visual disturbance

  • 文章类型: Published Erratum
    [这更正了文章DOI:10.3389/fnins.2023.1278626。].
    [This corrects the article DOI: 10.3389/fnins.2023.1278626.].
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  • 文章类型: Case Reports
    鞍结节脑膜瘤通常表现为双颞侧偏视,视神经压迫导致视力丧失。两名女性患者(48岁和58岁)由于鞍结节脑膜瘤(25和10毫米,分别)。尽管他们的视野缺陷不是很大,日常活动,包括走路或阅读受到阻碍。通过完全切除两名患者的肿瘤,暗点被治愈,日常活动恢复。当患者表现出视觉缺陷时,尤其是在较低的中心领域,即使肿瘤很小且视力缺陷有限,也应考虑手术切除,因为可以改善视力和日常活动。
    Tuberculum sellae meningiomas commonly present as bitemporal hemianopia and loss of visual acuity due to optic nerve compression. Two female patients (48 and 58 years old) presented with a small scotoma at the lower visual field center due to tuberculum sellae meningioma (25 and 10 mm, respectively). Despite the fact that their visual field defect was not very large, daily activities, including walking or reading were hindered. By the total removal of the tumors in both patients, the scotoma was cured and daily activities recovered. When patients exhibit visual deficits, especially in the lower center fields, surgical removal should be considered even if the tumors are small and visual deficits are limited because improvement of both vision and daily activities can be achieved.
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  • 文章类型: Journal Article
    研究患者报告的视觉障碍对角膜屈光手术后近视患者动态视力的影响。
    这是一项前瞻性非随机研究。成人近视患者接受双侧激光辅助上皮下角膜磨镶术(LASEK),飞秒激光辅助原位角膜磨镶术(FS-LASIK),包括带平角靶的小切口微透镜提取(SMILE)。评估了八种类型的患者报告的视觉障碍的频率,术后3个月测量严重程度和令人困扰的动态视力(DVA)为每秒40度和80度(dps).
    该研究纳入了95名患者,平均年龄为27.6±6.4岁。最常报告的视觉障碍是视力波动(70.5%),其次是眩光(66.3%)和光晕(57.4%)。术后80dps的DVA与光环总分(p=0.038)和判断距离的难度(p=0.046)显着相关。在有光环的患者中,术后DVA在40dps时比没有光环的患者明显更差(p=0.024)。对于没有光环或难以判断距离的患者,80dps的DVA明显优于有症状的患者(光环,p=0.047;判断距离困难,p=0.029)。通过外科手术进行的亚组分析表明,仅在接受FS-LASIK的患者中观察到有和没有视力障碍的患者之间DVA的显着差异。
    术后,患有晕圈或难以判断距离的近视角膜屈光手术患者的低速和高速DVA明显比没有症状的患者差。本研究为患者有视觉障碍时涉及动态视觉的日常任务的术后指导提供了基础。
    UNASSIGNED: To investigate the impact of patient-reported visual disturbance on dynamic visual acuity in myopic patients after corneal refractive surgery.
    UNASSIGNED: This is a prospective nonrandomized study. Adult myopic patients receiving bilateral laser-assisted sub-epithelial keratomileusis (LASEK), femtosecond laser-assisted in situ keratomileusis (FS-LASIK), or small incision lenticule extraction (SMILE) with Plano target were included. Eight types of patient-reported visual disturbance were evaluated regarding frequency, severity and bothersome and dynamic visual acuity (DVA) of 40 and 80 degrees per second (dps) was measured postoperatively at 3 months.
    UNASSIGNED: The study enrolled 95 patients with an average age of 27.6 ± 6.4 years. The most frequently reported visual disturbance was the fluctuation in vision (70.5%), followed by glare (66.3%) and halo (57.4%). Postoperative DVA at 80 dps was significantly associated with the total score of haloes (p = 0.038) and difficulty in judging distance (p = 0.046). Significant worse postoperative DVA at 40 dps was observed in patients with haloes than those without (p = 0.024). The DVA at 80 dps for patients without haloes or difficulty in judging distance was significantly better than that with the symptoms (haloes, p = 0.047; difficulty in judging distance, p = 0.029). Subgroup analysis by surgical procedures demonstrated that the significant difference in DVA between patients with and without visual disturbance was only observed in patients receiving FS-LASIK.
