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: Journal Article
    目的:视神经脊髓炎谱系障碍是一种脱髓鞘和炎症性疾病,通常会导致视觉障碍。各种成像技术,包括自由水成像,已被用于确定神经炎症和变性。因此,这项研究旨在确定视神经脊髓炎谱系障碍患者之间的多模式影像学差异,尤其是那些有视觉障碍的人,和健康的控制。
    方法:85名视神经脊髓炎谱系障碍患者和89名年龄和性别匹配的健康对照者接受了3-T磁共振成像(MRI)。我们分析了调整后的大脑预测年龄差异,基于体素的形态计量学,与健康对照组相比,每个患者组(有或没有视觉障碍史的MRI阳性/阴性视神经脊髓炎谱系障碍患者)的基于道的空间统计和自由水校正的扩散张量成像(DTI)。
    结果:MRI阳性视神经脊髓炎谱系障碍患者表现为双侧丘脑体积减少。基于道的空间统计显示,在有视觉障碍史的MRI阳性视神经脊髓炎谱系障碍患者中,所有DTI指标中的弥漫性白质异常。在有视觉障碍病史的MRI阴性视神经脊髓炎谱系障碍患者中,基于体素的形态计量学显示双侧丘脑和视神经辐射的体积减少,和基于道的空间统计数据显示,在后验优势分布中,自由水校正的分数各向异性和平均扩散系数显着降低,包括视神经辐射.
    结论:自由水校正的DTI和基于体素的形态学分析可能反映视神经脊髓炎谱系障碍的视觉障碍症状。
    OBJECTIVE: Neuromyelitis optica spectrum disorder is a demyelinating and inflammatory affliction that often leads to visual disturbance. Various imaging techniques, including free-water imaging, have been used to determine neuroinflammation and degeneration. Therefore, this study aimed at determining multimodal imaging differences between patients with neuromyelitis optica spectrum disorder, especially those with visual disturbance, and healthy controls.
    METHODS: Eighty-five neuromyelitis optica spectrum disorder patients and 89 age- and sex-matched healthy controls underwent 3-T magnetic resonance imaging (MRI). We analyzed adjusted brain-predicted age difference, voxel-based morphometry, and free-water-corrected diffusion tensor imaging (DTI) by tract-based spatial statistics in each patient group (MRI-positive/negative neuromyelitis optica spectrum disorder patients with or without a history of visual disturbance) compared with the healthy control group.
    RESULTS: MRI-positive neuromyelitis optica spectrum disorder patients exhibited reduced volumes of the bilateral thalamus. Tract-based spatial statistics showed diffuse white matter abnormalities in all DTI metrics in MRI-positive neuromyelitis optica spectrum disorder patients with a history of visual disturbance. In MRI-negative neuromyelitis optica spectrum disorder patients with a history of visual disturbance, voxel-based morphometry showed volume reduction of bilateral thalami and optic radiations, and tract-based spatial statistics revealed significantly lower free-water-corrected fractional anisotropy and higher mean diffusivity in the posterior dominant distributions, including the optic nerve radiation.
    CONCLUSIONS: Free-water-corrected DTI and voxel-based morphometry analyses may reflect symptoms of visual disturbance in neuromyelitis optica spectrum disorder.
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  • 文章类型: Journal Article
    背景:圆锥角膜是导致角膜变薄的进行性疾病(Sedaghat等人。科学报告11(1):11971,2021),ectasia,和不规则的散光,导致视力不佳,无法用标准的球圆柱眼镜片矫正。角膜角膜炎的一个特征是像差,表现出比正常人高五六倍的高阶像差,健康的眼睛即使在疾病的早期阶段,这些畸变也会导致视觉障碍。
    方法:在过去,诊断来自临床症状,但是技术进步揭示了多种临床前特征,允许在更早的阶段区分角膜和正常的眼睛。这些包括角膜前表面和后表面抬高,角膜测厚曲线,角膜上皮模式,波前像差度量,和角膜生物力学(Sedaghat等人。科学报告11(1):11971,2021)。这篇综述讨论了与圆锥角膜相关的像差,如何测量它们,和治疗方法,以尽量减少其负面影响。
    结论:早期诊断可以导致早期治疗,并可能阻止进展,从而改善长期预后。随着屈光手术的加速,识别圆锥角膜患者很重要,因为它们通常是屈光手术的禁忌。
    BACKGROUND: Keratoconus is a progressive disorder of the cornea that causes thinning (Sedaghat et al. in Sci Rep 11(1):11971, 2021), ectasia, and irregular astigmatism, resulting in poor visual acuity that cannot be corrected with standard sphero-cylindrical spectacle lenses. One feature distinguishing keratoconic corneas is ocular aberrations, manifesting up to five or six times the amount of higher-order aberrations than a normal, healthy eye. These aberrations can cause visual disturbances even at the very early stages of the disease.
