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The 46th meeting of the Upper Midwest Neuro-Ophthalmology Group (UMNOG), held on July 26, 2024, and hosted by Northwestern University at Chicago, brought together a group of neuro-ophthalmologists, researchers, and trainees. This conference served as a forum for presenting research findings, illustrating challenging cases in clinical practice, and discussing them from an expert viewpoint. Key topics included visual outcomes following the treatment of various optic neuropathies, and advancements in diagnostic techniques, including the integration of machine learning. Case demonstrations covered a wide range of afferent and efferent neuro-ophthalmological conditions, primarily related to systemic illnesses and novel treatments. The proceedings aimed to disseminate valuable knowledge and foster further research, offering comprehensive insights into the discussion held during the meeting. [ABSTRACT FROM AUTHOR]

Therapies, such as adalimumab, aimed at inhibiting the pro-inflammatory cytokine "tumour necrosis factor" (TNF) are effective and are frequently used in combination with non-biologic disease-modifying anti-rheumatic drugs to treat rheumatoid arthritis (RA) and other autoimmune diseases. Some reports indicate that, rarely, demyelinating CNS disorders such as optic neuritis can present in association with therapy initiation, whilst others suggest that there is no association between the two. Oral corticosteroids such as prednisone, though similarly effective in the treatment of inflammatory or auto-immune conditions, can be associated with adverse effects upon their discontinuation or tapering. We present a patient who developed an acute inflammatory optic neuropathy shortly after a self-taper of oral prednisone while being treated with adalimumab for RA, and discuss the challenge of deciding whether or not to halt anti-TNF therapy. [ABSTRACT FROM AUTHOR]

Our case describes a patient diagnosed with a carotid-cavernous fistula (CCF) secondary to a spontaneously ruptured cavernous carotid aneurysm, presenting with sudden vision loss, and a concomitant central retinal artery occlusion as visualized by a cherry-red spot in the macula and posterior ischemic optic neuropathy. Computed tomography of the brain and orbits showed mild hydrocephalus, orbital fat haziness, and proptosis with concern for fluid in the basal cisterns. Cerebral angiography confirmed the suspected diagnosis of CCF. After angiography, a Magnetic resonance imaging of the brain demonstrated abnormal diffusion restriction in the posterior right optic nerve confirmed on the apparent diffusion coefficient map, consistent with ischemia of the optic nerve in this location. Two weeks after discharge, outpatient fundus photography showed resolution of her cherry-red spot, and optical coherence tomography showed thinning of the entire retinal nerve fiber layer as compared to the contralateral eye. In CCFs, congestive symptoms of proptosis, pain, and even central retinal vein occlusion findings are frequently described. However, our patient's no light perception vision and imaging findings suggest associated central retinal artery occlusion and ischemic optic neuropathy. These findings underscore the multitude of serious visual effects of high flow CCFs. [ABSTRACT FROM AUTHOR]

Traumatic oculomotor nerve palsies may result in aberrant regeneration and synkinesis that can impair normal facial function. We retrospectively investigated 16 patients with traumatic oculomotor nerve palsies who were treated with and without steroids to evaluate the rates of aberrant regeneration. The overall rates of aberrant regeneration were similar between the two groups and in line with other published series. Some limitations to our study may limit our ability to detect real differences, and additional studies would be beneficial. [ABSTRACT FROM AUTHOR]