| OCR Text |
Show Neuro-Ophthalmology News 60th ISCEV meeting will be held in Kyoto, Japan, on March 15–18, 2023. Meagan D. Seay, DO Departments of Ophthalmology and Neurology, University of Utah Moran Eye Center, Salt Lake City, Utah ACKNOWLEDGMENTS American Headache Society Meeting Scottsdale Arizona November 17–20, 2022 cardiac arrest, and even death from the use of bupivacaine given as nerve blocks or trigger point injections. She stressed the importance of having mitigating strategies in your office if you do these injections including oxygen, ambu bag, and taking a patient's weight and calculate the dose of the injected anesthetic. Although bupivacaine has been implicated the most, lidocaine can also cause it. Another lecture highlighted that during the pandemic, our patients are more irritable, and across the country, there is an increase in verbal and even physical aggression. This has led to shortages in nurses, technicians, and providers from burn out. Importantly, we as providers must protect ourselves and our staff and not tolerate abuse and keep ourselves safe. In particular, reporting these to officials is important. Also, some states allow patients to record their visit without the consent of the provider, and few states have mutual recording permissions—meaning that the patient needs the provider's permission to record the visit. Finally, of course, there was an entire session devoted to both high and low intracranial pressure, and 3 neuroophthalmologists participated in this session. Dr. Marie di Nome presented on vision and papilledema and how to follow and treat. Dr. Kathleen Digre presented on issues in idiopathic intracranial hypertension (IIH). Dr. Deborah Friedman covered the MRI diagnosis of IIH—stressing you cannot make the diagnosis from MRI alone. This year, as with last year, one could attend in person or virtually. In fact, you can still register and listen to lectures and receive up to 47 American Medical Association Category 1 Credits! https://americanheadachesociety.org/events/2022-scottsdale-headache-symposium/ E very year, the Scottsdale Headache Symposium is a real jewel for headache education. Held at the JW Marriott Camelback Inn in a relaxed atmosphere, one can learn headache medicine in a weekend. This year as with many other years, there was plenty for a neuro-ophthalmologist to learn. The organizing committee was led by our own Dr. Deborah Friedman; so you know there was neuroophthalmology sprinkled around the headache symposium! Some highlights of the sessions included learning the cerebellum is playing a role in photophobia. The cerebellum is chock full of calcitonin gene-related peptide (CGRP) receptors and may play a role by modulating the posterior thalamus and contributing to light aversion and photophobia. A migraine preventative, atogepant (a small molecule gepant that blocks CGRP) approved for episodic migraine has weight loss associated with it with very few side effects. Many of our patients with migraine may benefit from this new therapy. Indomethacin responsive headaches that we see in neuro-ophthalmology, such as hemicrania continua and paroxysmal hemicranias, can respond to neuromodulation by the external vagal nerve stimulator. This has very few side effects and may be helpful to our patients. An update on coronavirus was also really informative. Secondary headaches seen with COVID include headaches related to venous sinus thrombosis, posterior reversible cerebrovascular syndrome, and cervical artery dissection. New daily persistent headache may also follow. Long COVID is associated with headache at least 21% of the time. There were updates on cannabinoids and psychedelics for treatment of migraine and cluster headache. Psilocybin has been found particularly helpful for cluster headache. One particularly important plenary was on office and practice safety. Dr. Deborah Friedman presented a case of LAST syndrome—“local anesthetic systemic toxicity”— from the use of bupivacaine and other related drugs (1). The syndrome consists of dizziness, seizure, bradycardia, e62 Dr. M. Seay is supported in part by an Unrestricted Grant from Research to Prevent Blindness, New York, NY, to the Department of Ophthalmology and Visual Sciences, University of Utah. Kathleen B. Digre, MD Departments of Ophthalmology and Neurology, Moran Eye Center, University of Utah, Salt Lake City, Utah REFERENCE 1. Wolfe JW, Butterworth JF. Local anesthetic systemic toxicity: update on mechanisms and treatment. Curr Opin Anaesthesiol. 2011;24:561–566. Neuro-Ophthalmology News: J Neuro-Ophthalmol 2023; 43: e61-62 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited. |
