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Erdem S, Ucmak F, Karahan M, Ava S, Dursun ME, Dursun B, Hazar L, Yolaçan R, Keklikci U. Evaluation of Retinal Microvascular Perfusion Changes in Patients with Celiac Disease. Ocul Immunol Inflamm 2022; 30:1876-1882. [PMID: 34477488 DOI: 10.1080/09273948.2021.1968001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE We aimed to determine whether there are retinal microvascular changes in patients with celiac disease (CD). METHODS A total of 30 patients with CD (group 1) and 30 healthy controls (group 2) were included in this study. AngioVue optical coherence tomography angiography (OCTA) device was used to evaluate the retinal microvascular structure. RESULTS Some of the values of both optic nerve head (ONH) vessel density (VD) and radial peripapillary capillary VDs were found to be significantly lower in group 1 than in group 2. These 2 groups were similar except for one of the parameters of superficial capillary plexus VD (SCP-VD), whereas it was found that deep capillary plexus VD (DCP-VD) was lower in group 1 than in group 2 except for the foveal area. CONCLUSION It was determined that some VDs obtained from the ONH and DCP-VD obtained from most areas of the macular region were significantly lower.
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Affiliation(s)
- Seyfettin Erdem
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Feyzullah Ucmak
- Department of Gastroenterology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Mine Karahan
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Sedat Ava
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Mehmet Emin Dursun
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Birgul Dursun
- Department of Ophthalmology, Diyarbakır Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Leyla Hazar
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ramazan Yolaçan
- Department of Gastroenterology, Dicle University Medical Faculty, Diyarbakır, Turkey
| | - Ugur Keklikci
- Department Ophthalmology, Dicle University Medical Faculty, Diyarbakır, Turkey
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Micronutrient Deficiencies Presenting with Optic Disc Swelling Associated with or without Intracranial Hypertension: A Systematic Review. Nutrients 2022; 14:nu14153068. [PMID: 35893919 PMCID: PMC9331791 DOI: 10.3390/nu14153068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a neurological disorder characterised by optic disc swelling secondary to raised intracranial pressure (ICP) of unknown cause. Obesity is the most established and prevalent risk factor in developed countries. As obesogenic diets are high in calories and nutrient-poor, there may be associated nutritional deficiencies that contribute to the clinical presentation of IIH. Yet none, aside from iron deficiency, are currently included in the inclusion or exclusion criteria for the diagnosis of IIH. Our primary aim was to determine which micronutrient deficiencies, aside from iron deficiency, could present with optic disc swelling associated with or without intracranial hypertension that could potentially meet current IIH diagnostic criteria. To this end, we conducted a systematic search of articles published between 1 January 1980 and 18 December 2020 reporting cases of optic disc swelling associated with micronutrient deficiencies. In total, 65 cases met the eligibility criteria from initial searches: all were case reports and case series with a high risk of bias. Our findings suggest that patients with IIH or unexplained optic disc swelling ought to be screened, investigated, and treated for associated micronutrient deficiencies in vitamin A, B1 and B12; and weight loss interventions in IIH patients ought to promote better nutrition in addition to overall calorie restriction.
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Wang D, Artymowicz A, Park J. A Child With Severe Autism Spectrum Disorder With Bilateral Corneal Ulcers. JAMA Ophthalmol 2022; 140:650-651. [PMID: 35446352 DOI: 10.1001/jamaophthalmol.2022.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Diane Wang
- Department of Ophthalmology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, New York, New York
| | - Anna Artymowicz
- Department of Ophthalmology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, New York, New York
| | - Jennifer Park
- Department of Ophthalmology, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, New York, New York
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Aragão MDFVV, Araújo LC, Valença MM. Headache and neuroimaging findings in conditions of cerebrospinal fluid (CSF) circulation disorders: in hydrocephalus, pseudotumor cerebri, and CSF hypotension syndrome. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The authors wish in this narrative minireview show and comment on some neuroimaging findings encountered in patients with conditions of cerebrospinal fluid circulation disorders, such as in the hydrocephalus, pseudotumor cerebri, and CSF hypotension syndrome. The MRI of a young woman with a clinical diagnosis of post-dural puncture headache, performed on the fourth postpartum day after cesarean delivery, evolving with headache and diplopia, is shown. Non-contrast-enhanced sagittal T1 magnetic resonance imaging shows that the cerebellar tonsils are at the level of the foramen magnum, therefore still within normal limits, but, despite that, the opening of the cerebral aqueduct in the third ventricle is below the imaginary line connecting the anterior clinoid to the vein of Galen, therefore considered abnormally lower than the expected anatomical position. The axial T1-weighted images with post-contrast fat suppression also show impregnation and thickening of the dura mater. There is also mild engorgement of the cerebral venous sinuses, best demonstrated on T1 with post-contrast fat suppression, which is also identified on post-contrast magnetic resonance angiography, with no signs of venous thrombosis. We conclude that the diagnosis of a patient with intracranial hypotension syndrome can be suspected or confirmed with typical neuroimaging findings.
