Diffusion-Weighted Imaging Changes in a Child With Posterior Ischemic Optic Neuropathy

Harrar, Dana; Solomon, Jessica; Shah, Ankoor S.; Vaughn, Jennifer; Durbin, Adam D.; Rivkin, Michael J.

doi:10.1016/j.pediatrneurol.2018.03.014

Cited by 6 publications

(5 citation statements)

References 15 publications

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“…In the remaining 3 cases, diagnosis of PION could not be established due to concurrent ocular disease. The results of our systematic investigation support the notion that DWI-MRI is able to visualize optic nerve ischemia in acute PION, as indicated by previous case reports 8,10,12,13,[16][17][18][19]25 . This finding is of major significance as DWI-MRI allows for an early diagnosis of clinically suspected PION in the acute phase of the disease, thereby possibly reducing the time delay to the initiation of corticosteroid treatment in GCA.…”

Section: Discussionsupporting

confidence: 88%

“…Cerebral DWI has long been an established method to identify ischemic stroke, which is a feared complication in GCA patients with cranial artery involvement 48 . However, a growing number of case reports [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]49 and systematic studies 26,32,33,50,51 substantiate the presence of DWI abnormalities in non-arteritic ischemic lesions of the optic nerve and retina. Additionally, DTI studies by Fang and Wang et al have observed changes in ON fractional anisotropy in subacute AION of unspecified etiology 52,53 .…”

Section: Discussionmentioning

confidence: 99%

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Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis

Danyel

Miszczuk

Pietrock

et al. 2022

Sci Rep

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This study assessed diffusion abnormalities of the optic nerve (ON) in giant cell arteritis (GCA) patients with acute onset of visual impairment (VI) using diffusion-weighted magnetic resonance imaging (DWI). DWI scans of GCA patients with acute VI were evaluated in a case-control study. Two blinded neuroradiologists assessed randomized DWI scans of GCA and controls for ON restricted diffusion. Statistical quality criteria and inter-rater reliability (IRR) were calculated. DWI findings were compared to ophthalmological assessments. 35 GCA patients (76.2 ± 6.4 years; 37 scans) and 35 controls (75.7 ± 7.6 years; 38 scans) were included. ON restricted diffusion was detected in 81.1% (Reader 1) of GCA scans. Localization of ON restricted diffusion was at the optic nerve head in 80.6%, intraorbital in 11.1% and affecting both segments in 8.3%. DWI discerned affected from unaffected ON with a sensitivity, specificity, positive and negative predictive value of 87%/99%/96%/96%. IRR for ON restricted diffusion was κinter = 0.72 (95% CI 0.59–0.86). DWI findings challenged ophthalmologic diagnoses in 4 cases (11.4%). DWI visualizes anterior and posterior ON ischemia in GCA patients with high sensitivity and specificity, as well as substantial IRR. DWI may complement the ophthalmological assessment in patients with acute VI.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis

Danyel

Miszczuk

Pietrock

et al. 2022

Sci Rep

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“…1 Several prior reports have demonstrated the utility of MRI in PION, showing diffusion restriction in the ON [hyperintensity on diffusion weighted imaging with decreased apparent diffusion coefficient (ADC)], indicating ischemic injury following infection, noninflammatory optic neuropathies, radiation, and/or surgical interventions as shown in Table 1. 4,6,[8][9][10][11][12][13][14][15][16] Out of these reports, only a handful of cases described the presence of ON diffusion restriction in patients diagnosed with PION following nonocular surgeries, especially those that are prolonged, performed in a prone position or associated with massive blood loss. [3][4][5][6]17 Ophthalmoscopic examination in these patients revealed no abnormalities initially and optic disc pallor later.…”

Section: Discussionmentioning

confidence: 99%

Unilateral Optic Nerve Diffusion Restriction After Sinus Surgery Secondary to Central Retinal Artery Occlusion

