Acute retinal ischaemic events, ranging from central retinal artery occlusions (CRAO) and branch retinal artery occlusions (BRAO) to transient ischaemic monocular vision loss (TMVL), cause sudden and often severe vision loss, yet their broader implications for systemic vascular health are not well defined. To investigate this, we conducted a large, propensity-matched cohort study including a total of 566 patients at an academic ophthalmic hospital in London, United Kingdom, linking ophthalmic diagnoses to national records of cardiovascular events and mortality. Our findings reveal that patients experiencing a CRAO have a nearly threefold increased risk of a subsequent ischaemic stroke or myocardial infarction, when compared to matched controls. This elevated risk, however, was not apparent in individuals who suffered a BRAO or TMVL, suggesting a distinct risk profile for CRAO. Systemic comorbidities like hypertension and diabetes were prevalent in all groups. Atrial fibrillation was newly diagnosed in 6% of patients with CRAO within one year. Patients with BRAO were more likely to undergo carotid endarterectomy than those with CRAO. The substantial risk of serious cardiovascular morbidity following retinal arterial ischaemia highlights the need to ensure such patients benefit from early treatment and prolonged cardiac monitoring and rigorous implementation of secondary prevention in RAO and suspected embolic TMVL.

Acute visual loss following transsphenoidal pituitary surgery is rare but potentially reversible if promptly identified and treated. Migration of fat graft into the sella is an infrequently recognised but treatable cause. A woman in her early 60s presented with pituitary acromegaly and underwent endoscopic endonasal transsphenoidal surgery for a pituitary macroadenoma. Postoperatively, she developed sudden bilateral visual loss. MRI revealed optic chiasm compression by migrated fat graft used for sellar reconstruction. Emergency re-exploration and decompression led to complete restoration of vision. Fat graft migration can cause chiasmal compression and sudden painless vision loss after pituitary surgery. Immediate imaging and decompression are critical for visual recovery.

Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality, with Streptococcus pneumoniae as a leading cause. Chest radiography, the standard initial imaging modality, can miss early complications, which lead to delays in diagnosis and treatment. Computed tomography (CT) provides greater detail in identifying complications. We report a 67-year-old male with chest pain who was treated in an outpatient setting with oral antibiotics for suspected CAP; however, he experienced clinical deterioration, including fever, cough, weight loss, and worsening respiratory symptoms. Repeat chest X-ray revealed increased lung opacities, prompting a CT thorax, which revealed a large pulmonary abscess not visualized on prior imaging. Failure of outpatient management required inpatient admission with intravenous antibiotics and CT-guided percutaneous drainage. A total of 450 mL of purulent fluid was drained, and cultures grew Streptococcus intermedius. The patient improved and was given targeted antibiotics. This case highlights the importance of considering less common pathogens such as S. intermedius in patients with prolonged symptoms or failure of outpatient therapy. CT imaging should be considered in patients who fail to improve, thus expediting diagnosis and guiding management. S. pneumoniae typically causes acute pneumonia with lobar consolidation. S. intermedius often causes necrotizing abscesses and empyema, often with a longer, more subacute presentation. Differentiating the two on initial presentation is quite difficult, as in our patient's case.

Serous retinal detachment (SRD) is an uncommon but vision-threatening manifestation of hypertensive disorders of pregnancy, particularly in the context of severe preeclampsia and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. We report two cases of young primigravid women who developed bilateral SRD associated with HELLP syndrome. Both patients presented with acute bilateral vision loss and were diagnosed using optical coherence tomography. Management included antihypertensive therapy, magnesium sulfate, and delivery without any ophthalmological intervention. Both patients experienced complete visual recovery within two weeks. This report underscores the importance of prompt recognition, appropriate obstetric management, and the typically favorable visual prognosis of SRD in preeclampsia.

