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Iwona Plonka - Optic atrophy (USA) Posted on July 23, 2012

Author Julia Views Posted at 2014/01/13

Name: Iwona Plonka
Sex: Female
Country: USA
Age: 59
Diagnoses: 1. Optic atrophy 2. Depression 3. Hyperlipidemia
Admission Date: June 17, 2012
Days Admitted to Hospital: 26

About 11 years ago, Iwona was thought to have ingested methanol resulting in a coma. Two weeks after being admitted to the ICU of the local hospital, she came out of her coma. At that time the vision in both eyes had severely declined. The color vision in both eyes had disappeared as well as the central visual field. Iwona could count the number of fingers from a distance of 5 feet with the peripheral vision. Both pupils had weakened reflexes to light stimulus. The diameter of each pupil had increased to 5mms. Iwona was given intravenous injections and was prescribed oral medication for the symptoms, but there were no improvements to the vision. Three months later the vision declined further. It got to the point where Iwona could only see the outlines of objects that were further than 30 cms away. The vision in the right eye was eventually completely gone. Up to that point in time there was no effective treatment.

Nervous System Examination:
Iwona was alert and her speech was clear. The orientation, calculation ability and comprehension were almost normal. Both pupils were equal in size and the diameter of both pupils was 6.0mms. The left pupil was sensitive to direct light stimuli, but the right pupil had no reaction to direct light stimuli. The left pupil had no indirect reflection and the right pupil had inertia to indirect reflection. There was color vision deficiency in both eyes. The right eye had no vision. There was an absence of the central visual field and above visual field in the left eye. She could only perceive the movement of objects around the nasal area and below. The bitamporal could make out fingers at a distance of 30 cms. Beyond that distance, she could only see the object's outline. Opthalmoscope performance: there was no exudation in either fundus, and no edema. The optic papillae were pale. The left macular area was weakened. The right side macular area had disappeared. The arteriovenous ratio was 1:3. Both eyes could move freely, with no obvious nystagmus. The muscle tone of all four limbs was almost normal; the muscle strength of all four limbs was almost level 5. The abdominal reflexes and tendon reflexes of all four limbs were not elicited. The sucking reflex and palm jaw reflex were negative. The bilateral Hoffmann's sign was negative. The pathologic reflex of both lower limbs was negative. The deep and shallow sensation exists. The coordinated movements were normal.

The patient received treatment from June 17, 2012. We gave the patient treatment to improve the blood circulation in order to increase the blood supply and nourish the damaged neurons.

The left eys's vision, visual field and color vision has improved. Both pupils were equal in size and the diameter of both pupils was 4-5mms, the left pupil was sensitive to direct light stimuli and the right pupil had slow responses to direct light stimuli. The left pupil's indirect reflection has disappeared and the right pupil has inertia to indirect reflection. The patient's right eye has regained some vision. She can make out the outlines of large objects and moving small objects at a distance of 2 meters. The right eye's temporal visual field is about 70 degrees, the vision above and below the nasal area is poor. The left eye has gained central visual field; temporal visual field has increased 20 degrees and reached 90 degrees. The lower vision is about 70 degrees and the nasal area visual field is about 5 degrees. The upper visual field is poor. The patient can make out fingers from directly ahead 60cms distance and can make out large flower basket and the colors of a large flower basket from 105cms distance. The left eye can make out colors, such as pink, yellow, blue, etc. Opthalmoscope performance: there is no exudation in either fundus, and no edema. The optic papillae were pale. The border of the optic was not clear. The left macular area diopter has been enhanced. The right side macular area could be seen. The arteriovenous ratio was 2:3.





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