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One Eye or Two: Statistical Considerations in Ophthalmology With a Focus on Interventional Clinical Trials
Mollan, Susan P. FRCOphth; Homer, Victoria MsC; Gates, Simon PhD; Brock, Kristian PhD; Sinclair, Alex J. PhD
doi : 10.1097/WNO.0000000000001446
December 2021 - Volume 41 - Issue 4 - p 421-423
Bedside Assessment of Vergence in Stroke Patients
Anagnostou, Evangelos MD, PhD; Koutsoudaki, Penelopi MD; Tountopoulou, Argyro MD, PhD; Spengos, Konstantinos MD, PhD; Vassilopoulou, Sophia MD, PhD
doi : 10.1097/WNO.0000000000001035
December 2021 - Volume 41 - Issue 4 - p 424-430
Given the widely distributed network of midbrain, pontine, cerebellar, and cortical areas involved in the neural control of vergence, one might expect various vergence deficits in stroke patients. In this article, we investigated the localizing value of bedside vergence testing with respect to different supratentorial and infratentorial infarction locations.
Peripapillary Hyper-reflective Ovoid Mass-like Structure (PHOMS): An Optical Coherence Tomography Marker of Axoplasmic Stasis in the Optic Nerve Head
Fraser, J. Alexander MD; Sibony, Patrick A. MD; Petzold, Axel MD, PhD; Thaung, Caroline MB, ChB, DPhil; Hamann, Steffen MD, PhD; for the ODDS Consortium
doi : 10.1097/WNO.0000000000001203
December 2021 - Volume 41 - Issue 4 - p 431-441
With the development and widespread adoption of spectral-domain optical coherence tomography (OCT), peripapillary hyper-reflective ovoid mass-like structures (PHOMS) have become a frequent OCT finding in neuro-ophthalmic practice. Although originally assumed to represent a form of buried optic disc drusen (ODD), PHOMS differ from ODD in many important ways. The histopathological underpinnings of PHOMS are now becoming more clearly understood.
Effects of Parkinson Disease on Blur-Driven and Disparity-Driven Vergence Eye Movements
Gupta, Palak BS; Beylergil, Sinem PhD; Murray, Jordan PhD; Jacobs, Jonathan PhD; Kilbane, Camilla MD; Shaikh, Aasef G. MD, PhD; Ghasia, Fatema F. MD
doi : 10.1097/WNO.0000000000001422
December 2021 - Volume 41 - Issue 4 - p 442-451
Synchronous movements of the 2 eyes in the opposite direction, disconjugate movements such as vergence, facilitate depth perception. The vergence eye movements are affected in Parkinson disease (PD). Visual blur (accommodation) and fusion (retinal disparity) are important triggers for the vergence. The neural circuit responsible for blur-driven and disparity-driven vergence is tightly coupled. We investigated the effect of PD on these 2 vergence paradigms. In the experiment involving 14 patients with PD and 6 healthy controls, substantial differences between blur-driven and disparity-driven vergence were found. The gain (ratio of actual vs desired eye movements) was reduced in patients with PD in case of disparity-driven vergence but not in blur-driven vergence. The latency of disparity-driven vergence onset was significantly longer for patients with PD compared with healthy controls. Four strategies were used to drive disparity-driven vergence: a) pure disconjugate vergence, b) conjugate saccadic movements, c) disconjugate vergence followed by saccadic movements, and d) conjugate saccades followed by disconjugate vergence movements. Blur-driven vergence had only 2 strategies: a) conjugate saccades followed by disconjugate vergence and b) conjugate saccadic movements only. The results are consistent with the prediction that PD primarily affects disparity-driven vergence, but there are some effects on the strategies to execute blur-driven vergence. We speculate that the deep cerebellar nuclei and the supraoculomotor area of the midbrain that carry the disparity-driven and blur-driven vergence are affected in PD. It is possible to modulate their function through projections to the subthalamic nuclei.
Neuroradiologic Imaging of Neurologic and Neuro-Ophthalmic Complications of Coronavirus-19 Infection
Marsiglia, Marcela MD, PhD; Chwalisz, Bart K. MD; Maher, Mary MD
doi : 10.1097/WNO.0000000000001454
December 2021 - Volume 41 - Issue 4 - p 452-460
To review the literature and provide a summary of COVID-19–related neurologic and neuro-ophthalmic complications.
Teprotumumab in Clinical Practice: Recommendations and Considerations From the OPTIC Trial Investigators
Douglas, Raymond S. MD, PhD; Wang, Yao MD; Dailey, Roger A. MD; Harris, Gerald J. MD; Wester, Sara T. MD; Schiffman, Jade S. MD; Tang, Rosa A. MD; Fowler, Brian MD; Fleming, James MD; Smith, Terry J. MD
doi : 10.1097/WNO.0000000000001134
December 2021 - Volume 41 - Issue 4 - p 461-468
Thyroid eye disease (TED) is a vision-threatening and debilitating condition that until very recently had no Food and Drug Administration (FDA)-approved medical therapies. Teprotumumab has recently been approved to treat TED. We aim to provide guidance for its use, based on the input of the US investigators who participated in Phase 2 and Phase 3 clinical trials.
Interocular Difference in Retinal Nerve Fiber Layer Thickness Predicts Optic Neuritis in Pediatric-Onset Multiple Sclerosis
Waldman, Amy T. MD, MSCE; Benson, Leslie MD; Sollee, John R. BS; Lavery, Amy M. PhD; Liu, Geraldine W. ALM; Green, Ari J. MD, MCR; Waubant, Emmanuelle MD; Heidary, Gena MD, PhD; Conger, Darrel CRA; Graves, Jennifer MD, PhD; Greenberg, Benjamin MD, MHS
doi : 10.1097/WNO.0000000000001070
December 2021 - Volume 41 - Issue 4 - p 469-475
Optical coherence tomography (OCT) is capable of quantifying retinal damage. Defining the extent of anterior visual pathway injury is important in multiple sclerosis (MS) as a way to document evidence of prior disease, including subclinical injury, and setting a baseline for patients early in the course of disease. Retinal nerve fiber layer (RNFL) thickness is typically classified as low if values fall outside of a predefined range for a healthy population. In adults, an interocular difference (IOD) in RNFL thickness greater than 5 ?m identified a history of unilateral optic neuritis (ON). Through our PERCEPTION (PEdiatric Research Collaboration ExPloring Tests in Ocular Neuroimmunology) study, we explored whether RNFL IOD informs on remote ON in a multicenter pediatric-onset MS (POMS) cohort.
Variation in Evolving Optic Neuritis
Bouffard, Marc A. MD; Mallery, Robert M. MD; Liao, Yaping J. MD, PhD; Torun, Nurhan MD
doi : 10.1097/WNO.0000000000001310
December 2021 - Volume 41 - Issue 4 - p 476-479
The typical natural history of optic neuritis is subjected to important exceptions. Recognition of these exceptions has led to valuable insights regarding specific etiologies of optic neuritis. Exceptions to the natural history of recovering optic neuritis are well-defined (e.g., chronic relapsing inflammatory optic neuropathy), but exceptions to the natural history of evolving optic neuritis are less so.
Referral Patterns of Central Retinal Artery Occlusion to an Academic Center Affiliated With a Stroke Center
Flowers, Alexis M. MD; Chan, Wesley MD, MSc; Meyer, Benjamin I. MD; Bruce, Beau B. MD, PhD; Newman, Nancy J. MD; Biousse, Valérie MD
doi : 10.1097/WNO.0000000000001409
December 2021 - Volume 41 - Issue 4 - p 480-487
Central retinal artery occlusion (CRAO) is a medical emergency, and patients who present acutely should be immediately referred to the nearest stroke center. We evaluated practice patterns for CRAO management at one academic center over the last decade.
