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Gandhi RA, MacIntosh PW, Lee AG, Van Stavern GP. Should Patients With Optic Neuritis Be Screened for Tuberculosis? J Neuroophthalmol 2024:00041327-990000000-00660. [PMID: 38874910 DOI: 10.1097/wno.0000000000002185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Affiliation(s)
- Rashmin A Gandhi
- Centre for Sight (RAG), Hyderabad, India; Foresight Worldwide (RAG), Jaipur, India; Ophthalmology Residency Program, Neuro-Ophthalmology Service (PWM), Global Ophthalmology Fellowship, Illinois Eye and Ear Infirmary (PWM), University of Illinois College of Medicine, Chicago, Illinois; Department of Ophthalmology (AGL), Houston Methodist, Houston, Texas; and Department of Ophthalmology and Visual Sciences (GPVS), Washington University in St Louis, St Louis, Missouri
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Tang J, Chen H, Chen F. CT and MRI presentation of nasopharyngeal tuberculosis (with a case report). Radiol Case Rep 2024; 19:1702-1707. [PMID: 38384704 PMCID: PMC10877107 DOI: 10.1016/j.radcr.2024.01.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/27/2024] [Indexed: 02/23/2024] Open
Abstract
Nasopharyngeal tuberculosis is a rare extrapulmonary tuberculosis caused by Mycobacterium tuberculosis invading the nasopharynx. Early clinical symptoms are atypical, making the condition easy to overlook and misdiagnosed. We retrospectively reviewed the case of a 37-year-old man who visited the clinic in March 2023, presenting with enlarged cervical lymph nodes persisting for over a year. Computed tomography and magnetic resonance imaging showed the nasopharynx wall was thickened, and cervical multiple enlarged lymph nodes were visible, presenting bead-like appearance. The enhanced scan revealed the lesion uneven enhancement. He was diagnosed with nasopharyngeal carcinoma with lymph node metastasis based on the images. However, the histopathological examination finally confirmed that the nasopharyngeal and neck mass were tuberculous granulomas. Nasopharyngeal tuberculosis is easily misdiagnosed and mistreated, and it is especially difficult to differentiate from nasopharyngeal carcinoma. When diagnosing and treating neck masses, clinicians should consider the possibility of nasopharyngeal tuberculosis in patients with chronic nasopharyngeal symptoms. Nasopharyngoscope biopsy and histopathological examination have great value in the diagnosis of nasopharyngeal tuberculosis.
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Affiliation(s)
| | | | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), NO. 19, Xiuhua ST, Xiuying Dic, Haikou, Hainan, 570311, China
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Ismail MA, Shariffudin NS, Bt Abd Jalil NF, Yew TC, Wan Hitam WH. Concurrent Tuberculous Optic Neuritis and Optic Perineuritis in a Patient With Human Immunodeficiency Virus (HIV). Cureus 2024; 16:e55867. [PMID: 38595896 PMCID: PMC11002712 DOI: 10.7759/cureus.55867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/11/2024] Open
Abstract
Concurrent tuberculous optic neuritis (ON) and optic perineuritis (OPN) in a patient with human immunodeficiency virus (HIV) is extremely rare. HIV-induced progressive CD4 depletion is associated with an increased risk of tuberculosis (TB), disseminated TB, and death. Early detection and initiation of anti-TB therapy with corticosteroid commencement helps in achieving better visual outcomes. Interestingly, we report a case of concurrent ON and OPN in a patient with HIV-TB co-infection. A 29-year-old lady, a prisoner, with newly diagnosed treatment-naive HIV, presented with acute-onset reduced vision in the left eye for 10 days. It was associated with pain in eye movement and headache. The patient was known to be a drug abuser since the age of 19 years and was a sexual worker. Her CD4 count was 292 cells/mm3.Visual acuity of the right eye was 6/12 with a pinhole of 6/9, and there was no perception of light (NPL) in all four quadrants of the left eye. Relative afferent pupillary defect (RAPD) was positive in the left eye. Both anterior segments were unremarkable. The right eye fundoscopy showed a normal optic disc, while the left eye showed a hyperemic disc. During subsequent follow-up, the patient had reduced right eye vision, and the vision dropped to 6/30 with a pinhole of 6/15. Her erythrocyte sedimentation rate (ESR) was raised to 88 mm/h. The Mantoux test was positive. Chest radiography was normal. MRI of the brain and orbit showed significant enhancement of the right optic nerve and left optic nerve sheath suggesting the diagnosis of right eye ON and left eye OPN secondary to TB. The patient was co-managed with an infectious disease team. She was started on highly active antiretroviral therapy (HAART) treatment (oral Tenvir-EM and efavirenz) upon presentation. Anti-TB therapy was commenced two months later. She was started on the intensive phase of the anti-TB regime followed by the maintenance phase. Oral dexamethasone was given concurrently according to the central nervous system (CNS) TB regime for six weeks. During follow-up, her right eye visual acuity was 6/9, and her left eye visual acuity improved to 6/12. Fundoscopy showed bilateral pale discs. To date, no episodes of recurrence have been seen.
