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Mahatme C, Shah VM, Saravanan VR. Images in Vascular Medicine: Takayasu retinopathy as a primary presentation of active vasculitis. Vasc Med 2024:1358863X241241022. [PMID: 38573120 DOI: 10.1177/1358863x241241022] [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: 04/05/2024]
Affiliation(s)
- Chinmay Mahatme
- Ophthalmology Resident, Aravind Eye Hospital, Coimbatore, TN, India
| | - Virna M Shah
- Department of Neuro-ophthalmology, Aravind Eye Hospital, Coimbatore, TN, India
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Bhanuman R, Varadharajan S, Kumar K, Shah VM. Lethal mycotic pseudoaneurysm presenting as isolated sixth nerve palsy. Digit J Ophthalmol 2024; 30:19-21. [PMID: 38601898 PMCID: PMC11001566 DOI: 10.5693/djo.02.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Pseudoaneurysm of the internal carotid artery caused by skull base osteomyelitis (SBO) is a lethal condition seen in immunocompromised patients, predominantly those with diabetes mellitus. Cranial nerve involvement is a common complication and generally indicates a poor prognosis. We report the case of a 62-year-old diabetic patient who presented with isolated sixth cranial nerve palsy. She had uncontrolled blood sugar levels and high erythrocyte sedimentation rate, and she suffered from pyelonephritis. Neuroimaging detected SBO with multiple secondary mycotic pseudoaneurysms prominent at the petrocavernous junction. Ischemia is the most common etiology for an isolated abducens nerve palsy, but in certain cases neuroimaging is warranted to prevent life-threatening complications. This case highlights the importance and urgency of identifying and managing such conditions.
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Affiliation(s)
- Rasna Bhanuman
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Shriram Varadharajan
- Radiology Department, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - Karthik Kumar
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Virna M. Shah
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Rai B, Kaushik M, Vijayan K, Mani KK, Shah VM. Aspergillosis of Meckel Cave in an Immunocompetent Patient. J Neuroophthalmol 2024; 44:e123-e124. [PMID: 38109290 DOI: 10.1097/wno.0000000000001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Bhagyata Rai
- Neuro-ophthalmology Services (BR, MK, KKM, VMS), Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India; and Royal Care Superspeciality Hospital (KV), Coimbatore, Tamil Nadu, India
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4
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Shah VM, Kene RD, Shafeena PP, Mani KK. Neuro-ophthalmic sequelae post-COVID-19. Indian J Ophthalmol 2023; 71:3261. [PMID: 37602620 PMCID: PMC10565929 DOI: 10.4103/ijo.ijo_894_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Affiliation(s)
- Virna M Shah
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Rakshita D Kene
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - P P Shafeena
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Karthik K Mani
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Gosalia H, Kumar KM, Karan AK, Saravanan VR, Shah VM. Comparison of glaucomatous from non-glaucomatous optic neuropathy using Bruch's membrane opening minimum rim width optical coherence tomography measurements. Indian J Ophthalmol 2023; 71:3005-3009. [PMID: 37530273 PMCID: PMC10538806 DOI: 10.4103/ijo.ijo_3171_22] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
Purpose To compare glaucomatous from non-glaucomatous optic atrophy using optical coherence tomography (OCT) based on the measurement values of Bruch's membrane opening minimum rim width (BMO-MRW), which is a difficult task otherwise due to their varied course of disease progression, treatment protocols, and systemic association to visual impairment. Methods This study was conducted in 40 eyes, comprising 20 eyes with non-glaucomatous optic neuropathy (NGON) and 20 eyes with glaucomatous optic neuropathy (GON). All patients underwent a complete ophthalmic examination followed by an OCT optic disc scan to calculate the measurement of BMO-MRW. Results The 5-fold cross-validated area under the curve for GON versus NGON from logistic regression models was 0.95 (95% confidence interval [CI]: 0.86-1.00) using BMO-MRW values from all sectors. The results revealed that the measurements were significantly lesser in GON than in NGON patients. Conclusion Hence, OCT-based BMO-MRW values could be used as an additional test to compare glaucomatous with non-glaucomatous optic neuropathy patients, especially in cases of high clinical suspicion.
