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Biomedical subjects

Rod Foroozan

Publications and source records attributed to Rod Foroozan.

At least 19 recordsLinked to original sources
PubMed2005

Optic neuropathy associated with linezolid treatment.

Two patients undergoing long-term treatment with linezolid for pneumonia had decreased visual acuity, dyschromatopsia, and cecocentral scotomas characteristic of toxic optic neuropathy. Visual function slowly recovered 3 to 4 months after discontinuation of the antibiotic treatment in both patients. Toxic optic neuropathy may occur from linezolid. Early withdrawal of the antibiotic may be associated with visual recovery.

Acetamides↗
PubMed2004

Diagnosis of metastatic carcinoma to the cavernous sinus by computed tomograpy-guided fine-needle aspiration.

PURPOSE: To describe a case of metastatic lung carcinoma to the cavernous sinus and orbital apex diagnosed by fine-needle aspiration guided by computed tomography. DESIGN: Case report. METHOD: A 52-year-old man who presented with right-sided ptosis and ophthalmoplegia was found to have an enhancing mass of the right orbital apex and cavernous sinus extending into the temporal fossa on magnetic resonance imaging. Chest computed tomography revealed hilar adenopathy and a lesion of the right lower lobe of the lung. Bronchial washings and transbronchial needle biopsies of the lung were nondiagnostic. Computed tomography-guided fine-needle aspiration of the temporal fossa portion of the mass was performed. RESULT: Biopsy of the mass showed malignant cells consistent with metastatic non-small cell lung carcinoma. CONCLUSION: Computed tomography-guided fine-needle aspiration can be useful in the diagnosis and management of some masses involving the cavernous sinus.

Biopsy, Fine-Needle↗
PubMed2004

Microsaccadic opsoclonus: an idiopathic cause of oscillopsia and episodic blurred vision.

PURPOSE: To describe the clinical presentation and results of three-dimensional video-oculography of a patient with idiopathic microsaccadic opsoclonus. DESIGN: Observational case report. METHODS: Neuro-ophthalmologic examination and video-oculographic recording of horizontal, vertical, and torsional eye movements. RESULTS: A 67-year-old man with intermittent blurred vision and oscillopsia, which persisted with monocular occlusion, over a five year period was found to have high frequency, small amplitude back-to-back multivectorial saccadic movements which were visible with slit lamp biomicroscopy and direct ophthalmoscopy. Video-oculography showed a 20 Hz, 0.2 to 1 degree pattern of horizontal, vertical, and torsional microsaccades. This microsaccadic disorder has persisted for five years with no etiology. CONCLUSIONS: Microsaccadic opsoclonus is an idiopathic disorder that presents with oscillopsia and intermittent blurred vision. The diagnosis can be confirmed with three-dimensional eye movement recordings.

Aged↗
PubMed2004

Voluntary suppression of the multifocal electroretinogram.

OBJECTIVE: To describe multifocal electroretinogram (mfERG) responses in 2 patients with nonorganic visual loss and in 11 eyes of 6 healthy persons who suppressed their mfERG responses. DESIGN: Observational case series. METHODS: The mfERG results were recorded in all individuals using the Veris Science 4.2 instrument. All subjects were instructed to adjust the hexagonal test pattern so that it was in best focus. A second mfERG was recorded subsequently in volunteers who attempted suppression with inattention and poor fixation and by adjusting the focus to greatest blur. MAIN OUTCOME MEASURES: Amplitude and latency of mfERG responses. RESULTS: Suppressed mfERGs in patients with nonorganic visual loss and healthy volunteers demonstrated reduced amplitude, especially centrally. Amplitude reduction was statistically significant in the postsuppression as compared with the presuppression recordings in wave forms N1 and N2. Statistically significant shortening of postsuppression implicit times of P1 and N2 waveforms also was demonstrated. CONCLUSIONS: The mfERG responses may be suppressed voluntarily. Amplitude may be reduced. In contrast to most reported pathologic conditions, the implicit time is shortened.

