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Published in: Documenta Ophthalmologica 1/2011

01-08-2011 | Case Report

Normal sensory and absent cognitive electrophysiological responses in functional visual loss following chemical eye burn

Authors: Nada Jiraskova, Miroslav Kuba, Jan Kremlacek, Pavel Rozsival

Published in: Documenta Ophthalmologica | Issue 1/2011

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Abstract

Objective

To present a unique case of a 34-year-old patient with unilateral functional visual loss after chemical burn with normal visual evoked potentials (VEPs) and absent cognitive response (P300 wave).

Methods

Visual functions, complete ophthalmic and neurologic examinations including computed tomography of the brain, electrophysiological testing of the visual pathway up to the cognitive brain cortex were evaluated. Data were collected prospectively during 1-year follow-up and compared with data from published case series and a literature review.

Results

No abnormalities were found that could account for such a rapid monocular loss of vision with exception of absence of the P300 wave in the affected eye during cognitive tasks. Vision slowly improved during 1 year without any treatment.

Conclusions

Functional vision loss is a diagnosis of exclusion. In the event of reduced vision in the context of a normal ocular health examination, all other pathology must be ruled out before the diagnosis of functional visual loss is established. Complex visual electrophysiological testing is the preferred tool for objective examination of such disorders.
Literature
1.
go back to reference Villegas RB, Ilsen PF (2007) Functional vision loss: a diagnosis of exclusion. Optometry 78:523–533PubMed Villegas RB, Ilsen PF (2007) Functional vision loss: a diagnosis of exclusion. Optometry 78:523–533PubMed
3.
go back to reference Ellwanger J, Tenhula WN, Rosenfeld JP, Sweet JJ (1999) Identifying simulators of cognitive deficit through combined use of neuropsychological test performance and event-related potentials. J Clin Exp Neuropsychol 21(6):866–879PubMedCrossRef Ellwanger J, Tenhula WN, Rosenfeld JP, Sweet JJ (1999) Identifying simulators of cognitive deficit through combined use of neuropsychological test performance and event-related potentials. J Clin Exp Neuropsychol 21(6):866–879PubMedCrossRef
4.
go back to reference Lorenz J, Kunze K, Bromm B (1998) Differentiation of conversive sensory loss and malingering by P300 in a modified oddball task. Neuroreport 9(2):187–191PubMedCrossRef Lorenz J, Kunze K, Bromm B (1998) Differentiation of conversive sensory loss and malingering by P300 in a modified oddball task. Neuroreport 9(2):187–191PubMedCrossRef
5.
go back to reference Jeon YW, Polich J (2001) P3a from a passive visual stimulus task. Clin Neurophysiol 112(12):2202–2208PubMedCrossRef Jeon YW, Polich J (2001) P3a from a passive visual stimulus task. Clin Neurophysiol 112(12):2202–2208PubMedCrossRef
6.
go back to reference Kubova Z, Kuba M, Spekreijse H, Blakemore C (1995) Contrast dependence of motion-onset and pattern-reversal evoked potentials. Vision Res 35(2):197–205PubMedCrossRef Kubova Z, Kuba M, Spekreijse H, Blakemore C (1995) Contrast dependence of motion-onset and pattern-reversal evoked potentials. Vision Res 35(2):197–205PubMedCrossRef
7.
8.
go back to reference Kuba M, Kubova Z, Kremlacek J, Langrova J (2007) Motion-onset VEPs: characteristics, methods, and diagnostic use. Vision Res 47(2):189–202PubMedCrossRef Kuba M, Kubova Z, Kremlacek J, Langrova J (2007) Motion-onset VEPs: characteristics, methods, and diagnostic use. Vision Res 47(2):189–202PubMedCrossRef
9.
go back to reference Kremlacek J, Kuba M, Kubova Z, Chlubnova J (2004) Motion-onset VEPs to translating, radial, rotating and spiral stimuli. Doc Ophthalmol 109(2):169–175PubMedCrossRef Kremlacek J, Kuba M, Kubova Z, Chlubnova J (2004) Motion-onset VEPs to translating, radial, rotating and spiral stimuli. Doc Ophthalmol 109(2):169–175PubMedCrossRef
10.
go back to reference Kremlacek J, Kuba M, Chlubnova J, Kubova Z (2004) Effect of stimulus localisation on motion-onset VEP. Vision Res 44(26):2989–3000PubMedCrossRef Kremlacek J, Kuba M, Chlubnova J, Kubova Z (2004) Effect of stimulus localisation on motion-onset VEP. Vision Res 44(26):2989–3000PubMedCrossRef
