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Open accessJournal ArticleDOI: 10.1136/BCR-2021-242043

Paracentral acute middle maculopathy following SARS-CoV-2 infection: the D-dimer hypothesis.

04 Mar 2021-Case Reports (BMJ)-Vol. 14, Iss: 3
Abstract: We herein report a case of bilateral acute-onset scotoma following SARS-CoV-2 infection in a 19-year-old girl attributed to the presence of paracentral acute middle maculopathy (PAMM). She was tested positive for SARS-CoV-2 infection 2 weeks prior by reverse transcription PCR testing and

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Topics: Maculopathy (57%)
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6 results found


Journal ArticleDOI: 10.1097/ICU.0000000000000801
Abstract: Purpose of review The novel coronavirus disease in 2019 (COVID-19) has a wide range of systemic manifestations. Ocular manifestations are now well recognized, with conjunctivitis being the most common. Posterior segment involvement is uncommon and has mainly been described in case reports. This review provides an overview of the posterior segment involvement of COVID-19. Recent findings Severe acute respiratory syndrome coronavirus 2 affects the retina and the choroid through either direct entry or triggering an indirect inflammatory response. Majority of the retinal findings is a result of microvascular derangement leading to cotton wool spots, intraretinal hemorrhages, paracentral acute middle maculopathy, acute macular neuroretinopathy, or retinal vein occlusions. Rarely, inflammation involving the retina or the choroid, or reactivation of previously quiescent uveitis, can be seen. Summary It is important to recognize the possible correlation between ophthalmic conditions and COVID-19 as it can aid in diagnosis, management, and mitigation of the disease.

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Topics: Cotton wool spots (57%), Choroid (56%), Posterior segment of eyeball (56%) ... show more

1 Citations




Open accessJournal ArticleDOI: 10.1002/CCR3.4976
Abstract: The current findings is important in raising clinicians' awareness of the possibility of coincident acute macular neuroretinopathy (AMN) and COVID-19 as a potential cause of retinal vascular damage and ischemia.

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Open accessJournal ArticleDOI: 10.1136/POSTGRADMEDJ-2021-140500
Abstract: A 28-year-old man was admitted to hospital for surgical repair of a distal femur fracture sustained during a road traffic accident. Recovery was complicated by a pulmonary embolism. Two days later, his respiratory status declined, and he was transferred to intensive care unit (ICU) for ventilatory support due to confirmed SARS-CoV-2 infection. He reported bilateral reduced vision after being discharged from ICU. Visual acuities were 6/18 right and 6/12 left. Dilated funduscopy revealed bilateral cotton wool spots and small, sparse mid-peripheral intraretinal haemorrhages (figure 1). Discrete areas of retinal pallor involving the fovea were consistent with paracentral acute middle maculopathy (PAMM), confirmed on optical coherence tomography (OCT) (figure 2). Figure 1 Fundus autofluorescence of the right eye (A) and left eye (B) showing bilateral cotton wool spots …

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Topics: Cotton wool spots (55%), Maculopathy (54%)

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12 results found


Open accessJournal ArticleDOI: 10.1056/NEJMC2009787
Thomas J Oxley1, J Mocco1, Shahram Majidi1, Christopher P. Kellner1  +12 moreInstitutions (1)
Abstract: Stroke in Young Patients with Covid-19 Five patients younger than 50 years of age with large-vessel stroke and Covid-19 infection presented to a health system in New York City over a 2-week period....

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Topics: Stroke (59%)

1,357 Citations


Open accessJournal ArticleDOI: 10.1016/J.JCV.2020.104362
Abstract: Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus strain disease, has recently emerged in China and rapidly spread worldwide. This novel strain is highly transmittable and severe disease has been reported in up to 16% of hospitalized cases. More than 600,000 cases have been confirmed and the number of deaths is constantly increasing. COVID-19 hospitalized patients, especially those suffering from severe respiratory or systemic manifestations, fall under the spectrum of the acutely ill medical population, which is at increased venous thromboembolism risk. Thrombotic complications seem to emerge as an important issue in patients infected with COVID-19. Preliminary reports on COVID-19 patients' clinical and laboratory findings include thrombocytopenia, elevated D-dimer, prolonged prothrombin time, and disseminated intravascular coagulation. As the pandemic is spreading and the whole picture is yet unknown, we highlight the importance of coagulation disorders in COVID-19 infected patients and review relevant data of previous coronavirus epidemics caused by the severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and the Middle East Respiratory Syndrome coronavirus (MERS-CoV).

