1/27. Blurred vision during sexual arousal associated with narrow-angle glaucoma.PURPOSE: To describe three women with narrow-angle glaucoma who had transient blurred vision during sexual arousal. METHOD: case reports. RESULTS: Three women, aged 37, 45, and 55 years, were seen with bilateral narrow-angle glaucoma and were treated with bilateral laser iridotomy. In each patient, additional surgery was required to control the glaucoma. After establishing a rapport with her physician, each patient described transient blurred vision, from a few minutes to several hours in duration, which began during sexual arousal. This symptom resolved after peripheral iridotomy and, in one patient, after laser iridoplasty. CONCLUSION: The association of transient blurred vision with sexual activity may delay presentation of patients with symptomatic narrow-angle glaucoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/27. occipital lobe meningioma in a patient with multiple chemical sensitivities.BACKGROUND: The concurrent diagnosis of meningioma with increased intracranial pressure has not been reported previously in a patient who meets diagnostic criteria for multiple chemical sensitivities (MCS). methods: A patient who had been evaluated in an occupational medicine practice, and by several other physicians for sensitivity to chemical odors was found to have papilledema and a visual field deficit. The patient met the clinical criteria set forth by Cullen in 1987 for MCS. A magnetic resonance imaging (MRI) scan was performed. RESULTS: The MRI revealed a large occipital lobe meningioma, which was surgically resected. Removal of the meningioma had little effect on the patient's symptoms. She has been unable to return to her job as a custodian. DISCUSSION: The etiology of MCS has been disputed and is currently unresolved. Those who evaluate patients with MCS are reminded that meningiomas and other intracranial mass lesions can affect olfaction, and that patients with MCS can have treatable intracranial abnormalities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/27. Loss of vision from distant haemorrhage: report of four cases.To describe the occurrence of visual loss from ischaemia of the optic nerve following distant haemorrhages. Four patients who sustained vision loss following distant haemorrhage, presenting to the neuro-ophthalmic clinic of the department of ophthalmology, Addis Ababa University, from 1995 to 1997 were evaluated. The clinical presentation, management and prognosis are discussed. Post-haemorrhagic vision loss, other than being a rare occurrence, is under-reported due to the fact that these patients are very sick with massive blood loss and hence little attention is given to the vision loss by attending physicians and sometimes even the patients themselves. It is hoped that this paper will increase awareness about this condition among physicians attending to patients with severe bleeding and thus facilitate early diagnosis and referral.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/27. Spontaneous internal carotid artery dissection.Once considered uncommon, spontaneous dissection of the carotid artery is an increasingly recognized cause of stroke, headache, cranial nerve palsy, or ophthalmologic events, especially in young adults. Even in the presence of existing signs and symptoms, the diagnosis can be missed by experienced physicians of all specialties. We report a case of spontaneous internal carotid artery dissection in a 38-year-old woman with a cortical stroke and visual disturbances as initial symptoms. The diagnosis was confirmed by magnetic resonance imaging/angiography and by angiography. Prompt anticoagulation was instituted, and the patient had complete resolution of symptoms. Cervicocephalic arterial dissection should be included in the differential diagnosis of the causes of cerebrovascular events.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/27. Anterior ischemic optic neuropathy associated with viagra.A 42-year-old male presented with acute onset of an inferior visual field defect OD after sildenafil citrate use. Examination revealed a right relative afferent pupillary defect and a swollen disc with a 0.1 cup-to-disc ratio and a prominent disc hemorrhage. Anterior ischemic optic neuropathy (AION) is associated with acute episodes of hypotension in patients with structurally crowded discs. Sildenafil citrate may cause episodes of hypotension and was temporally related to the onset of symptoms in this patient. Because patients are often reluctant to volunteer their history of sildenafil citrate use, the physician may need to ask specifically about use of this medication. physicians should counsel patients with crowded optic discs and a history of nonarteritic anterior ischemic optic neuropathy in one eye that use of sildenafil citrate might increase their risk of ischemic optic neuropathy in the fellow eye.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/27. Effect of high-altitude exposure on myopic laser in situ keratomileusis.PURPOSE: To study the effect of high-altitude exposure on visual acuity after myopic laser in situ keratomileusis (LASIK). SETTING: Aconcagua, Mendoza, argentina. methods: In the early postoperative period after uneventful myopic LASIK, 2 physicians prospectively assessed their visual acuity during an ascent of Aconcagua (22841 feet). The distance uncorrected visual acuity (UCVA) and peripheral oxygenation were measured at approximately every 2000 feet of altitude. RESULTS: Both climbers developed a moderate loss of distance UCVA but described normal near and pinhole acuity consistent with a myopic shift. The distance UCVA diminished to 20/100 in the right eye and 20/125 in the left eye of Climber A and to 20/160 and 20/30, respectively, of Climber B. The vision loss worsened with increased altitude, duration of exposure, and decreased peripheral oxygenation. One week after the climb, the manifest refraction demonstrated