1/28. Inefficiency of the anticoagulant therapy in the regression of the radiation-induced optic neuropathy in Cushing's disease.Radiation-induced optic neuropathy is a rare complication (prevalence less than 1%) following radiotherapy of the sellar region. However, the vasculopathy in Cushing's disease predisposes to radiation-induced injury. We report the case of a 24-year-old man with Cushing's disease since he was 16. The hormonal study including bilateral inferior petrosal sinus catheterization diagnosed a pituitary right lesion, but imagiology was always negative. He underwent a transsphenoidal microadenomectomy and the pathological study showed the presence of corticotrophic hyperplasia but no adenoma. Secondary hypothyroidism and hypogonadism as well as permanent diabetes insipidus were diagnosed and because the patient was not cured he underwent a second transsphenoidal total hypophysectomy. After that and because he was still hypercortisolemic, pituitary external irradiation was given in a total dose of 6000 rad. Six months later he developed progressive bilateral visual loss. Cerebral MR revealed focal enhancement of the enlarged optic nerves and chiasm, associated with demyelination areas of the posterior visual pathways. Treatment was tried first with high doses of corticosteroids and later with anticoagulants-heparin EV. 1000 U/h during 7 days followed by warfarin, but unsuccessfully, probably because the patient was already amaurotic at the beginning of the last treatment.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
2/28. optic nerve sheath fenestration for a reversible optic neuropathy in radiation oncology.To the authors' knowledge, there is a paucity of published accounts of management of radiation-induced optic neuropathy (RION) by optic nerve sheath fenestration (ONSF) in the conventional medical literature. With higher doses of radiation being given by using conformal techniques, more radiation-induced optic neuritis and neuropathy will be identified. We report here the successful use of ONSF to restore vision to three consecutive patients with pending anterior RION, and the importance of early identification and intervention in these potentially reversible cases.- - - - - - - - - - ranking = 0.4keywords = radiation-induced (Clic here for more details about this article) |
3/28. pneumocystis carinii granuloma of the optic nerve: a histopathologic case report.A 30-year-old man under treatment for acute leukemia died of candida sepsis and pneumocystis carinii pneumonia. A small granuloma containing pneumocystis carinii was found in one optic nerve.- - - - - - - - - - ranking = 0.0010737427140746keywords = leukemia (Clic here for more details about this article) |
4/28. radiotherapy resolves leukemic involvement of the optic nerves.A 40-year-old woman with acute lymphoblastic leukemia had a visual disturbance OD. The optic disc was slightly swollen in the right fundus, and blast cells in the cerebrospinal fluid were found. radiotherapy to the brain and orbit resolved these findings. Five months later, visual acuity decreased OS. radiotherapy also was effective in treating the leukemic involvement of the optic nerve.- - - - - - - - - - ranking = 0.0010737427140746keywords = leukemia (Clic here for more details about this article) |
5/28. Optic neuropathy secondary to radiotherapy for nasal melanoma.Optic neuropathy is a rare but important complication of radiotherapy used in the treatment of cancers of the head and neck, usually resulting in rapidly progressive blindness in one or both eyes. The case is presented of a 77-year-old woman with bilateral optic neuropathy resulting in blindness, secondary to radiotherapy for a melanoma of the nasal cavity. The onset of optic neuropathy occurred 9 months post-radiotherapy, at a cumulative dose of 6000 rad. The left eye was first involved, with the right eye becoming involved within 2 weeks. Despite treatment with oral anticoagulation and high dose intravenous methylprednisolone, there was progressive deterioration resulting in bilateral optic atrophy, with final visual acuities of perception of light in the right eye and no perception of light in the left eye. This case demonstrates that oral anticoagulation was ineffective in the treatment of progressive radiation-induced optic neuropathy.- - - - - - - - - - ranking = 0.2keywords = radiation-induced (Clic here for more details about this article) |
6/28. Visual loss despite anticoagulation in radiation-induced optic neuropathy.Radiation therapy to the brain may produce necrosis and loss of function months after completion of the treatment. The case is presented of a 62-year-old man who developed radiation-induced optic neuropathy 2 years after treatment for a glioma of the left temporal lobe, despite being on anticoagulation therapy. Although anticoagulation appears to be beneficial in cerebral radiation necrosis, its usefulness in the treatment of radiation-induced optic neuropathy is unclear.- - - - - - - - - - ranking = 1.2keywords = radiation-induced (Clic here for more details about this article) |
