1/23. Spontaneous intracranial hypotension.PURPOSE: To describe a patient with classic presentation of spontaneous intracranial hypotension and subsequent improvement with targeted epidural blood patch. methods: Report of one case and review of the literature. RESULTS: Examination of cerebrospinal fluid after lumbar puncture disclosed a reduced opening pressure, an increased level of protein, and lymphocytic pleocytosis. magnetic resonance imaging of the brain with gadolinium showed diffuse enhancement of the pachymeninges, no evidence of leptomeningeal enhancement, and chronic subdural fluid collection. Radionuclide cisternography demonstrated reduced activity over the cerebral convexities, early accumulation of radiotracer in the urinary bladder, and direct evidence of leakage at the cervicothoracic junction (C7-T1). Clinical, laboratory, and radiologic features were consistent with the diagnosis of spontaneous intracranial hypotension. Therapy with a targeted epidural blood patch resulted in the rapid resolution of symptoms. CONCLUSIONS: In this report, we describe a classic case of spontaneous intracranial hypotension in a 63-year-old man with an initial presentation of postural headaches, blurred vision, pain in the left eye, diplopia on left gaze, and neck soreness.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/23. Idiopathic "benign" intracranial hypertension: case series and review.Idiopathic "benign" intracranial hypertension is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the diagnosis and management of idiopathic intracranial hypertension, giving special attention to treatments used. A retrospective chart review was conducted on 32 patients diagnosed with idiopathic intracranial hypertension between 1984 and 1995. Subjects included 23 females and ranged in age from 2 to 17.5 years. headache was the most common symptom, followed by nausea and vomiting, double vision, and visual loss. papilledema was the most common sign. Others were VIth cranial nerve palsy and compromised visual acuity at or within 3 months of presentation. Management included administration of acetazolamide or corticosteroids, lumboperitoneal shunt, optic nerve fenestration, and repeat lumbar puncture. Treatment combinations were used in 40% of cases. During follow-up, headache, papilledema, and decreased visual acuity persisted for longer than 10 months in a significant number of patients. We conclude that idiopathic intracranial hypertension causes significant short- and long-term morbidity with no proven effective treatment available. A prospective study is needed to establish the indications for treatment and the efficacy of the treatments used.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/23. Nasopharyngeal extension of a craniopharyngioma in a 4 year old girl.Nasopharyngeal extension of a craniopharyngioma is very rare and usually presents with headache, nasal obstruction and visual disturbances. We present a case of a 4 year old girl, who became symptomatic with visual deterioration. MRI showed a huge supra - and infrasellar cystic craniopharyngioma with extension into the sphenoid sinus. Primary treatment was a transnasal puncture of the cyst followed by a subfrontal approach with removal of the tumour preserving the chiasm and optic nerves. The visual acuity postoperatively improved while she needed hormone replacement due to panhypopituitarism. Follow-up 12 months after the operation showed no recurrence. This is the youngest patient of about 27 patients reported so far in the literature.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/23. Mesalazine-associated benign intracranial hypertension in a patient with ulcerative colitis.PURPOSE: To report a case of benign intracranial hypertension related to mesalazine use. DESIGN: Observational case report. methods: A 23-year-old-woman with sudden visual loss, headache, and a history of ulcerative colitis treated with mesalazine underwent ophthalmologic examination, echography, magnetic resonance imaging, and lumbar puncture. RESULTS: The examinations disclosed benign intracranial hypertension that resolved when mesalazine was discontinued and recurred when the drug was restarted. CONCLUSIONS: We recommend periodic ocular fundus examination for patients undergoing long-term therapy with mesalazine, especially if decreased vision, headaches, or neck stiffness are present, to avoid potentially severe complications of intracranial hypertension- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
5/23. Intravitreal angiostrongyliasis: report of 2 cases.Two male patients presented with unilateral blurred vision. A small motile worm was found in the vitreous cavity in both cases. In one case, another dead, disintegrated worm was noted in the inferior portion of the vitreous cavity. On each eye, vitreous surgery was performed and the worm was removed by an aspirator. Both worms were identified as angiostrongylus cantonensis. Since both patients had no signs of meningitis, lumbar puncture was not done. Long-term follow-up confirmed the benefit and safety of the vitreous surgery. fluorescein angiography revealed severe pigmentary alteration, probably from inflammation of the choroid and retina due to subretinal migration of the worm prior to access into the vitreous cavity.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/23. pseudotumor cerebri in children with sickle cell disease: a case series.headache is a frequent symptom in sickle cell disease (SCD) that usually is attributable to anemia or cerebrovascular disease. We report 3 pediatric patients with SCD (1 patient with SCD-SC and 2 patients with SCD-SS) who presented with headache and were diagnosed with pseudotumor cerebri (PC). All 3 patients had elevated opening pressures during a lumbar puncture with normal cerebrospinal fluid studies. magnetic resonance imaging revealed no evidence of hydrocephalus or arteriopathy in all 3 cases. Magnetic resonance venograms performed in 2 of the patients at diagnosis revealed no evidence of cerebral sinus thrombosis. Each patient received a thorough ophthalmologic examination. A diagnostic funduscopic examination revealed bilateral papilledema without signs of retinopathy in all 3 patients. There were no clinically significant changes in visual acuity or abnormalities of color vision in any patient. Goldmann or Humphrey visual-field assessment was abnormal only in patient 1, who demonstrated bilaterally enlarged blind spots at diagnosis and later developed reduced sensitivity in the inferomedial quadrant of the left eye in an arcuate pattern (which later resolved). The diagnosis of PC was made in all 3 patients, and acetazolamide treatment was started. Two of the patients' symptoms resolved completely with medical treatment, whereas the third patient's symptoms improved. None of these patients had permanent visual-field deficits as a result of their syndrome. PC has been reported in several other types of anemia including SCD-SC, but these cases are the first reported in conjunction with pediatric SCD. Early recognition of the signs and symptoms of PC in patients with SCD who present with headache can expedite proper diagnosis and treatment and prevent long-term ophthalmologic sequelae.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
