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Query: UMLS:C0344232 (blurred vision)
 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors report the case of an AIDS patient with rare neurologic manifestations: primary vasculitis of the central nervous system and VIII cranial nerve dysfunction. The authors make a review on the subject, and call special attention for the differential diagnosis. In fact, the patient, a 36 year old woman, with promiscuous life, presented with dizziness, gait ataxia, nausea, headache and hypoacusia. Seven days after the admission, she noted blurred vision in both eyes and soon she became blind. The physical examination showed bilateral optic neuritis and vestibulocochlear dysfunction, stiff neck and fever. No abnormalities were detected on CT scan. CSF showed 40 mononuclear cells/mm3, 79 mg/dl of proteins and normal glucose content. Microbiological research was negative. Serum anti-HIV test was positive. The hypothesis of primary CNS vasculitis was made, and pulse methylprednisolone therapy was introduced with good recovery of neurological syndrome except for persistent amaurosis.
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PMID:[Isolated vasculitis of the central nervous system and involvement of the 8th cranial nerve: rare manifestations of acquired immunodeficiency syndrome]. 130 67

Acute enlargement of pituitary adenomas due to haemorrhage or ischaemic necrosis in the tumour was described as "pituitary apoplexy" by Brougham et al. in 1950. Since then, more than 200 cases have been reported, but--especially in the German literature--the syndrome has caught only little attention. Therefore, in a series of 12 own patients, typical findings and clinical characteristics are demonstrated and the literature is discussed. 9 patients had a haemorrhage into the tumour, 3 an acute ischaemic necrosis. The guiding symptom was the acute onset with ophthalmoplegia (11 of 12 patients). Only in one case the adenoma was known before the apoplexy. Other symptoms were headache, blurred vision, drowsiness and, in severe cases, hemiparesis, coma, and hypothalamic disorder. Most important is the acute endocrinological substitution with hydrocortisone; this may be life-saving. Neuroophthalmological recovery depends on early operation: cases of oculomotor palsy require an operation within the first 2 weeks after the acute event. An emergency operation is required only by an acute amaurosis. In general there will be enough time for careful clinical endocrinological and radiological investigations.
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PMID:[Acute hemorrhage and ischemic necroses in hypophyseal tumors: hypophyseal apoplexy]. 259 99

Non-invasive carotid artery testing was performed on 500 consecutive patients with visual disturbances not related to local ophthalmic pathology to determine the extent of carotid artery disease, particularly in patients with symptoms not typical of amaurosis fugax. Three hundred eighty six patients (77.2%) had an abnormal study. However, the incidence of hemodynamically significant lesions was only 16%. The patients could be divided into three groups: Patients with symptoms that could be explained on an ocular basis, including amaurosis fugax, had a 79% incidence of ipsilateral carotid plaques. Patients with symptoms which could not be easily explained on an ocular basis, such as bilateral blurred vision, bilateral visual loss (both transient and permanent), and homonymous hemianopsia had an incidence of carotid artery plaques similar to patients with amaurosis fugax. Patients with unilateral blurred vision and bilateral scintillations had a lower incidence (57%) of carotid plaques than the other groups. Younger symptomatic patients had less carotid plaques than the overall series. Twenty-one percent of patients under age 50 had the Doppler finding of early systolic flutter turbulence, which is usually of mitral valve origin. Women predominated in the under 50 age group by about 2:1. In view of the prevalence of carotid plaques in the population of patients with visual symptoms other than amaurosis fugax, evaluation of these patients with non-invasive testing is indicated to determine which of these patients has hemodynamically significant obstruction to flow at the carotid artery bifurcation.
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PMID:Visual disturbance and carotid artery disease. 500 symptomatic patients studied by non-invasive carotid artery testing including B-mode ultrasonography. 352 Sep 77

