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Current Pain and Headache Reports May 2024Previous studies have indicated a possible link between the prevalence of cluster headache (CH) and sunlight exposure. However, this theory has yet to be tested... (Review)
Review
PURPOSE OF REVIEW
Previous studies have indicated a possible link between the prevalence of cluster headache (CH) and sunlight exposure. However, this theory has yet to be tested systemically. In this article, we aim to examine how latitude affects the prevalence and phenotypes of CH.
RECENT FINDINGS
To our knowledge, there is by far no article describing the effect of latitude on disease phenotype; thus, we performed a literature review. We noted positive effects of latitude on 1-year prevalence, the proportion of chronic CH, and the proportion of miosis and/or ptosis. Latitude may affect the phenotypic presentations of cluster headache, probably partially mediated via temperature and sunlight variations. Still, other factors, such as environmental exposure to smoking and the genetic difference between the Eastern and Western populations, may participate in the pathogenesis and clinical manifestations of CH.
Topics: Cluster Headache; Humans; Prevalence; Phenotype; Sunlight
PubMed: 38441794
DOI: 10.1007/s11916-024-01229-3 -
JMIR Medical Education Feb 2024Our research letter investigates the potential, as well as the current limitations, of widely available text-to-image tools in generating images for medical education....
Our research letter investigates the potential, as well as the current limitations, of widely available text-to-image tools in generating images for medical education. We focused on illustrations of important physical signs in the face (for which confidentiality issues in conventional patient photograph use may be a particular concern) that medics should know about, and we used facial images of hypothyroidism and Horner syndrome as examples.
Topics: Humans; Horner Syndrome; Education, Medical; Hypothyroidism
PubMed: 38386400
DOI: 10.2196/52155 -
Frontiers in Medicine 2024To evaluate adult-onset neuronal intranuclear inclusion disease (NIID)-related retinopathy with guanine-guanine-cytosine repeat expansions in .
PURPOSE
To evaluate adult-onset neuronal intranuclear inclusion disease (NIID)-related retinopathy with guanine-guanine-cytosine repeat expansions in .
MATERIALS AND METHODS
Neuro-ophthalmic evaluations, including best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP), ultrasound biomicroscopy, pupillometry, fundus photography, fundus autofluorescence (FAF), optical coherence tomography (OCT), Humphrey visual field, full-field electroretinography (ERG), and multifocal ERG (mf-ERG) were performed in patients with gene-proven NIID.
RESULTS
Nine patients (18 eyes) were evaluated, with a median age of 62 years (55-68) and only one man was included in our study. Six patients presented with decreased visual acuity or night blindness, whereas the other three were asymptomatic. The visual acuity was measured from 20/200 to 20/20. Miosis was present in eight patients, four of whom had ciliary process hypertrophy and pronation, and three of whom had shallow anterior chambers. Fundus photography, FAF, and OCT showed consistent structural abnormalities mainly started from peripapillary areas and localized in the outer layer of photoreceptors and inner ganglion cell layer. ERG and mf-ERG also revealed retinal dysfunction in the corresponding regions.
CONCLUSION
Patients with NIID showed both structural and functional retinopathies which were unique and different from common cone-rod dystrophy or retinitis pigmentosa. Patients with miosis may have a potential risk of an angle-closure glaucoma attack. Neuro-ophthalmic evaluations is essential for evaluating patients with NIID, even without visual symptom.
PubMed: 38288273
DOI: 10.3389/fmed.2024.1188193 -
IBRO Neuroscience Reports Dec 2023Artery of Percheron infarction is a rare one of the neurovascular structure variants of acute ischemic stroke characterized by bilateral paramedian thalamic infarcts...
Artery of Percheron infarction is a rare one of the neurovascular structure variants of acute ischemic stroke characterized by bilateral paramedian thalamic infarcts (BTPI), with or without mesencephalic infarction. Due to the low occurrence rate and various clinical manifestations, the early diagnosis of this disease is often missed. In addition, it is also difficult to diagnose this disease in an early implementation phase because cranial imaging and intracranial vascular imaging may show negative results. So far, its clinical cases have been rarely reported. We systematically reviewed the clinical manifestations, imaging characteristics, anatomical basis, and differentiation diagnosis of the artery of Percheron infarction and reported on three patients and their clinical and radiological medical imaging characteristic findings. We found that most of the infarct lesions in patients with an AOP infraction could not be displayed within a few hours or could not be fully displayed, even the embolism events, most of which showed typical imaging lesions at late review. The decrease of transient consciousness was obvious over the course of the three patients, and the decrease of active communication was also a major feature. Among the three cases, one patient had unilateral upper eyelid ptosis and miosis; the initial symptom of another patient was dizziness; and the other person had decreased computing power after infarction. These clinical symptoms are easily ignored in the diagnosis and treatment of patients with AOP infarction. Therefore, reporting the three clinical cases mentioned above will provide assistance for subsequent research by increasing clinical data.
