11/623. Long-term sequelae after surgery for orbital floor fractures.A surgical technique involving exact repositioning and rigid fixation is required for the reduction of fractures of the orbital floor. Even then, sequelae may be present long after the trauma. The aim of this study was to establish the frequency and type of sequelae after surgery for orbital floor fractures and to investigate the extent to which the method of surgery had any impact on the severity of the sequelae. A questionnaire was sent to all 107 patients (response rate 77%) 1 to 5 years after the injury. Further clinical data were obtained from the patients' charts. Eighty-three percent of the patients were affected by some kind of permanent sequelae in terms of sensibility, vision, and/or physical appearance. A high frequency of diplopia (36%) was related to the reconstruction of the orbital floor with a temporary "supporting" antral packing in the maxillary sinus, a technique which has now been abandoned at our department in favor of orbital restoration with sheets of porous polyethylene. Our conclusion is that, because long-term sequelae are common, the surgical technique must be subjected to continuous quality control to minimize future problems for this group of patients.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
12/623. Extradural balloon obliteration of the empty sella report of three cases (intrasellar balloon obliteration).empty sella syndrome is an anatomical and clinical entity composed of intrasellar reposition of the CSF and compression of the pituitary tissue, resulting in a clinical picture of headache, visual field defect, CSF rhinorrhea and some mild endocrinological disturbances. While some cases are primary with no appreciable aetiology, secondary cases are associated with prior operation or radiotherapy of the region. In our series, 3 patients with primary empty sella syndrome were treated by the current approach of extradural filling of the sellar cavity. This technique was first described by Guiot and widely accepted thereafter. We used a detachable silicon balloon filled with HEMA or liquid silicone for obliteration of the sellar cavity and obtained clinically satisfactory results without complications. Visual symptoms regressed and headache disappeared. But at long term follow-up all the balloons were found to be deflated. Despite the facility and efficacy of the technique we do not recommend it in the treatment of the empty sella because the filling of the sella is only transient and relapses may occur.- - - - - - - - - - ranking = 0.5keywords = ms (Clic here for more details about this article) |
13/623. The "thin man" phenomenon: a sign of cortical plasticity following inferior homonymous paracentral scotomas.AIM: To investigate an image distortion, experienced by patients with homonymous paracentral scotomas. methods: Two consecutive patients with right inferior homonymous paracentral scotomas resulting from ischaemic brain insults were examined. Neuro-ophthalmological examination included tangent screen and Amsler grid evaluation. In addition, the patients were asked to describe a figure showing two vertical lines, identical in length and symmetrically located on either side of a fixation point. This figure was presented in such a way that when the subject looked at the fixation point the right line crossed the scotoma. Finally, the patients were asked whether, when looking at the face of an interlocutor, both sides of the body looked the same. RESULTS: In both patients field defects were markedly smaller when delineated with Amsler grids than using a tangent screen. With the parallel line test, the right line appeared uninterrupted in patient 1, whereas in patient 2 it looked slightly blurred in a two degree long segment corresponding to the middle of the scotoma. To both subjects the right line appeared shorter than the left line. Finally both subjects indicated that, after steadily fixating their interlocutor's face or neck for 5-10 seconds, the left shoulder appeared narrower than the right one, which made him look surprisingly thin. This perceptual alteration was called the "thin man" phenomenon. CONCLUSIONS: Paracentral homonymous scotomas can be associated with perceptual completion and shape distortion, owing to apparent displacement of images adjacent to the scotoma towards the field defect. Occurrence of such a perceptual change should alert one to the possibility of paracentral homonymous scotomas, which often go undetected when using routine visual field testing procedures.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
14/623. Diaphragma sellae metastasis from colon carcinoma mimicking a meningioma. A case report.We describe a rare case of metastatic intra-suprasellar adenocarcinoma from colonic cancer mimicking a meningioma of the "diaphragma sellae". autopsy studies indicate breast and lung carcinoma to be the most frequent primary tumor metastasizing this site, particularly in patients with systemic spread. While diabetes insipidus is reported to be one of the commonest symptoms in these cases, the only clinical manifestation of the tumor in our patient was a bitemporal hemianopia, while the primary tumor remained asymptomatic. In the available literature are reported only two pituitary metastasis from operated colon carcinoma. In both cases the diagnosis of the colon cancer preceded the pituitary operation. The clinico-pathological and neuroradiological aspects of this unusual lesion are analyzed in the light of the relevant literature on the topic focusing on recent MRI acquisitions.- - - - - - - - - - ranking = 0.5keywords = ms (Clic here for more details about this article) |