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Kilic K, Korsbæk JJ, Jensen RH, Cvetkovic VV. Diagnosis of idiopathic intracranial hypertension - the importance of excluding secondary causes: A systematic review. Cephalalgia 2021; 42:524-541. [PMID: 34822742 DOI: 10.1177/03331024211056580] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension is characterized by increased intracranial pressure without any pathological findings on neuroimaging, except for signs of high intracranial pressure. Before diagnosing idiopathic intracranial hypertension secondary causes of increased intracranial pressure should be excluded. OBJECTIVE to characterize the phenotype of patients with secondary intracranial hypertension and to identify possible risk factors for secondary intracranial hypertension. METHODS We have systematically searched the PubMed database. The publications were analyzed according to the patient phenotype, age, gender, comorbidities, body mass index/weight status, and additional medication. The results are summarized in four categories: medication, infection, hormonal induced intracranial hypertension and miscellaneous groups of diseases related to sIH. RESULTS We identified 105 eligible papers which included 272 cases. There were 49.6% pediatric cases. Among the adult group,70.9% were women. A total of 40.4% of all cases were obese or overweight, 27% among adults and 13.4% among pediatric cases. Increased BMI and recent weight gain, anemia, renal diseases and hypertension were the most frequent comorbidities related to sIH. CONCLUSION Among sIH patients, 40.4% were obese or overweight; two thirds were women. We recommend that even patients with a typical IIH phenotype should be screened for secondary causes.
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Affiliation(s)
- Kubra Kilic
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Johanne Juhl Korsbæk
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rigmor H Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vlasta Vukovic Cvetkovic
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pathmanandavel K, Gupta S, Dutt S, Wong M, Williams A. Unusual presentation of coeliac disease with idiopathic intracranial hypertension. J Paediatr Child Health 2021; 57:1321-1322. [PMID: 33349969 DOI: 10.1111/jpc.15182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Karrnan Pathmanandavel
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sachin Gupta
- The T.Y. Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Shoma Dutt
- Department of Gastroenterology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Melanie Wong
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Andrew Williams
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
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Abstract
PURPOSE To evaluate ophthalmic parameters in adult celiac patients. METHODS This cross-sectional study included 31 celiac patients (58 eyes) and 25 healthy controls (50 eyes). Tear break up time (TBUT), schirmer test were measured; corneal thickness, anterior chamber parameters were obtained using scheimpflug camera; retinal nerve fiber layer thickness (RNFL) evaluated by using spectral domain optical cohorence tomography. RESULTS There were no statistically significant differences between the groups in terms of gender, age, and intraocular pressure (p > .05). Schirmer's test results and TBUT were significantly lower in celiac patients (p < .001, p < .001). Additionally, the superior RNFL was significantly thinner (p = .017), nasal RNFL thicker (p = .007), and anterior chamber depth larger (p = .037) in celiac patients. The tissue transglutaminase 2 IgA antibody and superior RNFL were negatively correlated (r = -0.394, p = .012). The anterior chamber volume and anti-gliadin IgA antibody were positively correlated (r = 0.369 p = .027). CONCLUSION Celiac disease affects Schirmer's test results, TBUT, segmental RNFL thickness, and anterior chamber parameters. Ocular parameters might be affected in celiac disease especially in the presence of high antibody titer.