Utility of Ultrasound and Optical Coherence Tomography in Differentiating Between Papilledema and Pseudopapilledema in Children
Farazdaghi, Marybeth K. MD; Trimboli-Heidler, Carmelina CDOS; Liu, Grant T. MD; Garcia, Arielle COT; Ying, Gui-Shuang PhD; Avery, Robert A. DO, MSCE
doi : 10.1097/WNO.0000000000001248
December 2021 - Volume 41 - Issue 4 - p 488-495
Differentiating between papilledema and pseudopapilledema in children presenting with mild-to-moderate optic nerve head elevation is challenging. This study sought to determine which B-scan ultrasonography (BSUS) and optical coherence tomography (OCT) features, individually or in combination, are best able to differentiate between papilledema and pseudopapilledema in children.
Variability Within Optic Nerve Optical Coherence Tomography Measurements Distinguishes Papilledema From Pseudopapilledema
Flowers, Alexis M. MD; Longmuir, Reid A. MD; Liu, Yuhan MS; Chen, Qingxia PhD; Donahue, Sean P. MD, PhD
doi : 10.1097/WNO.0000000000001137
December 2021 - Volume 41 - Issue 4 - p 496-503
To report a linear risk score obtained using clock-hour optical coherence tomography (OCT) data from papilledema and pseudopapilledema nerves that differentiates between the 2 diagnoses with high sensitivity and specificity.
Good Visual Outcomes After Pituitary Tumor Surgery Are Associated With Increased Visual Cortex Functional Connectivity
Lang, Stefan T. MD; Ryu, Won Hyung A. MD, MSc, MTM; Starreveld, Yves P. MD, PhD; Costello, Fiona E. MD; the PITNET Study Group
doi : 10.1097/WNO.0000000000001155
December 2021 - Volume 41 - Issue 4 - p 504-511
Patients presenting with visual impairment secondary to pituitary macroadenomas often experience variable recovery after surgery. Several factors may impact visual outcomes including the extent of neuroaxonal damage in the afferent visual pathway and cortical plasticity. Optical coherence tomography (OCT) measures of retinal structure and resting-state functional MRI (rsfMRI) can be used to evaluate the impact of neuroaxonal injury and cortical adaptive processes, respectively. The purpose of this study was to determine whether rsfMRI patterns of functional connectivity (FC) distinguish patients with good vs poor visual outcomes after surgical decompression of pituitary adenomas.
Imaging Errors in Distinguishing Pituitary Adenomas From Other Sellar Lesions
Altshuler, David B. MD; Andrews, Chris A. PhD; Parmar, Hemant A. MD; Sullivan, Stephen E. MD; Trobe, Jonathan D. MD
doi : 10.1097/WNO.0000000000001164
December 2021 - Volume 41 - Issue 4 - p 512-518
Pituitary adenomas and nonadenomatous lesions in the sellar region may be difficult to distinguish by imaging yet that distinction is critical in guiding management. The nature of the diagnostic errors in this setting has not been well documented.
Neuro-Ophthalmic Complications in Patients Treated With CTLA-4 and PD-1/PD-L1 Checkpoint Blockade
Sun, Michel M. MD, PhD; Seleme, Nicolas MD; Chen, John J. MD, PhD; Zekeridou, Anastasia MD, PhD; Sechi, Elia MD; Walsh, Ryan D. MD; Beebe, Johanna D. MD; Sabbagh, Osama MD; Mejico, Luis J. MD; Gratton, Sean MD; Skidd, Philip M. MD; Bellows, David A. MD; Falardeau, Julie MD; Fraser, Clare L. MD; Cappelen-Smith, Cecilia MBBS, PhD; Haines, Scott R. MD; Hassanzadeh, Bahareh MD; Seay, Meagan D. DO; Subramanian, Prem S. MD, PhD; Williams, Zoë MD; Gordon, Lynn K. MD, PhD
doi : 10.1097/WNO.0000000000001148
December 2021 - Volume 41 - Issue 4 - p 519-530
In recent years, CTLA-4 and PD-1/PD-L1 checkpoint inhibitors have proven to be effective and have become increasingly popular treatment options for metastatic melanoma and other cancers. These agents work by enhancing autologous antitumor immune responses. Immune-related ophthalmologic complications have been reported in association with checkpoint inhibitor use but remain incompletely characterized. This study seeks to investigate and further characterize the neuro-ophthalmic and ocular complications of immune checkpoint blockade treatment.
Abnormal Vestibular–Ocular Reflexes in Children With Cortical Visual Impairment
Mansukhani, Sasha A. MBBS; Ho, Mai-Lan MD; Brodsky, Michael C. MD
doi : 10.1097/WNO.0000000000000999
December 2021 - Volume 41 - Issue 4 - p 531-536
To determine whether the vestibular–ocular reflexes (VORs) can be affected by central nervous system injury in children with cortical visual impairment (CVI).
Failure to Obtain Urgent Arterial Imaging in Acute Third Nerve Palsies
Chung, Jennifer E. BA; Schroeder, Richard M. MD; Wilson, Bradley MA; Van Stavern, Gregory P. MD; Stunkel, Leanne MD
doi : 10.1097/WNO.0000000000001337
December 2021 - Volume 41 - Issue 4 - p 537-541
Isolated third nerve palsy may indicate an expanding posterior communicating artery aneurysm, thus necessitating urgent arterial imaging. This study aims to assess the rate and duration of delays in arterial imaging for new isolated third nerve palsies, identify potential causes of delay, and evaluate instances of delay-related patient harm.
Progressive Functional and Neuroretinal Affectation in Patients With Multiple Sclerosis Treated With Fingolimod
Garcia-Martin, Elena PhD; Ruiz de Gopegui, Erika PhD; Satue, Maria; Gil-Arribas, Laura PhD; Jarauta, Laura MD; Ara, Jose R. PhD; Martin, Jesus PhD; Fernandez, Francisco J. PhD; Vilades, Elisa MD; Rodrigo, Maria J. PhD
doi : 10.1097/WNO.0000000000000991
December 2021 - Volume 41 - Issue 4 - p e415-e423
To evaluate the effect of fingolimod in visual function and neuroretinal structures in patients with multiple sclerosis (MS) for a period of 1 year.
Alterations in the Retinal Vascular Network and Structure in MOG Antibody-Associated Disease: An Optical Coherence Tomography Angiography Study
Yu, Jian PhD; Huang, Yongheng PhD; Quan, Chao PhD; Zhou, Lei PhD; ZhangBao, Jingzi PhD; Wu, Kaicheng PhD; Zong, Yuan PhD; Zhou, Xujiao PhD; Wang, Min PhD
doi : 10.1097/WNO.0000000000001116
December 2021 - Volume 41 - Issue 4 - p e424-e432
To determine retinal vessel density in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
Follow-up of Nonarteritic Anterior Ischemic Optic Neuropathy With Optical Coherence Tomography Angiography
Aghsaei Fard, Masoud MD, FICO; Ghahvechian, Hossein MD; Subramanian, Prem S. MD, PhD
doi : 10.1097/WNO.0000000000000997
December 2021 - Volume 41 - Issue 4 - p e433-e439
Peripapillary and macular microvasculature alterations after nonarteritic ischemic optic neuropathy (NAION) have been investigated in several studies. We aimed to explore the vascular changes from acute NAION (aNAION) to chronic NAION (cNAION).
