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Cardoso D, Bezerra S, Soares-dos-Reis R, Sá MJ, Guimarães J. Optic neuropathy diagnosis in the emergency room - retrospective observational study of the last 18 years. Eur J Ophthalmol 2024; 34:267-280. [PMID: 37218168 PMCID: PMC10757394 DOI: 10.1177/11206721231173005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 04/06/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Optic neuropathies (ON), a broad spectrum of disorders of the optic nerve, are a frequent cause of visual loss, presenting either in isolation or associated to neurological or systemic disorders. They are often first evaluated in the Emergency Room (ER) and a rapid determination of the etiology is imperative for implementing timely and appropriate treatment. We aim to describe ER demographic data and clinical characteristics, as well as the performed imaging exams, of patients subsequently hospitalized and diagnosed with ON. Furthermore, we seek to explore the accuracy of ER discharge diagnosis and evaluate possible predictive factors that may influence it. METHODS We retrospectively reviewed the medical records of 192 patients admitted to the ward of the Neurology Department of Centro Hospitalar Universitário São João (CHUSJ), with a discharge diagnosis of ON. Subsequently, we selected those admitted from the ER, with clinical, laboratory and imaging data, between January 2004 and December 2021. RESULTS We included 171 patients. All participants were discharged from the ER and admitted in the ward with a main diagnostic suspicion of ON. Patients were stratified according to suspected etiology at the time of discharge: 99 inflammatory (57.9%), 38 ischemic (22.2%), 27 unspecified (15.8%) and 7 other (4.1%). By comparing with current follow-up diagnosis, 125 patients had an accurate ER diagnosis category (73.1%), 27 had an ON diagnosis of unspecified etiology that was defined only during follow-up (15.8%) and 19 had an inaccurate diagnosis category (11.1%). Diagnostic change was more common with ER ischemic diagnosis (21.1%) compared to inflammatory diagnosis (8.1%) (p = 0.034). CONCLUSIONS Our study reveals that most patients with ON can be accurately diagnosed in the ER through clinical history neurological and ophthalmological evaluation.
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Affiliation(s)
- Daniel Cardoso
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Sofia Bezerra
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ricardo Soares-dos-Reis
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- i3S - Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Maria José Sá
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - Joana Guimarães
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Neurology, Centro Hospitalar de São João (CHUSJ), Porto, Portugal
- Center for Drug Discovery and Innovative Medicines (MedInUP), University of Porto, Portugal
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Majeed HA, Al-Rubiay Y, Abbas AA, AL Nuaimi ME, Khammas HM, Alsaedi ZA, Al Jammal AM, Abdlhasn MM, Abdul-Gaffar AM, Mohammed OS, Abbood ZB, Badr BD, Fahad ZK, Abd-alzahra HAA, Al-dabbag HS, Mahmood L, Al-Qaseer MFT, Al-Khafaji ZNH, Shareef L. An overview of neuro-ophthalmic disorders at Jenna Ophthalmic Center, Baghdad, Iraq (2021-2022). J Med Life 2024; 17:99-108. [PMID: 38737659 PMCID: PMC11080512 DOI: 10.25122/jml-2023-0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 05/14/2024] Open
Abstract
Neuro-ophthalmic disorders are often documented individually for each illness, with little data available on their overall incidence and pattern. The overall incidence of neuro-ophthalmic illnesses in Iraq is still not recorded. This study aimed to evaluate the clinical, demographic, and etiological features of patients seeking consultation at an Iraqi neuro-ophthalmology clinic. A prospective cross-sectional observational research was conducted at the Janna Ophthalmic Center in Baghdad, Iraq. The center serves a diverse patient population from various governorates. All newly diagnosed patients with neuro-ophthalmic disorders who visited the neuro-ophthalmological clinic, regardless of gender or age group, were included. The neuro-ophthalmologist established a diagnosis for each case by reviewing the patient's medical history, doing physical examinations, administering specific tests, and, in certain cases, using neuroimaging methods. The duration of the study was extended from March 2021 to November 2022. Among the 6440 patients evaluated, 613 cases were confirmed at the neuro-ophthalmology clinic. Ischemic optic neuropathy (NAION, AION, and PION) was the most prevalent diagnosis, accounting for 17.61% of newly reported cases in the field of neuro-ophthalmology. This was followed by sixth nerve palsy. Diabetes mellitus affected 42.7% of the cases, followed by hypertension, which affected 39.3% of the participants. The incidence of neuro-ophthalmic diseases tended to be high. Ischemic optic neuropathy and sixth nerve palsy, traumatic/compressive optic neuropathy, and papilledema were the most common neuro-ophthalmic disorders reported.
