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Biomedical subjects

Valérie Biousse

Publications and source records attributed to Valérie Biousse.

At least 19 recordsLinked to original sources
PubMed2007

Fulminant idiopathic intracranial hypertension.

OBJECTIVE: To describe the incidence and characteristics of acute and rapidly progressive visual loss in idiopathic intracranial hypertension (IIH). METHODS: We reviewed the medical records of all patients with IIH seen at two institutions. "Fulminant IIH" was defined as the acute onset of symptoms and signs of intracranial hypertension (less than 4 weeks between onset of initial symptoms and severe visual loss), rapid worsening of visual loss over a few days, and normal brain MRI and MR venography (or CT venogram). RESULTS: Sixteen cases with "fulminant IIH" were included (16 women, mean age 23.8 years [range 14 to 39 years]). All were obese. One patient had iron-deficiency anemia, four had systemic hypertension, and none had known sleep apnea syndrome. Acute or subacute headache, nausea and vomiting, and visual loss were present in all patients. The first lumbar puncture performed for the diagnosis showed a mean CSF opening pressure of 54.1 cm H(2)O (range 29 to 60 cm H(2)O). In addition to the initial lumbar puncture, medical treatment included acetazolamide (1 to 2 g/day) in all patients, and IV methylprednisolone in four patients. Repeat lumbar punctures were performed in 11 of the 16 patients. Surgical treatment (optic nerve sheath fenestration in five cases, lumboperitoneal CSF shunting procedure in nine cases, and ventriculoperitoneal shunting procedure in two cases) was performed because of ongoing visual loss in all cases. The median delay between evaluation in neuro-ophthalmology and surgery was 3 days (range a few hours to 37 days). All patients reported dramatic improvement of headaches and vomiting following surgery. Visual function improved in 14 cases, although 8 patients (50%) remained legally blind. Visual fields remained severely altered in all cases. CONCLUSION: Severe and rapidly progressive visual loss suggests "fulminant idiopathic intracranial hypertension" and should prompt aggressive management. Urgent surgery may be required in these patients, and temporizing measures such as repeat lumbar punctures, lumbar drainage, and IV steroids considered.

Acute Disease↗
PubMed2006

Progression of visual field defects in leber hereditary optic neuropathy: experience of the LHON treatment trial.

PURPOSE: To describe the visual fields of patients with Leber hereditary optic neuropathy (LHON), a maternally inherited disorder characterized by bilateral, often sequential vision loss, before and during progressive visual deterioration. DESIGN: Prospective longitudinal follow-up of serial visual fields in patients enrolled onto an open-label, nonrandomized pilot study of topical brimonidine purite as prophylactic treatment after first eye involvement in LHON. METHODS: Nine molecularly confirmed primary mutation patients with LHON with monocular vision loss for less than six months and normal visual function in the other eye were followed prospectively for up to two years. Visual fields were performed on automated perimetry at baseline and on many follow-up visits. RESULTS: Despite normal visual acuity at baseline in all patients, seven patients had some minimal changes in the central visual field of the second eye. All patients had subsequent deterioration of visual acuity, mean deviation, and foveal sensitivity in their second eye. The earliest pattern of abnormality was typically a cecocentral defect enlarging to become a central defect, often with a superior or inferior predilection. The visual field defects in the two eyes of any given patient were remarkably similar. CONCLUSIONS: LHON may be a bilateral condition at onset more frequently than appreciated. Automated static perimetry of the "normal" eye may reveal subclinical findings that typically worsen rapidly over weeks to months to similar central scotomatous damage. Quantitative automated static perimetry is helpful in elucidating the natural history of LHON and in understanding the underlying pathology and pathophysiology of this disease.

Administration, Topical↗
PubMed2006

Intracranial vascular anomalies in patients with morning glory disk anomaly.