Optical Coherence Tomography Angiography Characteristics and Predictors of Visual Outcomes in Patients With Acute and Chronic Nonarteritic Anterior Ischemic Optic Neuropathy
Moon, Yeji MD; Song, Min Kyung MD; Shin, Joong Won MD; Lim, Hyun Taek MD, PhD
doi : 10.1097/WNO.0000000000001102
December 2021 - Volume 41 - Issue 4 - p e440-e450
To investigate the correlation between optical coherence tomography angiography (OCTA) characteristics and visual outcomes in patients with acute and chronic nonarteritic anterior ischemic optic neuropathy (NAION).
Prevalence of Adrenal Insufficiency and Glucocorticoid Use in Pediatric Pseudotumor Cerebri Syndrome
Hoyos-Martinez, Alfonso MD; Horne, Vincent E. MD; Wood, Alexis C. PhD; Shah, Veeral MD, PhD
doi : 10.1097/WNO.0000000000001111
December 2021 - Volume 41 - Issue 4 - p e451-e457
The pathophysiology underlying pseudotumor cerebri syndrome (PTCS) is complex and not well understood. There are clear differences between PTCS in adults and pediatrics. Few and isolated case reports have suggested that adrenal function may be involved, yet no large cohort study has examined this relationship.
Weight Loss in Idiopathic Intracranial Hypertension: A Retrospective Review of Outcomes in the Clinical Setting
Ang, Juan Lyn MD, MSc; Teo, Kai Z. MD; Fraser, Clare L. MBBS (Hons), MMed, FRANZCO
doi : 10.1097/WNO.0000000000001107
December 2021 - Volume 41 - Issue 4 - p e458-e463
Weight loss is important in the management of idiopathic intracranial hypertension (IIH); however, extremely caloric restrictive diets have been used in published studies, which may not be practical for all patients. We aim to review the weight loss outcomes of IIH patients and weight loss methods used by patients who achieve clinical remission (CR) in a standard clinical setting.
Optic Nerve Angle in Idiopathic Intracranial Hypertension
Chen, Benson S. MBChB, FRACP; Asnafi, Solmaz MD; Lin, Mung Y. BS; Bruce, Beau B. MD, PhD; Lock, Jane H. MBBS, FRANZCO; Sharma, Rahul A. MD, MPH; Newman, Nancy J. MD; Biousse, Valérie MD; Saindane, Amit M. MD, MBA
doi : 10.1097/WNO.0000000000000986
December 2021 - Volume 41 - Issue 4 - p e464-e469
The tortuosity of the optic nerve can be quantified radiologically by measuring the angle of optic nerve deformation (the “optic nerve angle” [ONA]). In patients with idiopathic intracranial hypertension (IIH), lowering the intracranial pressure (ICP) to a normal range by lumbar puncture leads to straightening of the optic nerve and an increase in the measured sagittal ONA on MRI. It is uncertain whether there is any correlation between ONA and cerebrospinal fluid (CSF) opening pressure or visual function.
Comparison of Peripapillary Vessel Density of Acute Nonarteritic Anterior Ischemic Optic Neuropathy and Other Optic Neuropathies With Disc Swelling Using Optical Coherence Tomography Angiography: A Pilot Study
Chuang, Jasmine C. MB, BS; Chan, Noel C. Y. FRCSEd(Ophth); Cheung, Carol Y. PhD; Lok, Jerry K. H. FCOphth(HK); Chan, Carmen K. M. MRCP, FRCSEd(Ophth)
doi : 10.1097/WNO.0000000000001106
December 2021 - Volume 41 - Issue 4 - p e470-e482
The purpose of this study is to quantitatively compare the peripapillary vessel density (PPVD), measured with optical coherence tomography angiography (OCT-A), between acute nonarteritic anterior ischemic optic neuropathy (NAION) and other causes of disc swelling (“others”).
Enhanced Depth Imaging Optical Coherence Tomography Technology Reveals a Significant Association Between Optic Nerve Drusen Anterior Displacement and Retinal Nerve Fiber Layer Thinning Over Time
Ortiz-Toquero, Sara PhD; Muñoz-Negrete, Francisco J. MD, PhD; Rebolleda, Gema MD, PhD
doi : 10.1097/WNO.0000000000001103
December 2021 - Volume 41 - Issue 4 - p e483-e489
Optic disc drusen (ODD) are a dynamic phenomenon, and their appearance, size, and relative location may change. The purpose of this study is to evaluate and quantify the longitudinal changes of buried ODD with enhanced depth imaging (EDI) optical coherence tomography (OCT) over time.
Prediction of Postoperative Risk of Raised Intracranial Pressure After Spontaneous Skull Base Cerebrospinal Fluid Leak Repair
Buchowicz, Bryce MD; Chen, Benson S. MBChB, FRACP; Bidot, Samuel MD; Bruce, Beau B. MD, PHD; Newman, Nancy J. MD; Saindane, Amit M. MD, MBA; Levy, Joshua M. MD, MPH; Biousse, Valérie MD; for the CSF-Leak Study Group
doi : 10.1097/WNO.0000000000001118
December 2021 - Volume 41 - Issue 4 - p e490-e497
A relationship between idiopathic intracranial hypertension and spontaneous skull base cerebrospinal fluid (CSF) leaks has been proposed, by which CSF leak decreases intracranial pressure (ICP) and masks the symptoms and signs of elevated ICP. These patients are at risk of developing papilledema, symptoms of elevated ICP, or a recurrent CSF leak after CSF leak repair. The objective of this study was to assess whether radiographic signs of raised ICP on preoperative magnetic resonance or computed venography (MRI or CTV) are predictors of postoperative papilledema, recurrence of CSF leak, or need for CSF shunt surgery.
Papilledema Secondary to Neurologic Lyme Borreliosis: A Meta-Case Series
Vaysbrot, Elizaveta E. MD, MS; Bannuru, Raveendhara R. MD, PhD; Christopher, Mia-Cara MPH; Osani, Mikala C. BA; Halperin, John J. MD
doi : 10.1097/WNO.0000000000000983
December 2021 - Volume 41 - Issue 4 - p e498-e508
Papilledema can be a manifestation of neurologic Lyme borreliosis (LB). The clinical manifestations and progression of these cases have not been comprehensively documented to date. We aimed to describe clinical and diagnostic features and to assess patient outcomes in cases of papilledema secondary to neurologic LB.
Utility of Spectral-Domain Optical Coherence Tomography in Differentiating Papilledema From Pseudopapilledema: A Prospective Longitudinal Study
Jivraj, Imran BSc, MD, FRCSC; Cruz, Cesar A. MD; Pistilli, Maxwell MEd, MS; Kohli, Anita A. MD; Liu, Grant T. MD; Shindler, Kenneth S. MD, PhD; Avery, Robert A. DO, MSCE; Garvin, Mona K. MS, PhD; Wang, Jui-Kai MS, PhD; Ross, Ahmara MD; Tamhankar, Madhura A. MD
doi : 10.1097/WNO.0000000000001087
December 2021 - Volume 41 - Issue 4 - p e509-e515
Prospective and longitudinal studies assessing the utility of spectral-domain optical coherence tomography (SD-OCT) to differentiate papilledema from pseudopapilledema are lacking. We studied the sensitivity and specificity of baseline and longitudinal changes in SD-OCT parameters with 3D segmentation software to distinguish between papilledema and pseudopapilledema in a cohort of patients referred for evaluation of undiagnosed optic disc elevation.
The Value of Macular Optical Coherence Tomography in Watchful Waiting of Suprasellar Masses: A 2-Year Observational Study
Jørstad, Øystein Kalsnes MD; Wigers, Andreas Reidar MD; Marthinsen, Pål Bache MD; Evang, Johan Arild MD, PhD; Moe, Morten Carstens MD, PhD
doi : 10.1097/WNO.0000000000000993
December 2021 - Volume 41 - Issue 4 - p e516-e522
A possible benefit of optical coherence tomography (OCT) in the approach to tumors involving the optic chiasm may be the ability to foresee visual deterioration. This study investigated the value of OCT in watchful waiting for compressive optic neuropathy as the primary management of suprasellar masses.