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Affiliation(s)
- Hirika Gosalia
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Karthik M Kumar
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - A K Karan
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Veerappan R Saravanan
- Department of Vitreoretinal Services, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Virna M Shah
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Markose S, Varadharajan S, Vasudevan H, Shah VM. Stealthily growing large sinonasal lymphoma with intracranial extension. Curr J Neurol 2023; 22:203. [PMID: 38011348 PMCID: PMC10626135 DOI: 10.18502/cjn.v22i3.13802] [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] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/10/2023] [Indexed: 11/29/2023]
Abstract
The Article Abstract is not available.
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Affiliation(s)
- Shyma Markose
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Shriram Varadharajan
- Department of Radiology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - Haritha Vasudevan
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Virna M. Shah
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Post Graduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Rajendra S, Shah VM, Manayath GJ, Kumar K. Multimodal Imaging Features of Subacute Methanol-Induced Bilateral Optic Neuropathy. J Neuroophthalmol 2023:00041327-990000000-00338. [PMID: 37166998 DOI: 10.1097/wno.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Sharanya Rajendra
- Departments of Neuro-Ophthalmology (SR, VMS, KK) and Retina Vitreous (GJM), Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Murugesan S, Senthilkumar E, Kumar K, Shah VM. Isolated bilateral lateral geniculate body necrosis following acute pancreatitis: A rare cause of bilateral loss of vision in a young female. J Postgrad Med 2023; 69:53-55. [PMID: 36453385 PMCID: PMC9997598 DOI: 10.4103/jpgm.jpgm_1134_21] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Sudden bilateral visual loss because of bilateral lateral geniculate body (LGB) necrosis is a very rare entity. The mechanisms causing these isolated lesions have still not been fully understood. We report a case of sudden loss of vision in a 22-year-old female following an attack of acute pancreatitis, just after starting the paleo diet. Neuroimaging revealed bilateral LGB necrosis. Multidisciplinary approach was sought and she was subsequently managed successfully. On follow-up, her visual acuity showed improvement, and neuroimaging revealed resolution of hyperintensities in bilateral LGB with residual blooming suggestive of old hemorrhagic gliosis. The possible reasons for isolated lesions of the LGB are hemorrhagic infarction and osmotic demyelination. In the present case, we postulate a vascular pathology, possibly hypo-perfusion because of shock following acute pancreatitis.
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Affiliation(s)
- S Murugesan
- Department of Neuro-Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - E Senthilkumar
- Department of Neurology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - K Kumar
- Department of Neuro-Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - V M Shah
- Department of Neuro-Ophthalmology, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
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Affiliation(s)
- Rakshita D Kene
- DNB Resident, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - PP Shafeena
- DNB Resident, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - M Karthik Kumar
- Department of Neuro ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
| | - Virna M Shah
- Department of Neuro ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India
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Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has a vast array of presentations and associations with neuro-ophthalmic diseases. There has been a recent surge in ophthalmic manifestations secondary to fungal sinus infections in India especially in diabetic patients who were given systemic steroids. We present our COVID-19-related cranial neuropathies presenting in our clinic. METHODS This is a retrospective case series of 10 patients affected with COVID-19 disease and who presented with cranial nerve palsies at the neuro-ophthalmic department of a tertiary eye care hospital in South India. An analysis of electronic medical records data was performed, including their comorbidities, symptoms, cranial nerves involved, ocular and neuroimaging findings, site of lesion, etiology, and prognosis. RESULTS Most of the patients (7 of 10) presented with multiple cranial nerve palsies (MCNP) with poor visual acuity. 2 of the 10 cases succumbed to death due to the intracranial involvement. All MCNP cases had uncontrolled diabetes with a history of systemic steroids, and neuroimaging of these cases showed sinusitis of varying severity most of which were suggestive of fungal invasive type. CONCLUSION Our study emphasizes the need to screen for fungal involvement in COVID-19 cases presenting with MCNP especially on diabetic patients on systemic steroids so that an early diagnosis may reduce visual loss and mortality. Physicians treating COVID-19 cases need to be aware of this dreadful complication.
