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Pasol J, Ortega MR. Acute Macular Neuroretinopathy After COVID-19 Infection in a Patient With Multiple Sclerosis. J Neuroophthalmol 2024:00041327-990000000-00619. [PMID: 38589999 DOI: 10.1097/wno.0000000000002155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Affiliation(s)
- Joshua Pasol
- Clinical Ophthalmology (JP), Bascom Palmer Eye Institute University of Miami Miller School of Medicine, Plantation, Florida; and University of Miami Miller School of Medicine (MRO), Boca Raton, Florida
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Pasol J, Uddin MS, Tekin M, Moore HP. Leber Hereditary Optic Neuropathy in 2 Sisters With Friedreich Ataxia. J Neuroophthalmol 2024:00041327-990000000-00606. [PMID: 38564284 DOI: 10.1097/wno.0000000000002143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Joshua Pasol
- Bascom Palmer Eye Institute (JP), University of Miami Miller School of Medicine, Plantation, FL; Palmetto General Hospital (MSU); and Departments of Clinical and Translational Genetics (MT) and Neurology (HPM), University of Miami Miller School of Medicine, Miami, FL
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Men CJ, Amarikwa L, Pham B, Sears C, Clauss K, Lee BW, Lee WW, Pasol J, Ugradar S, Shinder R, Cockerham K, Wester S, Douglas R, Kossler AL. Teprotumumab for the Treatment of Recalcitrant Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg 2023:00002341-990000000-00281. [PMID: 37972960 DOI: 10.1097/iop.0000000000002564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE Teprotumumab, an insulin-like growth factor 1 receptor monoclonal antibody, is FDA-approved to treat thyroid eye disease (TED). The initial clinical trials excluded patients with previous orbital irradiation, surgery, glucocorticoid use (cumulative dose >1 gm), or prior biologic treatment. Information on the use of teprotumumab for patients who failed prior therapy is limited. Our purpose is to characterize the efficacy of teprotumumab for the treatment of recalcitrant TED. METHODS This is a multicenter retrospective study of all patients treated with teprotumumab for moderate-to-severe TED after failing conventional therapy with corticosteroids, orbital radiation, surgical decompression, biologics, or other steroid-sparing medications. Treatment failure was defined as an incomplete response to or reactivation after previous treatment. Only patients who received at least 4 infusions of teprotumumab were included in the analysis. Primary outcome measures comprised proptosis response (≥2 mm reduction in the study eye without a similar increase in the other eye), clinical activity score (CAS) response (≥2-point reduction in CAS), and diplopia response (≥1 point improvement in Gorman diplopia score in patients with baseline diplopia) following treatment. Adverse events and risk factors for recalcitrant disease were also evaluated. RESULTS Sixty-six patients were included in this study, 46 females and 20 males. Average age was 59.3 years (range 29-93). The mean duration of disease from TED diagnosis to first infusion was 57.8 months. The proptosis, CAS, and diplopia responses in this recalcitrant patient population were 85.9%, 93.8%, and 69.1%, respectively. Patients experienced a mean reduction in proptosis of 3.1 ± 2.4 mm and a mean improvement in CAS of 3.8 ± 1.6. Patients who underwent prior decompression surgery experienced a statistically significant decrease in diplopia response (46.7% vs. 77.5%, p = 0.014) and proptosis response (75.0% vs. 90.9%, p = 0.045) when compared with nondecompression patients. Additionally, there were no significant differences in proptosis, CAS, and diplopia responses between patients with acute (defined as disease duration <1 year) versus chronic (disease duration ≥1 year) TED. While most adverse events were mild to moderate, 4 patients reported serious adverse events related to persistent hearing loss. CONCLUSIONS Patients with recalcitrant TED demonstrated a significant improvement after teprotumumab in each of the primary study outcomes. The degree of proptosis reduction, diplopia response, and CAS improvement in the recalcitrant group were similar to those of treatment-naïve patients from the pivotal clinical trials. Patients with a prior history of orbital decompression, however, demonstrated poor improvement in diplopia and less reduction in proptosis than surgery naïve patients. These results indicate that teprotumumab is a treatment option for the treatment of patients with TED recalcitrant to prior medical therapies.