Unilateral Isolated Paucisymptomatic Optic Disc Edema
Hawy, Eman MD; Sharma, Rahul A. MD, MPH; Peragallo, Jason H. MD; Dattilo, Michael MD, PhD; Newman, Nancy J. MD; Biousse, Valérie MD
doi : 10.1097/WNO.0000000000001136
December 2021 - Volume 41 - Issue 4 - p e523-e534
Unilateral isolated optic disc edema (UIODE) represents a challenging clinical presentation that frequently precipitates an extensive diagnostic work-up. Patients without an apparent diagnosis despite appropriate investigations are often categorized as having “papillophlebitis,” an entity that is poorly defined in the existing literature. Our aim was to describe the characteristics of a series of patients with paucisymptomatic UIODE, determine the optimal diagnostic approach to such cases, and clarify the clinical features of presumed papillophlebitis.
Neuro-Ophthalmologic Monitoring in the Management of Increased Intracranial Pressure From Leaking Arachnoid Cysts
Deveney, Tatiana K. MD; Lebas, Maud MD; Lobo, Remy R. MD; Maher, Cormac O. MD; Trobe, Jonathan D. MD
doi : 10.1097/WNO.0000000000001143
December 2021 - Volume 41 - Issue 4 - p e535-e540
Intracranial arachnoid cysts are common incidental imaging findings. They may rarely rupture, leading to the development of subdural hygromas and high intracranial pressure (ICP). Neurosurgical intervention has been advocated in the past, but recent evidence indicates that most cases resolve spontaneously. The role of neuro-ophthalmologic monitoring in identifying the few cases that have persisting vision-threatening papilledema that justifies intervention has not been emphasized.
The Radiologic Characteristics and Retinal Thickness Are Correlated With Visual Field Defect in Patients With a Pituitary Mass
Suh, Hiebum MD; Choi, Heeyoung MD, PhD; Jeon, Hyeshin MD
doi : 10.1097/WNO.0000000000001011
December 2021 - Volume 41 - Issue 4 - p e541-e547
Investigation of visual field defects (VFDs) is important to decide the treatment and to predict the prognosis in patients with a pituitary mass. The aim of this study was to evaluate the correlation among 2 diagnostic modalities—MRI and optical coherence tomography (OCT)—and VFDs.
Visual Outcomes in Surgically Treated Intracranial Meningiomas
Zhang, Yibing BA; Kim, John MD; Andrews, Chris PhD; Archer, Erica MD; Bursztyn, Lulu MD; Grabe, Hilary MD; Margolin, Edward MD; Sullivan, Stephen MD; Trobe, Jonathan MD
doi : 10.1097/WNO.0000000000001205
December 2021 - Volume 41 - Issue 4 - p e548-e559
Intracranial meningiomas that arise from the medial sphenoid ridge, anterior clinoid process, tuberculum sellae, or planum sphenoidale often impair vision by compressing the optic nerves and optic chiasm. Although many studies have reported visual outcome following surgery for these tumors, documentation has often been incomplete and not validated by patient self-report.
Optic Disc Cupping Due to Dolichoectatic Internal Carotid Artery Optic Nerve Compression
Micieli, Jonathan A. MD; Margolin, Edward A. MD
doi : 10.1097/WNO.0000000000001113
December 2021 - Volume 41 - Issue 4 - p e560-e565
To determine whether significant compression of the optic nerve by the internal carotid artery (ICA) can produce an optic neuropathy with optic disc cupping that resembles glaucoma in patients without elevated intraocular pressure (IOP).
Unilateral Blindness With Bilateral Brain Infarction After Cosmetic Facial Filler Injection
Lee, Jong Suk MD; Kim, Jun Yup MD; Woo, Se Joon MD, PhD
doi : 10.1097/WNO.0000000000001009
December 2021 - Volume 41 - Issue 4 - p e566-e571
To describe a case of bilateral brain infarction associated with iatrogenic ophthalmic artery occlusion after cosmetic facial filler injection and to elucidate the pathogenic mechanism of bilateral brain infarction.
The Frequency of Carotid Intraplaque Hemorrhage on Vessel Wall Imaging in Patients With Retinal Artery Occlusion: A Cross-Sectional Prevalence Study
Larson, Anthony S. BS; Chen, John J. MD, PhD; Bhatti, M. Tariq MD; Klaas, James P. MD; Lanzino, Giuseppe MD; Huston, John III MD; Brinjikji, Waleed MD
doi : 10.1097/WNO.0000000000001156
December 2021 - Volume 41 - Issue 4 - p e572-e577
Intraplaque hemorrhage (IPH) in a carotid artery plaque viewed on vessel wall imaging has been shown to be associated with ischemic stroke. Whether such an association between carotid IPH and retinal artery occlusion (RAO) exists remains unknown.
Complete Visual Recovery From Severe Outer Retinitis After Tonsillitis
Kawashima, Rumi MD, PhD; Matsushita, Kenji MD, PhD; Hashida, Noriyasu MD, PhD; Kuniyoshi, Kazuki MD, PhD; Fujikado, Takashi MD, PhD; Nishida, Kohji MD, PhD
doi : 10.1097/WNO.0000000000001073
December 2021 - Volume 41 - Issue 4 - p e578-e583
To report a case of severe acute bilateral outer retinitis after tonsillitis and rapid morphologic and functional recovery after steroid treatment.
Neuro-Ophthalmic Manifestations of Acute Leukemia
Alrobaian, Malek A. MD; Henderson, Amanda D. MD
doi : 10.1097/WNO.0000000000001071
December 2021 - Volume 41 - Issue 4 - p e584-e590
Ophthalmic involvement in acute leukemia is common, with 36% of patients having ophthalmic involvement at the time of diagnosis. However, neuro-ophthalmic involvement is relatively rare. We present a characterization of neuro-ophthalmic findings in patients with acute leukemia and discuss the implications of these findings on patient management and prognosis.
Neuro-Ophthalmic Manifestations of Sarcoidosis
Henderson, Amanda D. MD; Tian, Jing MS; Carey, Andrew R. MD
doi : 10.1097/WNO.0000000000001108
December 2021 - Volume 41 - Issue 4 - p e591-e597
Sarcoidosis is an idiopathic, multisystem, inflammatory disease that has central nervous system involvement in 5%–15% of cases. The presentation of neurosarcoidosis is highly variable, and the MRI findings often mimic the appearance of other central nervous system diseases. Therefore, the diagnosis can be challenging. About one-third of neurosarcoidosis cases have neuro-ophthalmic manifestations and, thus, may be evaluated by a neuro-ophthalmologist early in the disease course.
Characterization of Visual Pathway Abnormalities in Infants With Congenital Zika Syndrome Using Computed Tomography and Magnetic Resonance Imaging
Henderson, Amanda D. MD; Ventura, Camila V. MD, PhD; Huisman, Thierry A. G. M. MD; Meoded, Avner MD; Hazin, Adriano N. MD; van der Linden, Vanessa MD; de Lima Petribu, Natacha C. MD; May, William N. MD
doi : 10.1097/WNO.0000000000001127
December 2021 - Volume 41 - Issue 4 - p e598-e605
Severe visual impairment is present in nearly all infants with congenital Zika syndrome (CZS); however, ocular abnormalities are present only in a subset of these infants. The purpose of this study was to characterize the visual pathway abnormalities seen on computed tomography (CT) and MRI scans in infants with CZS.
