Kathleen Digre

University of Utah | UOU · Department of Neurology

Background: This study evaluates the effectiveness of a multidisciplinary protocol for management of patients with papilledema and vision loss secondary to increased intracranial pressure. Methods: Retrospective record review of all adult patients who presented with vision-threatening papilledema (VTPE) and were treated under this protocol. Pati...

Tolosa-Hunt syndrome (THS) is a rare, idiopathic, non-specific inflammation within the cavernous sinus and/or superior orbital fissure leading to painful ophthalmoplegia. The authors describe the first case of a 12-year-old otherwise healthy girl who presented with painful ophthalmoplegia after a documented COVID-19 infection. Neuroimaging revealed...

An 11-year-old boy presented with 2 weeks of intermittent headache, right orbital pain, and constant diplopia. Brain MRI showed dural thickening and enhancement of the right lateral cavernous sinus, right orbital apex, and tentorium. Initial cerebral spinal fluid analysis showed only mild pleocytosis, and serum diagnostics were unrevealing. The wor...

Objective: To report a case of arachnoiditis as a complication of epidural blood patch procedures and to systematically review the diagnostic workup, clinical outcomes, and treatment modalities reported in the literature. Background: Epidural blood patching is an effective treatment for low-pressure headache secondary to spontaneous cerebrospina...

Background Despite plausibility of migraine headaches contributing to impaired sexual function among women, data are inconsistent and point to obesity as a potential confounder. Prospective studies that assess the relative importance of migraine improvements and weight loss in relation to sexual function could help elucidate associations among migr...

Peripapillary hyperreflective ovoid mass-like structures (PHOMS) are a new retinal optical coherence tomography (OCT) finding. The Optic Disc Drusen Studies Consortium had made recommendations to distinguish PHOMS from true optic disc drusen (ODD) in 2018. While publications on PHOMS have increased since then, the accuracy of the definition of PHOM...

Purpose Comparisons between clinical features of tetracycline-induced pseudotumor cerebri (PTC-T) and those of idiopathic intracranial hypertension (IIH) are absent in the literature. We hypothesized that significant clinical differences between these etiologies exist and could be better understood by retrospective analysis. Design Retrospective c...

Our aim was to examine the symptoms and clinical characteristics of visual snow in a group of 6 patients from a Department of Ophthalmology and a Department of Neurology. Visual snow is now recognized as a true physiological disorder. Previously, physicians unaware of this syndrome may have misinterpreted its symptoms as a persistent visual aura. B...

Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure, almost always associated with papilloedema, in the absence of underlying central nervous system pathology. It is a rare disease, with an annual incidence of around 1/100,000 persons with an onset between 11 and 58 years. It is predominantly seen in obese women...

Background/Introduction/Objective: Recent studies have shown that food insecurity is associated with obesity, depression, and other adverse health outcomes although little research has been focused on these relationships in underrepresented cultural and social groups. In this study we elucidate the relationship between food insecurity, community fa...

A woman presented with bilateral visual disturbances that had been diagnosed as visual snow. Dilated ophthalmic examination and multimodal imaging were strongly suggestive of birdshot chorioretinopathy, meriting initiation of systemic immunomodulatory therapy. Visual snow requires a thorough ophthalmologic exam to exclude other ocular diseases.

Background The calcitonin gene-related peptide monoclonal antibody medications represent a novel and effective group of treatment options that can be added on to existing regimens such as onabotulinum toxin A injections for the treatment of refractory chronic migraine. Mechanistically, calcitonin gene-related peptide antibodies have been shown to i...

Background and objective: Patients with migraine frequently report ocular or visual symptoms including aura, photophobia, and eye pain. Using validated instruments, our group previously reported that due to these symptoms, patients have marked reductions in visual quality of life. In chronic migraine, these reductions can be as substantial as thos...

Background: Migraine is very common. In addition to affecting visual quality of life, migraine can be seen in the neuro-ophthalmology office with regularity. Treatment is critical to assist in the reduction of disability and symptoms. Knowing the evidence-based new treatments is important for every neuro-ophthalmologist. Methods: Using PubMed, a...

Background: Routine assessment of photophobia in the clinical setting may underestimate the presence and severity of this condition. We aimed to develop and validate a questionnaire to improve evaluation of the impact of photophobia on activities of daily living, and to determine the relationship of this questionnaire to psychophysical assessment...