11.
go back to reference Kuba M, Kubova Z (1992) Visual evoked potentials specific for motion onset. Doc Ophthalmol 80(1):83–89PubMedCrossRef Kuba M, Kubova Z (1992) Visual evoked potentials specific for motion onset. Doc Ophthalmol 80(1):83–89PubMedCrossRef
12.
go back to reference Kubova Z, Chlubnova J, Szanyi J, Kuba M, Kremlacek J (2005) Influence of physiological changes of glycemia on VEPs and visual ERPs. Physiol Res 54:245–250PubMed Kubova Z, Chlubnova J, Szanyi J, Kuba M, Kremlacek J (2005) Influence of physiological changes of glycemia on VEPs and visual ERPs. Physiol Res 54:245–250PubMed
13.
go back to reference Kubova Z, Kremlacek J, Valis M, Szanyi J, Langrova J, Vit F, Kuba M (2010) Effect of memantine in Alzheimer’s disease evaluated by visual-evoked potentials to pattern-reversal, motion-onset, and cognitive stimuli. J Clin Neurophysiol 27:334–340PubMedCrossRef Kubova Z, Kremlacek J, Valis M, Szanyi J, Langrova J, Vit F, Kuba M (2010) Effect of memantine in Alzheimer’s disease evaluated by visual-evoked potentials to pattern-reversal, motion-onset, and cognitive stimuli. J Clin Neurophysiol 27:334–340PubMedCrossRef
14.
go back to reference Langrova J, Kuba M, Kremlacek J, Kubova Z, Vit F (2006) Motion-onset VEPs reflect long maturation and early aging of visual motion-processing system. Vis Res 46:536–544PubMedCrossRef Langrova J, Kuba M, Kremlacek J, Kubova Z, Vit F (2006) Motion-onset VEPs reflect long maturation and early aging of visual motion-processing system. Vis Res 46:536–544PubMedCrossRef
15.
go back to reference Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M (2005) Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry 162(5):847–855PubMedCrossRef Mayou R, Kirmayer LJ, Simon G, Kroenke K, Sharpe M (2005) Somatoform disorders: time for a new approach in DSM-V. Am J Psychiatry 162(5):847–855PubMedCrossRef
16.
go back to reference Henningsen P, Zimerman T, Sattel H (2003) Medically unexplained physical symptoms, anxiety, and depression: a meta-analytical review. Psychosom Med 65(4):528–533PubMedCrossRef Henningsen P, Zimerman T, Sattel H (2003) Medically unexplained physical symptoms, anxiety, and depression: a meta-analytical review. Psychosom Med 65(4):528–533PubMedCrossRef
17.
go back to reference Sharpe M (2002) Medically unexplained symptoms and syndromes. Clin Med 2(6):501–504PubMed Sharpe M (2002) Medically unexplained symptoms and syndromes. Clin Med 2(6):501–504PubMed
18.
go back to reference Stone J, Carson A, Sharpe M (2005) Functional symptoms in neurology: management. Neurol Pract 76(SI):i13–i21 Stone J, Carson A, Sharpe M (2005) Functional symptoms in neurology: management. Neurol Pract 76(SI):i13–i21
19.
go back to reference Beatty S (1999) Non-organic visual loss. Postgrad Med J 75:201–207PubMed Beatty S (1999) Non-organic visual loss. Postgrad Med J 75:201–207PubMed
20.
go back to reference Raghunandan A, Buckingham RS (2008) The utility of clinical electrophysiology in a case of nonorganic vision loss. Optometry 79:436–443PubMed Raghunandan A, Buckingham RS (2008) The utility of clinical electrophysiology in a case of nonorganic vision loss. Optometry 79:436–443PubMed
21.
go back to reference Niemeyer G, Barthelmes D (2010) Looking at non-organic visual loss. Doc Ophthalmol 121(Suppl.1):9–10 Niemeyer G, Barthelmes D (2010) Looking at non-organic visual loss. Doc Ophthalmol 121(Suppl.1):9–10
22.
go back to reference Heinrich SP, Marhöfer D, Bach M (2010) “Cognitive” visual acuity estimation based on the event-related potential. Clin Neurophysiol 12:1464–1472CrossRef Heinrich SP, Marhöfer D, Bach M (2010) “Cognitive” visual acuity estimation based on the event-related potential. Clin Neurophysiol 12:1464–1472CrossRef
Metadata
Title
Normal sensory and absent cognitive electrophysiological responses in functional visual loss following chemical eye burn
Authors
Nada Jiraskova
Miroslav Kuba
Jan Kremlacek
Pavel Rozsival
Publication date
01-08-2011
Publisher
Springer-Verlag
Published in
Documenta Ophthalmologica / Issue 1/2011
Print ISSN: 0012-4486
Electronic ISSN: 1573-2622
DOI
https://doi.org/10.1007/s10633-011-9275-0

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