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Affiliation(s)
- Leyla Hazar
- Departmant of Ophthalmology, Kızıltepe State Hospital , Mardin, Turkey
| | - Gülistan Oyur
- Departmant of Ophthalmology, Mardin State Hospital , Mardin, Turkey
| | - Kadri Atay
- Departmant of Gastroenterology, Mardin State Hospital , Mardin, Turkey
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Fousekis FS, Katsanos A, Katsanos KH, Christodoulou DK. Ocular manifestations in celiac disease: an overview. Int Ophthalmol 2020; 40:1049-1054. [PMID: 31916055 DOI: 10.1007/s10792-019-01254-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To review and highlight the ocular manifestations associated with celiac disease (CD) and presentation of their pathogenetic mechanisms. METHODS A thorough review of the literature was performed using PubMed to identify articles about serrated polyposis syndrome. The search was performed using the search string: ("celiac disease" OR "coeliac disease") AND ("ocular manifestations" OR "eye" OR "orbitopathy" OR "uveitis" OR "neuro-ophthalmic manifestations"). Only articles in English were reviewed. RESULTS Several ocular symptoms and disorders have been associated with CD and are a result of defective intestinal absorption and immunological mechanisms. These include nyctalopia, dry eye, cataract, thyroid-associated orbitopathy, uveitis, central retinal vein occlusion and neuro-ophthalmic manifestations. In addition, CD-related ocular disease may represent the first manifestation of CD. CONCLUSION CD may hold accountable for the development of ocular diseases of obscure etiology.
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Affiliation(s)
- Fotios S Fousekis
- Department of Gastroenterology and Hepatology, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45100, Ioannina, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Konstantinos H Katsanos
- Department of Gastroenterology and Hepatology, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45100, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Department of Gastroenterology and Hepatology, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, 45100, Ioannina, Greece.
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Headache Associated with Coeliac Disease: A Systematic Review and Meta-Analysis. Nutrients 2018; 10:nu10101445. [PMID: 30301194 PMCID: PMC6213149 DOI: 10.3390/nu10101445] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/25/2018] [Accepted: 09/29/2018] [Indexed: 01/09/2023] Open
Abstract
Objective: The aim of this systematic review was to explore the relationship between coeliac disease (CD) and headache. The objectives were to establish the prevalence of each entity amongst the other, to explore the role of gluten free diet (GFD), and to describe the imaging findings in those affected by headaches associated with CD. Methodology: A systematic computer-based literature search was conducted on the PubMed database. Information regarding study type, population size, the age group included, prevalence of CD amongst those with headache and vice versa, imaging results, the nature of headache, and response to GFD. Results: In total, 40 articles published between 1987 and 2017 qualified for inclusion in this review. The mean pooled prevalence of headache amongst those with CD was 26% (95% CI 19.5–33.9%) in adult populations and 18.3% (95% CI 10.4–30.2%) in paediatric populations. The headaches are most often migraine-like. In children with idiopathic headache, the prevalence of CD is 2.4% (95% CI 1.5–3.7%), whereas data for adult populations is presently unavailable. Brain imaging can be normal, although, cerebral calcifications on CT, white matter abnormalities on MRI and deranged regional cerebral blood flow on SPECT can be present. GFD appears to be an effective management for headache in the context of CD, leading to total resolution of headaches in up to 75% of patients. Conclusions: There is an increased prevalence of CD amongst idiopathic headache and vice versa. Therefore, patients with headache of unknown origin should be screened for CD, as such patients may symptomatically benefit from a GFD.
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Abstract
PURPOSE To determine possible eye involvement in pediatric patients with celiac disease. METHODS Children (aged 5-18 years) with classic celiac disease and sex- and age-matched controls were included. In addition to a complete ophthalmologic examination, all patients were scanned by a Scheimpflug camera and spectral domain optical coherence tomography, and Schirmer and break-up time (BUT) tests were performed. Data were evaluated by paired t test, with a P value of <0.05 considered statistically significant. RESULTS A total of 31 celiac patients (19 females [61%]) and 34 controls (20 females [59%]) were included. Mean age of the celiac patients was 11.0 ± 4.4 years (range, 4-18 years); of the controls, 10.4 ± 2.6 years (range, 5-15 years; P = 0.473). Mean follow-up of patients was 5.4 ± 1.7 years (range, 3-7.2 years). The eyes of children with celiac disease, compared to controls, did show decreased anterior chamber depth (3.5 ± 0.2 vs 3.7 ± 0.2, resp.; P < 0.001), decreased anterior chamber volume (170.8 ± 25.5 vs 190.7 ± 27.4; P < 0.001), lower Schirmer (17.9 ± 9.1 vs 21.6 ± 4.1; P = 0.038), and lower BUT (10.8 ± 3.8 vs 12.1 ± 1.7; P = 0.046), as well as lower retinal nerve fiber layer (general 102.8 ± 8.2 vs 108.9 ± 10.1; P < 0.001). CONCLUSIONS Decreases in retinal nerve fiber, anterior chamber shallowing, and qualitative and quantitative reduction in tears can occur in celiac patients, even if routine ocular examination reveals no abnormality.