    METHODS: In the past, a diagnosis was derived from clinical symptoms, but technological advances have revealed multiple pre-clinical features, allowing for the differentiation between keratoconic and normal eyes at a much earlier stage. These include anterior and posterior corneal surface elevations, the corneal pachymetry profile, corneal epithelial patterns, wavefront aberration metrics, and corneal biomechanics (Sedaghat et al. in Sci Rep 11(1):11971, 2021).This review discusses the aberrations associated with keratoconus, how to measure them, and treatment methods to minimize their negative influence.
    CONCLUSIONS: Early diagnosis can lead to early treatment and may allow for arresting progression, thereby improving the long-term prognosis. With the acceleration of refractive surgery, it is important to identify patients with keratoconus, as they are usually contraindicated for refractive surgery.
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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
    一名6岁女孩出现中等强度头痛,频繁呕吐,视觉障碍,左侧听力下降7个月。神经系统检查显示右上运动神经元面神经麻痹,左侧4毫米缓慢瞳孔(右:3毫米反应性),和不稳定的步态。眼底镜检查可见双侧乳头水肿。增强脑磁共振成像显示巨大的多部位鞍上囊性病变(9.7×10.5×7.6cm)。它延伸到左前颅窝,两个中颅窝,后颅窝脑前区对脑干和中度脑积水有影响。患者接受了右额外室引流插入和左额颞部开颅手术和肿瘤切除术。组织病理学切片与菱形颅咽管瘤相容。很少报道巨大的颅咽管瘤。本文介绍了患有巨大颅咽管瘤的患者的临床和放射学结果。
    A 6-year-old girl presented with moderate-intensity headache, frequent vomiting, visual disturbance, and left-sided decreased hearing for 7 months. The neurologic examination revealed a right upper motor neuron facial nerve palsy, left-sided 4-mm sluggish pupil (right: 3-mm reactive), and unsteady gait. Fundoscopy was notable for bilateral papilledema. Brain magnetic resonance imaging with contrast demonstrated a giant multiloculated suprasellar cystic lesion (9.7 × 10.5 × 7.6 cm). It extended to the left anterior cranial fossa, both middle cranial fossae, and posterior fossa prepontine region with consequent effect on the brainstem and moderate hydrocephalus. The patient underwent a right frontal external ventricular drain insertion and left frontotemporal craniotomy and tumor resection. Histopathologic sections were compatible with adamantinomatous craniopharyngioma. Giant craniopharyngiomas have rarely been reported. This article presents the clinical and radiologic outcomes of a patient with a giant craniopharyngioma.
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  • 文章类型: Case Reports
    进行性多灶性白质脑病(PML)是由少突胶质细胞的JC病毒感染引起的严重脱髓鞘疾病。关于PML患者的铁沉积的报道很少。在这里,我们报告了一例PML病例,在71岁的女性中,在利妥昔单抗加环磷酰胺治疗16个月后出现双侧视觉障碍和进行性失语,并伴有白质病变。阿霉素,长春新碱,和泼尼松龙治疗滤泡性淋巴瘤。磁共振成像显示左顶叶和其他叶的白质病变,并在皮质病变中大量铁沉积。JC病毒的PCR检测呈阳性,确认PML的诊断。尽管使用甲氟喹和米氮平治疗,病人六个月后死亡。尸检时,在左顶叶主要发现脱髓鞘。此外,富含含铁血黄素的巨噬细胞和含有铁蛋白的反应性星形胶质细胞在靠近白质病变的近区丰富。这是以前未报道的淋巴瘤后PML病例,其中铁沉积在放射学和病理学上都得到证实。
    Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease caused by JC virus infection of oligodendrocytes. Little has been reported on iron deposits in patients with PML. Herein, we report a case of PML with massive iron deposition in the juxtacortical regions attaching white matter lesions in a 71-year-old woman who developed bilateral visual disturbance and progressive aphasia after 16 months of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone treatment for follicular lymphoma. Magnetic resonance imaging revealed white matter lesions in the left parietal and other lobes with massive iron deposition in the juxtacortical lesions. A PCR test for JC virus was positive, confirming the diagnosis of PML. Despite treatment with mefloquine and mirtazapine, the patient died six months later. At autopsy, demyelination was found dominantly in the left parietal lobe. Moreover, hemosiderin-laden macrophages and reactive astrocytes containing ferritin were abundant in the juxtacortical regions adjacent to the white matter lesions. This is a previously unreported case of PML after lymphoma, in which iron deposition was confirmed both radiologically and pathologically.
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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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