Szemészet, 2011 (148. évfolyam, 1-4. szám)
2011-06-01 - Supplementum
148. évfolyam (2011) Supplementum I. 123 Unilateral visual decay following upper respiratory tract infection - case report Teodóra Balogh, Zsolt Balla, Zsuzsanna Pámer, Zsolt Bíró University of Pécs, Clinical Center, Department of Ophthalmology, Pécs Objective: To draw a lesson concerning diagnostic pitfalls of a case of 63-year-old female patient with unilateral, fast progressing visual decay which turned up 3 days after an upper respiratory tract infection. Results: A female with hypertension and type 2 diabetes mellitus perceived ambiguous visual disturbance on right eye 3 days after upper respiratory tract infection with high fever and cough. Family doctor employed antibiotic treatment for the infection. In the patient’s medical history, mastectomy for malignancy performed 3 years before should be emphasized. She has been followed in oncology since then, without any signs of local recidive or metastases. She was followed up in our ambulance 2 weeks after visual decline: visual acuity (VA) o.u. +5.0 D Sph 0.8, o.d. CFF 34 FIz, central relative scotoma, moderate RAPD, dimmed color perception with gray dominance. Functional parameters of the left eye were normal. Slit lamp examination showed minimal nuclear sclerosis, fundus examination represented normal posterior pole, optical coherence tomography showed normal macula in both eyes. Goldmann perimetry of right eye detected narrowing of visual field to 10-20° of outer border and enlarged blind spot with 1/4 sign. Neurological examination toward retrobulbar neuritis lacked any abnormal symptoms, but the neurologists suggested cranio-orbital MRI. Therapy for improving microcirculation and vitaminé supplementation was started. VEP detected axonal laesion with slightly decreased conduction velocity assuming vascular, or by chance compressive cause. During 2 weeks period her visual functions progressively declined, VA decreased to 0.2, CFF to 20 Hz, with unchanged further parameters. MRI revealed multiplex brain metastases. Conclusion: The correct exploration of general anamnesis with ophthalmologic history is indispensable for correct diagnosis and therapeutic strategy. Our results emphasize, that a coecocentral scotoma characteristic to neuritis, may also be a symptom of optic nerve compression! Monoculus beteg többször visszatérő arteritis temporalis esetének ismertetése Futó Gábor,1 Stettler Márta,1 May Zsolt2 Szent Borbála Kórház, Tatabánya, Szemészeti Osztály,1 Neurológiai Osztály2 83 éves nőbetegünk jobb szemén 2 éve már csak látóidegsorvadást észleltünk. Bal szemen eddig négy alkalommal kezdődött arteritis temporalis tüneteként papillitis vascularis, mely az időben alkalmazott intenzív szteroidkezelés hatására maradéktalanul gyógyult. Azóta az újabb recidiva megelőzése érdekében fenntartó (4 mg) Medrol-terápia következtében kialakult cataracta rontja a látását, melynek műtétjéről a beteg most készül dönteni. Functionally monocular patient with multiply recurrent temporal arteritis - case report Gábor Futó,1 Márta Stettler,1 Zsolt May2 St. Borbála Hospital, Tatabánya, Department of Ophthalmology,1 Department of Neurology2 83 year old female patient had serious optic nerve atrophy on the right eye for years. She had papillitis four times on the left eye as a symptom of temporal arteritis. Entirely resolved the optic nerve inflammation due to timely applied intensive corticosteroid therapy. To prevent further recurrence we administered Medrol (4 mg) as a maintenance therapy, which induced cataract. This reduced patient’s visual acquity, so she will decide on cataract surgery. A Magyar Szemorvostársaság Kongresszusa