    UNASSIGNED: Postoperatively, myopic patients undergoing corneal refractive surgery with haloes or difficulty in judging distance have significantly worse low and high-speed DVA than those without the symptoms. The present study provided the basis for postoperative guidance in daily tasks involving dynamic vision when patients have visual disturbances.
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  • 文章类型: Case Reports
    横纹肌样脑膜瘤(RM)是一种罕见的恶性脑膜瘤。这里,我们报告了一例颅内RM,表现为视觉障碍和视神经(ON)明显的高强度。
    一名20岁女性,有1年的头痛史。在介绍时,她的视力(VA)右侧是20/50,左侧是20/40,两侧的眼压为17mmHg。脑磁共振成像显示右额叶凸面有广泛的肿瘤。直径82mm×65mm×70mm,伴随着囊性成分,并且不均匀地增强。眶内ON在建设性干扰稳态序列上表现出明显的髓内高强度。进行大体肿瘤全切除,病理符合RM。手术后立即,她的VA和IOP分别为20/17和10mmHg,分别,具有显着的髓内高强度分辨率。
    在患有慢性颅内高压的患者中,在ON中发现的明显的高强度可能是视觉障碍的指标。颅内高压消退后可迅速消退,功能恢复。
    UNASSIGNED: Rhabdoid meningiomas (RMs) are a rare type of malignant meningioma. Here, we report a case of intracranial RM presenting with visual disturbance and prominent hyperintensity in the optic nerve (ON).
    UNASSIGNED: A 20-year-old female presented with a 1-year history of headache. At presentation, her visual acuity (VA) was 20/50 on the right side and 20/40 on the left, with an intraocular pressure of 17 mmHg on both sides. Cerebral magnetic resonance imaging revealed a broad-based tumor in the right frontal convexity. It measured 82 mm × 65 mm × 70 mm in diameter, accompanied by cystic components, and was inhomogeneously enhanced. The intraorbital ONs demonstrated prominent intramedullary hyperintensity on the constructive interference steady-state sequence. Gross total tumor resection was performed and the pathology was consistent with RM. Immediately after surgery, her VA and IOP were 20/17 and 10 mmHg, respectively, with a remarkable resolution of the intramedullary hyperintensity.
    UNASSIGNED: Prominent hyperintensity in the ON identified in patients with chronic intracranial hypertension may be an indicator of visual disturbance. It can rapidly resolve after resolution of intracranial hypertension with functional recovery.
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  • 文章类型: Case Reports
    未经证实:垂体转移在癌症患者中非常罕见,通常起源于肺或乳腺肿瘤。它们通常发生在已知转移性疾病的患者中,但很少可能是原发性肿瘤的首次表现。
    未经授权:我们介绍了一个58岁的男性,他报告了三个月的多尿多饮综合征病史,全身乏力,全垂体功能减退症和双颞侧偏盲。脑MRI显示大量垂体肿块,导致鞍后增大和周围结构(包括垂体柄)受压,视神经交叉,和视神经.
    未经证实:患者接受了神经外科手术切除肿块。组织学检查显示来源不确定的低分化腺癌。全身CT扫描显示左肾肿块随后被切除。组织学特征与透明细胞癌一致。然而,消化道内镜检查显示胃card门的溃疡和浸润性腺癌。用18F-FDG进行的全身PET/CT扫描证实胃card门中有一个孤立的积聚区域,在其他地点没有过度积累。
    未经授权:据我们所知,没有胃贲门腺癌发生垂体转移的报道.我们的患者出现鞍区受累的症状,并且没有其他身体转移的证据。因此,尿崩症的突然发作和视力恶化应导致怀疑迅速增长的垂体肿块,这可能是原发性颅外腺癌的表现。垂体肿块的组织学研究可以指导诊断检查,然而,它必须是完整的。
    UNASSIGNED: Pituitary metastases are very rare in cancer patients and often originate from lung or breast tumors. They usually occur in patients with known metastatic disease, but rarely may be the first presentation of the primary tumor.
    UNASSIGNED: We present the case of a 58 years-old-man who reported a three-month history of polyuria-polydipsia syndrome, generalized asthenia, panhypopituitarism and bitemporal hemianopsia. Brain-MRI showed a voluminous pituitary mass causing posterior sellar enlargement and compression of the surrounding structures including pituitary stalk, optic chiasm, and optic nerves.
