Download Free Medical A case of AAION PowerPoint Presentation

A case of AAION PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : giant cell arterirtis caused AAION

Tags : optha cases,giant cell arteritis

Published on : Dec 08, 2019 | Views : 1833 | Downloads : 0

Shareable Url :

Embed Code :

Comment

lolliwels

love the set of this design

Transcript

Slide 1-

Department of Ophthalmology CASE DISCUSSION JANGAM CHAKRAVARTHI BLOCK 4
Slide 2-

Case A 70-year old woman suffered sudden but painless loss of vision in one eye. She also has experienced headaches and shoulder pain during the past several months. The affected eye is shown in the photograph. Her other eye remains normal.
Slide 3-

Salient Features 70 year old female Sudden but painless unilateral loss of vision Headaches Shoulder pain Pale swollen optic disc
Slide 4-

Differential Diagnosis Amaurosis Fugax Non-arteritic ischemic optic neuropathy (NAION) Arteritic ischemic optic neuropathy (AION) Giant Cell Arteritis
Slide 5-

Amaurosis Fugax ( AF )
Slide 6-

Non-arteritic anterior ischemic optic neuropathy (NAION)
Slide 7-

Arteritic anterior ischemic optic neuropathy (AAION)
Slide 8-

Giant Cell Arteritis
Slide 9-

Arteritic anterior ischemic optic neuropathy (AAION) caused by Giant cell arteritis (GCA) Final Diagnosis
Slide 10-

Discussion
Slide 11-

ION is due to: poor blood flow to the optic nerve Acute occlusion of the feeding arteries Ischemic Optic Neuropathy ( ION ) Short posterior ciliary arteries Ophthalmic artery
Slide 12-

Ischemic Optic Neuropathy ( ION ) Nonarteritic ION (cardiovascular risk factors) Arteritic ION (vasculitis) Nonarteritic Anterior ION (NAION) with swollen optic disc Nonarteritic Posterior ION (NA-PION) with normal optic disc Arteritic Anterior ION (AAION) with swollen optic disc Arteritic Posterior ION (APION) with normal optic disc
Slide 13-

ppt slide no 13 content not found
Slide 14-

Anterior Ischemic Optic Neuropathy Most serious type of ION. Most common over 50 years Primary cause is due to a disease called GCA or Giant Cell Arteritis or temporal arteritis. Gender – more common in women 3:1 Painless monocular over hours to days
Slide 15-

Pathophysiology
Slide 16-

Age: Fifty years of age or older at onset. Gender : 3 times more common in women than in men Race: Common among Caucasians > other races Giant cell arteritis New onset of localized headache. Temporal artery pulse. Elevated ESR. Positive temporal artery biopsy. RISK FACTORS
Slide 17-

CLINICAL FEATURES (Ocular)
Slide 18-

PRESENTATION (Physical)
Slide 19-

Systemic symptoms GCA : Patients with NA-AION have no systemic symptoms of giant cell arteritis. Visual symptoms: Amaurosis fugax is highly suggestive of AAION and is extremely rare in NA-AION. Hematologic abnormalities:Elevated ESR and CRP, particularly CRP, is helpful in the diagnosis of GCA. Patients with NA-AION do not show any of these abnormalities. Early massive visual loss: Extremely suggestive of A-AION. Chalky white optic disc edema: This is almost diagnostic of A-AION and is seen in 69% of AAION eyes. In NAAION, chalky white optic disc edema occurs only very rarely with embolic occlusion of the posterior ciliary artery. AAION associated with cilioretinal artery occlusion . This is almost diagnostic of AAION. Fluorescein fundus angiography: Evidence of posterior ciliary artery occlusion in AAION. Temporal artery biopsy. DIFFERENTIATION : AAION FROM NAAION
Slide 20-

Peripapillary hemorrhages Nerve fiber layer edema Obscured borders 20 The involved swollen optic disc is acutely pale AAION NAION
Slide 21-

WORK UP : AAION The diagnostic work-up for GCA includes Erythrocyte sedimentation rate (ESR) >47mm C-reactive protein >2.45 MG/DL Fluorescein fundus angiographic (FFA): Critical diagnostic test for A-AION during the early stages shows thrombosis and occlusion of the posterior ciliary artery in GCA Jaw Claudication Neck pain
Slide 22-

GIANT CELL ARTERITIS (Temporal Arteritis) Generalized granulomatous inflammation of medium- to large-sized vessels that occurs in the elderly. The most common primary vasculitis in adults. Presents with vision loss. Associated symptoms: headache, jaw claudication, diplopia, myalgias, and constitutional symptoms.
Slide 23-

Diagnosis
Slide 24-

There are specific funduscopic findings Choroidal hypoperfusion indicates multifocal ischemia on Fluorescein angiography normal choroid Lack of choroidal perfusion 24
Slide 25-

ppt slide no 25 content not found
Slide 26-

The workup of suspected Arteritic ION GCA Symptoms / signs ? Do blood tests but ESR, CRP, Hb, PLT, Fibrinogen Urgent TAB* TAB* in 1 wk Iv Methylprednisolone  oral Prednisone + aspirin yes no IV Methylprednisolone  oral Prednisone + aspirin until biopsy results high normal NAION * TAB = Temporal Artery Biopsy 26
Slide 27-

Treatment AAION is an EMERGENCY. Early treatment is essential. Tocilizumab is a monoclonal antibody humanized for treatment of AAION Methotrexate is one of the most widely studied “steroid sparing” agents. Steroids Oral prednisone in the range of 60-100mg/day may be used initially and for follow up to intravenous pulse therapy IV methylprednisolone at 1g/day for the first three days has been recommended for severe cases.
Slide 28-

Thank you!
Slide 29-

ppt slide no 29 content not found
Slide 30-

PRESENTATION Sudden onset Painless Monocular Always discovered on awakening Nocturnal Hypotension VISUAL LOSS Non-arteritic anterior ischemic optic neuropathy (NAION)
Slide 31-

SIGNS PARAMETER Visual Acuity Visual Field Colour Vision Ophthalmic Exam Findings FA Finding Laboratory Evaluation FINDING Often better than 20/100. Typically Inferior Altitudinal defect. May be severely impaired when VA is good. Diffuse OR sectorial hyperaemic disc swelling associated with FEW peripapillary splinter- shaped haemorrhages. Small OR cupless disc in fellow eye. Swelling gradually resolves and pallor in 3-6 weeks after onset. Acute Stage: localized disc hyperfluorescence, intense, eventually involves entire disc. No associated laboratory abnormalities.
Slide 32-

Non-arteritic Anterior Ischemic Optic Neuropathy
Slide 33-

The pathogenesis of NAION differs from IHD or CVA decrease in blood flow Edema of optic disc Blockage of axonal flow Compression of axons and blood vessels Necrosis and demyelination of nerve fibers Cardiovascular risk factors Crowded optic disc 33