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Affiliation(s)
- Muhammat Asyari Ismail
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, MYS
- Department of Ophthalmology, Hospital Melaka, Melaka, MYS
| | | | | | - Tze Cheng Yew
- Department of Radiology, Hospital Melaka, Melaka, MYS
| | - Wan-Hazabbah Wan Hitam
- Department of Ophthalmology and Visual Sciences, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, MYS
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He RL, Liu Y, Tan Q, Wang L. The rare manifestations in tuberculous meningoencephalitis: a review of available literature. Ann Med 2023; 55:342-347. [PMID: 36598144 PMCID: PMC9828632 DOI: 10.1080/07853890.2022.2164348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Aim: Tuberculous meningitis is an infectious disease of the central nervous system caused by Mycobacterium tuberculosis (M. tuberculosis). It mainly involves the meninges and brain parenchyma, as well as the spinal cord and meninges; Disability and mortality rates are high. In recent years, due to the increase of drug-resistant tuberculosis patients, population mobility and the prevalence of acquired immune deficiency syndrome, the incidence rate of tuberculosis has increased significantly, and tuberculous meningitis has also increased.Methods: At present, tuberculosis is still a worldwide infectious disease that seriously threatens human health, especially in underdeveloped and developing countries. China is the largest developing country in the world with a large population.Results: The situation of tuberculosis prevention and control is grim. Its disability rate is the highest in tuberculosis infection. In addition to the common non-specific manifestations, tuberculous meningoencephalitis may also have rare manifestations of stroke, hearing loss and visual loss.Conclusion: Understanding and timely improvement of corresponding examinations and targeted treatment will help improve the prognosis of patients.
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Affiliation(s)
- Rong Li He
- Department of Infection Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yun Liu
- Department of Infection Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Quanhui Tan
- Department of Infection Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lan Wang
- Department of Infection Disease, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Jamali Dogahe S, Pakravan P, Pakravan M. Acute Optic Neuritis: An Update on Approach and Management. J Ophthalmic Vis Res 2023; 18:433-440. [PMID: 38250236 PMCID: PMC10794797 DOI: 10.18502/jovr.v18i4.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 01/23/2024] Open
Abstract
This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases.
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Fung THM, Pradeep A. Bilateral Atypical Retrobulbar Optic Neuritis Associated With Tuberculosis in an Immunocompetent Patient. J Neuroophthalmol 2021; 41:e174-e176. [PMID: 32701759 DOI: 10.1097/wno.0000000000001022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Timothy H M Fung
- The Queens Medical Centre, EENT Centre, Department of Ophthalmology, Nottingham, United Kingdom
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Hsieh YY, Tsai CC, Chen CC, Chao TY. Decreased visual acuity after chemotherapy in a case with diffuse large B cell lymphoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2021. [DOI: 10.4103/jcrp.jcrp_16_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shahidatul-Adha M, Zunaina E, Liza-Sharmini AT, Wan-Hazabbah WH, Shatriah I, Mohtar I, Azhany Y, Adil H. Ocular tuberculosis in Hospital Universiti Sains Malaysia - A case series. Ann Med Surg (Lond) 2017; 24:25-30. [PMID: 29062482 PMCID: PMC5647468 DOI: 10.1016/j.amsu.2017.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ocular tuberculosis (TB) encompasses a broad spectrum of clinical manifestations affecting different structures of the eye. It is caused by Mycobacterium tuberculosis, a great ancient organism that induces various types of diseases and unfavorable outcomes if unrecognized and not well treated. PURPOSE To report the clinical profile of 34 ocular TB cases observed during 6 years period in Hospital Universiti Sains Malaysia (HUSM). METHOD A retrospective review of medical records from 34 patients diagnosed with ocular TB in HUSM from January 2011 until December 2016. RESULTS The mean age was 43 ± 14.6 years old. Both male and female affected in about 1:1 ratio. The majority of subjects were local Malays (91.2%). Risk factors included previous contact with pulmonary TB patients (38.2%), and patients with underlying diabetes mellitus (26.5%). Most patients showed normal chest radiography (79.4%). However they had positive Mantoux test (94.1%) and raised erythrocyte sedimentation rate (ESR) value (58.8%). Uveitis was the most common ocular manifestation of ocular TB (70.6%) while the rare ocular manifestations included optic perineuritis and optic neuritis, orbital apex syndrome, orbital cellulitis, sclerokeratitis, corneal ulcer and conjunctival abscess. All patients responded well to anti-TB treatment, but visual outcome was variable. CONCLUSIONS This review shows the diverse entity of ocular TB spectrum in an endemic area. Good clinical response to anti-tuberculous therapy supported the presumed diagnosis of ocular TB in majority of the cases.
