Spine surgery is estimated to have the highest incidence of PION, 0.028%. Long duration of feet-above-head position in prostate surgery has also been suggested to increase risk of PION. Diagnosis
The diagnosis of PION is often difficult since the optic nerves initially appear normal. The injury occurs posterior to that portion of the nerve visible during ophthalmoscopic examination. There may be an abnormal relative pupillary response (APD) if the injury is confined to one optic nerve, but often it is bilateral and the symmetry of pupillary responses is maintained. Furthermore, MRI scanning may not be helpful. It is not uncommon for the erroneous diagnoses of malingering or cortical blindness to be made. If possible, an urgent neuro-ophthalmology consult is most likely to lead to the correct diagnosis.There is no confirmatory test for PION. PION is a diagnosis of exclusion. To prevent impending blindness, it is urgent to rule out giant cell arteritis when a patient over 50 presents with sudden vision loss. Differential diagnosis
In the postoperative setting, without gross eye injury, visual loss requires an assessment of the whole visual system for ischemic damage. The optic nerve is not the only tissue of the visual pathway susceptible to decreased blood flow. Decreased oxygenation of the retina or brain could also impair vision. Anterior ischemic optic neuropathy
PION is less common than Anterior Ischemic Optic Neuropathy (AION).
Angiostrongylus cantonensis is a parasitic nematode (roundworm) that causes angiostrongyliasis, the most common cause of eosinophilic meningitis in Southeast Asia and the Pacific Basin. The nematode commonly resides in the pulmonary arteries of rats, giving it the common name rat lungworm. Snails are the primary intermediate hosts, where larvae develop until they are infectious. Humans are incidental hosts of this roundworm, and may become infected through ingestion of larvae in raw or undercooked snails or other vectors, or from contaminated water and vegetables. The larvae are then transported via the blood to the central nervous system, where they are the most common cause of eosinophilic meningitis, a serious condition that can lead to death or permanent brain and nerve damage. Angiostrongyliasis is an infection of increasing public health importance, as globalization contributes to the geographic spread of the disease. History
First described by the renowned Chinese parasitologist Hsin-Tao Chen (1904–1977) in 1935, after examining Cantonese rat specimens, the nematode Angiostrongylus cantonensis was identified in the cerebrospinal fluid of a patient with eosinophilic meningitis by Nomura and Lim in Taiwan in 1944. They noted that raw food eaten by the patient may have been contaminated by rats. In 1955, Mackerass and Sanders identified the lifecycle of the worm in rats, defining snails and slugs as the intermediate hosts, and noting the path of transmission through the blood, brain, and lungs in rats. Infectious agent
A. cantonensis is a helminth of the phylum Nematoda, order Strongylida, and superfamily Metastrongyloidea.