducted to determine the best treatment options for these patients.
PubMed: 38592219
DOI: 10.3390/jcm13051373 -
Korean Journal of Ophthalmology : KJO Jun 2024To determine subjective symptoms and medical history of patients with intermittent exotropia in a large study population. (Observational Study)
Observational Study
PURPOSE
To determine subjective symptoms and medical history of patients with intermittent exotropia in a large study population.
METHODS
The Korean Intermittent Exotropia Multicenter Study (KIEMS) is a nationwide, observational, cross-sectional, multicenter study conducted by the Korean Association for Pediatric Ophthalmology and Strabismus including 5,385 patients with intermittent exotropia. Subjective symptoms and medical history of patients with intermittent exotropia were extracted by a comprehensive survey based on a self-administered questionnaire according to the study protocol of the KIEMS.
RESULTS
The mean age of symptom onset was 5.5 years. The most common symptom reported in patients with intermittent exotropia was photophobia (52.1%), followed by diplopia at near fixation (7.3%) and distance fixation (6.2%). Preterm birth was found in 8.8%, and 4.1% had perinatal complications. A family history of strabismus was present in 14.9%, and 5.5% of patients had a family member who underwent strabismus surgery.
CONCLUSIONS
The KIEMS is one of the largest clinical studies on intermittent exotropia. Intermittent exotropia frequently caused photophobia and diplopia, and patients with a family history was not uncommon.
Topics: Humans; Exotropia; Male; Female; Cross-Sectional Studies; Republic of Korea; Child; Child, Preschool; Surveys and Questionnaires; Self Report; Adolescent; Adult; Young Adult; Middle Aged; Infant
PubMed: 38584440
DOI: 10.3341/kjo.2023.0129 -
Noro Psikiyatri Arsivi 2023The 12-item Utah Photophobia Symptom Impact Scale (UPSIS-12) is a questionnaire to assess the impact of photophobia on daily living during and outside migraine episodes....
INTRODUCTION
The 12-item Utah Photophobia Symptom Impact Scale (UPSIS-12) is a questionnaire to assess the impact of photophobia on daily living during and outside migraine episodes. We aimed to translate UPSIS-12 and assess its usability in the Turkish cohort by analyzing internal consistency, reliability, and reproducibility.
METHODS
In this multicenter prospective, descriptive study, 120 patients with migraine were recruited. The patients received the diagnosis of migraine without aura (MwoA) and migraine with aura (MwA) according to the International Classification of Headache Disorders 3rd edition. The scale was translated into Turkish, and the patients were evaluated by headache experts in two visits four weeks apart from each other.
RESULTS
The questionnaire showed highly correlated test-retest reliability (r=0.828). Cronbach alpha values of internal consistency revealed good to excellent results ranging from 0.78-0.82. There was a strong and positive correlation between self and physician-administered scales at both visits (r=0.964 and 0.985, respectively). The questionnaire was considered "well understood" by 95.6% of the patients. The average UPSIS-12 score of each visit was 25.8 and 26.9 (average standard deviation of 10.4). Subjects with MwoA (25.5±10.4) had remarkably lower mean scores compared to MwoA plus MwA (29.2±8.9) and MwA (32.9±9.4) (p=0.0167). Patients with high frequency migraine presented with a higher mean UPSIS-12 score than those with low frequency (31.3±9.5 and 24.7±9.8, respectively). It was noted that the mean UPSIS-12 scores of those with severe (29.4±9.4) and moderate ictal cutaneous allodynia (CA) (28.4±10.6) were higher than those without CA (22.0±9.3)(p=0.020).
CONCLUSION
The Turkish version of the UPSIS-12 questionnaire is a reliable tool and well-understood by the Turkish population. Patients with MwA, frequent migraine headache days and moderate to severe CA presented with higher scores. Given the independent burden of photophobia in migraineurs, the use of UPSIS-12 scale should be encouraged in Turkish population.
PubMed: 37645073
DOI: 10.29399/npa.28353 -
Frontiers in Medicine 2023To verify the International Chronic Ocular Graft-Versus-Host Disease (ICCGVHD) Group diagnostic criteria and establish an easy-to-use and reliable diagnosis model for...
PURPOSE
To verify the International Chronic Ocular Graft-Versus-Host Disease (ICCGVHD) Group diagnostic criteria and establish an easy-to-use and reliable diagnosis model for quick identification of chronic oGVHD.