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Affiliation(s)
- M Shahidatul-Adha
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - E Zunaina
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - A T Liza-Sharmini
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - W H Wan-Hazabbah
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - I Shatriah
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - I Mohtar
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Y Azhany
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - H Adil
- Department of Ophthalmology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
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Dalvin LA, Smith WM. Intraocular manifestations of mycobacterium tuberculosis: A review of the literature. J Clin Tuberc Other Mycobact Dis 2017; 7:13-21. [PMID: 31723696 PMCID: PMC6850243 DOI: 10.1016/j.jctube.2017.01.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 01/04/2017] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
Mycobacterium tuberculosis: is most commonly associated with pulmonary infection. However, tuberculosis (TB) can also affect the eye. TB can affect nearly any tissue in the eye, and a high index of suspicion is required for accurate diagnosis, as many of the intraocular manifestations of TB can mimic other, more common diseases. Correct diagnosis is critical because systemic anti-tuberculosis treatment may be required, and vision loss or even loss of the affected eye can occur without proper treatment. Thus, it is important for ophthalmologists and infectious disease specialists to work together to accurately diagnose and treat intraocular TB. This article reports the various known presentations of intraocular TB and reviews important elements of diagnosis and treatment.
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Affiliation(s)
| | - Wendy M. Smith
- Department of Ophthalmology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
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Garg RK, Malhotra HS, Kumar N, Uniyal R. Vision loss in tuberculous meningitis. J Neurol Sci 2017; 375:27-34. [PMID: 28320145 DOI: 10.1016/j.jns.2017.01.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/23/2016] [Accepted: 01/09/2017] [Indexed: 12/11/2022]
Abstract
Vision loss is a disabling complication of tuberculous meningitis. Approximately, 15% of survivors are either completely or partially blind. All structures of the visual pathway may be affected in tuberculous meningitis. Optic nerve and optic chiasma are most frequently and dominantly affected. Thick-gelatinous exudates lying over the base of brain, are the pathological hallmark of tuberculous meningitis and are responsible for almost all of its major complications, including vision loss. Strangulation of optic nerves and optic chiasma by the exudates, compression over optic chiasma by the dilated third ventricle, raised intracranial pressure, endarteritis, shunt failure, bacterial invasion of optic nerves and drug-induced optic nerve damage are important reasons that are considered responsible for vision loss. Prompt antituberculosis treatment is the best management option available. Immunomodulatory drugs and cerebrospinal fluid diversion procedures are of limited help. Early recognition and treatment of tuberculous meningitis is the only way forward to tackle this problem.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
| | | | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Uniyal
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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Gordon LK. Optic Nerve. Handb Exp Pharmacol 2017; 242:369-386. [PMID: 27787712 DOI: 10.1007/164_2016_19] [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] [Indexed: 06/06/2023]
Abstract
Optic nerve diseases arise from many different etiologies including inflammatory, neoplastic, genetic, infectious, ischemic, and idiopathic. Understanding some of the characteristics of the most common optic neuropathies along with therapeutic approaches to these diseases is helpful in designing recommendations for individual patients. Although many optic neuropathies have no specific treatment, some do, and it is those potentially treatable or preventable conditions which need to be recognized in order to help patients regain their sight or develop a better understanding of their own prognosis. In this chapter several diseases are discussed including idiopathic intracranial hypertension, optic neuritis, ischemic optic neuropathies, hereditary optic neuropathies, trauma, and primary tumors of the optic nerve. For each condition there is a presentation of the signs and symptoms of the disease, in some conditions the evaluation and diagnostic criteria are highlighted, and where possible, current therapy or past trials are discussed.
