Treatment of Acute Visual Loss in Giant Cell Arteritis: Should We Prescribe High-Dose Intravenous Steroids or Just Oral Steroids?

Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, IA 52242-1091, USA.
Journal of neuro-ophthalmology: the official journal of the North American Neuro-Ophthalmology Society (Impact Factor: 1.95). 09/2012; 32(3):278-87. DOI: 10.1097/WNO.0b013e3182688218
Source: PubMed
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    • "Initial treatment is with corticosteroids. Use of high-dose intravenous steroids as initial therapy is preferred by many, especially when visual complaints are present but this remains highly controversial [20]. The last decade has witnessed a much improved understanding of the immunopathology of GCA, and is impacting the diagnostic approach to patients with GCA. "
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    ABSTRACT: Cranial or cervical vascular disease is commonly associated with headaches. The descriptions may range from a thunderclap onset of a subarachnoid hemorrhage to a phenotype similar to tension type headache. Occasionally, this may be the sole manifestation of a potentially serious underlying disorder like vasculitis. A high index of clinical suspicion is necessary to diagnose the disorder. Prompt recognition and treatment is usually needed for many conditions to avoid permanent sequelae that result in disability. Treatments for many conditions remain challenging and are frequently controversial due to paucity of well controlled studies. This is a review of the recent advances that have been made in the diagnosis or management of these secondary headaches.
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    ABSTRACT: Ischemic optic neuropathy is of two types: anterior and posterior. Non-arteritic anterior ischemic optic neuropathy (NA-AION) is the most common type of ischemic optic neuropathy. There are three major misconceptions about NA-AION: (1) that its pathogenesis is not known, (2) that NA-AION and ischemic cerebral stroke are similar in nature, pathogenetically and in management, and (3) that there is no treatment. All these misconceptions are based on lack of in-depth knowledge of the subject. They are discussed in the light of our current scientific knowledge. The pathogenesis of NA-AION is known but is highly complex. NA-AION and ischemic cerebral stroke are very different clinical entities, pathogenetically and in management. Aspirin has no beneficial effect. Corticosteroid therapy during the initial stages can be beneficial. To reduce the risk of development of NA-AION in the other eye or of further visual loss in the same eye, it is essential to reduce as many risk factors as possible. Management of arteritic anterior ischemic optic neuropathy and of posterior ischemic optic neuropathy is discussed.
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    ABSTRACT: To provide a clinical update of the neuro-ophthalmology literature over the last twelve months. This is an annual review of current literature from August 1, 2011 to August 1, 2012. The authors conducted a one year English language neuro-ophthalmology literature search using PubMed from August 1, 2011 to August 1, 2012 using the following search terms: pupil abnormalities, eye movements, diseases of muscle and musculoskeletal junction, optic nerve disorders, optic neuritis and multiple sclerosis, chiasm and posterior primary visual pathway lesions, increased intracranial pressure and related entities, tumors (e.g., meningioma) and aneurysm affecting the visual pathways, vascular diseases, higher visual functions, advances in neuroimaging, and miscellaneous topics in neuro-ophthalmology. The authors included original articles, review articles, and case reports, which revealed the new aspects and updates in neuro-ophthalmology. Letters to the editor, unpublished work, and abstracts were not included in this annual literature review. We propose to update the practicing clinical ophthalmologist on the most clinically relevant literature from the past year. However, this review is not meant to be all-inclusive and highlights only the literature most applicable to the practicing clinical ophthalmologist. We reviewed the literature over the past year in neuro-ophthalmology of potential interest and relevance to the comprehensive ophthalmologist. This annual review provides a brief update on a number of neuroophthalmic conditions that might be of interest to the practicing clinical ophthalmologist.
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