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Aylward SC, Reem RE. Pediatric Intracranial Hypertension. Pediatr Neurol 2017; 66:32-43. [PMID: 27940011 DOI: 10.1016/j.pediatrneurol.2016.08.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Abstract
Primary (idiopathic) intracranial hypertension has been considered to be a rare entity, but with no precise estimates of the pediatric incidence in the United States. There have been attempts to revise the criteria over the years and adapt the adult criteria for use in pediatrics. The clinical presentation varies with age, and symptoms tending to be less obvious in younger individuals. In the prepubertal population, incidentally discovered optic disc edema is relatively common. By far the most consistent symptom is headache; other symptoms include nausea, vomiting tinnitus, and diplopia. Treatment mainstays include weight loss when appropriate and acetazolamide. Furosemide may exhibit a synergistic benefit when used in conjunction with acetazolamide. Surgical interventions are required relatively infrequently, but include optic nerve sheath fenestration and cerebrospinal fluid shunting. Pain and permanent vision loss are the two major complications of this disorder and these manifestations justify aggressive treatment. Once intracranial hypertension has resolved, up to two thirds of patients develop a new or chronic headache type that is different from their initial presenting headache.
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Affiliation(s)
- Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Rachel E Reem
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
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Tepe D, Demirel F, Seker ED, Arhan EP, Tayfun M, Esen I, Kara O, Kizilgun M. Prevalence of idiopathic intracranial hypertension and associated factors in obese children and adolescents. J Pediatr Endocrinol Metab 2016; 29:907-14. [PMID: 27464033 DOI: 10.1515/jpem-2015-0470] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is one of the most important and rare complications of obesity. Prevalence of IIH in childhood obesity is not known. The purpose of this study was to determine the prevalence of IIH in obese children and adolescents and to investigate the relevant factors. METHODS In this study, 1058 obese children and adolescents between 2 and 18 years of age were included. Funduscopic examination was conducted for all subjects. In cases with papilledema, increase in intracranial pressure was clarified by measuring CSF pressure with a lumbar puncture. Other causes of IIH were ruled out with clinical, laboratory tests and imaging techniques. RESULTS Idiopathic intracranial hypertension was diagnosed in 14 subjects (1.32%). Rates of headache and systemic hypertension in subjects with IIH was determined to be 78.6% and 28.6%, respectively. Morning cortisol, fasting insulin and HOMA-IR values were found to be significantly higher in this cases (p<0.05). CONCLUSIONS In childhood obesity, IIH should be kept in mind as a serious complication. Funduscopic examination is an easy method that suggests IIH. In particular, obese children with systemic hypertension and refractory headache should be considered for IIH.
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Ramkumar HL, Verma R, Crow J, Robbins S, Granet DB, Sheldon CA, Henretig FM, Liu GT. A baby with a lot of nerve. Surv Ophthalmol 2015; 61:506-11. [PMID: 26656927 DOI: 10.1016/j.survophthal.2015.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 11/18/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
An infant presented with bilateral disk edema and an acute left sixth cranial nerve (CN VI) palsy because of pseudotumor cerebri (PTC). PTC is rare in infants where it is often associated with endocrine abnormalities, medications, viral infections, systemic conditions, and nutritional etiologies such as vitamin A toxicity. We report a case of PTC in an infant associated with hypervitaminosis A with an unlikely source-a common prenatal vitamin.
