Acute Onset of Diplopia in an Uncontrolled Diabetic

A 50-year-old man with uncontrolled diabetes with recent dental surgery presented with an acute left sixth nerve palsy. He underwent urgent workup and, with a high degree of clinical suspicion, was taken to the operating room and found to have biopsy positive mucor mycosis infection. After repeated debridements and aggressive treatment with both local and systemic antifungal therapy, the patient survived and made a good clinical recovery overall.

UPFRONT Cases Section Editor: Larry Frohman, MD Postoperative Vision Loss A 74-year-old African-American man with vasculopathic risk factors including hypertension, diabetes mellitus II, and hyperlipidemia underwent complicated left superficial femoral artery endarterectomy with immediate postoperative right painless loss of vision. The surgery was prolonged duration (12 hours), and complicated by transfusion requiring hypotension secondary to extensive blood loss. Neuro ophthalmic examination revealed visual acuity of count finders right eye, 20/30 left eye, relative afferent pupillary defect right eye, with optic disc swelling right eye, consisted with a diagnosis of nonarteritic anterior ischemic optic neuropathy postsuperficial femoral endarterectomy in the setting of acute anemia and hypotension perioperatively. The case is available to download via the following link: https://journals.lww.com/jneuro-ophthalmology/Documents/JNO%20Upfront%20Cases/UPFRONT%20Case %207%20-%20Post-operative%20Vision%20Loss.pptx. Acute Onset of Diplopia in an Uncontrolled Diabetic A 50-year-old man with uncontrolled diabetes with recent dental surgery presented with an acute left sixth nerve palsy. He underwent urgent workup and, with a high degree of clinical suspicion, was taken to the operating room and found to have biopsy positive mucor mycosis infection. After repeated debridements and aggressive treatment with both local and systemic antifungal therapy, the patient survived and made a good clinical recovery overall. The case is available to download through the following link: Intractable Headache and Vomiting in a Pediatric Patient A 6-year-old girl presented with severe, intractable headache, and vomiting, but no visual complaints. She had a history of cystic-peritoneal shunt placement in childhood, and neurosurgical evaluation during the current presentation did not reveal any abnormalities. Neuro-ophthalmic examination was essential in determining the etiology of her symptoms and proceeding with appropriate intervention. The case is available to download through the following link: e458 Amir Ali, BSA School of Medicine, University of Texas Medical Branch, Galveston, Texas Subahari Raviskanthan, MBBS Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas Ardalan Sharifi, MD Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas Andrew G. Lee, MD Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas The authors report no conflicts of interest. https://journals.lww.com/jneuro-ophthalmology/Documents/ JNO%20Upfront%20Cases/UPFRONT%20Case%208% 20-%20Acute%20Onset%20of%20Diplopia%20in%20an %20Uncontrolled%20Diabetic.pptx. Aditya S. Gill, MD Roger Turbin, MD Larry Frohman, MD Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey. The authors report no conflicts of interest. https://journals.lww.com/jneuro-ophthalmology/Documents/JNO%20Upfront%20Cases/UPFRONT%20Case %209%20-%20Intractable%20Headache%20and% 20Vomiting%20in%20a%20Pediatric%20Patient.pptx. Khelly A. Shah, MD Larry P. Frohman, MD Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey. The authors report no conflicts of interest. UPFRONT Cases: J Neuro-Ophthalmol 2022; 42: e458 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.