PURPOSE: An association between morning glory disk anomaly (MGDA) and intracranial vascular anomalies including Moyamoya disease has been recognized. We evaluated a series of patients with MGDA to ascertain the frequency of cerebrovascular anomalies. DESIGN: Retrospective observational case series. METHODS: We reviewed the neurologic histories and neuroimaging studies of twenty patients with MGDA at two institutions between 1982 and 2004. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brain was performed on all patients who had not undergone neuroimaging. MRI/MRA studies done for 40 pediatric patients without MGDA were also evaluated for cerebrovascular anomalies. The prevalence of anomalies in the two groups was compared by Fisher exact test. RESULTS: Nine of 20 patients (45%) with MGDA had cerebrovascular anomalies. Anomalies ranged from agenesis of the A1 segment of the anterior cerebral artery to bilateral stenosis of the internal carotid arteries with moyamoya disease. Three patients underwent revascularization procedures. Ten of 40 patients (25%) in the control group had any intracranial vascular anomaly, whereas only two of 40 (5%) had an abnormality of the anterior circulation, the most common finding in the MGDA group. CONCLUSION: We recommend that all patients with MGDA undergo MRI/MRA or computerized tomographic angiography to detect vascular and structural brain anomalies. It may be unclear whether cerebrovascular anomalies represent isolated congenital anomalies or findings of progressive occlusive cerebrovascular disease. Follow-up imaging should be considered in patients with cerebrovascular anomalies and is clearly indicated if neurologic signs or symptoms are present.

Adolescent↗
PubMed2006

Ophthalmoparesis in idiopathic intracranial hypertension.

PURPOSE: To report unusual ocular motility disturbances in the setting of idiopathic intracranial hypertension (IIH). DESIGN: Interventional case series. METHODS: Two cases with IIH and unusual ophthalmopareses are reported. RESULTS: Two patients with confirmed IIH presented with headache, diplopia, and papilledema. The first patient had bilateral sixth nerve palsies and a partial right third nerve palsy, which resolved rapidly after a cerebro spinal fluid (CSF) shunting procedure; the second patient had alternating skew deviation and upbeat nystagmus. Both cases had normal brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) and normal CSF contents, ruling out a secondary cause of intracranial hypertension. CONCLUSIONS: These exceptional vertical and horizontal ophthalmopareses in the setting of IIH may be related directly to very elevated CSF pressures and may be secondary to altered CSF flow in the posterior fossa.

Adult↗
PubMed2006

Pediatric homonymous hemianopia.

INTRODUCTION: Homonymous hemianopia is a disabling condition caused by numerous lesions affecting the retrochiasmal visual pathways. Little is known about homonymous hemianopia in childhood. METHODS: All patients seen in the Neuro-Ophthalmology Unit at Emory University with homonymous hemianopia (confirmed by Goldmann, Humphrey, or confrontation visual fields) between 1989 and 2004 were included. Demographic characteristics, clinical features, and evolution of the visual field defects were compared between the pediatric group (18 years of age or younger) and the adult group (older than 18 years). RESULTS: Among 852 patients with homonymous hemianopia, there were 81 children (86 homonymous hemianopias) and 771 adults (818 homonymous hemianopias). Formal visual field testing was obtained in 93% of pediatric cases and 96% of adults; a majority of patients in both groups were evaluated with Goldmann visual field testing. Demographic and visual field characteristics were similar in both groups. Significant differences were noted for the causative lesions and their location. Traumatic brain injury (34%) and tumor (27%) were the most common causes of homonymous hemianopia in the pediatric group, whereas infarction (63%), traumatic brain injury (12%), and hemorrhage (11%) were the most common causes in the adult group. Most lesions involved the optic radiations (37%), followed by the occipital lobes (26%), in the pediatric group, whereas occipital lobes (47%), followed by optic radiations (32%), were most commonly involved in adults. Approximately one third of the pediatric patients were seen in follow-up, and one third of these homonymous hemianopias spontaneously improved over the course of time. Of the 16 pediatric homonymous hemianopias evaluated within 1 month of onset of the cerebral disorder, 8 (50%) improved. CONCLUSION: Trauma and tumors are the most common cause of homonymous hemianopia in childhood. Although spontaneous improvement can be expected in approximately one third to one half of patients within the first few months, the recognition of homonymous hemianopia frequently is delayed in this population.

Adolescent↗
PubMed2006

Subretinal hemorrhage from a peripapillary choroidal neovascular membrane in papilledema caused by idiopathic intracranial hypertension.