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Affiliation(s)
- Hema L Ramkumar
- Department of Ophthalmology, University of California, San Diego, San Diego, California, USA
| | - Rohan Verma
- School of Medicine, University of California, San Diego, San Diego, California, USA
| | - Janet Crow
- Department of Pediatrics, University of California, San Diego, California, USA
| | - Shira Robbins
- Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center & Shiley Eye Institute, University of California, San Diego, San Diego, California, USA
| | - David B Granet
- Pediatric Ophthalmology and Adult Re-Alignment Services, Ratner Children's Eye Center & Shiley Eye Institute, University of California, San Diego, San Diego, California, USA.
| | - Claire A Sheldon
- Division of Neuro-Ophthalmology, Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fred M Henretig
- Section of Clinical Toxicology, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Grant T Liu
- Neuro-ophthalmology Service, Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chiu M, Watson S. Xerophthalmia and vitamin A deficiency in an autistic child with a restricted diet. BMJ Case Rep 2015; 2015:bcr-2015-209413. [PMID: 26438671 DOI: 10.1136/bcr-2015-209413] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report the ocular and systemic manifestations of vitamin A deficiency in a child with a complicated medical history including autism and a restricted diet, living in a developed country. This child had significant vitamin A deficiency despite being under long-term medical care, yet the diagnosis was not considered until he had an ophthalmology review for visual deterioration.
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Affiliation(s)
- Mimi Chiu
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie Watson
- Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia Department of Paediatric Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Abstract
Celiac disease (CD) is an immune-mediated disease characterized by permanent gastrointestinal tract sensitivity to gluten in genetically predisposed individuals. It has varied clinical manifestations, ranging from gastrointestinal to extraintestinal, including neurological, skin, reproductive and psychiatric symptoms, which makes its diagnosis difficult and challenging. Known neurological manifestations of CD include epilepsy with or without occipital calcification, attention deficit hyperactivity disorder and ataxia, headache, neuropathies and behavior disorders. We present the case of a 14-year-old female with headaches and blurred vision for 1 year; she was noted to have papilledema on ophthalmic examination with increased cerebrospinal fluid opening pressure on lumber puncture and was diagnosed as a case of pseudotumor cerebri (PTC). Meanwhile her workup for chronic constipation revealed elevated tissue transglutaminase IgA and antiendomysial IgA antibodies. Upper gastrointestinal endoscopy with duodenal biopsy confirmed the diagnosis of CD. The patient was started on a gluten-free diet, leading to resolution of not only gastrointestinal symptoms but also to almost complete resolution of symptoms of PTC. This report describes the correlation of CD and PTC as its neurological manifestation.
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Affiliation(s)
- Uzma Rani
- State University of New York Upstate Medical University, Syracuse, N.Y., USA
| | - Aamer Imdad
- State University of New York Upstate Medical University, Syracuse, N.Y., USA
| | - Mirza Beg
- State University of New York Upstate Medical University, Syracuse, N.Y., USA
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Abstract
PURPOSE To report the occurrence of xerophthalmia and keratomalacia in a patient with Alagille syndrome. METHODS The patient's record and relevant literature were reviewed. RESULTS A 3-year-old boy with Alagille syndrome was examined at our institution due to severe bilateral ocular irritation. A corneal ulcer and keratomalacia were found in the right eye and severe dryness with corneal opacification was found in the left eye. He was treated with topical fortified antibiotics in the right eye, followed by amniotic membrane transplantation. Due to his systemic condition, characterized by severe cholestasis and intestinal malabsorption, a suspicion of vitamin A deficiency was raised and was later confirmed in serum analysis. CONCLUSION This is the first report of xerophthalmia in a patient with Alagille syndrome. Vitamin A deficiency leading to xerophthalmia is common in developing countries; however, its occurrence in the West is rare, leading to a reduced awareness of this disorder amongst clinicians. Unusual eating habits, intestinal malabsorption and liver disease are possible causes for such a deficiency. The purpose of this case report is to raise awareness to the possibility of vitamin A deficiency in children with keratopathy, especially when associated with these disorders.
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Affiliation(s)
- Elad Moisseiev
- Department of Ophthalmology, Tel Aviv Medical Center, 'Dana-Dwek' Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel ; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, 'Dana-Dwek' Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel ; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gad Dotan
- Department of Ophthalmology, Tel Aviv Medical Center, 'Dana-Dwek' Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel ; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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