PubMed: 38204568
DOI: 10.1016/j.ibneur.2023.04.006 -
SAGE Open Medical Case Reports 2023A 30-year-old female patient with no previous chronic illness underwent hemithyroidectomy unusually complaint of ptosis on first postoperative day. On examination, she...
A 30-year-old female patient with no previous chronic illness underwent hemithyroidectomy unusually complaint of ptosis on first postoperative day. On examination, she also had miosis. Thus, diagnosis of Horner's syndrome was made on ground of ruling out other complication. As it is caused by nerve insult, with a prolonged observation under close follow-up, the patient is fully recovered. Horner's syndrome after thyroidectomy is a rare entity. In textbook also, it is not mentioned as complication after thyroidectomy.
PubMed: 38152685
DOI: 10.1177/2050313X231220811 -
Ophthalmology and Therapy Feb 2024Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed perioperatively to reduce intraoperative prostaglandin release, diminishing pain, preventing miosis,...
INTRODUCTION
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly employed perioperatively to reduce intraoperative prostaglandin release, diminishing pain, preventing miosis, modulating postoperative inflammation, and reducing the incidence of cystoid macular edema (CME).
CASE REPORT
A 70-year-old female patient without previous history of ocular or systemic disease was urgently referred to our hospital because of a sudden corneal perforation concerning her left eye (OS). The patient had instilled bromfenac eye drops and antiseptic eye drops twice and four times daily, respectively, for 2 days only, in preparation of scheduled cataract surgery. Slit-lamp examination revealed diffuse inferior corneal melting with a 1 × 2 mm area of full-thickness perforation and a very shallow anterior chamber. Both topical agents were immediately discontinued. Cyanoacrylate glue was applied to seal the perforation and a bandage contact lens was applied together with a topical antibiotic given hourly. Two hours later, the anterior chamber started to reform. The following day, the anterior chamber was fully reformed with a negative Seidel test. At her next follow-up appointment, 1 month later, the glue was detached and the cornea was seen to have successfully healed with only some corneal thinning remaining inferiorly.
CONCLUSIONS
Perioperative use of topical NSAIDs in combination with antiseptic eye drops may rarely elicit corneal perforation in certain susceptible elderly individuals. Their use should therefore be carefully monitored.
PubMed: 38127195
DOI: 10.1007/s40123-023-00864-0 -
Biological & Pharmaceutical Bulletin Jan 2024Diclofenac instillation is useful in preventing intraoperative miosis and macular edema caused by postoperative inflammation in cataract surgery; however, optimum...
Diclofenac instillation is useful in preventing intraoperative miosis and macular edema caused by postoperative inflammation in cataract surgery; however, optimum efficacy is not attained when the instilled diclofenac strongly binds to albumin in patients' aqueous humor. Therefore, a method that inhibits diclofenac binding and increases the concentration of its free fraction is needed. We conducted a basic study regarding the effects of inhibitors on the binding of instilled diclofenac to albumin and endogenous substances in aqueous humor. Aqueous humor samples from 16 patients were pooled together for analysis. The free fraction of diclofenac was measured using ultrafiltration methods in various experiments with pooled and mimic aqueous humor. Free fraction of diclofenac, a site II drug, in pooled aqueous humor was 0.363 ± 0.013. The binding of diclofenac in the presence of phenylbutazone (PB), a site I inhibitor, was significantly inhibited (free fraction = 0.496 ± 0.013); however, no significant inhibition by ibuprofen, a site II inhibitor, (free fraction = 0.379 ± 0.004), was observed. The unexpected result was due to free fatty acids (FFAs; palmitic acid (PA)) and L-tryptophan (Trp). The inhibition of diclofenac binding by PB in the mimic aqueous humor containing these endogenous substances revealed significant binding inhibition in the presence of PA and Trp. Diclofenac is strongly rebound from site II to site I in the presence of FFAs and Trp in the aqueous humor because FFAs and Trp induce a conformational change in albumin. Therefore, PB significantly inhibits the binding of diclofenac to albumin.
Topics: Humans; Diclofenac; Anti-Inflammatory Agents, Non-Steroidal; Aqueous Humor; Cataract; Albumins
PubMed: 38057117
DOI: 10.1248/bpb.b23-00301 -
Open Veterinary Journal Oct 2023Intra-lenticular foreign bodies are rare in veterinary medicine and uncommon in human medicine. Approximately 50% of perforating ocular injuries in canines have...