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Affiliation(s)
- V K Hema
- Neuro-Ophthalmology Department, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Coimbatore, India
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Verghese S, Berkowitz ST, Shah VM, Shah P, Priya S, Saravanan VR, Narendran V, Selvan VA. Assessment of retinal manifestations of Parkinson's disease using spectral domain optical coherence tomography: A study in Indian eyes. Indian J Ophthalmol 2022; 70:448-452. [PMID: 35086214 PMCID: PMC9023951 DOI: 10.4103/ijo.ijo_1409_21] [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] [Indexed: 12/03/2022] Open
Abstract
Purpose: To assess the retinal manifestations of Parkinson’s disease using optical coherence tomography. Methods: A prospective case-control study comparing 30 eyes from 15 patients with Parkinson’s disease and 22 eyes from 11 healthy age-matched controls. Total macular subfield thickness and the thickness of the ganglion cell layer, nerve fiber layer, and peripapillary retinal nerve fiber layer were measured with spectral-domain optical coherence tomography (SD-OCT). Results: The mean age of PD patients was 68.4 years ± 10.64 (range: 46–82) and in the control group was 66.36 ± 5.22 (range: 64–68). The average disease duration in patients with PD was 6.7 ± 2.8 years (range: 2–10 years). The mean best-corrected visual acuity in PD was 20/26 and 20/20 in controls, with P = 0.0059, which was significant. Significant difference was also found in the contrast sensitivity between both groups. Structural differences in the central macular thickness (P = 0.0001), subfield thicknesses in the superior (P = 0.003), inferior (P = 0.001), nasal (P = 0.004), and temporal subfields (P = 0.017) was seen. Severe thinning of the ganglion cell layer was seen in PD patients (P = 0.000) as well as of the nerve fiber layer (P = 0.004). Peripapillary retinal nerve fiber thickness measured showed significant thinning in superotemporal (P = 0.000), superonasal (P = 0.04), inferonasal (P = 0.000), inferotemporal (P = 0.000), nasal (P = 0.000), and temporal quadrants (P = 0.000). Conclusion: Visual dysfunction was observed in patients with PD along with structural alterations on OCT, which included macular volumes, ganglion cell layer, and peripapillary retinal nerve fiber layer.
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Affiliation(s)
- Shishir Verghese
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Sean T Berkowitz
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, USA
| | - Virna M Shah
- Department of Neuro Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Parag Shah
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - S Priya
- Department of Neuro Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Veerappan R Saravanan
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Venkatapathy Narendran
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - V A Selvan
- Department of Neurology, Kovai Medical College and Hospital, Coimbatore, Tamil Nadu, India
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Jeslin J, Seetharaman C, Shah VM. Optic Neuritis During Lactation: A Case Series. J Hum Lact 2021; 37:577-580. [PMID: 33201757 DOI: 10.1177/0890334420970496] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic neuritis is a rare condition that can lead to sudden blindness and also could be a precursor to multiple sclerosis. When it occurs postpartum during lactation, it is called lactation optic neuritis. MAIN ISSUE We present four cases of optic neuritis in lactating mothers, two of which had additional features of demyelinating disease upon neurological imaging. MANAGEMENT All participants were treated with high dose intravenous steroids followed by 11 days of oral steroids, per the optic neuritis treatment trial, which led to complete recovery of vision. Two participants with demyelinating disease on magnetic resonance imaging scans were advised to wean, because of a need for immunosuppressive therapy later. CONCLUSION Optic neuritis during lactation should be suspected following acute loss of vision. Prompt referral to an ophthalmologist is mandated for early diagnosis and treatment to prevent long-term co-morbidities.
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Affiliation(s)
- Johnson Jeslin
- 75196 Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - C Seetharaman
- 29908 Radiology Department, Kovai Medical Center and Hospitals, Coimbatore, India
| | - Virna M Shah
- 75196 Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
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Abstract
Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare congenital disorder characterized by absence of conjugate horizontal eye movements and accompanied by progressive scoliosis developing in childhood and adolescence. It occurs due to mutation in ROBO 3 gene/chromosome 11q23-q25. We report a case of a 60-year-old lady who presented with complaints of defective vision in both eyes. On examination, she had scoliosis with restricted abduction and adduction in both eyes with intact elevation and depression. Magnetic resonance imaging of the brain and orbit showed brainstem hypoplasia with absence of facial colliculi, presence of a deep midline pontine cleft (split pons sign), and a butterfly configuration of the medulla, which are the radiological findings seen in this disorder.
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Affiliation(s)
- P Shalini
- Department of Neuro Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Virna M Shah
- Department of Neuro Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Abstract
Cavernomas or cavernous malformations are the most common clinically significant vascular anomalies, accounting for 8-15% of all brain and spinal vascular malformations. While there are several articles in the literature on cavernomas, most cases report haemorrhage from these lesions as the cause of cranial nerve palsies. We report a rare case of multiple intracranial cavernomas in the brain and pons causing an isolated compressive sixth nerve palsy.