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Topics: Coronavirus (66%), Middle East respiratory syndrome coronavirus (64%), Population (51%) ... show more

499 Citations


Open accessJournal ArticleDOI: 10.1148/RADIOL.2020201561
23 Apr 2020-Radiology
Abstract: Thirty-two of 106 patients (30% [95% confidence interval: 22%, 40%]) with coronavirus disease 2019 infection were positive for acute pulmonary embolus on pulmonary CT angiograms.

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378 Citations


Open accessJournal ArticleDOI: 10.1001/JAMAOPHTHALMOL.2013.4056
David Sarraf1, David Sarraf2, Ehsan Rahimy2, Ehsan Rahimy1  +11 moreInstitutions (7)
01 Oct 2013-JAMA Ophthalmology
Abstract: Importance With the advent of more sophisticated imaging systems, such as spectral domain optical coherence tomography (SD-OCT), disruption of the inner segment/outer segment (IS/OS) band, and thinning of the outer nuclear layer (ONL) have been identified in association with acute macular neuroretinopathy (AMN). Objectives To characterize a new SD-OCT presentation of AMN as a paracentral acute middle maculopathy and to describe multimodal imaging findings that implicate an underlying pathogenesis related to retinal capillary ischemia. Design, Setting, and Participants Retrospective observational case series (January 1, 2012, to January 1, 2013) reviewing clinical and imaging data from 9 patients (11 eyes) with AMN at 6 tertiary referral centers. Lesions were classified as type 1 or 2 in relation to the SD-OCT location of the lesion above (type 1) or below (type 2) the outer plexiform layer (OPL) at 6 tertiary referral centers. Results Of the 9 patients, 5 were female and 4 were male (mean age, 47.6 years; range, 21-65 years). All patients presented with an acute paracentral scotoma and demonstrated a classic dark gray paracentral lesion with near-infrared imaging. Visual acuity ranged from 20/15 to 20/30. Six eyes (5 patients) had type 1 SD-OCT lesions, also referred to as paracentral acute middle maculopathy, and 5 eyes (4 patients) had type 2 SD-OCT lesions. Although type 1 lesions lead to inner nuclear layer (INL) thinning, type 2 lesions resulted in ONL thinning. Type 2 lesions were always associated with significant outer macular defects, including disruption of the inner segment/outer segment and outer segment/retinal pigment epithelium bands, whereas type 1 lesions spared the outer macula. Conclusions and Relevance Paracentral acute middle maculopathy may represent a novel variant of AMN that affects the middle layers of the macula above the OPL as diagnosed with SD-OCT imaging. Two types of AMN lesions may be seen with SD-OCT occurring above and below the OPL. Type 1 refers to hyperreflective bands in the OPL/INL region with subsequent INL thinning. Type 2 is hyperreflective bands in the OPL/ONL region with subsequent ONL thinning. Type 2 lesions may be associated with concomitant defects of the inner segment/outer segment layer. We propose that each of these lesions may be explained by occlusion of either the superficial capillary plexus (type 1) or deep capillary plexus (type 2) located in the innermost and outermost portion of the INL, respectively, immediately adjacent to each corresponding lesion type.

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Topics: Maculopathy (56%), Outer nuclear layer (52%), Outer plexiform layer (51%)

264 Citations


Open accessJournal ArticleDOI: 10.1016/J.JVS.2020.04.483
Abstract: Objective The aim of our study was to determine the incidence, characteristics, and clinical outcomes of patients with the novel coronavirus (COVID-19) infection who had presented with and been treated for acute limb ischemia (ALI) during the 2020 coronavirus pandemic. Methods We performed a single-center, observational cohort study. The data from all patients who had tested positive for COVID-19 and had presented with ALI requiring urgent operative treatment were collected in a prospectively maintained database. For the present series, successful revascularization of the treated arterial segment was defined as the absence of early ( Results We evaluated the data from 20 patients with ALI who were positive for COVID-19. For the period from January to March, the incidence rate of patients presenting with ALI in 2020 was significantly greater than that for the same months in 2019 (23 of 141 [16.3%] vs 3 of 163 [1.8%]; P Conclusions In our preliminary experience, the incidence of ALI has significantly increased during the COVID-19 pandemic in the Italian Lombardy region. Successful revascularization was lower than expected, which we believed was due to a virus-related hypercoagulable state. The use of prolonged systemic heparin might improve surgical treatment efficacy, limb salvage, and overall survival.

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Topics: Revascularization (53%)

217 Citations


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