IRVAN syndrome: A case report and a literature review

Introduction and Importance

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare retinal defect. It has a female predominance. The staging of IRVAN was defined depending on ocular criteria.

Case presentations

A 30-year-old female patient presented with floaters in the left eye. One year later, it was diagnosed with Fluorescein fundus angiography (FFA) at stage Ⅲ of IRVAN syndrome. After one year, the right eye was affected, diagnosed at stage Ⅱ, and successfully treated with heavy Pan-Retinal Photocoagulation (PRP).

Clinical discussion

IRVAN Syndrome is an extremely rare retinal defect which has female predominance. The etiology of this syndrome still idiopathic. The most encountered symptoms are blurred vision and vision loss. FFA is the best diagnostic investigation to reveal the retinal abnormalities. Many suggested protocols were mentioned to treat IRVAN Syndrome. Our experience suggests IRVAN Syndrome a differential diagnosis for patients with floaters, and assures that PRP is an affective curement for late stages of IRVAN Syndrome.

Conclusions

Heavy PRP was used successfully for stage II and III. The case emphasizes the importance of early diagnosis to assert the complications. Furthermore, IRVAN syndrome should be considered as a differential diagnosis in patients with floaters. Therefore, heavy PRP is highly recommended as a suitable treatment for IRVAN syndrome.

Schwannoma of the sympathetic trunk: A case report

Introduction and Importance

Schwannomas are benign tumors commonly found in the cranial vault at the cerebellopontine angle. Schwannomas could arise from any nerve that has Schwann sheath. Their most common extra-cranial localization is the parapharyngeal space. Schwannomas do not usually metastasize, and recurrence is uncommon.

Case presentation

We present a case of a sympathetic trunk schwannoma in a patient that presented with dysphagia and a painful neck mass. Oro-pharyngeal examination revealed the presence of a mass filling-up the left tonsillar fossa, and pushing the uvula to the right side. The larynx was also deviated to the right due to the mass effect. The mass was resected en-bloc with the involved part of the sympathetic trunk. The patient developed Horner's syndrome postoperatively.

Clinical discussion

The occurrence of Sympathetic trunk Schwannomas is very rare. The majority of patients presented with a cervical mass and non-specific symptoms. The most effective treatment is surgical resection. Our experience suggests sympathetic trunk Schwannomas as a differential diagnosis of slow-growing neck masses and asserts that the surgical resection is the main treatment.

Conclusion

The occurrence of Schwannomas in the sympathetic trunk is rare. High clinical suspicion is required to achieve the preoperative diagnosis. The optimal management is the total surgical resection. Recurrence is uncommon when the mass is totally resected.

•

Schwannoma of the sympathetic trunk is a probable diagnosis for slow-growing cervical masses.

•

Totally surgical resection is the chosen procedure to avoid recurrence.

•

Nerve grafts are not recommended to reconstruct the damaged part of the nerve.

•

Microsurgery techniques could prevent developing Horner's Syndrome after mass resecting.