A 42-year-old man with idiopathic intracranial hypertension and chronic papilledema had severe visual loss in his left eye caused by subretinal bleeding from a peripapillary choroidal neovascular membrane (CNVM). After optic nerve sheath fenestration in his left eye, the papilledema improved, allowing improved visualization of the CNVM. Visual function did not improve after the surgery. CNVM can complicate chronic papilledema and account for sudden worsening of vision. The appropriate management of this type of CNVM is unresolved.

Adult↗
PubMed2006

Homonymous hemianopia in stroke.

BACKGROUND: Previous reports have suggested that most cases of homonymous hemianopia (HH) are caused by occipital stroke. However, these reports have not always been supported by brain imaging. METHODS: We reviewed the medical records of all patients seen in our unit between 1989 and 2004 who had HH documented by formal perimetry or confrontation visual fields and had undergone brain imaging. HHs were divided into those caused by stroke and by non-stroke conditions. The clinical and visual field characteristics were compared in the two groups. RESULTS: Among 850 patients with 902 HHs, 629 (69.7%) resulted from stroke, of which 531 (84.4%) were from infarction and 98 (15.6%) from primary intraparenchymal hemorrhage. Non-stroke causes included head trauma (123), brain tumor (102), neurosurgical procedures (22), multiple sclerosis (13), and miscellaneous conditions (13). Occipital lesions most commonly resulted from stroke. The configuration of the HH did not predict where in the retrochiasmal visual pathway the responsible lesion lay. CONCLUSIONS: Ischemic stroke causes most HHs from lesions in the occipital lobe that generally do not produce other neurologic manifestations. The configuration of the HH does not predict the location of the lesion within the retrochiasmal visual pathway.

Adolescent↗
PubMed2006

Isolated painful third nerve palsy.

A 50-year-old woman presented with an acute painful complete third nerve palsy involving the pupil. Noninvasive imaging ruled out an aneurysmal compression of the third nerve, and brain magnetic resonance imaging demonstrated an intrinsic lesion of the third nerve. Work-up remained negative. All symptoms and signs resolved with steroids. In this case review, we briefly discuss the management of isolated third nerve palsies.

Decision Trees↗
PubMed2006

The natural history of optic neuritis.

Optic neuritis is a common cause of visual loss in young patients, typically presenting with painful monocular visual loss and decreased color vision. Visual function generally spontaneously improves over weeks, and 95% of patients return to visual acuity of at least 20/40 within 12 months. The initial magnetic resonance imaging (MRI) helps stratify the risk of multiple sclerosis (MS) in patients with acute isolated optic neuritis. In the Optic Neuritis Treatment Trial, the 10-year risk of MS in the group of patients with at least one MRI T2 lesion was 56%, whereas the 10-year risk with a normal baseline MRI was 22%. A normal MRI in concert with painless optic neuritis, severe optic nerve head edema, peripapillary hemorrhages, or a macular star defines a very low MS risk subgroup. High-dose steroids hasten the rate, but not the final extent, of visual recovery in optic neuritis, and the decision to use this therapy is individualized. Interferon beta-1a therapy should be considered in selected high-risk patients.

Disease Progression↗
PubMed2005

Transient monocular visual loss.

PURPOSE: To provide a practical update on the diagnosis and management of transient monocular visual loss (TMVL). DESIGN: Perspective. METHODS: Review of the literature. RESULTS: TMVL is an important clinical symptom. It has numerous causes but most often results from transient retinal ischemia. It may herald permanent visual loss or a devastating stroke, and patients with TMVL should be evaluated urgently. A practical approach to the evaluation of the patient with TMVL must be based on the patient's age and the suspected underlying etiology. In the older patient, tests should be performed to investigate giant cell arteritis, atherosclerotic large vessel disease, and cardiac abnormalities. In the younger patient, TMVL is usually benign and the evaluation should be tailored to the particular clinical setting. CONCLUSIONS: Specific prevention strategies are tailored to the most likely cause of TMVL and the patient's underlying risk factors. Prevention of a future event should begin in the ophthalmologist's office with education and aggressive treatment of artherosclerotic risk factors.

Humans↗
PubMed2005

Voluntary alteration of full-field electroretinogram.