The pathogenesis of anterior ischemic optic neuropathy (AION) primarily involves interference with the posterior ciliary artery blood supply to the prelaminar optic nerve. Uremic patients often have coexisting pathology such as hypotension (decreased blood delivery), or hypertension, atherosclerosis (increased resistance to blood supply), and anemia (low blood oxygen carrying capacity), predisposing them to AION. We describe a 49-year-old patient on dialysis for many years. He had long-standing hypotension, worsened during each dialysis treatment. He awoke one morning at age 48 complaining of blurred vision in the left inferior field. Based on the clinical course, funduscopic and fluorangiographic examination and visual field defects, AION was diagnosed. Nine months after the loss of vision in the left eye, vision in the right eye became blurred and worsened over the next 24 hours. The diagnosis of AION in the right eye was made. At the last examination ten months later, the patient, still amaurotic, was given a very poor prognosis for further recovery of the visual defects. Surprisingly, very few cases of AION have been reported in chronic uremic patients on dialysis: to the best of our knowledge, only 12 including ours. Most of these cases share some features, including hypotension above all and anemia as common risk factors. Neither the type of dialysis treatment (hemo-, peritoneal dialysis) nor sex seem to have any influence on the occurrence of AION. Uremic children can be affected. What is striking in the three published pediatric cases is that they all had polycystic kidney disease. Treatment of AION in all 12 cases consisted of a combination of steroids, i.v. saline, blood transfusions and rhEpo. AION was more frequently bilateral and irreversible, ending in permanent amaurosis. In conclusion, this study aims to stress that most cases of AION occurring in chronic uremic patients on dialysis have some common features, including hypotension above all and anemia as common risk factors.
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PMID:Anterior ischemic optic neuropathy and dialysis: role of hypotension and anemia. 1173 Feb 78

Atrial septal defect (ASD) is a common diagnosis in young adults with congenital heart disease. The aim of this study was to determine if ocular symptoms following percutaneous treatment are due to microemboli. The study group included 20 adult patients (9 men, 11 women, mean age 57.2 years) with ASD who had undergone successful closure with the Amplatzer occluder. The patients were treated with aspirin or warfarin during 6 months after the procedure. All were evaluated neurologically and an ocular medical history was obtained. Ocular examination included the 120-point Humphrey visual field. Transcranial Doppler (TCD) was performed to monitor the middle cerebral artery. Two patients complained of amaurosis fugax at 1 and 3 months after the procedure, and two patients complained of blurred vision at 3 and 4 months after the procedure. TCD performed for 45 minutes within 24 hours of the visual complaints revealed no abnormalities. In all patients, the neurological and ocular examinations, including the visual field test, were normal. In conclusion, microembolic events could not be demonstrated to be the cause of the ocular complaints in patients with ASD treated with Amplatzer occluder. Further studies in larger samples are needed to confirm these results.
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PMID:Do complaints of amaurosis fugax and blurred vision after transcatheter device closure of atrial septal defect indicate microemboli to retinal vessels? 1578 50

Atrial septal defect (ASD) is a common diagnosis in adults undergoing surgical repair. The aim of the study was to determine if ocular symptoms following treatment are due to microemboli. The study group included 20 adult patients (9 men, 11 women, mean age 57.2 years) with ASD who had undergone successful closure with the Amplatzer occluder. Patients were treated with aspirin or warfarin during the 6 months after the procedure. All were evaluated neurologically and an ocular medical history was obtained. Ocular examination included the 120-point Humphery visual field. Transcranial Doppler (TCD) was performed to monitor the middle cerebral artery. Two patients complained of amaurosis fugax at 1 and 3 months after the procedure, and two patients complained of blurred vision at 3 and 4 months after the procedure. TCD performed within 24 h of the complaints revealed no abnormalities. In all patients, the neurological and ocular examinations, including the visual field test, were normal. In conclusion, microembolic events do not appear to be the cause of the ocular complaints in patients with ASD treated with Amplatzer occluder. Further studies in larger samples are needed to confirm these results.
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PMID:Do complaints of amaurosis fugax and blurred vision after transcatheter device closure of atrial septal defect indicate microemboli to retinal vessels? 1613 4