METHODS
This study included 180 patients (355 eyes) who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) and visited the Peking University Third Hospital Cornea and Ocular Surface Disease Specialist Clinic from July 2020 to February 2021. The proportion of chronic oGVHD was 76.06% (279/355).
RESULTS
Five complaints, including eye dryness, photophobia, foreign body sensation, eye redness, and burning sensation; six ophthalmic examinations, including Ocular Surface Disease Index (OSDI) score, corneal fluorescein staining (CFS), tear break-up time (TBUT), Schirmer's test score without anesthesia, conjunctival score, tear meniscus height, and non-ocular GVHD-involved organs were significantly different between patients with chronic oGVHD and control group ( < 0.05). Binary logistic regression (backward LR algorithm) selection demonstrated that three variables retained diagnostic significance for chronic oGVHD: CFS (OR = 2.71 (1.92-3.81), < 0.001), Schirmer's test score without anesthesia (OR = 0.83 (0.76-0.91), < 0.001), and conjunctival score (OR = 1.96 (1.13-3.42), = 0.031). A nomogram for the identification of chronic oGVHD was developed, and its performance was examined using an internal validation cohort (118 eyes). The areas under the curve (AUCs) for the three-variable-based nomogram were 0.976 (95% CI (0.959-0.992), < 0.01) and 0.945 (95% CI (0.904-0.986), < 0.01) in the development and internal validation cohorts, respectively.
CONCLUSION
This concise three-variable-based nomogram based on ICCGVHD criteria could serve as an easy-to-use and reliable tool for rapid screening of chronic oGVHD.
PubMed: 37964878
DOI: 10.3389/fmed.2023.1277194 -
BMC Ophthalmology Nov 2023Transepithelial corneal crosslinking (CXL) is a novel surgical approach for the treatment of keratoconus, which is a bilateral asymmetrical ophthalmological disease... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Transepithelial corneal crosslinking (CXL) is a novel surgical approach for the treatment of keratoconus, which is a bilateral asymmetrical ophthalmological disease accompanied by progressive corneal ectasia. Silicon hydrogel (SiH) contact lenses have been extensively used in clinical ophthalmologic medicine, as a postoperative ophthalmological intervention. However, the ideal lens application duration after transepithelial CXL remains uncertain. Here, we aimed to investigate the effects and comfort of immediate corneal contact lens use after transepithelial CXL for keratoconus.
METHODS
In this prospective study, 60 patients with keratoconus who underwent transepithelial CXL treatment were enrolled from September 2021 to January 2023 with a male:female ratio of 39:21, and an average age of 25.42 ± 5.47 years. The patients were divided randomly into two groups: group A contained 30 patients wearing silicone hydrogel contact lenses for 7 days postoperatively, and group B contained 30 patients wearing the same contact lenses for 3 days. Ten subjective ophthalmologic symptoms were surveyed by the patients, including pain, photophobia, foreign body sensation, tearing, burning, blurred vision, dry eyes, difficulty opening the eyes, astringency, and stinging. Ophthalmologic signs, including corneal edema and conjunctival congestion, were recorded by a single clinician on postoperative days 1, 3, and 7.
RESULTS
Each surgical procedure was readily performed without complications, and both groups postoperative day 7 (P = 0.04), where group B scored (0.01 ± 0.41) lesser than group A (0.12 ± 0.29), whilst corneal edema in both groups recorded significantly different on postoperative days 5 and 7 (group A demonstrated the result of 0.17 ± 0.14 and 0.08 ± 0.11 for the respective days, whereas group B indicated 0.10 ± 0.13 and 0.03 ± 0.07 at the corresponding times).
CONCLUSIONS
Immediate use of silicone hydrogel corneal lenses after transepithelial CXL effectively alleviates postoperative ocular distress, particularly with a three-day use period as the ideal duration.
Topics: Humans; Male; Female; Young Adult; Adult; Keratoconus; Silicon; Prospective Studies; Corneal Cross-Linking; Hydrogels; Corneal Edema; Cornea; Contact Lenses; Silicones; Cross-Linking Reagents; Photosensitizing Agents; Riboflavin; Ultraviolet Rays; Corneal Topography
PubMed: 37985976
DOI: 10.1186/s12886-023-03217-4 -
Cureus Oct 2023A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in...