    UNASSIGNED: The patient underwent neurosurgical removal of the mass. Histological examination revealed a poorly differentiated adenocarcinoma of uncertain origin. A total body CT scan showed a mass in the left kidney that was subsequently removed. Histological features were consistent with a clear cell carcinoma. However, endoscopic examination of the digestive tract revealed an ulcerating and infiltrating adenocarcinoma of the gastric cardia. Total body PET/CT scan with 18F-FDG confirmed an isolated area of accumulation in the gastric cardia, with no hyperaccumulation at other sites.
    UNASSIGNED: To the best of our knowledge, there are no reports of pituitary metastases from gastric cardia adenocarcinoma. Our patient presented with symptoms of sellar involvement and without evidence of other body metastases. Therefore, sudden onset of diabetes insipidus and visual deterioration should lead to the suspicion of a rapidly growing pituitary mass, which may be the presenting manifestation of a primary extracranial adenocarcinoma. Histological investigation of the pituitary mass can guide the diagnostic workup, which must however be complete.
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  • 文章类型: Case Reports
    背景1型神经纤维瘤病(NF1)患者由于血管脆性而有多种血管疾病,但没有发现巨大血栓性动脉瘤病例的报告。我们在NF1患者中治疗了罕见的颈内动脉(ICA)巨大血栓性动脉瘤病例。病例介绍一名60岁的男子视力丧失和同义偏盲恶化。对比增强计算机断层扫描显示,位于视神经交叉中的ICA前壁有一个巨大的血栓形成的动脉瘤。我们计划并完成了使用桡动脉移植物的颈外动脉-大脑中动脉高流量旁路。手术后14天进行视野测试。同源偏盲持续存在,但未观察到视野损害的恶化。术后14天未发现并发症,术后进展顺利。结论颈外动脉-大脑中动脉搭桥术是治疗NF1合并巨大血栓性动脉瘤安全有效的方法。
    Background  Patients with neurofibromatosis type 1 (NF1) have various vascular diseases due to the vascular fragility, but no reports of case of giant thrombotic aneurysm was found. We treated a rare case of giant thrombotic aneurysm of the internal carotid artery (ICA) in a patient with NF1. Case Presentation  A 60-year-old man had suffered deteriorating visual loss and homonymous hemianopia. Contrast-enhanced computed tomography showed a giant thrombosed aneurysm on the anterior wall of the ICA located in the optic chiasma. We planned and completed the external carotid artery-middle cerebral artery high-flow bypass using radial artery graft. The visual fields test was performed 14 days after surgery. Homonymous hemianopia persisted but no exacerbation of visual field impairment was observed. No complications were found at 14 days after surgery and the postoperative course was uneventful. Conclusion  We consider that external carotid artery-middle cerebral artery bypass surgery using radial artery grafts is a safe and effective treatment method for giant thrombotic aneurysm associated with NF1.
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  • 文章类型: Case Reports
    一名76岁的男子接受口服类固醇治疗免疫球蛋白G4(IgG4)相关疾病的维持治疗,以视力障碍为主要主诉。他的右眼和左眼的最佳矫正视力分别为1.2和0.7。汉弗莱视野测试显示左眼下耳颞叶四分之一失明。在详细了解IgG4相关疾病的病史后,基于影像学的临床诊断显示,明显的垂体/垂体柄增大并伴有视交叉压迫。根据历史和初步评估结果,对IgG4相关眼科疾病进行了诊断.强化类固醇治疗,这导致了症状的解决。当观察到双侧偏盲时,在鉴别诊断中考虑IgG4相关疾病。当存在单侧视力和视野缺陷时,应考虑IgG4相关疾病和其他器官疾病。
    A 76-year-old man receiving maintenance therapy with oral steroids for immunoglobulin G4 (IgG4)-related disease presented to our hospital with the chief complaint of visual disturbance. His best corrected visual acuities of the right and left eye were 1.2 and 0.7, respectively. Humphrey visual field test revealed inferior auriculotemporal one-quarter blindness in the left eye. After detailed history-taking for IgG4-related disease, clinical diagnosis based on imaging revealed the marked pituitary/pituitary stalk enlargement with associated optic chiasm compression. Based on the history and initial evaluation findings, a diagnosis of IgG4-related ophthalmic disease was made. Intensified steroid therapy was performed, which led to symptom resolution. IgG4-related diseases are considered in the differential diagnosis when bilateral hemianopsia is observed. When unilateral visual acuity and visual field defects are present, IgG4-related diseases and other organ disorders should be considered.
