Prof. Prem Subramanian from the University of Colorado School of Medicine, USA,
presented cases which showcase the importance of neuroimaging in the presence of pain.
The first case is of a 58-year-old man who had intermittent left eye pain for several days.
He presented at the neuro-ophthalmology clinic with foreign body sensation
and blurred vision because other physicians could not explain the cause of his pain.
He underwent a visual field test, which led to the decision of getting a neuroimaging, ลาวสามัคคี
which showed that there’s some opacification of the tissue at the posterior aspect of his left orbit.
“With that, the differential diagnosis is quite broad for this condition.
It can be: meningioma, sarcoidosis, lymphoma, IgG4(+) disease, or granulomatosis with polyangiitis.
It was the pain that led him to seek neuroophthalmic consultation.
So, if pain is present with persistent blurred vision, don’t hesitate to get a visual field test so that you don’t miss the underlying process,” said Prof. Subramanian.
In another case, a man lost vision in his left eye due to subtle signs of inflammation at his left orbit
that were not picked up early, as contrast and T1 fat suppressed imaging was not done.
“Without any ocular surface findings in a 50-year-old man who had never had headache before, early workup should have included neuroimaging,
which would have potentially led to the early discovery of the orbital inflammatory process and prevented his permanent left eye vision loss,
which we presumed is a combined inflammatory and ischemic optic neuropathy,” he said.
“Pain and foreign body sensation may occur from orbital or central nervous system (CNS) processes.
Nonspecific initial symptoms may mislead. Thorough history and examination are required.
Don’t image all patients with pain, look for additional signs of dysfunction which may be subtle. Follow closely if needed.
You’ll save a life when it’s not just dry eye,” he concluded.
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