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Affiliation(s)
- Clara J Men
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Linus Amarikwa
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Brandon Pham
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
| | - Connie Sears
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, U.S.A
| | - Kevin Clauss
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
| | - Bradford W Lee
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
- Department of Surgery, Ophthalmology Division, University of Hawai'i John A. Burns School of Medicine, Honolulu, Hawaii, U.S.A
| | - Wendy W Lee
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
| | - Joshua Pasol
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
| | - Shoaib Ugradar
- Private Practice, Beverly Hills, Los Angeles, California, U.S.A
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical, Brooklyn, New York, U.S.A
| | - Kimberly Cockerham
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, U.S.A
- Private Practice, San Diego, California, U.S.A
| | - Sara Wester
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, U.S.A
| | - Raymond Douglas
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Andrea L Kossler
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California, U.S.A
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Khodeiry MM, Chau VQ, Yasin A, Starke RM, Miri S, Pasol J. Morning glory disc anomaly associated with moyamoya disease and pituitary stalk duplication. Am J Ophthalmol Case Rep 2022; 27:101632. [PMID: 35813587 PMCID: PMC9259472 DOI: 10.1016/j.ajoc.2022.101632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose We report a case of a 10-year-old with Moring glory disc anomaly (MGDA) associated with Moyamoya disease and pituitary stalk duplication. Observations A 10-year-old Asian child presented with decreased vision in the right eye and bilateral nystagmus. Both dilated fundus exam and magnetic resonance imaging (MRI) of the orbit confirmed MGDA of the right eye. MRI of the brain demonstrated duplication of the pituitary stalk. Magnetic resonance angiography (MRA) of the brain revealed bilateral severe narrowing (greater on the right side) of the distal supraclinoid internal carotid arteries with bilateral reconstitution at the carotid terminus and prominent collaterals, suggestive of Moyamoya disease. Conclusions Patients with MGDA should undergo neuroimaging due to the associated central nervous system (CNS) anomalies.
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Affiliation(s)
- Mohamed M. Khodeiry
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Viet Q. Chau
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anas Yasin
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert M. Starke
- Department of Neurological Surgery and Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shahnaz Miri
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua Pasol
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, FL, USA
- Corresponding author. Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL, 33136, USA.
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Khodeiry MM, Lind JT, Pasol J, Lam BL, Lee RK. Metastatic paraganglioma presenting as ajunctional scotoma. Am J Ophthalmol Case Rep 2022; 25:101253. [PMID: 35036631 PMCID: PMC8749452 DOI: 10.1016/j.ajoc.2021.101253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To report a unique case of metastatic paraganglioma presenting as a junctional scotoma. OBSERVATIONS A 38-year-old Caucasian man with a history of abdominal paraganglioma presented with minimally blurred vision 20/25 visual acuity in the left eye. The patient was found to have a junctional scotoma upon visual field testing. Cranial MRI revealed a large peri-clival mass compressing the pre-chiasmal optic nerves and other loci of metastatic disease. Intracranial masses, including metastases, can present with a relatively intact central acuity and nonspecific visual symptoms. CONCLUSIONS AND IMPORTANCE To the best of our knowledge, this is the first report of metastatic paraganglioma causing a junctional scotoma. In cases with junctional scotoma, careful neuro-ophthalmic assessment and imaging are of paramount importance, even in patients with excellent visual acuity.
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Affiliation(s)
- Mohamed M. Khodeiry
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, Research Institute of Ophthalmology, Giza, Egypt
| | - John T. Lind
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joshua Pasol
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Richard K. Lee
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Patel N, RIch BJ, Patel S, Watts JM, Benveniste R, Abramowitz M, Markoe A, Eichberg DG, Komotar RJ, De La Fuente M, Pasol J, Diwanji T. Emergent Radiotherapy for Leukemia-Induced Cranial Neuropathies Refractory to Intrathecal Therapy. Cureus 2021; 13:e15212. [PMID: 34178531 PMCID: PMC8221003 DOI: 10.7759/cureus.15212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Neurologic symptoms from leukemic infiltration of the central nervous system are an oncologic emergency, and expeditious treatment is required to preserve function. We report the case of a 44-year-old patient with relapsed acute myeloid leukemia (AML) who developed sub-acute cranial neuropathies refractory to treatment with intrathecal (IT) chemotherapy. The patient was therefore treated with an emergent course of whole-brain radiotherapy, resulting in immediate improvement and subsequent resolution of cranial neuropathies. This case illustrates that while central nervous system involvement by AML is rare, radiotherapy remains an effective modality to avoid long-term morbidity in patients failing to respond to systemic or IT chemotherapy.