Introducing the 24-2C Visual Field Test in Neuro-Ophthalmology
Yamane, Maya L. M. MD; Odel, Jeffrey G. MD
doi : 10.1097/WNO.0000000000001157
December 2021 - Volume 41 - Issue 4 - p e606-e611
The Humphrey 24-2C visual field test is a modified 24-2 visual field test that incorporates 10 additional test points in the central 10° of vision. This study compares the new 24-2C test to the standard Humphrey 10-2 visual field test in patients presenting for neuro-ophthalmology evaluation to evaluate its ability to detect central visual field defects.
Cyclotorsion Measurement on Scanning Laser Ophthalmoscopy Imaging Compared With Fundus Photography in Patients With Fourth Nerve Palsy and Healthy Controls: CySLO-IV Study
Kanku, Madeleine S. MD; Sele, Silvano MSc; Held, Ulrike PhD; Jaggi, Gregor P. MD; Landau, Klara MD; Traber, Ghislaine L. MD
doi : 10.1097/WNO.0000000000000996
December 2021 - Volume 41 - Issue 4 - p e612-e618
The purpose of the study is to evaluate the agreement of the foveopapillary angle (FPA) on conventional fundus photography (c-FPA) with the FPA on scanning laser ophthalmoscopy (SLO) imaging (SLO-FPA) in patients with fourth nerve palsy and healthy controls (HCs).
Comitant Ocular Deviation in Myasthenia Gravis
Pike-Lee, Tiffany MD; Hill, Jeremy MD; Li, Jianbo PhD; Kosmorsky, Gregory S. DO; Li, Yuebing MD, PhD
doi : 10.1097/WNO.0000000000001056
December 2021 - Volume 41 - Issue 4 - p e619-e621
Occurrence of comitant ocular deviation in myasthenia gravis (MG) is not well described.
Effect of Initial Prednisone Dosing on Ocular Myasthenia Gravis Control
Shah, Yesha S. BBA, BSA; Henderson, Amanda D. MD; Carey, Andrew R. MD
doi : 10.1097/WNO.0000000000001058
December 2021 - Volume 41 - Issue 4 - p e622-e626
Ocular myasthenia is an autoimmune condition that results in double vision or ptosis. It often requires treatment with prednisone for immunosuppression, but there have been no prospective trials to help clinicians determine ideal dosing.
The Usefulness of Anti-acetylcholine Receptor Binding Antibody Testing in Diagnosing Ocular Myasthenia Gravis
Chung, In Young MBBS Hons, BBMED; Sheth, Shivanand J. MBBS, MS (Ophthal), FICO, FAICO, FRANZCO; Wells, Kristen K. MD, FRANZCO; Campbell, Thomas G. MBBS, DPhil
doi : 10.1097/WNO.0000000000001061
December 2021 - Volume 41 - Issue 4 - p e627-e630
Anti-acetylcholine receptor antibody (AChR–Abs) testing is a safe and simple ancillary method for confirming the diagnosis of myasthenia gravis. Despite the test's high sensitivity (85%–90%) for generalized myasthenia gravis, AChR–Abs testing has been reported to have a low sensitivity 44%–66% for ocular myasthenia gravis (OMG). The aim of the study is to assess the effectiveness of AChR binding Abs testing for diagnosing OMG by evaluating the test's sensitivity, specificity, positive predictive value, and negative predictive value.
Orbital Apex Syndrome Secondary to Invasive Aspergillus Infection: A Case Series and Literature Review
Yuan, Melissa BA; Tandon, Anika MD; Li, Anfei PhD; Johnson, Editha DO; Greer, Christine MD; Tooley, Andrea MD; Tran, Ann Q. MD; Godfrey, Kyle J. MD; Dinkin, Marc MD; Oliveira, Cristiano MD
doi : 10.1097/WNO.0000000000001105
December 2021 - Volume 41 - Issue 4 - p e631-e638
Invasive fungal sinusitis carries high morbidity and mortality and often poses a diagnostic challenge. Orbital apex syndrome (OAS) is not an uncommon presentation in the setting of invasive fungal sinusitis. Delays in diagnosis and appropriate treatment can result in permanent visual dysfunction and, potentially, death. We present 2 cases of OAS secondary to invasive sinus aspergillosis, detailing the diagnostic process, treatment, and outcome for both patients. Subsequently, we present a review of the literature and combined analysis of our 2 patients plus 71 cases from previously published reports.
Delayed-Onset Cranial Nerve Palsy After Transvenous Embolization of Indirect Carotid Cavernous Fistulas
Wang, Arthur MD; Halbach, Van V. MD; Dowd, Christopher F. MD; Alexander, Matthew D. MD; Hallam, Danial K. MD; Ghodke, Basavarj MD; Moazami, Golnaz MD; Mandigo, Grace K. MD; Lavine, Sean D. MD; Meyers, Philip M. MD
doi : 10.1097/WNO.0000000000001067
December 2021 - Volume 41 - Issue 4 - p e639-e643
Carotid cavernous fistulas (CCF) often present with diplopia secondary to cranial nerve palsy (CNP). Immediate development of postoperative CNP has been described in the literature. This study described delayed-onset of CNP after complete and reconfirmed obliteration of the CCF and resolution of initial CNP.
Dorsal Midbrain Syndrome: Clinical and Imaging Features in 75 Cases
Yousif, Jonah E. BS; Liao, Eric MD; Trobe, Jonathan D. MD
doi : 10.1097/WNO.0000000000001052
December 2021 - Volume 41 - Issue 4 - p e644-e654
Dorsal midbrain syndrome (DMS) consists of a constellation of clinical features, including reduced upgaze, pupillary light-near dissociation, lid retraction, convergence retraction, and eye misalignment. This syndrome results mostly from intrinsic or extrinsic mesodiencephalic tumors or strokes, obstructive hydrocephalus, failure of cerebrospinal fluid shunting to correct obstructive hydrocephalus, and head trauma. Published reports that include imaging corroboration are based on relatively small cohorts and have not included comprehensive patient self-reports on the impact of these abnormalities on quality of life.
Resolved External Ophthalmoplegia and Hearing Loss in Wernicke's Encephalopathy With Thiamine Replacement
Nyce, Maxwell Q. DO; Chisholm, Joshua S. DO; Szmanda, Julia A. DO; Boyce, A. Katharina AuD; Boczar, Caroline M. AuD; Kattah, Jorge C. MD
doi : 10.1097/WNO.0000000000001057
December 2021 - Volume 41 - Issue 4 - p e655-e660
Wernicke encephalopathy (WE) is classically described by a clinical triad consisting of confusion, ataxia, and ophthalmoplegia, but recent reports emphasize a history of malnutrition along with 2 elements of the WE triad (Caine's criteria) to enhance diagnostic sensitivity. The ophthalmoplegia, vestibular, and auditory expeditious improvement with intravenous thiamine usually confirms the diagnosis; serum levels generally provide additional diagnostic certainty.
Eye Movements in Fragile X-Associated Tremor/Ataxia Syndrome
Hall, Deborah A. MD, PhD; Leehey, Maureen A. MD; Hagerman, Randi J. MD; Pelak, Victoria S. MD
doi : 10.1097/WNO.0000000000001082
December 2021 - Volume 41 - Issue 4 - p e661-e664
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder characterized by ataxia, tremor, and parkinsonism. Eye motility abnormalities on the clinical examination of FXTAS patients have not been formally studied.
Ocular Motor and Vestibular Characteristics of Antiglutamic Acid Decarboxylase–Associated Neurologic Disorders
Wang, Yujie MD; Tourkevich, Roksolyana MD; Bosley, Justin; Gold, Daniel R. DO; Newsome, Scott D. DO
doi : 10.1097/WNO.0000000000001084
December 2021 - Volume 41 - Issue 4 - p e665-e671
Antiglutamic acid decarboxylase (GAD)-associated neurologic disorders are rare, with varied presentations, including stiff-person syndrome (SPS) and cerebellar ataxia (CA). Vestibular and ocular motor (VOM) dysfunction can be the main presentation in a subset of patients.