Adult↗
PubMed2004

Transient visual loss may anticipate occipital infarction from hemodialysis.

BACKGROUND: The aim of this study was to report on a patient who had occipital infarction from intradialytic hypotension and review the literature on hemodialysis and visual loss. METHODS: Neuro-ophthalmologic examination and magnetic resonance imaging (MRI) of the brain were conducted. RESULTS: A 61-year-old woman had acute onset of a right homonymous superior quadrantic visual field defect during dialysis after several episodes of transient visual loss associated with symptomatic intradialytic hypotension. MRI showed acute infarction in the left occipital lobe. CONCLUSION: Visual loss is an uncommon complication of hemodialysis. The mechanism usually is related to hypotension and is usually from anterior ischemic optic neuropathy. Although cortical blindness secondary to stroke has been reported as a complication after hemodialysis, we were unable to find another report of visual loss secondary to stroke attributed to intradialytic hypotension with preceding episodes of transient visual loss. Transient visual loss may be a risk factor for stroke during hemodialysis.

Blindness↗
PubMed2004

Bilateral anterior ischemic optic neuropathy after liposuction.

A 30-year-old woman had bilateral anterior ischemic optic neuropathy after undergoing large-volume liposuction. Visual function remained stable over a four-month follow-up, with decreased visual acuity and marked constriction of the visual fields. To our knowledge, this is the second reported case of ischemic optic neuropathy in this setting.

Acetazolamide↗
PubMed2004

Orbital apex syndrome.

PURPOSE OF REVIEW: Visual loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves are the hallmarks of an orbital apex syndrome. Historically, the terms superior orbital fissure, orbital apex, and cavernous sinus have been used to define the anatomic locations of a disease process. However, the diagnostic evaluation and management is similar for each of these entities. The authors reviewed the literature on the diagnosis and evaluation of disorders involving the orbital apex. RECENT FINDINGS: High-resolution MRI is the preferred modality for evaluating most lesions involving the orbital apex. CT is a useful tool in the setting of trauma, to evaluate bone involvement, or when MRI is contraindicated. Although laboratory studies may be useful adjuncts in the diagnostic evaluation of lesions involving the orbital apex, surgical biopsy is often required for definitive diagnosis. SUMMARY: Orbital apex syndromes may result from a variety of inflammatory, infectious, neoplastic, iatrogenic/traumatic, and vascular conditions. A detailed history with review of systems is important in narrowing the differential diagnosis. Management is directed at the underlying cause and may be guided by surgical biopsy. Corticosteroids may be useful if an inflammatory etiology is suspected, but should be used with caution.

Cranial Nerves↗
PubMed2004

Orbital apex syndrome after ethmoidal artery ligation for recurrent epistaxis.

A 34-year-old man with severe, recurrent epistaxis underwent external anterior and posterior ethmoidal artery ligation on the right side. Visual loss from optic neuropathy and complete ophthalmoplegia developed after surgery. Computed tomography revealed surgical clips within the right orbital apex. Emergent removal of the surgical clips and medial wall decompression were performed. Four weeks later, his visual acuity and extraocular motility were unchanged, and diffuse pallor of the right optic disc was observed. Orbital apex syndrome can be a complication of ethmoidal artery ligation. Severe visual loss and ophthalmoplegia may persist despite prompt recognition and treatment.

Adult↗
PubMed2004

Combined central retinal artery and vein occlusion from orbital inflammatory pseudotumour.