Perioperative visual loss (POVL) is an uncommon but life-altering complication that has been reported most often after prolonged spine procedures performed in the prone position. Among the recognized causes, posterior ischemic optic neuropathy (PION) accounts for the majority of cases in this setting and is believed to result from impaired perfusion of the retrobulbar optic nerve. Clinical and registry data consistently associate PION with intraoperative anemia, sustained or relative hypotension, substantial blood loss, large-volume fluid administration with hemodilution, and preexisting vascular disease that limits autoregulatory reserve. Advanced age and systemic atherosclerotic burden further increase susceptibility by reducing the optic nerve's tolerance to ischemic stress. This case-based educational review describes an elderly patient with significant systemic diseases, including vasculopathy, who developed acute, painless visual loss after lumbar spinal surgery. Using this clinical scenario, we examine the interplay between patient-specific risk factors and intraoperative physiology, review the underlying vascular anatomy and pathophysiology of PION, and outline an approach to early recognition and differential diagnosis of postoperative visual deficits. Management principles are discussed with an emphasis on hemodynamic optimization, prompt specialist consultation, and realistic counseling regarding prognosis. The goal of this structured discussion is to provide anesthesiology trainees and perioperative clinicians with a practical framework to recognize high-risk situations, implement preventive strategies, and respond appropriately should this rare but catastrophic complication occur.

Optic neuritis is an acute inflammatory disease that can cause acute visual loss. We present a case of a 22-year-old female in postpartum with acute headache, retroocular pain, and bilateral amaurosis. Orbit MRI revealed inflammatory changes in both neurovascular optical bundles. The patient required 5-day steroid therapy, presenting complete recovery.

Background/Objectives: Persistent dizziness after the apparent resolution of an acute or episodic vestibular disorder remains a frequent and clinically challenging condition. In many patients, symptoms persist despite negative positional testing, absence of spontaneous nystagmus, and preserved high-frequency vestibular responses on video head impulse testing. This discrepancy suggests that persistent dizziness may not always be explained by incomplete recovery of a single peripheral vestibular lesion but may reflect a dissociation between transient/high-frequency vestibular responses and sustained/low-frequency or integrative vestibular processing. The aim of this study was to propose a hypothesis-generating, case-based clinical framework for interpreting this dissociation and its implications for targeted vestibular rehabilitation. Methods: This was a retrospective, hypothesis-generating, case-based clinical study derived from routine specialist neuro-otological practice. Four illustrative cases were selected because they represented distinct patterns of persistent dizziness in which preserved or near-preserved transient vestibular responses coexisted with abnormalities in sustained, otolithic, visual-vestibular, or velocity-storage-dependent processing. All patients underwent detailed clinical history assessment, bedside neuro-otological examination, and multidomain vestibular assessment according to clinical indication. The purpose of the study was not to estimate prevalence, validate diagnostic accuracy, or demonstrate treatment efficacy but to illustrate a physiology-based interpretive framework. Results: The four cases showed different patterns of time-domain dissociation. These included low-frequency integrative dysfunction without clear peripheral lateralization, incompletely compensated unilateral vestibular asymmetry, selective unilateral otolithic loss despite preserved semicircular canal high-frequency responses, and bilateral sustained vestibular hypofunction unmasked by an apparently resolved BPPV-like event. Across cases, persistent symptoms were better explained by the relationship between transient and sustained vestibular domains than by any single test result considered in isolation. Conclusions: Persistent dizziness may arise from different combinations of preserved transient vestibular responses and impaired sustained or integrative vestibular processing. The proposed framework does not introduce new vestibular tests and does not claim to validate a new diagnostic entity. Rather, it organizes established vestibular investigations within a time-domain model that may help identify clinically meaningful dissociations and guide individualized, domain-specific vestibular rehabilitation. Prospective studies with larger samples and external validation are required to determine the diagnostic and therapeutic value of this approach.

Myeloid sarcoma is an extramedullary tumor composed of myeloid blasts, most commonly involving the skin, lymph nodes, and soft tissues. We report a rare case of myeloid sarcoma of the central nervous system (CNS) causing neuropsychiatric symptoms in an elderly woman with a history of JAK2-positive polycythemia vera and acute myeloid leukemia (AML) in long-term remission. The patient presented with a one-month history of complex visual hallucinations, short-term memory loss, and personality changes. Magnetic resonance imaging revealed a 2.4-cm enhancing mass in the septum pellucidum extending between the frontal horns of the lateral ventricle. Cytological analysis of the cerebrospinal fluid showed pleocytosis, and flow cytometry identified a 50% population of CD34 + blasts, consistent with the immunophenotype of the patient's prior biopsy-proven AML. This case highlights an exceedingly unusual presentation of AML relapse and emphasizes the need for clinicians to consider CNS involvement in hematologic patients presenting with new-onset neuropsychiatric symptoms, regardless of remission status.