2022

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Introduction: Permanent perioperative vision loss is caused by ischemic optic neuropathy (ION) or central retinal artery occlusion (CRAO). Whereas diffusion restriction of the optic nerve (ON) on brain magnetic resonance imaging has been previously reported in perioperative posterior ION (PION), there are no reports of ON diffusion restriction in patients diagnosed with acute perioperative CRAO. We present a case of perioperative CRAO to highlight this neuroimaging finding for neuroradiologists and neurologists. Case Report: A 71-year-old male without vascular risk factors underwent maxillary bilateral antrostomy and septoplasty for chronic sinusitis. Twenty to thirty minutes upon awakening, he complained of painless left eye vision loss. Ophthalmoscopic examination showed retinal whitening, segmented arterioles, and hyperemic disc. Brain MR-diffusion weighted imaging/apparent diffusion coefficient revealed ON diffusion restriction in the proximal segment. Despite attempted reperfusion, left eye remained with no light perception at 6 months. Patients undergoing nonocular surgeries who develop perioperative vision loss related to PION may exhibit ON diffusion restriction but usually have normal ophthalmoscopic findings. CRAO shows retinal whitening, edema, segmentation of arterioles, and cherry red spot on ophthalmoscopy. A recent study reported that ON diffusion restriction in nonperioperative CRAO cases has a sensitivity and specificity of 55% and 70% to 100%. Here, PION was initially considered based on imaging. However, given the neuro-ophthalmic findings, a proximal embolus in the central retinal artery, obstructing its entrance into the proximal ON was deemed more likely. Conclusion: We highlight that proximal ON diffusion restriction on brain magnetic resonance imaging can be diagnostic of proximal thromboembolic CRAO. Future studies should evaluate the diagnostic utility and accuracy of MR-diffusion weighted imaging/apparent diffusion coefficient in perioperative visual loss.

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“…PION is another possible cause of vision loss after blepharoplasty. It can be classified as perioperative, arteric or nonarteric PION and presents as acute vision loss without optic disc oedema[ 13 14 ] Etiologies include direct mechanical compression of the arteries that perfuse the optic disc caused by retrobulbar injection and vasoconstrictive activity of the local anaesthetic, vasospasms induced by use of vasoconstrictor agents, enhancement of vasoconstriction by vasoconstrictive agents released from retrobulbar blood,[ 5 ] and increased IOP and compromise of the vasculature caused by marked oedema or congestion of the intraorbital fat. Because of differences in vascular supply demands, the posterior/retrobulbar segment of the optic nerve is more vulnerable to damage than the anterior segment.…”

Section: Discussion and C Onclusionmentioning

confidence: 99%

Visual loss after cosmetic blepharoplasty using local anaesthesia containing epinephrine - A case series

Mommaerts

Kelen

2021

Ann Maxillofac Surg

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Rationale: Surgeons should be aware of the risk of vision loss associated with blepharoplasty. Patient Concerns: All patients complained of decreased vision, redness and/or pain after blepharoplasty using only local anaesthesia containing epinephrine. Diagnosis: Diagnosis of angle-closure glaucoma (ACG) was made clinically (decreased visual acuity (VA), increased intraocular pressure and a mid-dilated pupil) and through examination (slit lamp examination and dynamic gonioscopy revealed corneal oedema and a shallow anterior chamber respectively). Perioperative posterior ischaemic optic neuropathy (PION) was a diagnosis of exclusion based on the relative afferent pupil defect. Treatment: ACG was treated medically (intravenous [IV] mannitol and topic antiglaucoma medication or oral acetazolamide) and surgically (YAG iridotomy and an additional cataract extraction with trabeculectomy in one patient). PION was treated with IV methylprednisolone. Outcome: Patients with ACG fully recovered. Patients with PION improved clinically, but presented with a pale optic disc and an optic nerve-related visual field defect. Take-Away Lesson: Surgeons should intervene quickly to minimize the chance of permanent vision loss.

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Diffusion-Weighted Imaging Changes in a Child With Posterior Ischemic Optic Neuropathy

Cited by 6 publications

References 15 publications

Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis

Utility of standard diffusion-weighted magnetic resonance imaging for the identification of ischemic optic neuropathy in giant cell arteritis

Unilateral Optic Nerve Diffusion Restriction After Sinus Surgery Secondary to Central Retinal Artery Occlusion

Visual loss after cosmetic blepharoplasty using local anaesthesia containing epinephrine - A case series

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