Progressive, painful blurred vision and proptosis developed in the left eye of a 32-year-old man over an 8-day period. On initial neuro-ophthalmic evaluation the visual acuity in the left eye was no light perception. Erythema of the periorbital skin, 5 mm of proptosis, and ophthalmoplegia were noted on the left side. Funduscopy revealed occlusion of the central retinal artery and central retinal vein. Computed tomography and magnetic resonance imaging revealed marked distension of the left optic nerve and enhancement of the contents within the left orbit, with clear paranasal sinuses. The diagnosis of orbital inflammatory pseudotumour was made and the orbital signs improved rapidly with 80 mg of prednisone per day. Combined occlusion of the central retinal artery and vein is a rare complication of orbital inflammatory pseudotumour. It is postulated that marked distension of the optic nerve caused mechanical compression of the central retinal vessels leading to the vascular occlusions.

Adult↗
PubMed2004

Shock-induced anterior ischaemic optic neuropathy after radical prostatectomy.

The case is reported of a 61-year-old man who developed shock-induced anterior ischaemic optic neuropathy (SIAION) after undergoing radical prostatectomy. Visual loss began on the third postoperative day. Only one other patient with SIAION after prostatectomy has been reported in the past. SIAION may result in fixed visual loss after radical prostatectomy and ophthalmic evaluation should not be delayed in patients with postoperative visual loss.

Adenocarcinoma↗
PubMed2003

Optic disc structure and shock-induced anterior ischemic optic neuropathy.

PURPOSE: To describe a patient who developed unilateral shock-induced anterior ischemic optic neuropathy (SIAION) after gastrointestinal hemorrhage followed by presumed idiopathic nonarteritic anterior ischemic optic neuropathy (NAION) in the fellow eye. DESIGN: Retrospective, observational case report and literature review. METHODS: The case history of an 80-year-old man who developed SIAION, followed by NAION in the fellow eye, was reviewed. All previously reported cases of SIAION were reviewed. MAIN OUTCOME MEASURES: Neuro-ophthalmic examination, including visual acuity, funduscopy, and automated perimetry. RESULTS: An 80-year-old man, with a history of gastrointestinal bleeding from a duodenal ulcer, was hospitalized and received four units of packed red blood cells after he was found to be severely anemic (hemoglobin 6.7 g/dl). Three days later he complained of loss of vision of the right eye. Neuro-ophthalmic examination 2 weeks later disclosed a visual acuity of counting fingers at 6 inches in the right eye and 20/40 in the left eye, with a right relative afferent pupillary defect and a superior altitudinal visual field defect. Funduscopy revealed optic disc edema with a temporal parapapillary hemorrhage in the right eye and a small optic disc, with no cup, in the left eye. A diagnosis of SIAION secondary to anemia was made. Six weeks later he developed a new inferior altitudinal visual field defect in the left eye and diffuse optic disc swelling. He had no signs or symptoms of giant cell arteritis or polymyalgia rheumatica, his hemoglobin at this time was 11.9 g/dl, and the Westergren erythrocyte sedimentation rate was 6 mm/hour. CONCLUSIONS: Our patient developed optic disc swelling of the right eye after an episode of gastrointestinal hemorrhage (SIAION). The disc swelling in the left eye occurred 8 weeks later, when his hemoglobin had increased to 11.9 g/dl. The timing of the ischemic optic neuropathies suggests that the acute anemia led to involvement of the first but not the second eye. The configuration of the optic disc may have predisposed not only to the second event (NAION) but also to the first episode (SIAION).

Aged↗
PubMed2003

Recovery of visual function in patients with biopsy-proven giant cell arteritis.

OBJECTIVE: To assess the visual function of patients with giant cell arteritis (GCA) who had visual loss from either anterior ischemic optic neuropathy (AION) or central retinal artery occlusion and had a subsequent improvement in visual acuity after treatment with corticosteroids. DESIGN: Retrospective, observational case series. PARTICIPANTS: Thirty-two consecutive patients with biopsy-proven GCA treated at one institution between January 1992 and December 1997. INTERVENTION: Treatment with intravenous methylprednisolone 250 mg every 6 hours for 3 days, followed by oral prednisone 1 mg/kg daily for at least 4 weeks duration. MAIN OUTCOME MEASURES: The number of patients with an improvement in visual acuity after treatment with intravenous methylprednisolone; neuro-ophthalmic evaluation, including visual acuity, funduscopy, and visual field examination of these patients. RESULTS: Improvement in visual acuity occurred in 5 of 39 eyes (13%) with visual loss from biopsy-proven GCA, and all 5 patients had AION. Despite the improvement of visual acuity in these 5 patients, perimetry revealed marked constriction of the visual field in each affected eye. CONCLUSIONS: The prognosis for visual improvement in GCA is poor. Although an improvement in visual acuity occurred in 5 of our patients, marked constriction of the visual field was present in all of them.