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  • 文章类型: Journal Article
    UNASSIGNED:本研究旨在确定颅内动脉瘤患者术中视觉诱发电位(VEP)变化的发生率,并确定与视觉功能相关的血管内治疗过程中缺血并发症的相关性。
    UNASSIGNED:这项研究分析了104例连续患者的数据,这些患者接受了血管内弹簧圈栓塞治疗,以治疗与VEP和经颅运动诱发电位(MEP)监测下的视觉功能相关的颅内动脉瘤。我们分析了MEP和VEP的显著变化之间的关联,定义为振幅下降>50%,术中并发症和术后神经功能缺损。还评估了与术后神经功能缺损相关的因素。
    未经证实:治疗的动脉瘤主要位于颈内动脉(95%)。5%(5%)位于年夜脑后动脉(PCA)。术中VEP显著下降4例(4%),尽管这4例患者中的1例在手术过程中没有出现伴随的MEP下降.立即抢救程序避免了术后视力障碍。所有VEP降低都是短暂的,与术后视力障碍无关。在VEP评估下,接受术中球囊闭塞测试的三例患者中的一例表现出对近端PCA的球囊闭塞的耐受性;在这种情况下,进行了父母动脉闭塞而没有术后视力障碍。
    UNASSIGNED:尽管在与视觉功能相关的神经血管内动脉瘤治疗期间发生了4%的明显VEP下降,术中VEP监测可识别与视觉通路相关的缺血变化,并有助于迅速启动抢救程序.
    UNASSIGNED: The present study aimed to determine the incidence of intraprocedural visual-evoked potential (VEP) changes and to identify correlations with intraprocedural ischemic complications during endovascular treatment in patients with intracranial aneurysm related to visual function.
    UNASSIGNED: This study analyzed data from 104 consecutive patients who underwent endovascular coil embolization to treat intracranial aneurysms related to visual function under VEP and transcranial motor evoked potential (MEP) monitoring. We analyzed associations between significant changes in MEP and VEP, defined as a >50% decrease in amplitude, and both intraprocedural complications and postoperative neurological deficits. Factors associated with postoperative neurological deficits were also assessed.
    UNASSIGNED: Treated aneurysms were predominantly located in the internal carotid artery (95%). Five (5%) were located in the posterior cerebral artery (PCA). Significant decreases in intraprocedural VEP occurred in four patients (4%), although one of those four patients did not show concomitant MEP decreases during procedures. Immediate salvage procedures avoided postoperative visual disturbances. All VEP decreases were transient and not associated with postoperative visual impairment. One of three cases who underwent intraoperative balloon occlusion test showed tolerance to balloon occlusion of the proximal PCA under VEP assessment; parent artery occlusion was performed without postoperative visual disturbance in that case.
    UNASSIGNED: Although significant VEP decreases occurred 4% during neuro-endovascular aneurysm treatment related to visual function, intraprocedural VEP monitoring identifies ischemic changes associated with visual pathways and facilitates prompt initiation of salvage procedures.
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  • 文章类型: Case Reports
    在颈内动脉瘤的眼动脉中放置分流器支架后新的视觉症状的发病机制尚不清楚。我们报告了2例患者在放置分流器后出现视野障碍和视力下降。磁共振成像在视神经周围发现了“甜甜圈标志”。患者在放置分流器的一侧有进行性视野缺损和损伤。短tau反转恢复冠状图像显示患侧视神经周围的甜甜圈形高信号。两名患者均接受了类固醇脉冲治疗,1例接受血管内治疗。他们的症状逐渐好转,“甜甜圈标志”消失了。在磁共振成像上观察到的视神经周围的“甜甜圈标志”可以在手术后发现视觉障碍症状。建议对患有视力障碍且怀疑术后恶化的患者,术前进行短tau倒置恢复序列。
    The pathogenesis of new visual symptoms after flow diverter stent placement in the ophthalmic artery for internal carotid artery aneurysms remains unclear. We report two cases of patients who developed visual field disturbance and decreased visual acuity following flow diverter placement. The \"doughnut sign\" was found around the optic nerve on magnetic resonance imaging. The patients had progressive visual field defects and impairment on the side where the flow diverter was placed. Short tau inversion recovery coronal images showed a doughnut-shaped high-signal around the optic nerve on the affected side. Both patients were treated with steroid pulse therapy, and 1 received endovascular therapy. Their symptoms gradually improved, and the \"doughnut sign\" disappeared. The \"doughnut sign\" observed around the optic nerve on magnetic resonance imaging may be found alongside visual disturbance symptoms after paraclinoid aneurysm treatment. It is recommended that short tau inversion recovery sequences be performed preoperatively in patients presenting with visual impairment and in whom the possibility of postoperative exacerbation is suspected.
