1/20. Giant aneurysm at the junction of the left internal carotid and persistent primitive trigeminal arteries--case report.A 67-year-old female presented with an unruptured giant aneurysm at the junction of the left internal carotid artery (ICA) and the persistent primitive trigeminal artery (PTA), manifesting as progressive left abducens nerve paresis. The PTA was clipped by the left suboccipital approach. The aneurysm was then successfully thrombosed by ligation of the left ICA at the cervical portion following left superficial temporal artery-middle cerebral artery anastomosis. The left abducens nerve paresis improved postoperatively. magnetic resonance imaging was of considerable value in the pre- and postoperative evaluation of the giant aneurysm.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/20. Painful ophthalmoplegia: overview with a focus on tolosa-hunt syndrome.Painful ophthalmoplegia is an important presenting complaint to emergency departments, ophthalmologists, and neurologists. The etiological differential diagnosis of painful ophthalmoplegia is extensive and consists of numerous sinister etiologies including vascular (eg, aneurysm, carotid dissection, carotid-cavernous fistula), neoplasms (eg, primary intracranial tumors, local or distant metastases), inflammatory conditions (eg, orbital pseudotumor, sarcoidosis, tolosa-hunt syndrome), infectious etiologies (eg, fungal, mycobacterial), and other conditions (eg, microvascular infarcts secondary to diabetes, ophthalmoplegic migraine, giant cell arteritis). A systematic approach to the evaluation of painful ophthalmoplegia can lead to prompt recognition of serious disorders that if left untreated, can be associated with significant morbidity or mortality. Inflammatory conditions such as tolosa-hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids, but should be diagnoses of exclusion.- - - - - - - - - - ranking = 0.5keywords = giant (Clic here for more details about this article) |
3/20. blindness and total ophthalmoplegia after aesthetic polymethylmethacrylate injection: case report.microspheres of polymethyl-methacrylate (PMMA) are exciting new soft-tissue fillers that are becoming increasing popular for facial rejuvenation. Some reports of side effects of this procedure are basically in respect to dermal reaction, with late-onset granulomatous lesion with giant cells and vacuoles. We report blindness and total ophthalmoplegia after PMMA injection into glabellar area in a healthy woman and review the literature.- - - - - - - - - - ranking = 0.5keywords = giant (Clic here for more details about this article) |
4/20. Subdural hemorrhage in the posterior fossa caused by a ruptured cavernous carotid artery aneurysm after a balloon occlusion test. Case report.Given the relatively benign natural history of cavernous carotid artery aneurysms and based on anecdotal reports in the literature of subarachnoid hemorrhage (SAH) or subdural hemorrhage (SDH) from these aneurysms, observation is warranted and typically recommended. In this case report, the authors describe a woman who harbored a partially thrombosed, giant cavernous aneurysm that ruptured after she underwent a balloon occlusion test (BOT) and predominately led to an SDH. The authors believe that this occurrence is the first such report in the English literature. They discuss possible mechanisms for this event and the literature related to SAH or SDH from cavernous aneurysms, including why cavernous aneurysms cause such hemorrhages. The authors also recommend that attention be paid to such lesions regarding the possibility of aneurysmal rupture following a BOT.- - - - - - - - - - ranking = 0.5keywords = giant (Clic here for more details about this article) |
5/20. Bilateral orbital involvement in fatal giant cell polymyositis.The case of a young woman with giant cell polymyositis is described. She had bilateral, severe, midly painful proptosis and ophthalmoplegia. Extensive pharyngeal, laryngeal, and cardiac muscle involvement occurred 18 months later coincident with fatal cardiac arrhythmia. At autopsy, extensive muscle necrosis and giant cells were noted in extraocular, pharyngeal, laryngeal, and cardiac muscle with only minimal involvement of other striated muscles.- - - - - - - - - - ranking = 3keywords = giant (Clic here for more details about this article) |