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Affiliation(s)
- Nirav Patel
- Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, USA
| | - Benjamin J RIch
- Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, USA
| | - Shareen Patel
- Radiation Oncology, University of Miami Miller School of Medicine, Miami, USA
| | - Justin M Watts
- Hematology/Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, USA
| | - Ronald Benveniste
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Matthew Abramowitz
- Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, USA
| | - Arnold Markoe
- Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, USA
| | - Daniel G Eichberg
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Ricardo J Komotar
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | | | - Joshua Pasol
- Ophthalmology, University of Miami Sylvester Comprehensive Cancer Center, Miami, USA
| | - Tejan Diwanji
- Radiation Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, USA
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Sanghvi S, Sarna B, Alam E, Pasol J, Levine C, Casiano RR. Role of Adjunct Treatments for Idiopathic CSF Leaks After Endoscopic Repair. Laryngoscope 2020; 131:41-47. [PMID: 32401375 DOI: 10.1002/lary.28720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE A higher incidence of recurrent cerebrospinal fluid (CSF) leaks has been reported with idiopathic CSF leaks. A growing number of institutions advocate for routine use of intracranial pressure-lowering adjunct treatments after endoscopic repair. We report our results in a patient cohort in which only symptomatic patients are subjected to further testing and treatment. STUDY DESIGN Retrospective review. METHODS A retrospective review of patients who underwent endoscopic transnasal repair of idiopathic CSF rhinorrhea was performed at the University of Miami, Florida, from July 2010 to July 2017. The database was queried for demographical data, surgical details, radiological findings, and postoperative outcomes. Only patients with greater than a 12-month follow-up were included. RESULTS Thirty-three patients underwent endoscopic repair of an idiopathic CSF leak. Twenty-six (79%) were females, with an average age of entire study population being 48 years. The average body mass index (BMI) of the cohort was 33 kg/m2 , with 89% being overweight (BMI > 25 kg/m2 ). The skull base defect was found to be mainly at the cribriform plate (64%) and sphenoid sinus (30%). Endoscopic repair was performed successfully as a single repair in 32 patients (97%). The average follow-up was 47 months. Postoperative adjunct medications were used on four patients (12%) with symptomatic idiopathic intracranial hypertension. CONCLUSION Endoscopic repair of idiopathic CSF leaks was found to have a high rate of success in our study. Postoperatively, only four patients required additional measures to medically reduce symptomatic intracranial hypertension. Routine postoperative adjunct treatments are unnecessary and may expose patients to adverse long-term side effects. LEVEL OF EVIDENCE 4 Laryngoscope, 131:41-47, 2021.
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Affiliation(s)
- Saurin Sanghvi
- Department of Otolaryngology-Head & Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A
| | - Brooke Sarna
- Department of Otolaryngology-Head & Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A
| | - Elie Alam
- Department of Otolaryngology-Head & Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A
| | - Joshua Pasol
- Department of Opthalmology/Bascom Palmer Eye Institute, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A
| | - Corinna Levine
- Department of Otolaryngology-Head & Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A
| | - Roy R Casiano
- Department of Otolaryngology-Head & Neck Surgery, University of Miami-Miller School of Medicine, Miami, Florida, U.S.A
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Venkateswaran N, Cernichiaro-Espinosa LA, Negron C, Fallas B, Zhou XY, Lara W, Cavuoto KM, Pasol J, Davis JL, Dubovy SR, Berrocal AM. Subretinal Cysticercosis Extraction With Bimanual, 3-D, Heads–Up-Assisted Pars Plana Vitrectomy: Clinicopathological Correlation and Surgical Technique. Ophthalmic Surg Lasers Imaging Retina 2018; 49:708-711. [DOI: 10.3928/23258160-20180831-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
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Abstract
A 51-year-old female underwent four upper zygomatic dental implants (ZI) and one upper and four lower conventional implants. Immediately postoperatively, the patient had pain and diplopia upon manual elevation of the edematous eyelid. Panoramic x-ray showed a malpositioned right upper ZI, requiring removal of the right upper ZI the following day. The patient had delayed referral to ophthalmology one month later for persistent diplopia. Computed tomography scan and magnetic resonance imaging demonstrated a right inferolateral fracture with fibrosis surrounding the inferior oblique muscle. Clinical exam showed right lower eyelid retraction, right hypotropia, and inability to elevate in adduction, consistent with a right inferior oblique paresis. Surgical exploration revealed incarceration of lid and orbital tissue into the fracture. After repositioning of the prolapsed tissue, a high-density porous polyethylene implant was placed for fracture repair. The inferior fornix was reconstructed with amniotic membrane and 5-fluorouracil was injected into the scar tissue. Six months later, the patient underwent strabismus surgery with resolution of symptoms.