a small myopic shift in both eyes of Climber A; these subsequently resolved. CONCLUSIONS: Two climbers, 8 and 14 weeks after myopic LASIK, experienced vision loss consistent with a temporary myopic shift in the refractive error with ascent to high altitude. Climbers who have LASIK, particularly those in the early postoperative period, should be prepared for visual acuity fluctuations with high-altitude exposure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/27. pseudotumor cerebri secondary to minocycline intake.BACKGROUND: pseudotumor cerebri, or idiopathic intracranial hypertension, is a condition most commonly affecting women of childbearing age who are obese or who have experienced recent weight gain. Frequently the patient complains of headache accompanied by dizziness, nausea, or visual defects, and it is characterized by elevated intracranial pressure in the absence of a space-occupying lesion or infection methods: A patient had been prescribed minocycline and subsequently developed symptoms 6 weeks after an increase in the original dosage. She was initially examined by an ophthalmologist, then was sent to the Emergency Department, and finally admitted under the family practice service. Articles were searched through medline, MD Consult, and Google. Key words included "pseudotumor cerebri," benign intracranial hypertension," idiopathic intracranial hypertension," and "minocycline." RESULTS AND CONCLUSION: Although the pathogenesis of pseudotumor cerebri is not completely understood, an association has been observed with minocycline use. This report describes a 16-year-old girl who developed idiopathic intracranial hypertension while taking minocycline for acne. Symptoms of blurred vision and severe headache unrelated to position or activity; an absence of fever, bilateral disk edema, and focalizing neurologic signs; negative neuroradiographic findings; increased cerebrospinal fluid pressure with a normal cell count; and exclusion of systemic or structural cause of increased intracranial pressure satisfy the criteria for the diagnosis of idiopathic intracranial hypertension. minocycline is often used by family physicians for the treatment of acne, and this complication requires vigilance to protect against potential vision loss.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/27. multiple sclerosis.multiple sclerosis (MS) is the most common disabling neurologic disease of young people affecting between 350 and 450,000 individuals in the united states. Substantial advances have been made in the diagnostic assessment and treatment interventions over the last 10 years such that we are now able effectively to treat both the disease process and the associated symptomatic complaints associated with MS. Most patients consult with their primary care physician at the time when the first clinical manifestations of MS emerge. These physicians play a central role in the early identification and treatment of patients with MS. This article emphasizes the expanding diagnostic and therapeutic capabilities evolving for the MS patient and the crucial role played by primary care physicians in collaboration with neurologists in the coordination of the initial diagnostic and treatment plan.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
9/27. Visual side effects of pegylated interferon during therapy for chronic hepatitis C infection.Ocular toxicity, including retinopathy, optic neuropathy and ocular loss, has been infrequently (<1%) reported as a potentially serious adverse event associated with standard interferon therapy. The new pegylated interferons have improved pharmacokinetics which translates to better antiviral efficacy, however, this improved pharmacokinetic profile also has the potential to alter the frequency and extent of their adverse events. We describe a case of chronic hepatitis c infection that developed visual complaints after one month of pegylated interferon, and retinopathy confirmed on ophthalmologic examination. We place our report in context with a review of the literature related to visual complications associated with interferon therapy. From our compilation of case reports, it is apparent that variable doses and duration of interferon therapy have been associated with ocular toxicity, which in turn suggests an idiosyncratic drug reaction. In as much as this adverse event is unpredictable, and its frequency undefined with pegylated interferon therapy, further surveillance will be required for patients undergoing pegylated-interferon therapy. Although ocular toxicity is uncommon, it should be emphasized that it can occur any time after the start of interferon therapy, and physicians now treating chronic hepatitis c patients with pegylated interferon must be aware of this potentially serious adverse event.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/27. Late postpartum eclampsia as an obstetric complication seen in the ED.Preeclampsia is a complication of pregnancy associated with hypertension and proteinuria. Preeclampsia may be associated with grand mal seizures and is termed eclampsia. Historically, eclampsia occurring more than 48 hours after delivery, known as late postpartum eclampsia, was thought to be uncommon; however, recent evidence suggests that its incidence is increasing. In addition, the presentation of late postpartum preeclampsia-eclampsia may differ from that occurring during the pregnancy. This contributes to difficulty in diagnosing late postpartum preeclampsia-eclampsia in an emergency department setting. We report 2 cases of late postpartum eclampsia presenting 8 days after delivery, which highlight the unique features of this disorder and discuss some of the difficulties in managing these patients. Greater awareness and knowledge of this disorder by ED physicians should improve outcomes in these potentially life-threatening cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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