ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Five patients with a chief visual complaint of photophobia were subsequently found to have compressive lesions of the optic chiasm. Visual acuity and visual field deficits were often subtle. Magnetic resonance imaging scanning revealed large suprasellar masses, including three pituitary adenomas, a craniopharyngioma, and a clivus chordoma. Photophobia resolved in all patients following treatment of the tumors. A compressive lesion of the optic chiasm should be considered in patients who experience persistent photophobia unexplained by ocular abnormalities.

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesTo characterize the clinical features of patients with pseudotumor cerebri (PTC) fulfilling the Modified Dandy Criteria who were diagnosed at or after the age of 44 years.MethodsWe reviewed the medical records between 1987 and 1999 of 14 patients at a single institution who were diagnosed as having PTC at 44 years of age or older according to the Modified Dandy Criteria: neurologic manifestations attributable to generalized increased intracranial pressure, elevated cerebrospinal fluid pressure with normal cerebrospinal fluid composition demonstrated by lumbar puncture, and normal or small ventricles demonstrated by neuroimaging. We documented presenting symptoms and signs, significant medical conditions, and visual field follow-up.ResultsThere were nine women and five men. Nine patients (64%) were obese. Five patients (36%) were asymptomatic. None presented with headache alone. Four patients (29%) had an identifiable cause of intracranial hypertension, including two with transverse sinus thrombosis, one with severe chronic obstructive pulmonary disease and cor pulmonale, and one with corticosteroid withdrawal after prolonged administration. During a median follow-up of 2 years of 12 patients, visual fields remained stable in 8, improved in 3, and worsened in 1.ConclusionsIn comparison with patients who have idiopathic intracranial hypertension, our small series of 14 patients diagnosed after the age of 44 years were more often men, were less often obese, were less symptomatic, and had identifiable causes of intracranial hypertension in a substantial minority (29%). The visual prognosis in this age group is generally good. Because the nonidiopathic causes of PTC would be overlooked by adhering to the Modified Dandy Criteria, we propose a modification that excludes patients who have dural venous sinus disease demonstrated on magnetic resonance imaging and those who may be exposed to medications or toxins or have systemic disorders that are known to increase intracranial pressure.

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

A 69-year-old man underwent successful endovascular treatment of a posterior communicating artery aneurysm that had caused a third nerve palsy. Pupil size became normal within 10 days and ptosis and ocular ductions became normal within 3 weeks of the procedure. Based on the reported recovery rates of third nerve palsy after aneurysmal clipping, recovery may occur more rapidly in patients who undergo endovascular treatment. Further data are necessary to substantiate this hypothesis.

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Spasm of accommodation, creating pseudomyopia, is generally associated with miosis and excess convergence as part of spasm of the near reflex. It may also exist as an isolated entity, usually attributed to psychogenic causes. We present six cases of accommodative spasm associated with closed head injury. All patients were male, ranging in age between 16 and 37 years. The degree of pseudomyopia, defined as the difference between manifest and cycloplegic refraction, was 1.5 to 2 diopters. A 3-year trial of pharmacologically induced cycloplegia in one patient did not lead to reversal of the spasm when the cycloplegia was stopped. All patients required the manifest refraction to see clearly at distance. The pseudomyopia endured for at least 7 years following head trauma. This phenomenon may represent traumatic activation or disinhibition of putative brain stem accommodation centers in young individuals.

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

An elderly man developed acute progressive supranuclear ophthalmoplegia and other central nervous system manifestations that suggested Whipple disease. Results of small intestinal biopsy were negative but polymerase chain reaction testing of the cerebrospinal fluid confirmed the diagnosis.

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

ObjectivesTo study the relationship between the major horizontal and minor torsional components of congenital nystagmus to elucidate the diagnostic importance, effects on vision, and pathogenetic implications of the torsional components.MethodsWe recorded the eye movements of 13 subjects with congenital nystagmus using a three-dimensional magnetic search coil technique over a 15-year period. The subjects fixated on stationary targets straight ahead and along the horizontal and vertical meridians. Six of the 10 subjects with horizontal congenital nystagmus were asymptomatic; the remaining 4 (plus two with a vertical component to their congenital nystagmus) had adult-onset symptoms. An additional subject without symptoms had a vertical congenital nystagmus component plus seesaw nystagmus; one of the symptomatic subjects also had seesaw nystagmus.ResultsIn all 13 subjects, the horizontal and torsional cycles were phase-locked, and positive horizontal (rightward), vertical (upward, if any), and torsional (clockwise) motion coincided in 10 subjects. That is, rightward horizontal eye rotation coincided with clockwise curvilinear motion (rightward and downward) of the upper pole of each eye. During the horizontal foveation periods, torsional motion was also of low velocity. In 2 of 13 subjects, the torsional waveforms differed from those in the horizontal plane; in others, the direction or the variation with gaze angle differed from that predicted by Listing. In each of the 13 subjects, the torsional components ranged from 8.16% to 94.42% (median, 32.94%) of the peak-to-peak magnitudes of the congenital nystagmus. In most cases, the measured torsion was far greater than that predicted by Listing's law for a worst-case analysis (range, 0.69–11.83%; median, 4.91%). The torsional components of the two subjects with seesaw nystagmus were 60.48% and 264.02%.ConclusionsThe manner in which the horizontal and torsional components of “horizontal” congenital nystagmus were phase-locked made clinical detection of the torsional component difficult. Most “horizontal” congenital nystagmus is actually horizontal-torsional congenital nystagmus. Visual acuity during horizontal foveation periods is not significantly diminished by torsional motion. In only one subject did the torsional component of the congenital nystagmus have an amplitude equivalent to Listing torsion; in the other 12 subjects, torsion exceeded our estimate of what Listing's law would predict. The torsional components of the seesaw nystagmus in two subjects also greatly exceeded the torsion predicted by Listing torsion. The most parsimonious explanation for our data is that the cyclic torsion in congenital nystagmus was generated centrally and not a result of Listing torsion, mechanical crosstalk, or normal or abnormal extraocular-muscle (plant) dynamics. Further measurements are needed to confirm this hypothesis.

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

An 82-year-old woman with atherosclerosis developed central retinal artery occlusions (CRAOs) in both eyes within an interval of 5 minutes. There was no evidence of a thromboembolic source, systemic hypotension, vasculitis, migraine, or hypercoagulable state. Virtually simultaneous binocular CRAOs have been rarely reported, and suggest the possibility of a systemic but still undefined “hypercoagulable trigger.”

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Although generally considered safe, magnetic resonance imaging (MRI) has a number of safety issues, including the effects of high magnetic fields and radiofrequency pulses on the body, and on implanted devices, the side effects of contrast agents, toxicity during pregnancy, claustrophobia, and hearing loss.

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID

ISSN:1070-8022    

出版商:OVID    

年代:2002

数据来源: OVID