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Affiliation(s)
- Janardhanan Jinisha
- Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | | | - Virna M Shah
- Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
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Seetharaman C, Vasudev H, Shah VM. Bilateral third nerve palsy due to a midbrain cavernoma. Curr J Neurol 2021; 20:52-53. [PMID: 38011486 PMCID: PMC8511606 DOI: 10.18502/cjn.v20i1.6381] [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] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/04/2020] [Indexed: 11/24/2022]
Abstract
The article abstract is not available.
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Affiliation(s)
- Cannane Seetharaman
- Department of Radiology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - Haritha Vasudev
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
| | - Virna M. Shah
- Department of Neuro-Ophthalmology, Aravind Eye Hospital, Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Shah VM, Ranjan R, Jeste M, MacIntosh P, Ashwath D. Bilateral vertical gaze palsy due to midbrain infarct associated with iron deficiency anemia in a young boy. GMS Ophthalmol Cases 2020; 10:Doc28. [PMID: 32676273 PMCID: PMC7332997 DOI: 10.3205/oc000155] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An 8-year-old boy presented with complaints of sudden-onset binocular vertical diplopia of one day duration. Ophthalmic examination showed restricted up- and downgaze movement with rotatory nystagmus. Systemic investigations revealed iron-deficiency anemia and localized acute infarct in the left paramedian rostral and dorsal part of the upper midbrain at the level of the red nucleus on magnetic resonance imaging. The patient was started on oral iron supplement, which resulted in symptomatic as well as clinical improvement after 2 weeks.
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Affiliation(s)
- Virna M Shah
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Ratnesh Ranjan
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Mrunmayi Jeste
- Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Peter MacIntosh
- Ophthalmic Plastic & Reconstructive Surgery and Neuro-Ophthalmology, Illinois Eye and Ear Infirmary, Chicago, USA
| | - Duraiswamy Ashwath
- Department of Pediatrics, Kovai Medical Centre and Hospital, Coimbatore, India
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Shah VM, Burshina AT, Bhanuman R. Disseminated neurocysticercosis presenting as eyelid swelling. Orbit 2020; 40:263. [PMID: 32362170 DOI: 10.1080/01676830.2020.1762231] [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: 10/24/2022]
Affiliation(s)
- Virna M Shah
- Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - A T Burshina
- Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Rasna Bhanuman
- Neuro Ophthalmology Services, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
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MacIntosh PW, Kumar SV, Saravanan VR, Shah VM. Acute changes in ganglion cell layer thickness in ischemic optic neuropathy compared to optic neuritis using optical coherence tomography. Int J Ophthalmol 2020; 13:120-123. [PMID: 31956579 DOI: 10.18240/ijo.2020.01.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/29/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023] Open
Abstract
AIM To elucidate the changes of different ganglion cell layer (GCL) thinning patterns between the optic neuritis (ON) and non-arteritic anterior ischemic optic neuropathy (NAION). METHODS A prospective, observational study was conducted to evaluate the timing of GCL changes between acute ON and NAION using optical coherence tomography. RESULTS Thinning on optical coherence tomography in the NAION group occurs as early as 11d after symptomatic onset of vision loss and follows an altitudinal pattern. The mean superior-inferior GCL thickness difference in the NAION cohort was clinically significant at 5.7 µm in the NAION cohort compared to controls of 0.8 µm (P=0.032), but not significant in the ON group compared to controls with both groups measuring 1.1 µm. Global thinning was significant for the ON group compared to controls at 7.2 µm (P=0.011) but not the NAION group compared to controls at 1.35 µm. CONCLUSION These findings suggest that future treatments for NAION should be given early, and possibly before 11d in order to prevent GCL and irreversible vision loss.
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Affiliation(s)
- Peter W MacIntosh
- Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - S Vijay Kumar
- Neuro-Ophthalmology Service, Aravind Eye Hospital, Coimbatore 641014, India
| | - V R Saravanan
- Neuro-Ophthalmology Service, Aravind Eye Hospital, Coimbatore 641014, India
| | - Virna M Shah
- Neuro-Ophthalmology Service, Aravind Eye Hospital, Coimbatore 641014, India
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Singh SB, Vanathi N, Shah VM. A rare case of CNS hemangiopericytoma presenting with papilledema. GMS Ophthalmol Cases 2019; 9:Doc32. [PMID: 31531278 PMCID: PMC6734512 DOI: 10.3205/oc000121] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Hemangiopericytoma rarely affects the central nervous system (CNS) and usually presents to neurologists with neurological symptoms. We report a rare case of large CNS hemangiopericytoma which presented to an ophthalmologist with only signs of mild defective vision and papilledema.