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  • 文章类型: Systematic Review
    目的:通过回顾现有的关于视觉雪(VS)作为视觉雪综合征(VSS)的症状或一部分的临床研究,我们的目标是提高我们对VSS是一种网络障碍的理解。背景:VSS患者患有连续的视觉障碍,类似于调谐不良的模拟电视的视野(即,VS)和其他视觉,以及非视觉症状。这些症状可以持续多年,通常会严重影响生活质量。确切的患病率仍然未知,但高达2.2%的人口可能受到影响。目前,没有既定的治疗方法,潜在的病理生理学是未知的。近年来,已经有几种方法来识别所涉及的大脑区域及其相互作用来解释复杂的表现。方法:我们通过搜索PubMed和GoogleScholar术语“视觉雪”,从目前发表的有关VS及其综合征的原始研究中收集了临床和临床证据。我们纳入了英语或德语的原始研究,并排除了所有评论,没有为本审查主题添加新信息的病例报告,以及在PubMed或GoogleScholar中无法检索的文章。我们根据所使用的方法对研究进行分组。结果:本综述共发现53项研究。在VSS中,临床频谱包括额外的视觉障碍,如过度的漂浮物,Palinopsia,夜蛾,畏光,和内视现象。与其他知觉和情感障碍以及认知症状也有关联。这篇综述中包含的研究证明了结构,功能,以及大脑主要和/或次要视觉区域的代谢改变。除此之外,结果表明,皮层前视觉通路和包括默认模式网络和显著性网络在内的大规模网络中断.讨论:临床表现以及视觉和视觉外区域广泛的功能和结构改变的结合表明VSS是一种网络障碍。皮层前视觉结构和注意网络的参与可能会导致“过滤”受损,并将刺激作为自上而下的过程优先考虑,随后在暴露于无关的外部和内部刺激时过度激活视觉皮层。现有文献的局限性在于并非所有作者都使用了VSS的ICHD-3定义。有些人是指症状VS,在很多情况下,对照组的偏头痛或偏头痛先兆不匹配.
    Aim: By reviewing the existing clinical studies about visual snow (VS) as a symptom or as part of visual snow syndrome (VSS), we aim at improving our understanding of VSS being a network disorder. Background: Patients with VSS suffer from a continuous visual disturbance resembling the view of a badly tuned analog television (i.e., VS) and other visual, as well as non-visual symptoms. These symptoms can persist over years and often strongly impact the quality of life. The exact prevalence is still unknown, but up to 2.2% of the population could be affected. Presently, there is no established treatment, and the underlying pathophysiology is unknown. In recent years, there have been several approaches to identify the brain areas involved and their interplay to explain the complex presentation. Methods: We collected the clinical and paraclinical evidence from the currently published original studies on VS and its syndrome by searching PubMed and Google Scholar for the term visual snow. We included original studies in English or German and excluded all reviews, case reports that did not add new information to the topic of this review, and articles that were not retrievable in PubMed or Google Scholar. We grouped the studies according to the methods that were used. Results: Fifty-three studies were found for this review. In VSS, the clinical spectrum includes additional visual disturbances such as excessive floaters, palinopsia, nyctalopia, photophobia, and entoptic phenomena. There is also an association with other perceptual and affective disorders as well as cognitive symptoms. The studies that have been included in this review demonstrate structural, functional, and metabolic alterations in the primary and/or secondary visual areas of the brain. Beyond that, results indicate a disruption in the pre-cortical visual pathways and large-scale networks including the default mode network and the salience network. Discussion: The combination of the clinical picture and widespread functional and structural alterations in visual and extra-visual areas indicates that the VSS is a network disorder. The involvement of pre-cortical visual structures and attentional networks might result in an impairment of \"filtering\" and prioritizing stimuli as top-down process with subsequent excessive activation of the visual cortices when exposed to irrelevant external and internal stimuli. Limitations of the existing literature are that not all authors used the ICHD-3 definition of the VSS. Some were referring to the symptom VS, and in many cases, the control groups were not matched for migraine or migraine aura.
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