Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 65-year-old Caucasian male presented to the eye emergency department with bilateral significant visual loss. He was otherwise healthy with no significant past medical history. Ophthalmic history was significant for chronic open-angle glaucoma, for which the patient was using latanoprost once daily to both eyes. There was no preceding history of trauma or ocular surgery and the patient was emmetropic. Two weeks prior to his presentation, he reported a headache, which settled spontaneously. Slit-lamp examination demonstrated bilateral keratic precipitates, bilateral significantly shallow anterior chamber, and bilaterally normal intraocular pressures of 16 mm Hg. Fundal examination was significant for bilateral 360-degree choroidal detachments with exudative retinal detachment involving the maculae. These findings were confirmed using wide-field fundus photography, B-scan ultrasonography, and optical coherence tomography. Fundus fluorescein angiography did not reveal any evidence of retinal vasculitis. Indocyanine green chorioangiography of the posterior pole showed multiple areas of focal choroidal hypoperfusion. Extensive systemic investigation demonstrated no infectious, neoplastic, or inflammatory cause, and the patient did not complain of any systemic symptoms. Treatment with high-dose intravenous methylprednisolone was administered and this brought about complete resolution of both choroidal and retinal detachments, with partial visual recovery.
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PMID:A Mystery of Bilateral Annular Choroidal and Exudative Retinal Detachment with No Systemic Involvement: Is It Part of Vogt-Koyanagi-Harada Disease Spectrum or a New Entity? 2820 89

A 69-year-old man became aware of people's speech being out of synch with their lip movements alongside persistent headaches, both of which progressively worsened. A few weeks later, he developed progressive and painless visual loss in one eye. Initial neurological evaluation, inflammatory markers and head computed tomography scan were normal. Ophthalmological examination and OCT scan revealed right macular subretinal fluid with choroidal indentation, which prompted urgent further investigations including head MRI revealing extensive leptomeningeal disease. The patient continued to deteriorate and deceased shortly afterwards. This is the first reported case of neoplastic leptomeningeal disease presenting with loss of vision due to choroidal metastasis with localised exudative retinal detachment. Diagnosing neoplastic leptomeningeal disease requires a high index of suspicion from the treating physician. Symptoms may be nonspecific and/or subtle. Combining cerebrospinal fluid cytology from lumbar puncture with contrast-enhanced magnetic resonance imaging of the brain is considered the optimal diagnostic approach.
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PMID:Neoplastic leptomeningeal disease masquerading as central serous retinopathy. A case report. 2821 Jan 85

Vogt-Koyanagi-Harada syndrome is an uncommon multisystem inflammatory disorder characterized by panuveitis with serous retinal detachment and is often associated with neurologic and cutaneous manifestations including headache, hearing loss, vitiligo, and poliosis. The case of a 62-year-old female with diabetes mellitus and a history of primary open angle glaucoma (POAG) in both eyes, operated on the left eye two weeks prior to the presentation and under topical antiglaucomatous drops, was reported. She presented at the ophthalmological service for decreased visual acuity (VA) in both eyes. The slit lamp examination revealed keratic precipitates and posterior iris synechiae in both eyes and an ExPress aqueous shunt in the left eye. Inferior retinal detachment was observed on ocular fundus examination on both eyes. Intraocular pressure value was in normal range under antiglaucomatous drops (dorzolamid + timolol). The distinctiveness of this case was the association of the VKH syndrome with POAG and the inability to prolong the corticosteroid treatment, necessary in this case, due to the association of diabetes mellitus.
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PMID:Vogt-Koyanagi-Harada syndrome Case report. 2945 Mar 45

We here report the case of a 27-year old patient, followed-up in our Department for treatment of chronic Vogt-Koyanagi-Harada disease ( VKH disease). Fundus examination showed depigmentation of the retinal pigment epithelium and of the choroid, appearing as a pseudotumoral peripapillary lesion. Vogt-Koyanagi-Harada disease is a multisystem disorder, characterized by bilateral granulomatous panuveitis with serous exudative multifocal retinal detachment. Pathophysiology of this disease is unknown, but an immunological cellular reaction against melanocytes of the skin, the meninges, the retina, the uvea, the cochlea and the labyrinth is suspected. This disease mainly occurs in young subjects from the Far East as well as in pigmented subjects. Ocular involvement is often associated with neurological (meningeal stiffness, headache, sometimes associated with focal deficit and erebrospinal fluid (CSF) pleocytosis), auditory ( perceptive deafness) and cutaneous (vitiligo, poliosis, alopecia and canities) manifestations. It usually evolves in three phases: a prodromal phase mainly characterized by neurological signs, an acute uveitic phase, a chronic phase of convalescence characterized by choroidal and tegument depigmentation or a phase of recurrence during which subretinal neovessels and subretinal fibrosis may appear. Scarrings manifest during the chronic phase of VKH disease, which is dominated by diffuse depigmentation of the fundus of the eye, scars due to nummular chorioretinal atrophy, wheals due to diffuse depigmentation, macular scar remodeling. Pseudotumoral appearance is rare and atypical during the chronic phase of VKH disease. Treatment is based on intravenous corticosteroids followed by a cycle of oral therapy. Patient should be early treated with massive and prolonged therapy to improve prognosis.
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PMID:[A rare case of ocular scarrings in a patient with Vogt-Koyanagi-Harada disease]. 2972 Nov 43