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Affiliation(s)
- Husam Abdulhadi Majeed
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | - Yasser Al-Rubiay
- Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq
| | | | | | | | | | | | - Mohamed Mosa Abdlhasn
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | - Ali Mhawi Abdul-Gaffar
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | | | - Zainab Basim Abbood
- Imamain Al-Kathimain Medical City, Al-Karkh Health Directorate, Baghdad, Iraq
| | | | | | | | - Hasan Sameer Al-dabbag
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | - Labeeb Mahmood
- Ibn Al-Haitham Teaching Eye Hospital, Baghdad Al-Russafa Health Directorate, Baghdad, Iraq
| | | | | | - Laith Shareef
- Department of Pharmacy, Al-Rasheed University College, Baghdad, Iraq
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Webb Z. Intravenous Thrombolysis for Central Retinal Artery Occlusion: A Look at the Literature for the Emergency Medicine Physician. Cureus 2023; 15:e41878. [PMID: 37457612 PMCID: PMC10348395 DOI: 10.7759/cureus.41878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 07/18/2023] Open
Abstract
Central retinal artery occlusion (CRAO) is a subtype of ischemic stroke and true ocular emergency presenting with acute, painless, monocular vision loss. Typical findings include poor visual acuity (VA), impaired color vision, relative afferent pupillary defect, and on fundoscopic evaluation, retinal edema, cherry red spot, and occasionally visualization of retinal artery emboli. While there are no proven treatments for CRAO, options include orbital massage, hyperbaric oxygen therapy, and intra-arterial or intravenous thrombolysis (IVT). This study reviews the current literature on the efficacy of IVT for patients affected by acute, symptomatic CRAO and provides an up-to-date, evidence-based background for emergency physicians (EPs) who evaluate and manage these patients.
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Affiliation(s)
- Zachary Webb
- Emergency Medicine, Huntington Hospital, Northwell Health, Huntington, USA
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Xia X, Li L, Cheng Z, Chen Q, Huang T, Yu Y, Shang L. Comprehensive bibliometric research in neuroscience: focusing on ophthalmology. Front Neurosci 2023; 17:1106023. [PMID: 37397445 PMCID: PMC10308020 DOI: 10.3389/fnins.2023.1106023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/18/2023] [Indexed: 07/04/2023] Open
Abstract
Background This study aimed to comprehensively summarize the knowledge structure and research hotspots of ophthalmology in the field of neuroscience through bibliometric and visual analysis. Methods We searched the Web of Science Core Collection database for articles from 2002 to 2021 related to ophthalmology in the field of neuroscience. Using VOSviewer and CiteSpace, bibliometric analysis was conducted on the number of annual ophthalmology publications, authors, organizations, countries, journals, cited references, keywords, and burst keywords. Results A total of 9,179 articles were published from 34,073 authors, 4,987 organizations, and 87 countries. The cited references in these articles were published in 23,054 journals. Moreover, there were 30,864 keywords among the 9,179 articles. Notably, scholars have increasingly begun paying attention to ophthalmology in the field of neuroscience in the past 20 years. Claudio Babiloni published the most articles. The University of Washington had the greatest number of articles. The United States, Germany, and England led in the number of articles published. The Journal of Neuroscience was the most cited. The article with the highest outbreak intensity was an article published by Maurizio Corbetta in Nature Reviews Neuroscience in 2002 entitled "Control of goal-directed and stimulus-driven attention in the brain." The most important keyword was the brain, and the top burst keyword was functional connectivity. Conclusion This study visualized ophthalmology research in the field of neuroscience through bibliometric analysis and predicted potential research trends in future to help clinicians and basic researchers provide diversified perspectives and further carry out in-depth research on ophthalmology.
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Abstract
BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.
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Affiliation(s)
- Patrick T. Quaid
- Head of Optometry, VUE Cubed Vision Therapy Clinics, ON, Canada
- College of Optometrists of Ontario (Regulatory Body), ON, Canada
| | - Eric L. Singman
- Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
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