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Affiliation(s)
- Sanjana B. Singh
- Department of Neuro Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Narayanaswamy Vanathi
- Department of Neuro Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Virna M. Shah
- Department of Neuro Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India,*To whom correspondence should be addressed: Virna M. Shah, Department of Neuro Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India, Phone: +91 422 4360400, Fax: +91 422 2593030, E-mail:
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Shah VM, Gawas G. Purtscher's retinopathy in one and sixth nerve palsy in the other eye following head trauma. GMS Ophthalmol Cases 2019; 9:Doc09. [PMID: 30984509 PMCID: PMC6450042 DOI: 10.3205/oc000098] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purtscher’s retinopathy and sixth nerve palsy are often seen following head trauma. However, both are rarely seen coexisting together in the same patient. We present a rare case of both these entities occurring simultaneously in opposite eyes of the same patient following head trauma.
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Affiliation(s)
- Virna M Shah
- Department of Neuro-Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India
| | - Gauresh Gawas
- Department of Neuro-Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India
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Shah VM, Panikkar K. Optic neuritis in an immunocompetent 40-year-old female due to fungal sphenoidal sinusitis. GMS Ophthalmol Cases 2019; 9:Doc06. [PMID: 30984506 PMCID: PMC6436000 DOI: 10.3205/oc000095] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fungal shpenoidal sinusitis with osteomyelitis is rare in young immunocompetent patients. We present a case of a presumed fungal sphenoidal sinusitis presenting with second and sixth cranial nerve involvement which resolved well with systemic anti-fungal treatment.
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Affiliation(s)
- Virna M. Shah
- Department of Neuro-Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India,*To whom correspondence should be addressed: Virna M. Shah, Department of Neuro-Ophthalmology, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India, Phone: +91 422 4360400, Fax: +91 422 2593030, E-mail:
| | - Kartik Panikkar
- Department of Glaucoma, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India
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Kibbe AH, Franko TS, Shah VM. Oxycodone hydrochloride immediate-release analgesic for managing severe pain: abuse-deterrent formulations. Ther Clin Risk Manag 2018; 14:779-782. [PMID: 29750036 PMCID: PMC5933465 DOI: 10.2147/tcrm.s144564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper is an expert opinion in response to the development of abuse-deterrent immediate-release tablets containing oxycodone HCl. There is a potential impact, both positive and negative, of this type of dosage form on patients, those suffering from the disease of addiction, health care providers, and the cost of health care.
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Affiliation(s)
- A H Kibbe
- Department of Pharmaceutical Sciences, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA, USA
| | - T S Franko
- Department of Clinical Pharmacy, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA, USA
| | - V M Shah
- Department of Clinical Pharmacy, Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, PA, USA
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Bhosale A, Shah VM, Shah PK. Accuracy of crescent sign on ocular ultrasound in diagnosing papilledema. World J Methodol 2017; 7:108-111. [PMID: 29026691 PMCID: PMC5618144 DOI: 10.5662/wjm.v7.i3.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/17/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To study the usefulness of orbital ultrasonography in the diagnosis of papilledema.
METHODS Fifty patients who were referred to the neurophthalmology clinic and clinically suspected to have papilledema were selected. Thorough, clinical examination with slitlamp biomicroscopy and visual acuity assessment was done. These patients underwent ultrasonography to demonstrate the crescent sign. The patients were further evaluated with the neurologist and magnetic resonance imaging (MRI) thus confirming the diagnosis of papilledema. The results of our ultrasonographic evaluation were correlated with final diagnosis after thorough clinical evaluation, imaging and the neurologist’s opinion.
RESULTS Out of 50 patients diagnosed having papilledema on MRI, 46 (92%) showed crescent sign on B scan ultrasonography. Headache was most common presenting complaint in 47 (94%) and idiopathic intracranial hypertension was most common underlying cause of papilledema in 30 (60%) cases.
CONCLUSION “Crescent sign” seen on ultrasonography is a sensitive tool for diagnosis of papilledema. It is cost effective, less cumbersome and effective tool to differentiate between papilledema and pseudo papilledema before subjecting the patients to costly investigations like MRI. A positive crescent sign should always be followed by MRI to find out the cause of papilledema.