PURPOSE: To evaluate whether a normal subject can deliberately produce abnormal electroretinogram (ERG) results that simulate disorders of the retina. DESIGN: Prospective study. METHODS: Five normal subjects were evaluated twice with full-field ERGs. The subjects were randomly assigned to be compliant or noncompliant (i.e., to deliberately attempt to alter the test results) at each visit. Results from compliant eyes were compared with those of noncompliant eyes. RESULTS: While the amplitudes of all parameters were decreased in the noncompliant group, the difference was not statistically significant, and the results were usually within the normal limits of our laboratory. No subject was able to alter the results to mimic a retinal disease or to reproduce a specific pattern of changes. CONCLUSIONS: Although ERG results can be altered by noncompliant subjects, the results are usually only "borderline abnormal" and do not correspond to any pattern of retinal disease. These results confirm that abnormal full-field ERGs indicate true retinal disease.

Electroretinography↗
PubMed2005

Simultaneous bilateral retinal artery occlusions associated with a mitral valve mass.

A 52-year-old woman with simultaneous bilateral retinal artery occlusions and normal trans-thoracic echocardiography was found to have a mitral valve lesion on trans-esophageal echocardiography. Bilateral retinal artery occlusions suggest a source of emboli at the level of the heart or aortic arch. Such cases should be evaluated not merely by trans-thoracic echocardiography, but by trans-esophageal echocardiography, which better visualizes the aortic arch and left heart cavities.

Calcinosis↗
PubMed2005

Optic nerve glioma and optic neuritis mimicking one another: case report.

OBJECTIVE AND IMPORTANCE: The clinical and radiographic presentations of optic nerve gliomas and optic neuritis are for the most part distinct and their diagnoses straightforward. We present two cases illustrating the occasional difficulty one can encounter in distinguishing neoplastic from inflammatory optic neuropathies. CLINICAL PRESENTATION: Patient 1 is a 17-year-old girl who presented with acute onset of pain and rapidly progressive visual loss in the right eye. Patient 2 is a 38-year-old man who presented with painless progressive visual loss in the left eye. INTERVENTION: Patient 1 was initially diagnosed with idiopathic retrobulbar optic neuritis. Interval increase of the optic nerve on magnetic resonance imaging prompted a biopsy of the optic nerve, which revealed a pilocytic astrocytoma. Patient 2 was found to have left optic nerve enhancement most consistent with an optic nerve glioma. Before a biopsy, the patient spontaneously improved without treatment, indicating an inflammatory process. CONCLUSION: Differentiating between optic nerve neoplasm and inflammation may be difficult. On occasion, the classic clinical finding of pain with eye movement and the radiographic finding of enlargement and enhancement of the optic nerve may be misleading. Open biopsy of the optic nerve is indicated only after a completely negative metabolic, infectious, and inflammatory workup; interval increase of the optic nerve on magnetic resonance imaging; and failure of the patient to recover vision.

Adolescent↗
PubMed2004

Ischemic optic neuropathies.

PURPOSE OF REVIEW: To review recent clinical data on ischemic optic neuropathies, which are some of the most frequently encountered optic neuropathies. These disorders include nonarteritic anterior ischemic optic neuropathy, arteritic anterior ischemic optic neuropathy, and posterior ischemic optic neuropathy. RECENT FINDINGS: Recent studies have facilitated our understanding of the natural history of visual loss, recovery, and recurrence in these disorders. Additionally, the value of various diagnostic techniques and treatment options, particularly for arteritic anterior ischemic neuropathy, has been clarified. SUMMARY: Application of the studies described in this paper should allow the clinician to more accurately diagnose ischemic optic neuropathies and counsel the patient with regard to appropriate management, prognosis for visual recovery and future risk of recurrence.

Adrenal Cortex Hormones↗
PubMed2004

Small vessel vasculopathies affecting the central nervous system.

Small vessel diseases affecting the central nervous system are common causes of ischemic and hemorrhagic stroke. Diseases affecting the small vessels are due either to abnormalities in the content of the vessel or to abnormalities in the vessel wall. Causes include atherosclerosis, inflammatory vasculitides, and noninflammatory vasculopathies such as postpartum angiopathy, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), Susac syndrome, and Sneddon syndrome.

Acute Disease↗