HINTS Examination in Acute Vestibular Neuritis: Do Not Look Too Hard for the Skew
Green, Kemar E. DO; Gold, Daniel R. DO
doi : 10.1097/WNO.0000000000001013
December 2021 - Volume 41 - Issue 4 - p e672-e678
An ocular tilt reaction (OTR) is a triad of a skew deviation, head tilt, and ocular counter-roll that can be partial or complete. An OTR can occur anywhere along the utriculo-ocular motor pathways from the labyrinth to the interstitial nucleus of Cajal but is almost always central in origin. In acute vestibular neuritis (AVN), case reports have described patients with an OTR due to AVN, although it is unclear whether this examination finding is common or rare.
Predictive Value of International Classification of Diseases Codes for Idiopathic Intracranial Hypertension in a University Health System
Khushzad, Fareshta BS; Kumar, Riya; Muminovic, Irma MD; Moss, Heather E. MD, PhD
doi : 10.1097/WNO.0000000000000992
December 2021 - Volume 41 - Issue 4 - p e679-e683
Misclassification bias is introduced into medical claims–based research because of reliance on diagnostic coding rather than full medical record review. We sought to characterize this bias for idiopathic intracranial hypertension (IIH) and evaluate strategies to reduce it.
Antibody Development in Patients Treated Long-Term With OnabotulinumtoxinA for Benign Essential Blepharospasm and Hemifacial Spasm
Czyz, Craig N. DO; Burns, John A. MD; Bergstrom, Reece E. DO
doi : 10.1097/WNO.0000000000001171
December 2021 - Volume 41 - Issue 4 - p e684-e687
Report the development of onabotulinumtoxinA neutralizing antibodies in patients treated consecutively for 20 years or longer for benign essential blepharospasm (BEB), hemifacial spasm (HFS), and Meige Syndrome.
Involuntary “Voluntary” Nystagmus
Rosenberg, Michael L. MD
doi : 10.1097/WNO.0000000000001196
December 2021 - Volume 41 - Issue 4 - p e688-e691
Voluntary nystagmus is a common phenomenon in the general population and is believed to be under voluntary control. Some patients have an eye movement disorder indistinguishable from voluntary nystagmus and yet have no control over these movements.
Publication Rate of Abstracts Presented at the North American Neuro-Ophthalmology Society Annual Meeting From 2008 to 2017
Yuan, Po Hsiang (Shawn) BSc; MacLean, Luke J. MASc; Li, Erica A. MMASc; Yin, Shelly MD, CM; Micieli, Jonathan A. BSc
doi : 10.1097/WNO.0000000000001158
December 2021 - Volume 41 - Issue 4 - p e692-e698
Conference abstracts serve an important role in the timely dissemination of scientific and clinical advancements, but most fail to be published. The goal of this study was to investigate the publication rate and factors associated with publication of abstracts presented at the North American Neuro-Ophthalmology Society (NANOS) Annual Meeting over a 10-year period.
Should All Patients With Nonarteritic Anterior Ischemic Optic Neuropathy Receive a Sleep Study?
Fraser, Clare L. MD; Hedges, Thomas R. MD; Lee, Andrew G. MD; Van Stavern, Gregory P. MD
doi : 10.1097/WNO.0000000000001144
December 2021 - Volume 41 - Issue 4 - p 542-546
Multiple Cranial Neuropathies and Pachymeningitis in a Patient With a Pathogenic Nucleotide-Binding Oligomerization Domain 2 Polymorphism
Vegunta, Sravanthi MD; Bohnsack, John MD; Crum, Alison MD; Digre, Kathleen MD; Katz, Bradley MD, PhD; Seay, Meagan DO; Quigley, Edward MD, PhD; Kennedy, Sean MD; Mamalis, Nick MD; Warner, Judith MD
doi : 10.1097/WNO.0000000000001342
December 2021 - Volume 41 - Issue 4 - p 547-552
An 11-year-old boy presented with 2 weeks of intermittent headache, right orbital pain, and constant diplopia. Brain MRI showed dural thickening and enhancement of the right lateral cavernous sinus, right orbital apex, and tentorium. Initial cerebral spinal fluid analysis showed only mild pleocytosis, and serum diagnostics were unrevealing. The working diagnosis was Tolosa-Hunt syndrome. His pain and sixth nerve palsy resolved with corticosteroids. Five months after initial presentation, he developed new numbness of the right cheek, complete right ophthalmoplegia, and weakness and numbness of his right hand and leg, all of which were responsive to steroids. Fifteen months later, he returned to the emergency department with 2 weeks of left-sided headaches and acute diplopia. On examination, he had a left cranial nerve 6 palsy. Dural biopsy showed diffuse mononuclear inflammatory cell reaction consisting mostly of lymphocytes with no signs of granuloma formation, nor any epithelioid or giant cells. His clinical course was consistent with an autoinflammatory condition of unknown etiology. Genetic testing with an immunodeficiency panel showed a risk allele in NOD2 (nucleotide-binding oligomerization domain 2) c.3019dup (p.Leu1007Prof*2) that is associated with an increased risk for Crohn disease. His clinical condition had similarities to central nervous system sarcoidosis. Because of the similarities between our patient's clinical, imaging, and genetic findings and neurosarcoidosis, he was switched to a more targeted therapy—infliximab. His condition has since been stable for nearly 2 years. In conclusion, genetic testing should be considered in patients with suspected occult autoimmunity.
