Bilateral Retrobulbar Optic Nerve Infarctions after Blood Loss and Hypotension

Johnson, Mark W.; Kincaid, Marilyn C.; Trobe, Jonathan D.

doi:10.1016/s0161-6420(87)33236-1

Cited by 110 publications

(46 citation statements)

References 29 publications

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“…1 Our patient showed features of multiple areas of central nervous system ischaemia. The left parietooccipital lobe infarct was thought to be the cause for the visual field defects.…”

Section: Commentmentioning

confidence: 59%

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Visual loss due to cerebral infarcts in pseudoxanthoma elasticum

Aralikatti

Lee

Lipton

et al. 2002

Eye

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“…1 Our patient showed features of multiple areas of central nervous system ischaemia. The left parietooccipital lobe infarct was thought to be the cause for the visual field defects.…”

Section: Commentmentioning

confidence: 59%

“…More extensive detachments give rise to a 'double anterior chamber' after perforation of Descemet's membrane in deep lamellar keratoplasty. 1 Large DMD after cataract extraction is rare. Nonsurgical factors that could predispose to DMD are traumatic, congenital glaucoma and corneal ectasias, among others.…”

mentioning

confidence: 99%

Visual loss due to cerebral infarcts in pseudoxanthoma elasticum

Aralikatti

Lee

Lipton

et al. 2002

Eye

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“…Multiple factors seem to play a role, including arterial hypotension, blood loss and anemia, venous congestion, use of vasopressors, prone position, preexisting vaso-occlusive disease, and periorbital edema. [10][11][12] A course of high-dose systemic steroids can decrease optic nerve edema and thereby improve outcome. 13 Spontaneous recovery from or improvement of ischemic optic neuropathy is unlikely.…”

Section: Discussionmentioning

confidence: 99%

A Young Man With Severe and Disabling Complications of Septic Shock

Haas

Ploeg

Quak

et al. 2015

American Journal of Critical Care

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M ost patients discharged from critical care, particularly after septic shock, experience problems with physical, psychosocial, and emotional functioning. We report on bilateral blindness and unilateral sensorineural hearing loss as rare but severely disabling complications in a young survivor of septic shock. Case ReportA 42-year-old man with a history of psoriatic arthritis, for which he used methotrexate (2.5 mg once a week), came to the emergency department with abdominal pain 2 days after endoscopic repair of an inguinal hernia on the left side. Laboratory examination revealed an elevated level of C-reactive protein (51 mg/L, reference value < 10 mg/L; to convert to nanomoles per liter, multiply by 9.524) and leukocytosis (13.9 x 10 9 /L; reference value, 4.0-10.0 x 10 9 /L), with an elevated level of neutrophils (12.6 x 10 9 /L; reference value, 1.3-5.7 x 10 9 /L) among others. Ultrasound showed a fluid collection in the abdominal wall, thought to indicate a rectus hematoma.The patient was admitted to the surgical care area for observation and analgesia, but clinical deterioration occurred and septic shock developed within 12 hours of admission. The patient was admitted to the intensive care unit (ICU) and resuscitated with fluids and vasopressors. Antibiotics (ceftriaxone and metronidazole) were administered to treat Abstract A young man had severe septic shock with multiorgan failure due to necrotizing fasciitis caused by group A streptococcus after endoscopic repair of a preperitoneal inguinal hernia. He was treated with surgical exploration and antibiotics and resuscitated with fluids, vasopressors, and inotropic agents. He survived this critical illness, but when he woke up from sedation, his vision was lost in both eyes. Ophthalmological evaluation revealed minimal peripapillary retinal hemorrhages without signs of papillary edema. Visually evoked potentials were negative. Magnetic resonance imaging did not show a cause of the visual damage. The patient had bilateral ischemic optic neuropathy diagnosed. Two weeks later, unilateral sudden deafness also developed. The acquired blindness and hearing loss were unchanged after more than 1 year and seem to be permanent, severely disabling this young survivor of septic shock. (American Journal of Critical Care. 2015;24:450-452) Cases of Note Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient's experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc@aacn.org. a suspected abdominal infection and an emergency laparotomy was performed, which showed turbid fluid but no perforation or abscess. The mesh was removed and culture samples were taken. When cultures revealed hemolytic group A streptococcus, antibiotic treatment was swi...

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“…Interindividual variability and inconsistency in the blood supply to the posterior (retrobulbar) optic nerve plays a role in the development of postoperative PION [140,168] . PION have been associated with surgery, trauma and gastrointestinal bleeding in which severe anemia and hypotension occurred [91,94,140,169,170] . Prognosis is usually poorer with PION compared to AION [171] .…”

Section: Ionmentioning

confidence: 99%

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Kamel

Barnette

2014

WJO

103

111

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Positioning patients for spine surgery is pivotal for optimal operating conditions and operative-site exposure. During spine surgery, patients are placed in positions that are not physiologic and may lead to complications. Perioperative peripheral nerve injury (PPNI) and postoperative visual loss (POVL) are rare complications related to patient positioning during spine surgery that result in significant patient disability and functional loss. PPNI is usually due to stretch or compression of the peripheral nerve. PPNI may present as a brachial plexus injury or as an isolated injury of single nerve, most commonly the ulnar nerve. Understanding the etiology, mechanism and pattern of injury with each type of nerve injury is important for the prevention of PPNI. Intraoperative neuromonitoring has been used to detect peripheral nerve conduction abnormalities indicating peripheral nerve stress under general anesthesia and to guide modification of the upper extremity position to prevent PPNI. POVL usually results in permanent visual loss. Most cases are associated with prolonged spine procedures in the prone position under general anesthesia. The most common causes of POVL after spine surgery are ischemic optic neuropathy and central retinal artery occlusion. Posterior ischemic optic neuropathy is the most common cause of POVL after spine surgery. It is important for spine surgeons to be aware of POVL and to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters. Modification of risk factors extrinsic to the patient may help reduce the incidence of PPNI and POVL. It is important for spine surgeons to be aware of PPNI and POVL to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters.Kamel I, Barnette R. Positioning patients for spine surgery: Avoiding uncommon position-related complications. World J Orthop

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Bilateral Retrobulbar Optic Nerve Infarctions after Blood Loss and Hypotension

Cited by 110 publications

References 29 publications

Visual loss due to cerebral infarcts in pseudoxanthoma elasticum

Visual loss due to cerebral infarcts in pseudoxanthoma elasticum

A Young Man With Severe and Disabling Complications of Septic Shock

Positioning patients for spine surgery: Avoiding uncommon position-related complications

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