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Affiliation(s)
- Ananth Bhosale
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore 641014, Tamil Nadu, India
| | - Virna M Shah
- Department of Neuro Ophthalmology, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore 641014, Tamil Nadu, India
| | - Parag K Shah
- Department of Retina and Vitreous, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore 641014, Tamil Nadu, India
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Shah VM, Mangat GK, Joshi VR. Alpha interferon in systemic sclerosis. J Assoc Physicians India 2001; 49:676-7. [PMID: 11584956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Shah VM, Newman J, Crocker J, Antonakopoulos GN, Chapple CR, Collard MJ. Production of beta-human chorionic gonadotropin by prostatic adenocarcinoma and transitional cell carcinoma of the upper urinary tract. Br J Exp Pathol 1987; 68:871-8. [PMID: 2447930 PMCID: PMC2013093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Ectopic production and secretion of hormones by a wide variety of tumours has been known for many years. Recently human chorionic gonadotropin (HCG) production and/or secretion have been noted in 15 cases with prostatic adenocarcinoma (Fukutani et al. 1983; Papapetrou et al. 1980: Broder et al. 1977; Menon & Stefani 1980; McManus et al. 1976) and in two with upper urinary tract transitional cell carcinoma (Fukutani et al. 1983; McManus et al. 1976). In this study we utilised the indirect immunoperoxidate technique to demonstrate beta-HCG production in prostatic adenocarcinoma and upper urinary tract urothelial tumours. Of 100 cases of prostatic adenocarcinoma beta-HCG production was demonstrated in nine cases, eight of which were poorly differentiated, and of 14 urothelial tumours of the upper urinary tract beta-HCG production was present in two high grade transitional cell carcinomas.
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Affiliation(s)
- V M Shah
- Departments of Pathology, East Birmingham Hospital, Bordesley Green East, UK
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Chapple CR, Gannon MX, Shah VM, Newman J. Spontaneous regression of pulmonary metastases from renal adenocarcinoma before nephrectomy. Br J Surg 1987; 74:69-70. [PMID: 3828743 DOI: 10.1002/bjs.1800740125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Chapple CR, Shah VM, Newman J. Intraluminal mucus cast complicating carcinoma of the colon. Postgrad Med J 1986; 62:1061-2. [PMID: 3628155 PMCID: PMC2418985 DOI: 10.1136/pgmj.62.733.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A previously unreported complication of a stenosing carcinoma of the colon is described. This was first noticed as a rather unusual X-ray appearance, the significance of which only became clear following surgery.
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Shah VM, Newman J, Crocker J, Chapple CR, Collard MJ, O'Brien JM, Considine J. Ectopic beta-human chorionic gonadotropin production by bladder urothelial neoplasia. Arch Pathol Lab Med 1986; 110:107-11. [PMID: 3511880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Endocrine manifestations are rarely observed in bladder urothelial neoplasia. To our knowledge, only 11 cases of choriocarcinoma have been reported in this site, and recently the production of beta-human chorionic gonadotropin has been demonstrated in these tumors by applying the immunoperoxidase technique. Of 104 transitional cell neoplasms of the bladder, we demonstrated by the indirect immunoperoxidase technique beta-human chorionic gonadotropin production in 12 neoplasms, 11 of which were grade 3 and 4 transitional cell carcinomas.
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Abstract
A peroxidase-antiperoxidase technique for S-100 protein has been applied to 68 salivary glands. These included 17 pleomorphic adenomas, seven adenoid cystic carcinomas, 23 adenolymphomas and a number of other neoplasms. In addition, five specimens of myoepithelial sialadenitis ('benign lymphoepithelial lesion') and five normal parotid glands were included. Consistent results were obtained, myoepithelial cells and cells in myxoid and chondroid areas in pleomorphic adenomas staining intensely. In adenoid cystic carcinoma, on the other hand, there was no staining. The adenolymphomas possessed intensely S-100 protein-positive cells in the interfollicular lymphoid areas; these were probably interdigitating reticulum cells. In addition, branching structures, probably corresponding to Langerhans' cells, were observed in the epithelium of adenolymphomas.
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Shah SS, Shah VM. Myxedema associated with exophthalmos and digital clubbing. Indian J Med Sci 1972; 26:315-8. [PMID: 4541752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Betkerur UN, Mehta MJ, Shah MV, Shah VM. Twin transfusion syndrome (a case report). Indian Pediatr 1972; 9:231-3. [PMID: 4485616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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