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Affiliation(s)
- Ann Q Tran
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Daniela P Reyes-Capó
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Nimesh A Patel
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Joshua Pasol
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Hilda Capó
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
| | - Sara T Wester
- a Department of Ophthalmology , Bascom Palmer Eye Institute, University of Miami Miller School of Medicine , Miami , FL , USA
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Pasol J, Lam BL. Review of Walsh and Hoyt’s Clinical Neuro-Ophthalmology. JAMA Neurol 2016. [DOI: 10.1001/jamaneurol.2016.2524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Joshua Pasol
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Byron L. Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
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Schwartz SG, Pasol J, Lam BL, Flynn HW. Spectral-Domain Optical Coherence Tomography Documentation of Transsynaptic Retinal Degeneration. Ophthalmic Surg Lasers Imaging Retina 2016; 47:768-72. [DOI: 10.3928/23258160-20160808-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/06/2016] [Indexed: 11/20/2022]
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Daubert J, Hariharan L, Pasol J, McKeown C, Cavuoto K. Ocular Neuromyotonia Noted after Recent Botulinum Toxin Injection for Sixth Nerve Palsy Following Resection of a Posterior Fossa Skull Base Meningioma. Neuroophthalmology 2014; 39:39-41. [PMID: 27928330 DOI: 10.3109/01658107.2014.982132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/24/2014] [Accepted: 10/24/2014] [Indexed: 11/13/2022] Open
Abstract
A 56-year-old female complained of diplopia immediately after surgical excision of a recurrent left skull base tuberculum meningioma. She was found to have a left sixth nerve palsy, which was subsequently treated with botulinum toxin injection to the medial rectus muscle. Three months post injection, the patient had partial recovery of the sixth nerve palsy and new-onset ocular neuromyotonia.
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Affiliation(s)
| | - Luxme Hariharan
- University of Miami Miller School of MedicineMiami, FloridaUSA; Bascom Palmer Eye Institute Miami, FloridaUSA
| | - Joshua Pasol
- University of Miami Miller School of MedicineMiami, FloridaUSA; Bascom Palmer Eye Institute Miami, FloridaUSA
| | - Craig McKeown
- University of Miami Miller School of MedicineMiami, FloridaUSA; Bascom Palmer Eye Institute Miami, FloridaUSA
| | - Kara Cavuoto
- University of Miami Miller School of MedicineMiami, FloridaUSA; Bascom Palmer Eye Institute Miami, FloridaUSA
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Johnson JN, Elhammady M, Post J, Pasol J, Ebersole K, Aziz-Sultan MA. Optic pathway infarct after Onyx HD 500 aneurysm embolization: visual pathway ischemia from superior hypophyseal artery occlusion. J Neurointerv Surg 2013; 6:e47. [PMID: 24362967 DOI: 10.1136/neurintsurg-2013-010968.rep] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We report a case of visual deterioration after Onyx HD 500 embolization of a left 7 mm superior hypophyseal artery (SHA) aneurysm. After the procedure, the patient experienced a right incongruous homonymous hemianopia, and MRI showed an infarct of the ipsilateral optic chiasm/tract but no evidence of aneurysm mass effect or embolic cortical infarcts. The optic pathway ischemia is believed to be secondary to Onyx penetration and occlusion of an SHA branch near the aneurysm neck. Caution is advised when using liquid embolic agents to treat SHA aneurysms as SHA occlusion may lead to visual deficits.
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Affiliation(s)
| | - Mohamed Elhammady
- Department of Neurosurgery, University of Miami, Miami, Florida, USA
| | - Judith Post
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Pasol
- Department of Neuroradiology, University of Miami, Miami, Florida, USA
| | - Koji Ebersole
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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Johnson JN, Elhammady M, Post J, Pasol J, Ebersole K, Aziz-Sultan MA. Optic pathway infarct after Onyx HD 500 aneurysm embolization: visual pathway ischemia from superior hypophyseal artery occlusion. BMJ Case Rep 2013; 2013:bcr2013010968. [PMID: 24347448 PMCID: PMC3888536 DOI: 10.1136/bcr-2013-010968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of visual deterioration after Onyx HD 500 embolization of a left 7 mm superior hypophyseal artery (SHA) aneurysm. After the procedure, the patient experienced a right incongruous homonymous hemianopia, and MRI showed an infarct of the ipsilateral optic chiasm/tract but no evidence of aneurysm mass effect or embolic cortical infarcts. The optic pathway ischemia is believed to be secondary to Onyx penetration and occlusion of an SHA branch near the aneurysm neck. Caution is advised when using liquid embolic agents to treat SHA aneurysms as SHA occlusion may lead to visual deficits.
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Abstract
A 64-year-old female presented with ptosis, ophthalmoplegia, ataxia, and weakness. She was diagnosed with Miller Fisher syndrome (MFS) and was treated with plasmapheresis. Six months later, she developed bilateral oculomotor synkinesis, suggesting aberrant regeneration. The pathogenesis of MFS is reviewed in light of this unusual finding.
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