Aged↗
PubMed2003

Use of methotrexate in sarcoid-associated optic neuropathy.

OBJECTIVE: To demonstrate the possible beneficial effects of methotrexate (MTX) therapy for patients with sarcoid-associated optic neuropathy (SAON). DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Three patients diagnosed with SAON who received MTX. Two patients had tissue biopsies consistent with sarcoidosis, and 1 patient had clinically diagnosed sarcoidosis based on laboratory and radiographic studies. All 3 patients developed side effects with corticosteroid treatment of their optic neuropathy. INTERVENTION: Patients were treated with weekly doses of oral MTX and monitored with neuro-ophthalmic, medical, and laboratory examinations. MAIN OUTCOME MEASURES: Visual acuity, automated perimetry, and reduction of oral prednisone therapy. RESULTS: After initiation of MTX, all 3 patients showed an improvement or stabilization of visual acuity. All patients had a decrease in their corticosteroid requirements, and all had improved or stabilized visual field deficits. One of the 3 patients developed leukopenia that necessitated a reduction of the methotrexate dose. CONCLUSION: Methotrexate may be effective for SAON as an adjunct to corticosteroid therapy or as an alternative for corticosteroid-intolerant patients. Oral MTX reduced the corticosteroid requirements of 3 patients with SAON, and all 3 demonstrated stable or improved visual function.

Adult↗
PubMed2003

Scanning laser polarimetry of the retinal nerve fiber layer in central retinal artery occlusion.

PURPOSE: To report the results of scanning laser polarimetry (NFA/GDx; Laser Diagnostic Technologies, San Diego, CA). DESIGN: Prospective, consecutive observational case series. PARTICIPANTS: Ten consecutive patients with central retinal artery occlusion (CRAO). METHODS: Neuro-ophthalmic examination and scanning laser polarimetry of the retinal nerve fiber layer (RNFL) of 10 patients with CRAO. MAIN OUTCOME MEASURES: Duration of visual loss, visual acuity, funduscopy, and scanning laser polarimetry of the RNFL in 10 eyes of 10 patients with CRAO. RESULTS: The duration of visual loss before examination and scanning laser polarimetry ranged from 1 to 7 days. Visual acuity was counting fingers at 1 foot or worse in all 10 eyes with CRAO, and funduscopy revealed pallid retinal edema accompanied by a cherry red spot in all affected eyes. Funduscopy of the fellow eyes in all but one patient, who had anterior ischemic optic neuropathy and was subsequently diagnosed with giant cell arteritis, revealed no acute changes. Scanning laser polarimetry of all eyes with CRAO revealed diffuse attenuation of the retardation of the RNFL. Scanning laser polarimetry of the fellow eye revealed a normal bimodal distribution in the eight patients in whom it could be measured. In one patient who was examined 1 day after the onset of visual loss, repeat nerve fiber analysis 6 weeks later revealed further depression of the RNFL compared with the initial scan. Repeat analysis of the RNFL in four other patients showed persistence of the diffuse depression noted during their initial examinations. CONCLUSIONS: Scanning laser polarimetry in CRAO reveals diffuse depression of the retardation of the RNFL, which occurs acutely after the onset of visual loss. To our knowledge these patients represent the first reports of scanning laser polarimetry of the RNFL in acute CRAO.

Adult↗