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Meningeal carcinomatosis (MC) has an extremely poor prognosis and can present with various neurological symptoms. A 68-year-old man presented to our hospital with a 1 month history of headache and nausea followed by sudden decrease in vision in both eyes. Whilst being examined in the ophthalmology department he lost consciousness and had a generalised tonic clonic seizure. Accordingly, he was transferred to the Emergency Department. Head magnetic resonance imaging showed hydrocephalus. Abdominal contrast-enhanced computed tomography scanning reported changes suggestive of gastric carcinoma. Cerebrospinal fluid cytological examination showed numerous atypical cells, leading to the diagnosis of MC. An upper gastrointestinal endoscopy revealed an advanced gastric tumour. Systemic chemotherapy was initiated, however, he died within 16 days of admission. At autopsy, poorly differentiated adenocarcinoma was identified in the subarachnoid space, however it had not invaded the brain parenchyma or optic chiasm. This is the first report of loss of vision being the first presenting symptom of new-onset gastric carcinoma with MC. Although rare, MC should be suspected in cases where patients present with sudden loss of vision and symptoms of meningeal irritation, where there are no ophthalmological findings to explain the vision loss. [ABSTRACT FROM AUTHOR]

Familial Mediterranean fever (FMF) is a rare autoinflammatory disorder. Ocular involvement is rare. The full spectrum and response to treatment is poorly understood. An 18-year-old girl previously diagnosed with FMF presented with sudden loss of vision in the left eye (LE). Best-corrected visual acuity (BCVA) in the LE was finger counting at 1.5 meters. Angiitis with mild “frosting,” hemi-central retinal vein occlusion (HCRVO), and acute outer retina rupture (ORR) were observed in the LE. Systemic steroids were initiated immediately. The ORR was sealed 2 weeks later while vision improved to 6/15 (near vision: J2) 5 months later. No recurrences were observed over 5 years of follow-up. We report a rare manifestation of frosted branch angiitis with concomitant HCRVO and ORR in a young patient with FMF. Closure of ORR was attained and vision recovered after treatment with high-dose steroids.

Familial Mediterranean fever (FMF) is a rare autoinflammatory disorder. Ocular involvement is rare. The full spectrum and response to treatment is poorly understood. An 18-year-old girl previously diagnosed with FMF presented with sudden loss of vision in the left eye (LE). Best-corrected visual acuity (BCVA) in the LE was finger counting at 1.5 meters. Angiitis with mild "frosting," hemi-central retinal vein occlusion (HCRVO), and acute outer retina rupture (ORR) were observed in the LE. Systemic steroids were initiated immediately. The ORR was sealed 2 weeks later while vision improved to 6/15 (near vision: J2) 5 months later. No recurrences were observed over 5 years of follow-up. We report a rare manifestation of frosted branch angiitis with concomitant HCRVO and ORR in a young patient with FMF. Closure of ORR was attained and vision recovered after treatment with high-dose steroids. [ABSTRACT FROM AUTHOR]

Introduction. Leber’s hereditary optic neuropathy (LHON) typically affects young adults, with a higher prevalence in men, but can ultimately occur at any age, as well as in women. LHON is caused by point mutations in the mitochondrial DNA. Classically, LHON presents as a subacute unilateral loss of visual acuity, dyschromatopsia in the red–green axis and a central or centrocecal scotoma. The contralateral eye usually develops similar symptoms within 3–6 months of the disease onset. Case outline. A 55-year-old male patient presented to a neurologist 20 days after the onset of vision loss. The patient was admitted as an emergency case to the Clinic for Eye Diseases due to a sudden vision loss in both eyes. The best corrected visual acuity in both eyes was 4/60. The intraocular pressure on both eyes was normal. Oedema of the optic nerve head was found on the right eye and a disc with blurred borders was seen on the left eye. During hospitalization, several consultative examinations and diagnostic procedures were performed, together with blood laboratory and visual field perimetry. Genetic testing for LHON as well as antibodies to AQ4, immunoserology, virology, and lumbar puncture were performed, as well as the visual evoked potential and ultrasound examinations. Conclusion. In our patient, the presence of a heteroplasmic mutation m.11778 G>A (MT-ND4) in the mitochondrial DNA analyzed from a peripheral blood sample was shown. In the available literature, this is the first documented LHON case demonstrating complete restitution of visual acuity in both eyes.