A 46-year-old male, with no chronic medical illness, complained of pain, tearing, and redness for one-month duration, with no photophobia, discharge, or decrease in visual acuity. Examination revealed a small, painful, red swelling in the left sclera. Slit-lamp examination using a narrow bright slit beam revealed edema of the episcleral layer and injection of the superficial episcleral blood vessels. The rest of the anterior segment exam and fundoscopy were normal. The laboratory investigations and systemic workup were normal. The patient was initially treated with prednisolone acetate (Pred Forte) 1% every three hours per day for one week, and then four times per day for another week, and tapered gradually over eight weeks with systemic nonsteroidal anti-inflammatory drugs (NSAIDs) as diclofenac sodium for eight weeks with mild improvement of clinical symptoms, but the size of the lesion remained without any change and the patient started to have a relapse of symptoms at the end of the course. Topical tacrolimus drops of 0.1% concentration were prepared in the pharmacy under complete sterile precautions and were used four times per day for the following six weeks duration instead of the initial therapy (steroids and NSAIDs). Tacrolimus drops were then tapered gradually over another six weeks duration. The patient showed dramatic suppression of inflammation and exceptional remission of symptoms with complete resolution of the episcleritis. Topical tacrolimus is very effective in the treatment of nodular episcleritis, which is resistant to steroid therapy. Patients with nodular episcleritis suffer from prolonged bouts of inflammation that are characteristically more painful than the diffuse type and may be associated with other systemic diseases. The case is steroid-resistant nodular episcleritis, which did not respond to the usual treatment and showed a good response to treatment with tacrolimus, which was first introduced in episcleritis. Tacrolimus is being used in other ocular diseases, but its use in episcleritis is unique.
PubMed: 38022063
DOI: 10.7759/cureus.47057 -
Infection Jun 2024To describe clinical features and outcomes of viral lumbosacral radiculitis (Elsberg syndrome).
PURPOSE
To describe clinical features and outcomes of viral lumbosacral radiculitis (Elsberg syndrome).
METHODS
Nationwide population-based cohort study of all adults hospitalised for viral lumbosacral radiculitis at departments of infectious diseases in Denmark from 2015 to 2020.
RESULTS
Twenty-eight patients with viral lumbosacral radiculitis were included (mean annual incidence: 1.2/1,000,000 adults). The median age was 35 years (IQR 27-43), and 22/28 (79%) were female. All patients had urinary retention, with 17/28 (61%) needing a catheter. On admission, at least one sign or symptom of meningitis (headache, neck stiffness, photophobia/hyperacusis) was present in 18/22 (82%). Concurrent genital herpetic lesions were present in 11/24 (46%). The median cerebrospinal fluid leukocyte count was 153 cells/µL (IQR 31-514). Magnetic resonance imaging showed radiculitis/myelitis in 5/19 (26%). The microbiological diagnosis was herpes simplex virus type 2 in 19/28 (68%), varicella-zoster virus in 2/28 (7%), and unidentified in 7/28 (25%). Aciclovir/valaciclovir was administered in 27/28 (96%). At 30 days after discharge, 3/27 (11%) had persistent urinary retention with need of catheter. At 180 days after discharge, moderate disabilities (Glasgow Outcome Scale score of 4) were observed in 5/25 (20%).
CONCLUSIONS
Urinary retention resolved within weeks in most patients with viral lumbosacral radiculitis, but moderate disabilities according to the Glasgow Outcome Scale were common at the end of follow-up.
Topics: Humans; Denmark; Female; Adult; Male; Radiculopathy; Cohort Studies; Urinary Retention; Herpesvirus 2, Human; Middle Aged; Lumbosacral Region; Herpes Zoster; Herpesvirus 3, Human
PubMed: 37917395
DOI: 10.1007/s15010-023-02113-9 -
Cureus Jan 2024Therapeutic plasma exchange (TPE) is a procedure involving the filtration of a patient's plasma to eliminate pathogenic components or address deficiencies. This...
BACKGROUND
Therapeutic plasma exchange (TPE) is a procedure involving the filtration of a patient's plasma to eliminate pathogenic components or address deficiencies. This technique finds varied indications in the pediatric age group, particularly in neuroinflammatory diseases.
OBJECTIVES
The objective of this study is to delve into our local experience with TPE, focusing on indications, outcomes, and complications among children with neurological diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia.