Literature Commentary
Editor(s): Moster, Mark L. MD; Bhatti, M. Tariq MD
doi : 10.1097/WNO.0000000000001447
December 2021 - Volume 41 - Issue 4 - p 553-559
Isolated Asymmetric Progressive Optic Neuropathy as a First Presentation of Charcot–Marie–Tooth Disease Type 2A
Gabel, Maya BS; Mitchell, Jamie MD; Pramanik, Bidyut MD; Geraci, Anthony MD; Harel, Asaff MD, MSc
doi : 10.1097/WNO.0000000000001100
December 2021 - Volume 41 - Issue 4 - p e699-e702
Severe Vision Loss and Intracranial Hypertension Presenting as Delayed Sequelae of “Mild” Carbon Monoxide Poisoning
Garcia, James H. BS; Khanna, Sangeeta MD
doi : 10.1097/WNO.0000000000001104
December 2021 - Volume 41 - Issue 4 - p e703-e707
Papilledema in a Patient With Intracranial Hypotension
Kwok, Jason M. MD; Mandell, Daniel M. MD, PhD; Margolin, Edward A. MD
doi : 10.1097/WNO.0000000000001112
December 2021 - Volume 41 - Issue 4 - p e708-e710
Vitreopapillary Traction Masquerading as Papillitis and Papilledema
Fong, Joseph W. MD; Sallam, Ahmed B. MD; Chacko, Joseph G. MD
doi : 10.1097/WNO.0000000000001159
December 2021 - Volume 41 - Issue 4 - p e711-e712
Optic Neuritis Associated With Tumor Necrosis Factor–Alpha Inhibitor Certolizumab
Chen, Ariel MD; Miller, Neil R. MD; Bosley, Thomas M. MD
doi : 10.1097/WNO.0000000000001150
December 2021 - Volume 41 - Issue 4 - p e713-e714
Severe Leber Hereditary Optic Neuropathy Plus Disease in a Middle-Aged Man
Birnbaum, Faith A. MD; Gospe, Sidney M. III MD, PhD
doi : 10.1097/WNO.0000000000001151
December 2021 - Volume 41 - Issue 4 - p e715-e717
Food Aversion Leading to Nutritional Optic Neuropathy in a Child With Severe Vitamin A Deficiency
Farrell, Maureen C. MS; Weiss, Stephanie J. DO; Goodrich, Clifford MD; Martinez Lehmann, Maria Patricia MD; Delarato, Nicole MD
doi : 10.1097/WNO.0000000000001142
December 2021 - Volume 41 - Issue 4 - p e718-e719
Bilateral Optic Neuropathy Secondary to Toxicity From Tumor-Infiltrating Lymphocytes Therapy Combined With Checkpoint Blockade
Kabanovski, Anna BS; Jeeva-Patel, Trishal MD; Saibil, Sam MD, PhD; Margolin, Edward MD
doi : 10.1097/WNO.0000000000001153
December 2021 - Volume 41 - Issue 4 - p e720-e722
BRAF V600E-Mutated Ganglioglioma of the Optic Pathway: A Case Report and Review of the Literature
Solomon, Alexander M. MD; Chia, Tao Ming T. MD; Juric-Sekhar, Gordana MD, PhD; Francis, Courtney E. MD
doi : 10.1097/WNO.0000000000001154
December 2021 - Volume 41 - Issue 4 - p e723-e727
Reversal of Visual Loss From Skull Base Osteomyelitis in a Pediatric Patient
Ma, Kevin K. MD; Robson, Caroline D. MD; Gaier, Eric D. MD, PhD; Gise, Ryan MD
doi : 10.1097/WNO.0000000000001110
December 2021 - Volume 41 - Issue 4 - p e728-e730
Anterior Ischemic Optic Neuropathy Secondary to Carotid Artery Dissection
Lains, Ines MD, PhD; Diaz, Jose D. MD; Gittinger, John W. Jr MD; Gaier, Eric D. MD, PhD
doi : 10.1097/WNO.0000000000001161
December 2021 - Volume 41 - Issue 4 - p e731-e733
Neuro-Ophthalmic Presentations of Common Carotid Artery Occlusion: A Case Series
Zehden, Jason; Harish Bindiganavile, Shruthi MD; Bhat, Nita MD; Lee, Andrew G. MD
doi : 10.1097/WNO.0000000000001101
December 2021 - Volume 41 - Issue 4 - p e734-e737
Third Nerve Palsy Due to Posterior Communicating Artery Aneurysm Rupture Into the Subdural Space
Jeeva-Patel, Trishal MD; Mandell, Daniel M. MD, PhD; Margolin, Edward MD
doi : 10.1097/WNO.0000000000001123
December 2021 - Volume 41 - Issue 4 - p e738-e740
Slowly Progressive Ophthalmoplegia as a Presenting Symptom of Myotonic Dystrophy Type 1
Na, Seunghee MD; Lee, Eek-Sung MD, PhD; Kim, Young-Do MD, PhD; Lee, Tae-Kyeong MD, PhD
doi : 10.1097/WNO.0000000000001132
December 2021 - Volume 41 - Issue 4 - p e741-e742
Delayed Onset of Mixed Cranial Neuropathies and Cluster Headache After Embolization of Indirect Carotid-Cavernous Fistula
George, Rebecca S. MD; Pollmann, André S. MD; Maxner, Charles E. MD, FRCPC
doi : 10.1097/WNO.0000000000001138
December 2021 - Volume 41 - Issue 4 - p e743-e745
Dry Nonproductive Cough as the Presenting Symptom of Giant Cell Arteritis
Hubbard, Donald BS; Harish Bindiganavile, Shruthi MD; Divatia, Mukul MD; Bhat, Nita MD; Lee, Andrew G. MD
doi : 10.1097/WNO.0000000000001166
December 2021 - Volume 41 - Issue 4 - p e746-e748
Bitemporal Hemianopia Secondary to Acute Zonal Occult Outer Retinopathy
Zaslavsky, Kirill MD; Eshtiaghi, Arshia BSc; Jeeva-Patel, Trishal MD; Christakis, Panos G. MD; Margolin, Edward MD
doi : 10.1097/WNO.0000000000001167
December 2021 - Volume 41 - Issue 4 - p e749-e751
A 58-year-old man noticed shadows in the temporal visual field of each eye and photopsias within these scotomas for the past year. Formal visual fields demonstrated bitemporal hemianopia. MRI of the sella was normal, but fundus autofluorescence (FAF) demonstrated an area of hyperautofluorescence in the nasal retina of each eye corresponding to the loss of retinal pigment epithelium and photoreceptors. A diagnosis of acute zonal occult outer retinopathy was made based on the presence of trizonal involvement on FAF. This case is a reminder that bitemporal hemianopia can be caused by a retinopathy involving nasal retina in each eye, and FAF is a very useful test when assessing patients with suspected outer retinal disorders.
Sinonasal Chondrosarcoma Presenting With Isolated Severe Vision Loss
Nguyen, Michael T. B. MD; Farahvash, Armin BSc; Dickson, Brendan C. MD; Lee, John M. MD; Cusimano, Michael D. MD, PhD; Tsang, Derek S. MD, MSc; Micieli, Jonathan A. MD, CM
doi : 10.1097/WNO.0000000000001130
December 2021 - Volume 41 - Issue 4 - p e752-e755
A 24-year-old man presented with a 2-month history of progressive, painless vision loss in the right eye, with no history of headache, nasal congestion, rhinorrhea, or epistaxis. His visual acuity was counting fingers at 1 ft in the right eye and 20 of 20 in the left eye with a right relative afferent pupillary defect and mild temporal optic disc pallor. MRI of the brain and orbits showed a mass involving bilateral ethmoid and sphenoid sinuses and right nasal cavity. He underwent urgent extended endoscopic endonasal transsphenoidal approach for resection of the sinonasal skull base tumor and photon radiation therapy. Pathology revealed a well-differentiated cartilaginous neoplasm with focal areas of entrapped native bone, consistent with a chondrosarcoma WHO grade I/III. At 6-month follow-up after surgery, he had a visual acuity of 20/40 in the right eye and 20/20 in the left eye. Malignant tumors from the sinonasal area should be kept in the differential diagnosis for compressive optic neuropathies and may present with vision loss even in the absence of nasal or sinus symptoms.
Characteristic Visual Field Defect From Lateral Geniculate Body Stroke
Naguib, Mina M. MD; Woodland, Matthew B. BS; Foroozan, Rod MD
doi : 10.1097/WNO.0000000000001226
December 2021 - Volume 41 - Issue 4 - p e756-e758
A 58-year-old man presented with a complaint of subjective visual field loss on the right side and hypertensive emergency. Examination revealed a right homonymous hemianopia. Computed tomography imaging revealed an acute stroke of the left lateral geniculate body. A few months later, automated perimetry revealed characteristic visual field changes associated with this lesion. In this report, the anatomy, pathophysiology, clinical findings, and previously reported etiologies of lateral geniculate body lesions are reviewed.
Acute Complete Oculomotor Nerve Palsy in a Young Male Due to a Skull Base Myofibroma
Hoang, Tung Thanh MD, MOphth; Van Le, Thuy MD; Tran, Dat MD; Ho, Thuong Duc MD; Thi Le, Nhung Hong MD; Subramanian, Prem S. MD, PhD
doi : 10.1097/WNO.0000000000001177
December 2021 - Volume 41 - Issue 4 - p e759-e760
A 25-year-old male patient visited the ophthalmology clinic because of upper eye lid ptosis in the right eye, binocular double vision, and light sensitivity. He was diagnosed with a complete third nerve palsy caused by a skull base myofibroma, a rare clinical entity that has not been described before in oculomotor nerve palsy.
