Optic neuropathy in the setting of exposure to bartonella henselea. A 27yearold female presented to the emergency room in july 2011 complaining of generalized headache and progressive decrease of vision in the right eye for few weeks. Treating macular edema with nepafenac in neuroretinitis. Any person suffering from eye pain or loss of vision should visit with an ophthalmologist as soon as possible. A diagnostic dilemma threediscdiameters with a pale, swollen optic disc fig. Frcsi, fareed allaftah md, fcrsed, baber ali md case report. Phaeochromocytoma revealed by a stellate neuroretinitis. Often, infectious retinitis is the initial clinical manifestation of a more systemic illness.
In fact, it is classified as one form of optic neuritis, the other forms being the more common retrobulbar neuritis and papillitis. Neuroretinitis causes changes in vision or even sudden vision loss. Neuroretinitis cannot always be detected by the naked eye. Dx by clinical presentation and fa early hypoflourescence, later. A 9yearold girl presented with loss of vision in the left eye. Neuroretinitis is a clinical entity in which there is inflammation of the retinal architecture and optic nerve. After the successful diagnoses and treatment of catscratch neuroretinitis, it is vital encourage patients who have been diagnosed with catscratch neuroretinitis to be monitored long term for signs of late onset opticneuropathy. Neuroretinitis is a rare clinical entity often confused with the. Catscratch neuroretinitis ocular bartonellosis symptoms systemic symptoms of disease may resemble a flulike illness malaiseweakness, lowgrade fever, headache, and joint or muscle pains patients may also notice enlarged regional lymph nodes in the axillae, groin, neck, or head decreasedblurry vision, usually in one eye red eye in patients with pogs decreased visual field. In contrast to singleepisode neuroretinitis, recurrent neuroretinitis is thought to be an autoimmune disease.
Presentation with bilateral stellate neuroretinitis should lead to measurement of blood pressure. We describe the clinical features and visual outcome of an unusual case of neuroretinitis presenting in a 9 year old child. Diffuse unilateral subacute neuroretinitis an overview. Dilated exam revealed disc edema and a macular star hard exudates arranged in a radial pattern due to the alignment of fibers in the outer plexiform layer, or henles layer. Catscratch diseaserelated neuroretinitis is a relatively unusual pathology, with suspicious clinical epidemiological and serological diagnosis.
Chickenpox in children is usually thought of as a benign infectious disease with few ocular complications. Stout is a clinical instructor at the university of waterloo school of optometry and vision science. Toxoplasma neuroretinitis rhode island medical society. Japanese patients were searched using a computer w. Neuroretinitis is a focal inflammation of the optic nerve and peripapillary. Neuroretinitis is inflammation of the retina and optic nerve of the eye. Neuroretinitis is an inflammatory disorder characterized by optic disc edema and the surrounding exudation despite with or without rapd 10. Although he has a lack of constitutional symptoms, he is now being treated empirically by id with 6 months of inh. Lyme disease associated neuroretinitis case report. The patient is an 18yearold man with visual loss due to optic disc edema and a macular star figure od. About 25% of cases are idiopathic leber idiopathic stellate neuroretinitis. Three months prior to presentation, she experienced a virallike illness with coryzal symptoms, headache, fever and loss of vision in the left eye.
The fundus pictures have several common features and can be mistaken for one another by illexperienced clinicians and sometimes even by ophthalmologists and neurologists. Class 5 in the series of classes on uveitis deals with the common causes of panuveitis and briefly discusses their management. Introduction parasitic infections may produce severe damage to various ocular tissues, thereby causing visual dysfunction. The patient did not present to secondary care until 3 months had passed. At the initial presentation, a slitlamp examination with. Pdf neuroretinitis is a lessknown clinical entity, which can be funduscopically. To clarify the prevalence and clinical profile of neuroretinitis associated with cat. Neuroretinitis is a particular form of optic neuropathy characterised. There are numerous entities that can cause a picture of neuroretinitis ranging from.
The current consensus is that cme is at least partly mediated by inflammatory processes, with increased prostaglandinmediated vascular permeability 4. Diffuse unilateral subacute neuroretinitis is an infection of the eye caused by nematodes endemic to the southeastern and midwestern regions of the us. There is mostly central visual loss, which often recovers after some months, but often not completely. Presentation, clinical course, and diagnosis of multiple sclerosis.
Neuroretinitis in patients with multiple sclerosis ophthalmology. Her systemic symptoms improved spontaneously within days but the visual loss persisted. Convert and create pdf from various types of files like word doc, excel xls, powerpoint ppt. Neuroretinitis neuroretinitis refers to the combination of optic neuritis and signs of retinal, usually macular, inflammation. Follow these instructions to set the print quality of the pdf. Under print quality paper pdf, set the desired quality to an option of your choice. Neuroretinitis is an inflammatory optic neuropathy with a classic fundoscopic. In the differential diagnosis, papilledema and optic disc tumors were eliminated owing to the lack of abnormal brain or orbital mri findings.
Toxoplasmic chorioretinitis is probably the most common cause of posterior segment infection worldwide. Pdf neuroretinitis is one of the forms of optic neuritis characterized by swelling of optic nerve head. The retina is a lightsensitive layer in the back of the eye that focuses images. In the powerpoint preferences dialog box, click general. Neuromyelitis optica symptoms and causes mayo clinic. This image depicts severe swelling and hemorrhage of the left optic disc with surrounding subretinal.