RESULTS
Conducted at the pediatric department of KAUH in Jeddah from November 2008 to July 2023, this retrospective cohort study examined 15 patients, revealing a notable male predominance with 12 male patients (80%) and three female patients (20%). About two-thirds of patients exhibited an average illness severity, with a Glasgow Coma Scale (GCS) score of 10.7 and an Expanded Disability Status Scale (EDSS) score of 4.8. The median length of hospital stay was 23 days, and in the pediatric intensive care unit (PICU), it was 8.5 days. Presenting symptoms included limb weakness (n = 6), loss of consciousness (n = 3), dysphagia (n = 3), photophobia (n = 1), and ascending paralysis (n = 1). The TPE was performed for Guillain-Barré syndrome (GBS) (n = 7), myasthenia gravis (MG) (n = 3), transverse myelitis (TM) (n = 2), neuromyelitis optica (NMO) (n = 2), and systemic lupus erythematosus (SLE) cerebritis (n = 1). Twelve patients were admitted to the PICU, and mechanical ventilation was required for 10 patients. In magnetic resonance imaging (MRI) findings, abnormalities were observed in 10 cases, while the remaining five either had normal results or did not undergo MRI. Most patients required five sessions of TPE (n = 7). The median age at the initiation of TPE was 13 years. Twelve patients improved with TPE treatment, while three did not. Complications observed during and following TPE included fever (n = 5), electrolyte disturbance (n = 5), hypotension (n = 3), hypocalcemia (n = 2), bradycardia (n = 2), vomiting (n = 1), tachycardia (n = 1), eye rash (n = 1), infection (n = 1), and bleeding originating from the TPE procedure site (n = 1).
CONCLUSION
In conclusion, our study underscores the significance of TPE as a therapeutic modality, emphasizing the imperative for ongoing research to fully exploit its potential across diverse medical contexts for enhancing patient care. Our findings, consistent with prior research, reveal plasma exchange's (PLEX's) wide-ranging applications and complications in neurological disorders.
PubMed: 38384617
DOI: 10.7759/cureus.52691 -
The Journal of Headache and Pain May 2024GABA, a key inhibitory neurotransmitter, has synaptic and extrasynaptic receptors on the postsynaptic neuron. Background GABA, which spills over from the synaptic cleft,...
BACKGROUND
GABA, a key inhibitory neurotransmitter, has synaptic and extrasynaptic receptors on the postsynaptic neuron. Background GABA, which spills over from the synaptic cleft, acts on extrasynaptic delta subunit containing GABAA receptors. The role of extrasynaptic GABAergic input in migraine is unknown. We investigated the susceptibility to valid migraine-provoking substances with clinically relevant behavioral readouts in Genetic Absence Epilepsy of Rats Strasbourg (GAERS), in which the GABAergic tonus was altered. Subsequently, we screened relevant GABAergic mechanisms in Wistar rats by pharmacological means to identify the mechanisms.
METHODS
Wistar and GAERS rats were administered nitroglycerin (10 mg/kg) or levcromakalim (1 mg/kg). Mechanical allodynia and photophobia were assessed using von Frey monofilaments and a dark-light box. Effects of GAT-1 blocker tiagabine (5 mg/kg), GABAB receptor agonist baclofen (2 mg/kg), synaptic GABAA receptor agonist diazepam (1 mg/kg), extrasynaptic GABAA receptor agonists gaboxadol (4 mg/kg), and muscimol (0.75 mg/kg), T-type calcium channel blocker ethosuximide (100 mg/kg) or synaptic GABAA receptor antagonist flumazenil (15 mg/kg) on levcromakalim-induced migraine phenotype were screened.
RESULTS
Unlike Wistar rats, GAERS exhibited no reduction in mechanical pain thresholds or light aversion following nitroglycerin or levcromakalim injection. Ethosuximide did not reverse the resistant phenotype in GAERS, excluding the role of T-type calcium channel dysfunction in this phenomenon. Tiagabine prevented levcromakalim-induced mechanical allodynia in Wistar rats, suggesting a key role in enhanced GABA spillover. Baclofen did not alleviate mechanical allodynia. Diazepam failed to mitigate levcromakalim-induced migraine phenotype. Additionally, the resistant phenotype in GAERS was not affected by flumazenil. Extrasynaptic GABAA receptor agonists gaboxadol and muscimol inhibited periorbital allodynia in Wistar rats.
CONCLUSION
Our study introduced a rat strain resistant to migraine-provoking agents and signified a critical involvement of extrasynaptic δGABAergic receptors. Extrasynaptic δ GABAA receptors, by mediating constant background inhibition on the excitability of neurons, stand as a novel drug target with a therapeutic potential in migraine.
Topics: Animals; Rats, Wistar; Migraine Disorders; Rats; Receptors, GABA-A; Male; Phenotype; Disease Models, Animal; Hyperalgesia; Epilepsy, Absence; Nitroglycerin; Photophobia
PubMed: 38724972
DOI: 10.1186/s10194-024-01777-4