Purpose: To present the first reported case of paracentral acute middle maculopathy in association with Susac syndrome. Method: Case report. Results: A young female patient presented with unilateral sudden loss of vision of her right eye to count fingers. There were numerous cotton wool spots in a multifocal pattern concentrated around the right macula and optic disk. Clinical examination and spectral domain optical coherence tomography imaging were consistent with paracentral acute middle maculopathy, and fluorescein angiography showed features of retinal arteriole vasculitis. Magnetic resonance imaging demonstrated multiple white matter lesions in a pericallosal distribution. High-dose corticosteroid therapy was commenced, and visual acuity gradually improved to 6/6 corrected. The patient reported hearing impairment and was diagnosed with Susac syndrome for which she has responded extremely well to longterm immunosuppressive therapy. Conclusion: Paracentral acute middle maculopathy can occur in association with Susac syndrome. Susac syndrome may present only with multifocal retinal ischemia, and such patients with paracentral acute middle maculopathy should be checked for characteristic magnetic resonance imaging lesions and hearing loss. [ABSTRACT FROM AUTHOR]

A 12-year-old girl presented with unilateral, sudden painless loss of vision for the past 2 days. Ocular examination was normal. Optical coherence tomography, visually evoked potential, and magnetic resonance imaging of the brain and orbits were normal. With no organic cause found for vision loss, psychiatrist opinion was sought. After evaluation, she was diagnosed to have psychogenic blindness and treated with psychotherapy. When findings are inconsistent and no organic etiology can be diagnosed for the vision loss, psychogenic blindness is suspected and prompt referral to a psychiatrist is essential for complete recovery.

Topiramate acetate is a commonly used drug prescribed by neurologists and psychiatrists for the treatment of various diseases including migraine. Topiramate therapy can cause a forward displacement of the iris-lens diaphragm which can result in acute bilateral angle-closure glaucoma and myopia. Common complaints include visual disturbances and eye pain. In this case report, we offered a patient who had a sudden loss of vision and severe eye pain due to acute myopia and angle-closure glaucoma after the use of topiramate for migraine. This case report aimed to increase awareness among neurologists, psychiatrists and ophthalmologists about the side effects that may occur with the use of topiramate. [ABSTRACT FROM AUTHOR]

Pituitary adenomas usually arise from the anterior lobe of the pituitary gland and are manifested with hormonal disorders or mass effect. Mass effect usually occurs in nonfunctional tumors. Pituitary adenomas may be manifested with visual field defects or rarely in the form of total oculomotor palsy. Visual field defect is most frequently in the form of bitemporal hemianopsia and superior temporal defect. Sudden loss of vision, papilledema and ophthalmoplegia may be observed. Pituitary apoplexy is defined as an acute clinical syndrome characterized with headache, vomiting, loss of vision, ophthalmoplegia and clouding of consciousness. The problem leading to pituitary apoplexy may be decreased blood supply in the adenoma and hemorrhage following this decrease or hemorrhage alone. In this article, we present a patient who presented with fever, vomiting and sudden loss of vision and limited outward gaze in the left eye following trauma and who was found to have pituitary macroadenoma causing compression of the optic chiasma and optic nerve on the left side on cranial and pituitary magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Sudden loss of vision, which causes consternation for both the patient and clinician, is a clinical problem that is encountered fairly regularly in most primary healthcare settings. Sudden visual loss or obscuration which is transient may simply be a symptom of a dry eye or a migraine, but it may also be the onset of irreversible visual loss or a stroke. Most cases of sudden loss of vision are serious, require referral and have an associated underlying systemic disease. Visual loss is usually unilateral, but may be bilateral. This clinical problem may present a diagnostic challenge. No cause may be found in some instances. However, it is important to remember that the more sinister causes of sudden visual loss, such as temporal arteritis, carotid or cardiac emboli that cause retinal vascular occlusion, retinal detachment, vitreous haemorrhage and orbital masses, need to be identified early. Using the duration of the visual loss as the primary differentiating factor, with associated symptoms and signs as supplementary factors, the causes can be narrowed down. A thorough history, goal-directed examination, proper investigation and appropriate referral should enable early diagnosis and adequate management. This will prevent further ocular morbidity, and even patient mortality. [ABSTRACT FROM AUTHOR]

Retinal artery macroaneurysms are saccular dilatations of the retinal arterioles which are commonly seen in females and systemic hypertensive patients after 6th decade. In this case report, we defined a ruptured retinal artery macroaneurysm interestingly in a 37-year-old young male hipertensive patient who had a sudden painless loss of vision. According to our opinion, we believe that RAM should also be included in the list of priorities during the differential diagnosis of sudden loss of vision in young hypertensive patients. In addition to current imaging modalities, we have also discussed that the high resolution Optical Coherence Tomography (OCT) could have an important contribution to the diagnosis and follow-up after the treatment of RAMs. [ABSTRACT FROM AUTHOR]