Background: Revised diagnostic criteria for pseudotumor cerebri syndrome require three of four neuroimaging findings in the absence of papilledema. We examined the sensitivity and specificity of three or more of four of these magnetic resonance imaging (MRI) findings for pseudotumor cerebri syndrome in children. Methods: As part of clinical care...

Objective: Immigrants, especially refugees, face unique barriers to accessing health care relative to native born Americans. In this study, we examined how immigration status, health, barriers to access, and knowledge of the health care system relate to the likelihood of having a regular health care provider. Methods: Using logistic regression a...

Purpose: To identify the molecular cause in five unrelated families with a distinct autosomal dominant ocular systemic disorder we called ROSAH syndrome due to clinical features of retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and migraine headache. Methods: Independent discovery exome and genome sequencing in families 1, 2, an...

Objective: Revised diagnostic criteria for idiopathic intracranial hypertension (IIH) were proposed in part to reduce misdiagnosis of intracranial hypertension without papilledema (WOP) by using 3 or 4 MRI features of intracranial hypertension when a sixth nerve palsy is absent. This study was undertaken to evaluate the sensitivity and specificity...

Background: This study gauged the cost-effectiveness of a community-based health coaching intervention aimed at improving diet and physical activity among women in culturally diverse communities. Methods: The Coalition for a Healthier Community for Utah Women and Girls recruited women from 5 cultural and ethnic groups and randomized them to rece...

Objective Migraine is associated with several important visual symptoms, during both acute attacks and headache‐free intervals. The purpose of this investigation was to use validated vision‐related quality of life instruments to assess the effect of migraine on visual quality of life. Background Many migraineurs experience visual aura, increased p...

Background: Eye pain is a common complaint, but no previous studies have determined the most common causes of this presenting symptom. Our objective was to determine the most common causes of eye pain in 2 ophthalmology and neurology departments at academic medical centers. Methods: This was a retrospective cross-sectional analysis and chart rev...

The articles in the medical student outline in the Moran CORE (clinical ophthalmology resource for education) take a novel approach. First, they have gone through a peer review and are posted through a reputable institution. Second, these articles have been written by medical students who have a unique insight into identifying what is of greatest b...

Increasing burning and foreign body sensation following LASIK (or other corneal procedures) may represent a corneal neuralgia.

Trigeminal neuralgia has a characteristic signature: brief volley’s of pain in the same distribution which can be triggered by normal innocuous stimulation like light touch.

Always look at the pupils in patients with eye pain—is there a sympathetic defect?

Most conjunctivitis is viral and should be managed with preservative-free artificial tears, cool compresses, and strict hygiene.

Episodic stabbing headaches are common in individuals with migraine and there are only a few things that act or look like ice pick pain.

New headaches in older people need complete evaluation.

Eye pain can be caused by inflammation of the GON.

Make sure that CN palsies are isolated or not (Can you count to 7?).

While tension-type headache is very common, it is usually migraine which brings a patient in to the doctor.

Thyroid eye disease can cause eye pain.

Blepharospasm is a common disorder most frequently associated with mild eye pain often related to dry eye symptoms.

Recognize that MOH exists in anyone with frequent migraine. This is a treatable condition with education and stopping the offending medication.

Tenderness of the eyelid suggests an inflammatory, infectious, or traumatic cause of pain in the eye or eyelid.

Trigeminal autonomic cephalgias are unilateral headaches with autonomic (red eye, tearing, nasal stuffiness, rhinorrhea) symptoms. The Horner syndrome can be permanent.

Blurred vision and transient diplopia can be caused by pituitary tumors.

Herpes Zoster ophthalmicus causes eye pain—and risk factor is age. The pain may precede the rash, making the diagnosis more difficult.

Ophthalmoplegic migraine presents with migraine followed by 3NP in the first decade of life.

Dry eye syndrome is the most common cause of eye pain.

Uveitis can cause deep aching eye pain and photophobia.

Step back and look at the patient’s face. There may be subtle enlargement or swelling of an upper eyelid. This can be confirmed by palpation and looking under the upper eyelid.

Intermittent angle closure glaucoma is sudden onset and associated with blurred vision and nausea. It is uncommon and unilateral.

Diagnose the cause (s) of photophobia—realizing that dry eyes and migraine are the most frequent causes.

Intracranial hypotension or hypovolemia can occur with even trivial trauma like weight lifting and is characterized by a positional headache: worse upon being upright and better when lying down.