Contained Rupture of a Posterior Communicating Artery Aneurysm in a Patient With a Third Nerve Palsy
Dhoot, Arjan S. BMSc, MD(C); Guest, William C. MD, PhD; Bharatha, Aditya MD; Micieli, Jonathan A. MD
doi : 10.1097/WNO.0000000000001224
December 2021 - Volume 41 - Issue 4 - p e761-e763
It is recommended that every patient with a new third nerve palsy undergo urgent neuroimaging (computed tomography angiography or magnetic resonance angiography) to exclude a posterior communicating artery aneurysm. Because of the novel coronavirus (COVID-19) pandemic, our institution noted a significant decline in the number of patients with aneurysmal subarachnoid hemorrhage presenting to the hospital. We report one such example of a patient who developed new-onset severe headache and vomiting and did not seek medical attention because of COVID-19. Two months later, she was noted to have ptosis during a routine follow-up and was found to have a complete, pupil-involving third nerve palsy. Computed tomography angiography was performed and revealed an irregular bilobed saccular aneurysm (7 × 9 × 5 mm) of the right posterior communicating (PComm) artery, but no acute hemorrhage was visible on CT. On MRI, immediately adjacent to the aneurysm, there was a small subacute hematoma in the right medial temporal lobe with surrounding vasogenic edema. This case had a fortunate and unique outcome as she had a contained hematoma adjacent to the ruptured PComm aneurysm and did not experience severe morbidity from the subarachnoid hemorrhage nor did she rebleed in the interval in which she did not seek care. This case highlights the importance of providing neuro-ophthalmic care even during a pandemic.
Tonic Pupil Following COVID-19
Gopal, Madhumita MBBS, DO, DNB; Ambika, Selvakumar MBBS, DO, DNB; Padmalakshmi, Krishnakumar MBBS, DO, DNB
doi : 10.1097/WNO.0000000000001221
December 2021 - Volume 41 - Issue 4 - p e764-e766
A 37-year-old patient presented to our emergency department with sudden onset decreased vision with a history of being treated for COVID 19 3 weeks earlier. On examination, she was found to have a tonic right pupil, which was confirmed with a dilute pilocarpine test. As tonic pupils are known to be caused by neurotropic viruses and our current understanding of the SARS-CoV-2 is that it does affect the nervous system, we feel that the tonic pupil in our patient may be secondary to COVID 19.
A Great Conversation With Dr. Shirley Wray
Digre, Kathleen B. MD; Calix, Rachel A. MD; Seay, Meagan D. DO
doi : 10.1097/WNO.0000000000001403
December 2021 - Volume 41 - Issue 4 - p e767-e773
A Great Conversation With Dr. Valerie Purvin
Calix, Rachel A. MD; Seay, Meagan D. DO; Digre, Kathleen B. MD
doi : 10.1097/WNO.0000000000001397
December 2021 - Volume 41 - Issue 4 - p e774-e784
International Headache Society September 8–12, 2021
Digre, Kathleen B. MD
doi : 10.1097/WNO.0000000000001459
December 2021 - Volume 41 - Issue 4 - p e785
Myelin Oligodendrocyte Glycoprotein Antibody–Associated Optic Neuritis—A Review
Kaushik, Megha MBBS; Burdon, Michael A. MBBS
doi : 10.1097/WNO.0000000000001234
December 2021 - Volume 41 - Issue 4 - p e786-e795
Our understanding of demyelinating optic neuritis has substantially evolved over the past 2 decades. With advancements in serological testing, antibodies against myelin oligodendrocyte glycoprotein (MOG) have been recently discovered in a distinct subset of demyelinating neuroinflammatory disease. Although MOG-immunoglobulin G (IgG)–associated disorder (MOGAD) has previously been seen as a component of neuromyelitis optica spectrum disorder (NMOSD), evidence increasingly suggests that it should be distinguished as a separate condition. The distinction of MOGAD from aquaporin-4 IgG NMOSD is imperative as treatment plans need to be tailored to its unique disease course and prognosis. The purpose of this review is to explore the nature and outcomes of MOGAD optic neuritis to help guide acute and long-term immunosuppressive treatment decisions.
Leukemic and Lymphomatous Optic Neuropathy: A Case Series
Lee, Victoria PhD; Farooq, Asim V. MD; Shah, Hassan A. MD
doi : 10.1097/WNO.0000000000001365
December 2021 - Volume 41 - Issue 4 - p e796-e802
Optic neuropathy in the context of leukemia and lymphoma raises concern for central nervous system involvement or relapse and warrants prompt evaluation and treatment. To date, a gold standard for the diagnosis and management of leukemic optic neuropathy has yet to be established.
Contralateral Ocular Manifestations of a Carotid Cavernous Fistula Associated With Primitive Persistent Trigeminal Artery
Hoang, Tung Thanh MD; Nguyen, Cuong Ngoc MD; Nguyen, Anh Quoc MD; Nguyen, Hieu Lan MD, PhD; Subramanian, Prem S. MD, PhD; Pham, Van Trong MD, PhD
doi : 10.1097/WNO.0000000000001181
December 2021 - Volume 41 - Issue 4 - p e803-e805
Surgical Outcomes of Transposition Surgery for the Correction of Large-Angle Strabismus
Gokoffski, Kimberly Kinga MD, PhD; Lifton, Jacob MD; Xu, Benjamin Yixing MD, PhD; Patel, Vivek Ravindra MD
doi : 10.1097/WNO.0000000000001372
December 2021 - Volume 41 - Issue 4 - p e806-e814
Many potential surgical options exist to address large-angle deviations and head turns that result from various forms of paralytic strabismus. Muscle transposition surgeries serve as suitable alternatives to simple resection–recessions. Here, we report outcomes of augmented Hummelsheim and X-type transpositions for the correction of large-angle strabismus and provide insights for surgical planning.
Subacute Bilateral Vision Loss
Bekerman, Vladislav P.; Turbin, Roger; Frohman, Larry P.
doi : 10.1097/WNO.0000000000001270
December 2021 - Volume 41 - Issue 4 - p e815
Papilledema in a Patient Being Treated for Multiple Sclerosis
Frohman, Larry MD; Turbin, Roger E. MD; Wawrzusin, Peter J. MD; Srivastava, Gaurav MD; Sakla, Nicole M. DO
doi : 10.1097/WNO.0000000000001346
December 2021 - Volume 41 - Issue 4 - p e816
Acute Posterior Multifocal Placoid Pigment Epitheliopathy Complicated by Fatal Cerebral Vasculitis
Knox, David L. MD
doi : 10.1097/WNO.0000000000000987
December 2021 - Volume 41 - Issue 4 - p e817-e819
Acute Posterior Multifocal Placoid Pigment Epitheliopathy Complicated by Fatal Cerebral Vasculitis: Response
Harocopos, George MD; Van Stavern, Gregory MD; Dahiya, Sonika MD; Stunkel, Leanne MD; Maamari, Robi MD
doi : 10.1097/WNO.0000000000001019
December 2021 - Volume 41 - Issue 4 - p e819-e821
Neuro-Ophthalmologic Monitoring of Leaking Arachnoid Cysts
Jarocki, Adrienne BA; Liao, Eric MD; De Lott, Lindsey B. MD
doi : 10.1097/WNO.0000000000001440
December 2021 - Volume 41 - Issue 4 - p e821-e823
Comments on Disorders of the Fourth Cranial Nerve
Rutstein, Robert P. OD
doi : 10.1097/WNO.0000000000001441
December 2021 - Volume 41 - Issue 4 - p e823-e824
Comments on Disorders of the Fourth Cranial Nerve: Response
Demer, Joseph L. MD; Kline, Lanning B. MD; Vaphiades, Michael S. MD; Tavakoli, Mehdi MD
doi : 10.1097/WNO.0000000000001442
December 2021 - Volume 41 - Issue 4 - p e824-e825
