Correspondence
Evidence of nocturnal hypotension in an inpatient prior to an episode of classic NAION
Nonarteritic anterior ischemic optic neuropathy (NAION) is a known cause of acute, painless, monocular vision loss in patients with small cup-to-disc ratios and at least 1 vascular risk factor.1 The etiology has been debated, although Hayreh et al.2 have hypothesized that nocturnal hypotension impairs perfusion to the optic disc causing ischemia to the optic nerve. Despite evidence supporting this via retrospective monitoring of diurnal changes in blood pressure (BP) with Holter monitoring in patients with prior outpatient episodes of NAION, this BP change has not been documented at the time of the event.Rapid same-day resolution of internuclear ophthalmoplegia in Wernicke encephalopathy following parenteral high dose thiamine
Internuclear ophthalmoplegia (INO) is well known for its association with multiple sclerosis in young patients and ischaemic stroke in older patients. Lesions of the medial longitudinal fasciculus produce the clinical findings of INO. Wernicke encephalopathy (WE) is a metabolic disorder of thiamine deficiency that classically presents with confusion, ataxia, and nystagmus. Diplopia and ophthalmoplegia can also be the presenting or predominant complaint in WE. We report a case of WE presenting with an INO who had same-day resolution of symptoms and signs after high-dose parenteral thiamine.Leber hereditary optic neuropathy: 41-year interval between fellow eye involvement
Leber hereditary optic neuropathy (LHON) is an inherited mitochondrial disorder that typically presents in young men with painless, subacute, bilateral (simultaneous or sequential) central vision loss.1,2 Most cases have nonsimultaneous involvement of the contralateral eye in an interval less than 1 year.2,3 However, there are reports of loss of vision in the fellow eye over 1 year later. To date, the longest interval between affected eyes is 18 years.4 We present a patient with an interval of 41 years.