7/23. Post dural puncture headache in a pediatric patient with idiopathic intracranial hypertension.We describe the occurrence of postdural puncture headache (PPDH) in an adolescent with idiopathic intracranial hypertension (IIH) and its successful management with an epidural blood patch. PPDH is a very rare occurrence in patients with intracranial hypertension and is described as a paradoxical situation in the literature. There are only two previous case reports (in adults) of the possible association. A 15-year-old obese patient with a diagnosis of IIH had an uneventful diagnostic spinal tap using a 22G Quincke needle in the pediatric emergency department but returned 24 h later with PPDH. After a failed trial of conservative management, she had an uneventful but curative epidural blood patch with 15 ml of autologous venous blood and was able to return to school the day after the blood patch. Follow-up review by her neuro-ophthalmologist shows resolution of her headaches, considerable improvement in her visual field defect and resolution of papilledema. This is the first report of PPDH and its successful management with an epidural blood patch in a pediatric patient with IIH.- - - - - - - - - - ranking = 5keywords = puncture (Clic here for more details about this article) |
8/23. Resolution of optic nerve edema and improved visual function after optic nerve sheath fenestration in a patient with osteopetrosis.PURPOSE: To describe the outcome of a patient with visual loss and optic nerve edema that resulted from osteopetrosis who underwent an optic nerve sheath fenestration (ONSF). DESIGN: Interventional case report. methods: A 33-year-old man with osteopetrosis had bilateral visual field loss and optic nerve edema. Computed tomography and magnetic resonance imaging demonstrated open optic canals. Although a lumbar puncture showed a normal opening pressure, there were other findings that were suggestive of increased intracranial pressure. The patient elected to undergo a unilateral optic nerve sheath fenestration. RESULTS: After ONSF, the patient experienced markedly improved visual acuity, visual field, and optic nerve appearance. CONCLUSION: Individuals with visual loss and optic disk edema that is associated with osteopetrosis may benefit from ONSF if the optic canals appear to be open and the optic nerve edema is thought to be related to increased intracranial pressure.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/23. Bilateral giant retinal tear and retinal detachment in a young emmetropic man after Jarish-Herxheimer reaction in ocular syphilis.BACKGROUND: Giant retinal tears were previously described in patients affected by panuveitis. We report the case of a patient presenting giant retinal tears in both eyes affected by ocular syphilis. PATIENT AND METHOD: A 45-year-old patient presented a 5 days history of sudden bilateral drop of vision, two weeks after penicillin therapy for secondary syphilis. The best visual acuity was 0.5 RE and light perception LE. Biomicroscopy showed an intense vitritis associated with bilateral giant tear and retinal detachment. Both TPHA and VDRL were positive. Lumbar puncture showed lymphoplasmocytosis with intrathecal synthesis of IgM. RESULTS: Topical steroids treatment was applied and intravenous penicillin was given during 14 days. Pars plana vitrectomy with silicon oil tamponade was performed in association with endophotocoagulation in the left eye and cryocoagulation in the right eye. Vitreous PCR was negative. Evolution was successful with an attached retina. CONCLUSIONS: This represents the first reported case of giant retinal tear with retinal detachment in a patient presenting a syphilitic panuveitis.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/23. Pilot study of efficacy of tongue and body acupuncture in children with visual impairment.We studied the efficacy of tongue and body acupuncture in affecting visual recovery in children with central and peripheral visual disorders. Twelve children (five boys, seven girls) (age range 18 months to 14.5 years) with visual disorder with static functional visual ability for at least 12 months were recruited for the study. The causes of cortical visual impairment (10) included severe perinatal asphyxia (4), postencephalitis (1), traumatic brain injury (1), hydrocephalus (1), and increased intracranial pressure (3). Peripheral causes (2) were due to congenital optic atrophy. We used the following assessment tools: clinical visual improvement, defined as improvement of vision by one grade in one or both eyes with measurement of visual acuity; the functional visual outcome scale of 0 to 5, with positive outcome defined as improvement in one level on a functional scale; visual evoked potential, with positive improvement defined as 10% improvement in P100 latency of one or both eyes; [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) of the brain, with positive improvement defined as a 10% increase in glucose metabolism in one or both occipital lobes; and the Clinical Global Impression Scale (parental report). tongue and body acupuncture consisted of 60 sessions, with 5 sessions per week. Four children showed clinical or functional improvement (33%). Of nine children with abnormal visual evoked potentials, five had improvement (56%). Of seven children who underwent PET, six had improvement in glucose metabolism in the visual cortex (86%). Seven parents (58%) reported improvement (three children had 75% improvement; four children had 25% improvement). There was a significant correlation between the interval of onset of visual impairment and starting treatment with clinical or functional outcome, with a longer interval resulting in a better outcome (P = .0282). However, there was no correlation between cause, severity, or clinical or functional visual outcome with improvement in the visual evoked potential or PET. We demonstrated that tongue and body acupuncture can improve the visual status of children with visual disorders, both peripheral and central in origin. As children with chronic visual impairment also showed some visual recovery, more studies should be done to assess the full potential of acupuncture as an adjunct to Western medicine in neuroplasticity.- - - - - - - - - - ranking = 8keywords = puncture (Clic here for more details about this article) |
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