7/28. Isolated optic nerve involvement in chronic myeloid leukemia.eye involvement in chronic myeloid leukemia is well known. The signs are infiltration of the choroid, the sclera, the episclera, the conjunctiva and the optic nerve. eye involvement is more common in acute than in chronic forms of leukemia. This paper reports a case of chronic myeloid leukemia in which optic nerve involvement was the only initial sign of the disease.- - - - - - - - - - ranking = 0.0075161989985221keywords = leukemia (Clic here for more details about this article) |
8/28. optic nerve infiltration by acute lymphoblastic leukemia: MRI contribution.We describe the clinical presentation and imaging features of a patient with acute lymphoblastic leukemia (ALL) that was complicated by optic nerve infiltration. The clinical and diagnostic characteristics of this complication must be recognized so that optimal therapy can be started to prevent blindness. MR imaging is useful in early detection and should be performed in any leukemic patient with ocular complaints, even during remission.- - - - - - - - - - ranking = 0.0053687135703729keywords = leukemia (Clic here for more details about this article) |
9/28. Radiation-induced optic neuropathy: characteristic appearances on gadolinium-enhanced MR.PURPOSE: To assess the value of contrast-enhanced MR in the evaluation of radiation-induced optic neuropathy. MATERIALS AND methods: Three patients with rapid visual loss 1 1/2 to 3 years after radiation therapy to the optic nerves were studied with gadopentetate dimeglumine-enhanced MR images. All patients received over 5000 cGy, experienced rapid, permanent visual loss over several days to weeks, and underwent MR within weeks of presentation. RESULTS: Enhanced MR images on each patient revealed focal discrete enhancement of the intracranial optic nerve. One patient underwent biopsy of the enhancing segment; this revealed pathologic changes of radiation optic neuropathy. optic nerve enhancement in a patient with visual loss and a prior history of radiation therapy to the orbits or optic nerves suggests radiation optic neuropathy. CONCLUSION: Contrast-enhanced MR of the orbits, optic nerves, and chiasm is the imaging test of choice in patients with vision loss after radiation therapy for sellar or skull base disease; MR findings may obviate the need for biopsy.- - - - - - - - - - ranking = 0.2keywords = radiation-induced (Clic here for more details about this article) |
10/28. Partial visual recovery from radiation-induced optic neuropathy after hyperbaric oxygen therapy in a patient with Cushing disease.Here we describe the case of a 41-year-old woman with a history of Cushing disease who had previously undergone unsuccessful neurosurgery, followed by stereotactic radiosurgery. More than 4 years after this treatment, she presented severe visual impairment, which started in the left eye and was documented by neuro-ophthalmic evaluation. Radiological assessment by contrast-enhanced magnetic resonance (MR) imaging initially suggested the diagnosis of glioma of the optic nerve and the patient started corticosteroid treatment (first with prednisone, 80 mg/day, followed by dexamethasone, 8 mg/day). Despite the therapy, vision in the left eye rapidly worsened until light was no longer perceptible; similar symptoms and signs also developed in the right eye, evolving to complete temporal hemianopsia. The clinical evidence was confirmed by the rapid progression of the MR picture, which showed homogeneous enhancement of the chiasm and optic nerves. On the basis of these findings, the original diagnosis of glioma was excluded, and radiation-induced optic neuropathy was diagnosed. As corticosteroids had proved inefficacious, hyperbaric oxygen (HBO) therapy was promptly instituted and vision steadily started to improve. This improvement was documented and confirmed by the progressive recovery of the visual field in the right eye and the changes in the sequential follow-up MR scanning. Optic neuropathy is an infrequent but dramatic complication of radiation therapy. Symptoms develop, on average, 12 months after treatment, and the onset may be acute and characterized by the progressive loss of vision in one or both eyes. HBO has already been used to treat this complication, but its efficacy is still controversial. Here, in addition to describing this particular case, which presented a significantly delayed radiation injury of the optic pathways, we provide a brief literature review and discuss some important points.- - - - - - - - - - ranking = 1keywords = radiation-induced (Clic here for more details about this article) |
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