Choroidal and central nervous system metastases from prostate cancer are extremely rare. We report a case of choroidal and brain metastases from castration-resistant prostate cancer (CRPC). A 75-year-old male patient with metastatic CRPC presented with a 1-week history of a decrease in visual acuity in his left eye. An ophthalmoscopic examination revealed a choroidal tumor, 4 disc diameters across with serious retinal detachment. He was diagnosed with metastatic choroidal tumor from examination and patient's background. The external beam radiation therapy of total 30 Gy was successful and his visual acuity was improved. Three courses of chemotherapy with docetaxel (55 mg/m2) were performed, but finally he was found to have multiple brain metastases 4 months later. His headache disappeared after palliative whole brain radiotherapy, but he died 3 months after diagnosis of brain metastases. Although choroidal and brain metastases from prostate cancer are very rare, it is important for urologists to listen to the patient's complaints and consider the possibility of these rare metastases in patients with advanced cancer.
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PMID:[A Case of Choroidal and Brain Metastases from Castration-Resistant Prostate Cancer]. 2977 21

Vogt-Koyanagi-Harada (VKH) disease is an autoimmune disorder that occurs in the melanocytes present in the uvea, leptomeninges, skin and inner ear. Clinically, this disease is characterized by bilateral uveitis and retinal detachment and is associated with meningismus and hearing loss. Gadolinium (Gd)-enhanced MRI may aid in demonstrating bilateral choroidal thickening and central nervous system involvement. We present a case of VKH where Gd-enhanced three-dimensional (3D) fluid attenuation inversion recovery (FLAIR) imaging showed abnormal bilateral enhancement in the inner ears. A 36-year-old female was referred to our institution with symptoms of visual disturbance, headache and tinnitus, and was diagnosed with VKH based on fundus examination and clinical presentations. MRI findings revealed bilateral enhancement in the choroid, leptomeninges, and inner ears. In particular, Gd-enhanced 3D FLAIR showed more conspicuous enhancement of the leptomeninges and inner ear compared with Gd-enhanced 3D T 1 weighted image. Therefore, Gd-enhanced 3D FLAIR imaging can be used when leptomeningeal or inner ear pathology is clinically suspected.
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PMID:Inner ear enhancement on gadolinium-enhanced 3D FLAIR images in a patient with Vogt-Koyanagi-Harada disease. 3036 18

Electroconvulsive therapy (ECT) is the oldest among the early biological treatments introduced in psychiatry, and the only one still in use. In this paper we attempt a brief presentation of ECT usage over the last 80 years, since it was originally introduced. It is a safe, well-tolerated, and highly effective treatment option for major psychiatric disorders, such as mood disorders and schizophrenia, especially when there is an acute exacerbation of psychotic symptoms or if catatonic symptoms are prominent. ECT has also been used successfully for the treatment of Parkinson's disease, delirium, neuroleptic malignant syndrome, autism and agitation and depression in demented patients. There are no absolute contraindications. However, it is considered a high risk procedure for patients with increased intracranial pressure, recent myocardial infarction, recent cerebral hemorrhage or stroke, vascular aneurysm, retinal detachment and pheocromocytoma. Modern genetic and neuroimaging techniques have helped clarify possible mechanisms of action of ECT, but much remains unknown. Improvement of this method through a number of technical advancements has contributed in the reduction of side effects. Thus, modified ECT is currently considered as an effective and safe form of treatment even in vulnerable populations such as the geriatric patients, the adolescents and the pregnant patients. The mortality rate is very low, comparable to that of a minor anesthetic procedure. The most common adverse events are headache, nausea, myalgias and postictal delirium while the most severe are the cardiovascular side effects. Of note, the cognitive side effects especially amnesia, although transient, has been the focus of skepticism against the treatment. Major psychiatric disorders are chronic, recurring disorders. The relapse rate after a successful course of ECT without any intervention is extremely high. Pharmacotherapy or continuation ECT reduces equally the relapse rate up to 40%. Continuation and maintenance ECT, in combination with pharmacotherapy, have been successfully used in preventing relapse and recurrence. Gradual tapering off acute ECT treatments and individualized continuation and maintenance ECT treatments based on the needs of each patient seems the optimum clinical practice. Conclusively, despite impressive new developments in pharmacotherapy and in biological non pharmacological treatments ECT remains a valuable, irreplaceable treatment option for debilitating, resistant major psychiatric disorders.
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PMID:[Electroconvulsive therapy: 80 years of use in psychiatry]. 3081 39

