mycophenolic-acid and Retinal-Artery-Occlusion

We report a patient with branch retinal artery occlusion predominant Susac syndrome and review the literature on current diagnostic modalities and therapeutic approaches for this rare condition.. Case report.. A 23-year-old white male presented with a 5-month history of a scotoma in his right eye vision, headaches, and intermittent paresthesias of the lower extremities. Ophthalmic examination was normal with the exception of a hypopigmented small retinal area inferonasal to the fovea in the right eye. Optical coherence tomography demonstrated inner retinal atrophy and optical coherence tomography angiography showed deep capillary layer vessel dropout in both eyes. Ultra-wide-field fluorescein angiography revealed bilateral arteriolar wall hyperfluorescence. Corpus callosal lesions were present on magnetic resonance imaging. Lumbar puncture demonstrated elevated protein. Audiogram was normal. A diagnosis of Susac syndrome was made. The patient initially received oral steroids followed by intravenous steroids and mycophenolate mofetil because of new branch retinal artery occlusions. Thirteen months after initial presentation, the vision was stable at 20/20 in both eyes.. It is a diagnostic challenge when recurrent branch retinal artery occlusion secondary to Susac syndrome presents without the classic symptoms. Optical coherence tomography angiography and subtle magnetic resonance imaging findings aided in early recognition of the diagnosis in our patient. Ultra-wide-field fluorescein angiography was an important tool in disease monitoring. Aggressive management with intravenous corticosteroids and initiation of immunosuppression resulted in long-term preservation of vision and improvement in visual field.

Topics: Administration, Oral; Adrenal Cortex Hormones; Enzyme Inhibitors; Fluorescein Angiography; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Methylprednisolone; Mycophenolic Acid; Prednisone; Recurrence; Retinal Artery Occlusion; Susac Syndrome; Tomography, Optical Coherence; Young Adult

Topics: Adult; Albumins; Aphasia; Audiometry, Pure-Tone; Blood-Brain Barrier; Confusion; Corpus Callosum; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Enzyme Inhibitors; Female; Fluorescein Angiography; Glucocorticoids; Hearing Loss; Humans; Immunologic Factors; Magnetic Resonance Imaging; Mycophenolic Acid; Retinal Artery Occlusion; Serum Albumin; Susac Syndrome; Vertigo

To report a case of acute macular neuroretinopathy in a patient with Susac syndrome.. Case report.. A 39-year-old male patient presented with severe headache, photopsias, and a sudden onset of hearing loss in the right ear. Fluorescein angiography of the right eye revealed multiple branch retinal artery occlusions. Clinical presentation of encephalopathy, hearing loss, and branch retinal artery occlusions, along with characteristic magnetic resonance imaging findings, led to a diagnosis of Susac syndrome. Despite aggressive immunosuppression for four months, the patient later presented with acute macular neuroretinopathy in the left eye.. Acute macular neuroretinopathy and Susac is a new association of two well-defined disorders. The concurrence of both disorders supports retinal ischemia as the proximate cause of acute macular neuroretinopathy and inflammation as a potential etiology.

Topics: Administration, Oral; Adult; Drug Therapy, Combination; Enzyme Inhibitors; Fluorescein Angiography; Glucocorticoids; Headache; Hearing Loss, Sudden; Humans; Male; Methylprednisolone; Mycophenolic Acid; Prednisone; Retinal Artery Occlusion; Susac Syndrome; Tomography, Optical Coherence; Vision Disorders; White Dot Syndromes

A 25-year-old male patient presented to the emergency department with the chief complaint of sudden blindness and was found to have suffered bilateral central retinal artery occlusion (CRAO). This process is most commonly the result of a thrombus or embolus that occludes the retinal artery, and normally presents in a single eye in patients older than 65 who are predisposed to vascular disease. Diagnosis relies most heavily upon funduscopic exam. Potential treatments involve ocular massage, acetazolamide, anterior chamber paracentesis and systemic or local fibrinolysis. Despite these interventions vision is often significantly and permanently impaired. This case underscores the importance of the emergency physician's ability to promptly perform and interpret the funduscopic exam in order to diagnose and evaluate CRAO.

Topics: Adult; Anti-Inflammatory Agents; Antibiotics, Antineoplastic; Blindness; Humans; Male; Mycophenolic Acid; Prednisone; Retinal Artery Occlusion; Thrombolytic Therapy; Tomography, Optical Coherence; Treatment Outcome

Central retinal artery occlusion (CRAO) is uncommon among children and young adults. Bilateral CRAO before the age of 18 years are extremely rare. We present a case of an idiopathic bilateral CRAO in a young healthy female.

Topics: Adolescent; Blindness; Enzyme Inhibitors; Female; Fibrinolytic Agents; Fluorescein Angiography; Glucocorticoids; Humans; Magnetic Resonance Imaging; Methylprednisolone; Mycophenolic Acid; Retinal Artery Occlusion; Tissue Plasminogen Activator; Tomography, Optical Coherence; Vision, Low; Visual Acuity

Topics: Adult; Antiviral Agents; Blindness; Bone Marrow Transplantation; Cytomegalovirus Retinitis; Diagnosis, Differential; Drug Therapy, Combination; Fluorescein Angiography; Humans; Immunosuppressive Agents; Leukemia, Myeloid, Acute; Male; Mycophenolic Acid; Retinal Artery Occlusion; Retinal Vasculitis; Visual Acuity

To report a case of acute occlusive retinal vasculopathy secondary to systemic lupus erythematosus (SLE) successfully treated with plasma exchange and rituximab. Case report.. A 25-year-old female presenting acutely with lupus retinal vasculitis was treated urgently with plasma exchange after failure to respond to intravenous methylprednisolone. Following this, fluorescein angiography demonstrated reperfusion of occluded arterioles. Visual acuity improved from 6/60 to 6/6 bilaterally. Remission was maintained following rituximab (Rituxan) in combination with mycophenolatemofetil and oral prednisolone.. Early treatment with plasma exchange achieved reperfusion of the occluded microvascular circulation with correspondingly good visual recovery and should be considered when patients present with corticosteroid refractory retinal vasculitis associated with SLE.

Topics: Acute Disease; Adult; Antibodies, Monoclonal, Murine-Derived; Female; Fluorescein Angiography; Humans; Immunosuppressive Agents; Lupus Vasculitis, Central Nervous System; Methylprednisolone; Mycophenolic Acid; Neuroprotective Agents; Plasma Exchange; Prednisolone; Retinal Artery Occlusion; Retinal Vasculitis; Rituximab; Treatment Outcome; Visual Acuity

Topics: Adult; Cyclophosphamide; Diagnosis, Differential; Diagnostic Errors; Drug Therapy, Combination; Female; Fluorescein Angiography; Fundus Oculi; Glucocorticoids; Hearing Loss, Sensorineural; Humans; Methylprednisolone Hemisuccinate; Mycophenolic Acid; Nervous System Diseases; Prednisone; Retinal Artery Occlusion; Syndrome

A 39-year-old woman presented with multiple branch retinal artery occlusions almost three years before developing a mass lesion containing calcium in the left frontal lobe. Brain biopsy revealed a small vessel vasculitis and ischemic necrosis of brain with dystrophic calcification. We believe this to be the first case of primary CNS vasculitis with branch retinal artery occlusions and brain calcification.

Topics: Adult; Brain; Calcinosis; Cyclophosphamide; Diagnostic Techniques, Ophthalmological; Female; Humans; Immunosuppressive Agents; Mycophenolic Acid; Prednisone; Retinal Artery Occlusion; Tomography, X-Ray Computed; Treatment Outcome; Vasculitis, Central Nervous System