Abstract Details

Title Saturday Night Retinopathy – A Rare Case of Acute Onset Vision Loss and Ophthalmoplegia

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-019

Objective To describe a rare case of Saturday Night Retinopathy (SNR) presenting as acute onset monocular vision loss and ophthalmoplegia in a patient with history of chronic intravenous (IV) heroin use and excessive alcohol intake.

Background Saturday night retinopathy with ophthalmoplegia is a rare clinical syndrome of acute onset monocular vision loss, ophthalmoplegia, and periorbital edema. It was first described in 1974 and since then there are two additional case reports and one case series of three patients in literature. Most cases are associated with alcohol and IV drug use causing prolonged unconsciousness preceding the symptoms, and the pathophysiology is hypothesized to be secondary to prolonged pressure over the orbit.

Design/Methods Case Report

Results A 31-year-old female presented to the emergency department with acute onset of painful monocular vision loss and ophthalmoplegia after an unknown period of unconsciousness that followed IV heroin and crack cocaine use. She had proptosis of the left eye and upper lid edema. She had no light perception and her pupil was non-reactive with a relative afferent pupillary defect. Fundoscopy revealed retinal edema.

The differential diagnosis of the multiple cranial neuropathies included cavernous sinus or orbital apex syndrome. The acuity of onset and progression likewise suggested a vascular event which was excluded by an emergent CT Angiography of the head. MRI of the orbits showed edema of the extraocular muscles and lacrimal glands, with a normal-appearing optic nerve. The patient was started on high dose IV corticosteroids after infectious and vascular etiologies were excluded.

Conclusions SNR is a rare clinical syndrome that often leads to acute neurologic evaluation. Vascular, traumatic and infectious etiologies must be excluded, and the diagnosis should be suspected in the appropriate clinical setting (prolonged period of unconsciousness). There is currently no consensus on treatment, and options include high dose IV steroids and acetazolamide.

Authors/Disclosures
Maria Kristina C. Dorotan, MD (Yale School of Medicine) PRESENTER	Dr. Dorotan has nothing to disclose.
Yongwoo Kim, MD (Medstar Washinton Hospital Center)	Dr. Kim has nothing to disclose.
Justin Y. Kwan, MD, FAAN (National Institutes of Health)	Dr. Kwan has received research support from National Institutes of Health. Dr. Kwan has received personal compensation in the range of $100,000-$499,999 for serving as a Employee with National Institutes of Health.

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