Simultaneous bilateral posterior ischemic optic neuropathy secondary to giant cell arteritis: a case presentation and review of the literature

Albarrak, Anas Mohammad; Mohammad, Yousef; Hussain, Sajjad; Husain, Sufia; Muayqil, Taim

doi:10.1186/s12886-018-0994-9

Cited by 17 publications

(11 citation statements)

References 25 publications

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“…GCA is far more common among Caucasians than other races; however, it is reported among non-Caucasians all over the world, e.g., from China[ 7 8 9 10 ], Taiwan[ 11 ], Korea[ 12 ], Japan[ 13 ], Thailand[ 14 15 ], Malaysia[ 16 ], Israel[ 17 ], Arabs[ 18 ], Mexicans[ 19 ], African American[ 20 21 ], and Alaskan Natives. [ 22 ] There are several reports of variable numbers of patients of GCA from India, including from the Punjab[ 23 24 25 26 ], New Delhi[ 27 ], Mumbai[ 28 ], Goa[ 29 ], South India[ 30 31 32 33 34 35 ], and Assam.…”

Section: Giant Cell Arteritismentioning

confidence: 99%

Giant cell arteritis

Hayreh

2021

Indian Journal of Ophthalmology

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Section: Giant Cell Arteritismentioning

confidence: 99%

Giant cell arteritis

Hayreh

2021

Indian Journal of Ophthalmology

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“…Usually, ION could be divided into the subtypes of anterior ION (AION) and posterior ION (PION), according to the involved area of lesion. [ 1 ] The characterized and common symptoms of ION include a monocular painless decreasing vision, a relative afferent pupillary defect (RAPD), and the altitudinal, especially inferior, visual field defects. The hyperemic swelling of the optic disc is the typically clinical sign of AION, whereas the optic disc remains normal in PION.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of ischemic optic neuropathy caused by dissection of the internal carotid artery

Zheng

Wang²,

Chen³

et al. 2020

Medicine

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Rationale: Ischemic optic neuropathy (ION), due to diseases of the arteries supplying the optic nerve, is an ischemic damage of the optic nerve. This report highlights a case with monocular decreasing visual acuity caused by dissection of the internal carotid artery (ICA), which is a relatively rare cause for ION. Patient concerns: A 44-year-old woman presented with a decreasing visual acuity and defected visual field in the right eye for 1 week. The best corrected visual acuity (BCVA) was 20/400 in the right eye, and 20/20 in the left eye. In the right eye, the pupil showed little reaction to light with a relative afferent pupillary defect. The visual field test disclosed a defect in the inferior field connecting to the blind spot. Electroretinogram recording showed no obviously declined retinal function. No recognizable waveforms were presented in pattern visual–evoked potential (PVEP) examination, whereas the flash visual–evoked potential result revealed a delayed peak time and a reduced amplitude of P2-wave. Diagnosis: The patient was diagnosed as ION with the aid of computed tomographic angiography of the brain and neck, which revealed a stenosis in the right ICA and an occlusion in the right cerebral middle artery. The stenosis was verified as dissection of the ICA by digital subtraction angiography. Interventions: Based on the clinical findings, stent implantation inside the right ICA was performed. Outcomes: The ICA was recanalized soon and the BCVA of the right eye was improved to be 20/25 five months later. A second PVEP examination revealed a recognizable waveform in the right eye, although the peak time and amplitude of the P100-wave was a bit abnormal compared to that of the left eye. Lessons: ION with the sign of decreasing monocular visual acuity could occur due to dissection of the ICA, with no obvious neurologic symptom at the beginning. The present case emphasizes the importance of suspicion of ICA problems as the underlying cause for ION, which could help to take in-time measure to save the vision and avoid further complications.

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“…RD also leads to monocular vision loss, but optimal time to repair depends on multiple factors beyond our scope [ 23 ]. Unlike these usually unilaterally vision-impairing emergencies, delayed diagnosis and treatment of GCA may lead to rapid bilateral blindness [ 24 – 26 ]. Fortunately, GCA is uncommon; the estimated age-adjusted and sex-adjusted prevalence is 204 per 100,000 people aged ≥50 in the US [ 27 ], 15% to 25% of which may develop permanent vision loss [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States

Uhr

Governatori²,

Zhang

et al. 2020

Eye

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Background/objectives Patients with ophthalmic emergencies often present to emergency rooms. Emergency medicine (EM) physicians should feel comfortable encountering these conditions. We assessed EM physicians’ comfort working up, diagnosing, and managing ophthalmic emergencies. Subjects/methods 329 EM physicians participated in this cross-sectional multicentre survey. Questions inquired about the amount, type, and self-perceived adequacy of ophthalmic training. Likert scales were used to assess confidence and comfort working up, diagnosing, and managing ophthalmic emergencies. Results Participants recall receiving a median of 5 and 10 h of ophthalmic training in medical school and residency, respectively. Few feel this prepared them for residency (16.5%) or practice (52.0%). Only 50.6% feel confident with their ophthalmic exam. Most (75.0%) feel confident in their ability to identify an ophthalmic emergency, but 58.8% feel well prepared to work them up. Responders feel more comfortable diagnosing acute retrobulbar hematoma (72.5%), retinal detachment (69.8%), and acute angle closure glaucoma (78.0%) than central retinal artery occlusion (28.9%) or giant cell arteritis (53.2%). Only 60.2% feel comfortable determining if canthotomy and cantholysis is necessary in the setting of acute retrobulbar hematoma, and 40.3% feel comfortable performing the procedure. There was a trend towards attending physicians and providers in urban and academic settings feeling more comfortable diagnosing and managing ophthalmic emergencies compared to trainees, non-urban, and non-academic physicians. Conclusions Many participants do not feel comfortable using ophthalmic equipment, performing an eye exam, making vision or potentially life-saving diagnoses, or performing vision-saving procedures, suggesting the need to increase ophthalmic training in EM curricula.

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Simultaneous bilateral posterior ischemic optic neuropathy secondary to giant cell arteritis: a case presentation and review of the literature

Cited by 17 publications

References 25 publications

Giant cell arteritis

Giant cell arteritis

Diagnosis of ischemic optic neuropathy caused by dissection of the internal carotid artery

Training in and comfort with diagnosis and management of ophthalmic emergencies among emergency medicine physicians in the United States

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