BACKGROUND
Intra-lenticular foreign bodies are rare in veterinary medicine and uncommon in human medicine. Approximately 50% of perforating ocular injuries in canines have lenticular involvement. Treatment choices include conservative management and surgical options. Retained intra-lenticular foreign body with delayed removal has not been reported in animals.
CASE DESCRIPTION
A 3-year-old male neutered Lurcher presented with right-sided ocular discomfort and a sealed full-thickness corneal perforation. The full ophthalmic examination could not be performed at the initial presentation due to miosis. Recrudescence of anterior uveitis was seen post-drug cessation. Re-evaluation of the eye with a mydriatic pupil revealed an intra-lenticular foreign body. Surgical removal via phacoemulsification was performed 8 weeks after the initial perforating injury. The eye remains visual, comfortable, and normotensive 50 months post-operatively.
CONCLUSION
This is the first report of an encapsulated, retained intra-lenticular foreign body with delayed removal in a dog. Mydriasis and repeat examinations are of crucial importance when evaluating eyes post-perforation.
Topics: Humans; Male; Dogs; Animals; Lens, Crystalline; Eye Foreign Bodies; Phacoemulsification; Dog Diseases
PubMed: 38027412
DOI: 10.5455/OVJ.2023.v13.i10.18 -
Investigative Ophthalmology & Visual... Nov 2023A previous study demonstrated upper eyelid retraction synchronized with pupil dilation following a transition from photopic to scotopic conditions. The current study...
PURPOSE
A previous study demonstrated upper eyelid retraction synchronized with pupil dilation following a transition from photopic to scotopic conditions. The current study aimed to evaluate the role of Müller's muscle as the efferent arm of this suggested reflex arc.
METHODS
A video scan of both eyes of patients with unilateral Horner syndrome was performed using optical coherence tomography infra-red mode to document the transition between photopic and scotopic conditions. The affected side with sympathetic denervation was the study group, whereas the contralateral unaffected side of the same patients served as the control group. The pupil diameter, upper eyelid margin-to-reflex distance 1, lower eyelid margin-to-reflex distance 2, and vertical palpebral fissure height were measured. The control group was compared to the healthy subjects of a previous study to verify any compensatory changes to the side contralateral to denervation.
RESULTS
Ten patients with unilateral Horner Syndrome were included in the study. Transitioning from photopic to scotopic conditions, the mean change in margin-to-reflex distance 1 in the study and control groups was 315 ± 276 µm (P < 0.05) and 723 ± 432 µm (P = 0.005), respectively. Margin-to-reflex distance 1 and palpebral fissure height were significantly higher in the control group both in photopic (P = 0.005 and P = 0.017, respectively) and scotopic conditions (P = 0.005 and P = 0.007, respectively). The change in margin-to-reflex distance 1 and palpebral fissure height following the transition from light to dark was significantly greater in the control group (P = 0.022).
CONCLUSIONS
Reflexive eyelid retraction following a transition from photopic to scotopic conditions was significantly diminished in eyelids with sympathetic denervation compared with the unaffected contralateral side of the same patients. This study provides further evidence that the sympathetically innervated Müller's muscle serves as the efferent arm of this reflex.
Topics: Humans; Horner Syndrome; Eyelids; Eyelid Diseases; Oculomotor Muscles; Reflex; Blepharoptosis
PubMed: 38010698
DOI: 10.1167/iovs.64.14.35 -
Children (Basel, Switzerland) Oct 2023To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to...
BACKGROUND
To date, no study has specifically examined children with acute-onset pupillary motility disorders (APMD). Especially in the Emergency Department (ED), it is crucial to distinguish benign and transient conditions from life-threatening or urgent conditions (UCs). The aim of the study is to describe the clinical characteristics of children with APMD and their association with an increased risk of UCs.
METHODS
We conducted a pediatric retrospective study of APMD referred to ED over a 10-year period. We described the characteristics in the overall sample and in two subgroups divided according to urgency of the underlying condition. Furthermore, we applied a logistic regression model to identify the variables predictive of LT condition.
RESULTS
We analyzed 101 patients. In 59.4%, the APMD was isolated. In patients with extra-ocular involvement, the most frequently associated features were altered consciousness, headache, and vomiting. Exposure to toxic agents was reported in 48.5%. Urgent conditions occurred significantly more frequently in older children, presenting bilateral APMD and/or other ocular or extra-ocular manifestations.
CONCLUSIONS
Our study shows that UCs most commonly occur in patients presenting with bilateral APMD and other associated features. In unilateral/isolated APMD ophthalmological examination, exclusion of toxic exposure and observation until resolution of symptoms should be recommended.
PubMed: 38002830
DOI: 10.3390/children10111739