The triad of fever, headache/eye pain, and stiff neck should lead you to consider meningitis as a cause of eye pain.

Ask about GCA symptoms in your ROS for elderly patients with new eye pain or headache.

Always examine the fundus—looking for papilledema in anyone with new eye pain and headache.

C-C fistula can cause a red, painful eye without discharge or tearing.

Recurrent corneal erosions cause significant eye pain upon awakening associated with tearing, redness, and blur for several hours.

The key characteristics of migraine as episodes of eye pain include: moderate to severe pain, light and/or sound sensitivity, nausea and/or vomiting, and worsening with activity.

Pain with eye movements does not automatically equal optic neuritis. Patients have to lose visual function with optic neuritis.

Primary cough headache is an idiopathic disorder that occurs with Valsalva. MRI with contrast is indicated to rule out secondary causes in the posterior fossa.

Think about inflammatory orbital disease in anyone presenting with pain with eye movement or diplopia without evidence of optic neuropathy.

Proptosis and visual loss is an emergency and requires prompt imaging to determine where the problem is and what is causing it.

Palpation over the lacrimal gland, trochlea, infraorbital, and supraorbital nerve may help determine causes of eye pain.

Eyestrain occurs with prolonged reading and indicates an eye misalignment or inaccurate reading prescription at near.

Look for scars on the face and inquire about previous skin cancers with painful ophthalmoplegia.

All thunderclap onset headaches need extensive evaluation to rule out a secondary cause.

Think migraine when diagnosing eye pain related to sinus disease. You have a greater chance of being right!

Post-traumatic headache and eye pain is common.

Scleritis should be thought of if there is redness to the eye and pain in the eye that is severe.

Eye pain with eye movement and visual loss, should raise the possibility of opticneuritis. The finding of the RAPD with eye pain can be very helpful.

Tolosa Hunt Syndrome is a diagnosis of exclusion—always consider a secondary cause of the syndrome!

Day blindness or poor dark adaptation can occur in severe carotid stenosis.

Diagnosing a patient with unexplained ocular pain can be time-consuming and difficult, but taking an anatomic approach and excluding causes along the way can aid in the diagnosis. This book provides the reader with a systematic evaluation plan for these cases, written and edited by leaders in the field. A Case-Based Guide to Eye Pain is written for...

Purpose of review: We provide an overview of the neurological condition known as visual snow syndrome. Patients affected by this chronic disorder suffer with a pan-field visual disturbance described as tiny flickering dots, which resemble the static noise of an untuned television. Recent findings: The term 'visual snow' has only appeared in the...

Background The Coalition for a Healthier Community for Utah Women and Girls (CHC-UWAG) focused on addressing obesity-related health disparities impacting Utah women of color using community-based participatory research, a gender-based approach, and culturally sensitive health promotion activities delivered through community health workers (CHWs). A...

Background: Making an accurate diagnosis of optic disc drusen (ODD) is important as part of the work-up for possible life-threatening optic disc edema. It also is important to follow the slowly progressive visual field defects many patients with ODD experience. The introduction of enhanced depth imaging optical coherence tomography (EDI-OCT) has i...

Objectives: A number of neurologic and ophthalmic conditions are associated with abnormal light sensitivity (photophobia), but the most prevalent condition is migraine. We previously developed a questionnaire to quantify patients’ light sensitivity symptoms and the effects of their light sensitivity on activities of daily living. The objective of t...

Non-arteritic anterior ischaemic optic neuropathy (NAION) and optic neuritis (ON) may be difficult to distinguish early in their disease courses. Our goal was to determine if specific magnetic resonance imaging characteristics differentiate acute NAION from ON. Neuroradiologists, masked to diagnosis, reviewed the diffusion-weighted imaging (DWI) an...

Because of a previous association of pseudotumor cerebri (PTC) with levonorgestrel, we wished to evaluate the use of levonorgestrel-eluting intrauterine devices (“levonorgestrel intrauterine systems”, LNG-IUS) in our University of Utah and Rigshospitalet PTC patients. In our retrospective series, PTC prevalence was approximately 0.18% and 0.15% in...

Objectives: Ethnic and racial health disparities have been well-documented in the scholarly literature. In recent years, evidence about time spent in physical (in)activity and its relationship to physical and mental health has also emerged. This study assesses if observed ethnic/racial health differences were associated with differences in time us...