An attack of abrupt loss of vision in one eye that recovers completely after a short period is called "transient monocular blindness" (TMB) or amaurosis fugax. The most common cause of TMB is atherothromboembolism from the origin of the internal carotid artery (ICA), whereas atrial fibrillation is quite uncommon. TMB also can be caused by anterior optic nerve ischemia, that is usually caused by thrombosis in the posterior ciliary artery. Thrombosis in the central retinal vein may be another cause. Dissection of the ICA, vascular malformations, or fibromuscular dysplasia are other potential etiologies. Blurring of vision as compared with blackened vision or positive phenomena such as flashing is probably associated with a higher risk of future cardiovascular events, whereas involvement of the partial monocular field is associated with a relative benign prognosis. In patients with atherosclerosis, antiplatelet therapy is indicated and treatment of vascular risk factors should have high priority. Carotid endarterectomy should be performed only in case of an ICA stenosis of more than 70% in the presence of at least one other risk factor for stroke.
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PMID:Transient monocular blindness. 1683 32

Unintended intravascular injection from inferior alveolar nerve blocks can result in frustrating distant complications affecting such structures as the middle ear and eyes. Possible complications affecting the eyes include blurring of vision, diplopia, mydriasis, palpebral ptosis and amaurosis (temporary or permanent). In this article, we present a complication that has been reported only rarely. Two patients developed transient loss of power of accommodation of the eye resulting in blurred vision after routine inferior alveolar nerve blocks on the ipsilateral side. Clear vision returned within 10-15 minutes after completion of the blocks. The possible explanation for this phenomenon is accidental injection into the neurovascular bundle of local anesthetic agents, which were carried via the blood to the orbital region. This resulted in paralysis of a branch of cranial nerve III, the short ciliary nerves that innervate the ciliary muscle, which controls accommodation.
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PMID:Transient loss of power of accommodation in 1 eye following inferior alveolar nerve block: report of 2 cases. 1718 8

The main symptoms of acute primary angle-closure glaucoma (PACG) include pain in the head and/or the eyes in addition to the characteristic halo and blurred vision. When loss of vision is accompanied by such pain, PACG is usually suspected. However, no information has been available regarding painless acute angle-closure glaucoma. Recently, we treated a patient with painless acute PACG mimicking amaurosis fugax as a type of transient ischemic attack. Generally, amaurosis fugax causes transient monocular loss of vision due to occlusion of the ophthalmic artery. The formation of microemboli derived from the heart or carotid artery and/or the occurrence of some hemodynamic abnormality due to arteriosclerosis is closely related to amaurosis fugax, and most cases are complicated by intracranial or extracranial arterial lesions. In the present case, we provisionally diagnosed transient amaurosis fugax which, however, was shown by additional ocular testing to be painless PACG. Herein we describe our diagnostic process and the outcome.
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PMID:Painless transient monocular loss of vision resulting from angle-closure glaucoma. 1763 5

Several cases of hypothyroidism have been reported to develop idiopathic intracranial hypertension not directly precisely linked with cerebral venous sinus thrombosis (CVT). A 31-year-old Chinese woman presented with bilateral blurred vision and paroxysmal amaurosis for about 6 months without headache. Neurological examination revealed normal expect for the sixth cranial nerve palsy and bilateral papilledema. Laboratory tests showed pronounced hypothyroidism and greatly increased serum triglyceride. Cerebral spinal fluid showed the increased opening and closing pressure. Digital subtraction angiography (DSA) disclosed a filling defect in the adjunction of bilateral transverse sinuses and sigmoid sinuses. Her symptoms gradually improved with levothyroxine, mannitol and anticoagulants treatment. In presenting the rare case of lateral sinus thrombosis associated with primary hypothyroidism, we wish to alert physicians that patients presenting with papilledema and hypothyroidism may require investigations of DSA for CVT, even in the absence of headache.
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PMID:Lateral sinus thrombosis and intracranial hypertension associated with primary hypothyroidism: case report. 1828 54


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