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Affiliation(s)
- Lynn K Gordon
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
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Basal Y, Ermişler B, Eryilmaz A, Ertuğrul B. Two rare cases of head and neck tuberculosis. BMJ Case Rep 2015; 2015:bcr-2015-211897. [PMID: 26498669 DOI: 10.1136/bcr-2015-211897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis is an infectious disease, which is the leading cause of mortality and morbidity and is still a serious health concern. The fact that extra pulmonary tuberculosis does not have specific examination and radiographic findings and that clinical findings vary depending on the organ in which it is detected cause diagnostic difficulties. The head and neck region is an uncommon site for tuberculosis and tuberculosis can localise in many different places of the head and neck region. In this article, the authors present a case of nasopharyngeal tuberculosis, which clinically mimics nasopharyngeal carcinoma and rare cutaneous tuberculosis of the pinna. A wide knowledge of head and neck tuberculosis, including the disease in the differential diagnosis and carrying out microbiological examinations are necessary for accurate diagnosis.
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Affiliation(s)
- Yesim Basal
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Barış Ermişler
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Aylin Eryilmaz
- Department of Otorhinolaryngology, Adnan Menderes University, Aydın, Turkey
| | - Bülent Ertuğrul
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University, Aydın, Turkey
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Optic nerve lymphoma: report of two cases and review of the literature. Surv Ophthalmol 2014; 60:153-65. [PMID: 25595061 DOI: 10.1016/j.survophthal.2014.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 12/22/2022]
Abstract
Lymphoma may involve the optic nerve as isolated optic nerve lymphoma or in association with central nervous system (CNS) or systemic lymphoma. We present two biopsy-proven non-Hodgkin lymphomas of the optic nerve and compare our findings with previously reported cases. We discuss the mechanism of metastasis, classification of optic nerve involvement, clinical features, radiologic findings, optic nerve biopsy indications and techniques, histologic features, and treatments. We propose a classification system of optic nerve lymphoma: isolated optic nerve involvement, optic nerve involvement with CNS disease, optic nerve involvement with systemic disease, and optic nerve involvement with primary intraocular lymphoma. Although it is an uncommon cause of infiltrative optic neuropathy, optic nerve metastasis should be considered in patients with a history of lymphoma. The recommended approach to a patient with presumed optic nerve lymphoma includes neuroimaging and cerebrospinal fluid evaluation as part of the initial workup, then judicious use of optic nerve biopsy, depending on the clinical situation.
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight the clinical presentation of a variety of inflammatory optic neuropathies through a case-based format. While emphasis will be placed on optic neuritis, which represents the most common acquired inflammatory optic nerve injury, the cardinal clinical features of other demyelinating forms of optic neuropathy and potential mimics for typical optic neuritis will be discussed. RECENT FINDINGS Novel developments in the diagnostic evaluation, clinical associations, and treatment options for several inflammatory optic neuropathies will be described. Key points will emphasize clinical pearls and potential pitfalls that may thwart early diagnosis of underlying demyelinating, infectious, and inflammatory diseases presenting with optic nerve involvement. SUMMARY This review will aid the clinician in identifying potential red flags that should prompt consideration for causes of inflammatory optic nerve injury linked to neurologic and systemic disorders, and help guide safe and effective management for these conditions.
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Patil C, Kharat (Patil) R, Deshmukh P, Biswas J, John B. Primary tuberculosis of nasopharynx (adenoid)– A rare presentation. ASIAN PAC J TROP MED 2013; 6:246-8. [DOI: 10.1016/s1995-7645(13)60033-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/31/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022] Open
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Miliary tuberculosis with bilateral pneumothorax – A case report. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60109-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tedom, Penlap V, Kieft R, McArthur AG, Mbacham W, Mark Welch D, Hajduk SL, Titanji VPK. Molecular typing of Mycobacterium tuberculosis isolates from Yaoundé reveals RIF resistance markers, clonal relatedness and mutation patterns. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2012. [DOI: 10.1016/s2222-1808(12)60075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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