6/20. A pupil-sparing oculomotor palsy from a contralateral giant intracavernous carotid aneurysm.A patient presenting with a left pupil-sparing oculomotor palsy and periorbital pain was subsequently found to have a giant saccular aneurysm of the right internal carotid artery within the cavernous sinus. The aneurysm was of the contralateral artery compared to the side of all presenting neuro-ophthalmic signs and symptoms. diagnosis was achieved by bilateral carotid arteriography and surgical treatment with a Crutchfield arterial clamp and bypass graft has returned the patient essentially to normalcy.- - - - - - - - - - ranking = 2.5keywords = giant (Clic here for more details about this article) |
7/20. orbital myositis and giant cell myocarditis.A 65-year-old woman developed progressive, bilateral ophthalmoplegia, with thickened extraocular muscles on CT. One month later, a cardiac arrhythmia led to her death. Pathologically, the extraocular and skeletal muscles showed diffuse mononuclear cell inflammation, while the heart contained granulomatous myositis. This patient's syndrome of idiopathic, orbital myositis and giant cell myocarditis may be a distinct nosologic entity.- - - - - - - - - - ranking = 2.5keywords = giant (Clic here for more details about this article) |
8/20. Internuclear ophthalmoplegia in giant cell arteritis.ophthalmoplegia from ischemia to peripheral ocular motor nerves or muscles may complicate the course of giant cell arteritis (GCA). Although brainstem ischemia is known to occur in GCA, internuclear ophthalmoplegia has not been described. Two cases of biopsy-proven GCA are described in which internuclear ophthalmoplegia resulted from brainstem ischemia. Embolization from thrombosed extradural segments of inflammed vertebral arteries, or arteritis of brainstem perforating vessels may account for brainstem infarction. Rapid tapering of steroids was temporally related to brainstem infarction in both cases.- - - - - - - - - - ranking = 2.5keywords = giant (Clic here for more details about this article) |
9/20. Bilateral internuclear ophthalmoplegia--an unusual initial presenting sign of giant cell arteritis.A 63-year-old man presented six days after the sudden onset of horizontal double vision. His left eye became divergent two days later. On initial examination he had bilateral internuclear ophthalmoplegia with weakness of adduction and abducting nystagmus. Convergence was weak but there were no other neuro-ophthalmic signs. Constitutional signs included confusion and unsteadiness on his feet. A provisional diagnosis of arteritis was made. His ESR was 92 mm/h and a superficial temporal artery biopsy confirmed the diagnosis of giant cell arteritis. After two weeks or oral prednisolone his eye movements returned to normal. There have been no further relapses. This would appear to be a unique presentation of giant cell arteritis. The causes of internuclear ophthalmoplegia are discussed along with a review of the ocular and neuro-ophthalmic signs of giant cell arteritis.- - - - - - - - - - ranking = 3.5keywords = giant (Clic here for more details about this article) |
10/20. oculomotor nerve palsy in patients with cerebral aneurysms.Twenty-six patients with oculomotor nerve palsy due to cerebral aneurysms were examined. There were six males and twenty females with a mean age of 55 years. 25 of the 26 aneurysms were located at the junction of the internal carotid and the posterior communicating artery and one was at the junction of the basilar artery and the superior cerebellar artery. Twelve patients had associated subarachnoid hemorrhage (SAH); the other 14 did not. The initial symptoms in many patients were ptosis and double vision. Twenty-one of the patients had total oculomotor nerve palsy, one had a sparing of medial rectus muscle; three patients had only ptosis and anisocoria, and one had oculomotor nerve palsy with pupillary sparing. All aneurysms, including giant aneurysms, were clipped under a microscope, and six oculomotor nerves were found to be decompressed at surgery. The follow-up periods were from six months to three years. Nine patients had a complete recovery of oculomotor function; thirteen had an incomplete recovery; and four remained unchanged. The mean interval between the onset of palsy and the time of surgery was 24 days in complete recovery cases, 42 days in incomplete recovery cases, and 119 days in unchanged cases. The recovery of oculomotor function started with the levator palpebrae muscle and followed by the medial rectus muscle. The recovery of pupillary function was, however, not consistent. Of the factors influencing recovery from oculomotor nerve palsy, the interval between the onset of palsy and the time of surgery was most important. Therefore, aneurysms with oculomotor nerve palsy should be operated on as early as possible, regardless of the presence or absence of SAH.- - - - - - - - - - ranking = 0.5keywords = giant (Clic here for more details about this article) |
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