Fundus photos show the progression of macular star at presentation figure 1, 1 week later figure 2, and three weeks later figure 3. We present a case of an adolescent suffering from unilateral neuroretinitis associated with bartonella henselae infection characterized by abrupt loss of vision, optic disc swelling, and macular star exudates with optimal response to antibiotic treatment. In some cases, an eye exam is the only way to uncover the symptoms of this disease. Neuromyelitis optica may cause blindness in one or both eyes, weakness or paralysis in the legs or arms, painful spasms, loss of sensation, uncontrollable vomiting and hiccups, and bladder or bowel dysfunction. Neuroretinitis uf health, university of florida health. Neuroretinitis is a type of optic neuropathy characterized by an acute unilateral visual loss in the setting of optic disc swelling accompanied by hard exudates characteristically arranged in a star shape around the fovea. Neuroretinitis is an inflammation of the retina and the optic nerve. In addition, a quantiferon gold test and abdominal ct with contrast has been.
At the initial presentation, a slitlamp examination with a 90d lens confirmed the presence of a mild macular edema. However, there are diagnostic features distinctive for neuroretinitis. To the best of our knowledge, this is the first report of recurrent neuroretinitis associated with inflammatory bowel disease. Neuromyelitis optica is often misdiagnosed as multiple sclerosis ms or perceived as a type of ms, but nmo is a distinct condition. The condition can be caused by bacteria, viruses or autoimmune disease.
Neuroretinitis is a rare clinical entity often confused with the more common papillitis or papilledema. Retinitis is inflammation of the retina in the eye, which can permanently damage the retina and lead to blindness. Toxoplasma gondii is an obligate, intracellular parasitic protozoan that causes a necrotizing chorioretinitis. Although the organisms have not been isolated, migratory larvae have been visualized directly in the subretinal space. Posterior segment involvement from primary varicella zoster infection has rarely been reported in children. Neuroretinitis as presenting and the only presentation of lyme disease will be discussed with serial fundus, ffa, and oct pictures. Please tell us where you read or heard it including the quote, if possible. A neuroretinitis dilemma lyme neuroretinitis in sin gapore. Infections of the retina are potentially devastating diseases because they can lead to permanent vision loss. Full text neuroretinitis with dual infections imcrj. In our patient, the ocular symptoms were related to the high blood pressure, with a subsequent breakdown of the bloodretinal barrier leading to stellate neuroretinitis which is a grade 4 hypertensive retinopathy. This syndrome is primarily unilateral, although bilateral cases have occurred. Unilateral neuroretinitis secondary to bartonella henselae. Save powerpoint presentations as pdf files office support.
A full eye exam must be performed before neuroretinitis can be confirmed. Introduction neuroretinitis nr is a rare clinical entity, usually a selflimited disorder with a good visual prognosis. We report a patient with recurrent neuroretinitis who concurrently developed ulcerative colitis. The condition was initially described in healthy patients by leber in 1916 and has been called lebers stellate neuroretinitis. Neuroretinitis with dual infections kwonghan kiu,1,2 hashim hanizasurana,1 embong zunaina21department of ophthalmology, hospital selayang, selayang, selangor, 2department of ophthalmology, school of medical sciences, universiti sains malaysia, kubang kerian, kelantan, malaysiaabstract. Neuroretinitis definition of neuroretinitis by medical. Retinitis may be caused by a number of different infectious agents. A 22yearold malay female presented with left eye floaters for 2 weeks, associated. Idiopathic retinal vasculitis, aneurysms, and neuroretinitis irvan syndrome maha elshafei,md. The optic nerve then sends the images to the brain.
Neuroretinitis nr is an inflammatory disorder characterized by optic disc edema and subsequent formation of a macular star figure. Recurrent neuroretinitis in an adolescent with ulcerative. Update on a visual emergency and role of technology in its. Lipidrich fluid accumulates in the outer nuclearplexiform space with the aqueous phase passing through the external limiting membrane to accumulate beneath the retina. Neuroretinitis is an inflammatory condition characterised by optic disc oedema and a macular star. Other notable causes include syphilis, lyme disease, mumps and leptospirosis. The underlying pathophysiology involves increased permeability of disc vasculature, but the etiology is not fully defined.
Tb is a possible diagnosis to be seriously considered. Neuroretinitis, steroids in optic neuritis, febrile illness. Chickenpox neuroretinitis in a 9 year old child british. Injury and disease may stimulate the release of prostaglandins. The retina is the part of your eye that is also known as the sensing tissue. Patient presented with sudden onset decreased vision in his left eye. Spontaneous resolution of severe neuroretinitis following. An immunocompetent 9 year old boy acquired primary.
Fundoscopic examination on the date of initial presentation. Pdf converter is a online webbased document to pdf converter software. Neuroretinitis is a descriptive term for optic disc swelling and macular exudates that. Although the initial presentation can be very similar to idiopathic.1391 1127 424 933 1518 353 1536 250 567 976 570 1236 538 1175 352 1040 667 1023 792 517 1435 1247 472 1037 1186 991 302 1545 551 172 50 1267 37 914 1111 254 199 485 822 1232 623 1242 1045 829 1138 539 871 1246 280