Nivolumab is an anti-programmed cell death protein 1 monoclonal antibody that is used to treat metastatic cutaneous malignant melanoma. Although bilateral uveitis has been reported as a side effect of nivolumab administration, there are few reports of Vogt-Koyanagi-Harada disease (VKH)-like uveitis. We report such a case. A 63-year-old woman with metastatic cutaneous malignant melanoma experienced visual loss in both eyes 10 days after her second nivolumab injection. Her decimal best-corrected visual acuity (BCVA) was 0.7 in the right eye and 0.4 in the left eye. Examination revealed bilateral granulomatous keratic precipitates and posterior synechiae in the left eye. Optical coherence tomography showed multiple sites of serous retinal detachment (SRD) in the left eye and wavy retinal pigment epithelium in both eyes. Fluorescein angiography revealed multiple pinpoint-sized areas of leakage in both eyes and active leakage from the disc in her right eye. Indocyanine green angiography (IA) showed choroidal hyperfluorescence due to choroidal vascular leakage, with hypofluorescent dark spots during the late phase. These findings supported a diagnosis of VKH-like uveitis following nivolumab injections. Nivolumab was discontinued because of headache. Anterior chamber inflammation disappeared 3 weeks after starting topical corticosteroid treatment, and the SRD disappeared within 3 months. Her decimal BCVA recovered to 1.0 in the right eye and to 0.9 in the left eye. Also, the fluorescein angiography and IA findings had improved by 4 months. We concluded that careful follow-up is required after nivolumab treatment because VKH-like panuveitis might develop.
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PMID:Vogt-Koyanagi-Harada Disease-Like Uveitis during Nivolumab (Anti-PD-1 Antibody) Treatment for Metastatic Cutaneous Malignant Melanoma. 3109 47

Purpose: To report the manifestation of Vogt-Koyanagi-Harada-like disease (VKH) following yellow fever vaccination. Methods: Case report. Results: A 34-year-old immunocompetent male had tinnitus, headache, and decreased vision after a booster dose of yellow fever vaccine. Visual acuity was 20/100 in the right eye and 20/80 in the left, with serous retinal detachment (SRD) and choroidal thickening identified on clinical examination and multimodal imaging. Lumbar puncture revealed pleocytosis and an increased protein content, but extensive investigations ruled out infectious/neurological diseases. Pulse intravenous methylprednisolone was given, followed by a tapering regimen of high-dose oral prednisone. Azathioprine was started early, 3 weeks after initiation of oral steroids. Intraocular inflammation and SRD rapidly resolved, with visual acuity reaching 20/20 in both eyes, after 3 weeks. No recurrence of intraocular inflammation or sign of depigmentation was so far noticed, at 2 years of follow-up. Conclusion: Yellow fever vaccine may be a possible trigger for VKH.
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PMID:Vogt-Koyanagi-Harada-like Disease following Yellow Fever Vaccination. 3160 3

The patient is a 19-year-old female who presented with 3 weeks of right eye pain, eyelid swelling, blurry vision, and headache. Visual acuity was counting fingers at 1 foot. Intraocular pressure was normal, and there was diffuse scleral injection on anterior examination. She had a mild anterior chamber reaction with 15 cells/high-powered field and a mild vitreous inflammatory reaction. Fundus examination revealed diffuse choroidal thickening with multilobulated serous retinal detachments worse inferiorly (Figures 1 and 2). Fluorescein angiography demonstrated severe optic disc leakage. Ultrasonography demonstrated diffuse choroidal thickening, a serous retinal detachment, and a prominent "T-sign" (Figure 3). The patient was diagnosed with posterior scleritis and treated with 80 mg of oral prednisone. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:660.].
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PMID:Posterior Scleritis. 3167 Dec 1


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