15/623. Control of visual symptoms in two men with birdshot retinochoroidopathy using low-dose oral corticosteroid therapy.PURPOSE: To describe two men with birdshot retinochoroidopathy whose severe subjective visual symptoms were controlled by long-term use of low-dose oral corticosteroid therapy. METHOD: Chart review. RESULTS: Vision improved subjectively in both men after initial treatment with oral prednisone (1 mg/kg/day) and remained stable while taking 5 mg daily or less of prednisone for periods of 54 and 81 months. CONCLUSION: Some patients with birdshot retinochoroidopathy do well with no long-term therapy or only low-dose oral corticosteroids as long-term therapy.- - - - - - - - - - ranking = 2.5keywords = ms (Clic here for more details about this article) |
16/623. Neuro-ophthalmic manifestations of pituitary tumors.Pituitary tumors manifest with a variety of unique localizing signs and symptoms that neurosurgeons and neuro-ophthalmologists must readily identify. Visual disturbances may be the presenting complaint. Loss of central visual acuity, visual field deficits, and mechanisms of diplopia are discussed with case examples used to highlight each.- - - - - - - - - - ranking = 1keywords = ms (Clic here for more details about this article) |
17/623. The clinical spectrum of schwannomas presenting with visual dysfunction: a clinicopathologic study of three cases.Schwannomas (neurilemomas) are benign tumors that arise from schwann cells in the peripheral nervous system. The most commonly involved nerves that cause neuro-ophthalmic manifestations are cranial nerves V and VIII. In this series of three women, schwannomas presented as intraconal masses that mimicked a cavernous hemangioma, a superior orbital mass transgressing the superior orbital fissure, and an expansive frontal lobe mass with clinical symptoms and signs of increased intracranial pressure. Although all three complained of visual blurring, none of our patients presented with Vth or VIIIth cranial nerve dysfunction. Histopathologic studies demonstrated well-circumscribed, encapsulated spindle-cell lesions with classic Antoni A and B patterns. Histopathologic examination is essential to confirm the diagnosis of a schwannoma that may be otherwise clinically confusing. Direct optic nerve compression, globe indentation with induced hyperopia, or increased intracranial pressure with optic nerve compromise may be responsible for visual symptoms. A multidisciplinary approach is often required because of the size and location of schwannomas.- - - - - - - - - - ranking = 1.5keywords = ms (Clic here for more details about this article) |
18/623. Abnormal visual evoked potentials in children with "Alice in Wonderland" syndrome due to infectious mononucleosis.Visual illusions characterized by distortion of form, size, reciprocal position of objects, movement, or color, labeled as "Alice in Wonderland" syndrome, were discussed in children with infectious mononucleosis, as well as in other clinical conditions, such as migraine, epilepsy, use of certain hallucinogenic drugs, etc. The purpose of our study was to investigate for the first time visual evoked potential results in children with "Alice in Wonderland" syndrome associated with infectious mononucleosis. Five children with "Alice in Wonderland" syndrome associated with infectious mononucleosis underwent visual evoked potential studies during and after their clinical symptoms. Visual evoked potential results during the disease demonstrated statistically significant high amplitudes of P100-N145 in all children compared to the control group. A few weeks later, repeated studies after the resolution of the complaints were normal. Since the same findings can be observed in patients with migraine, we postulate that a common pathophysiologic underlying abnormality, which can cause transient focal decreased cerebral perfusion, could be involved in the disease process of these two conditions.- - - - - - - - - - ranking = 0.5keywords = ms (Clic here for more details about this article) |
19/623. Transient headache and impaired vision after intravenous thyrotropin-releasing hormone in a patient with pituitary macroadenoma.We report a case of transient headache and impaired vision following administration of intravenous thyrotropin-releasing hormone (TRH) to a woman with a non-functioning pituitary macroadenoma, visual field defect, and elevated thyroid-stimulating hormone (TSH). The symptoms lasted for two hours and then resolved without known sequelae. There are a few other reported cases of similar adverse reactions to neuroendocrine manipulation in patients with pituitary macroadenomas. This is the second reported case of such adverse reactions to TRH alone and the first in which the patient had prior elevation of TSH.- - - - - - - - - - ranking = 0.5keywords = ms (Clic here for more details about this article) |
20/623. Optic neuropathy occurring after bee and wasp sting.OBJECTIVE: To inform ophthalmologists about bee and wasp sting-related optic neuropathy. DESIGN: Two case reports and literature review. methods: review of two cases, clinical history, laboratory testing, and follow-up. RESULTS: Two cases of bee and wasp sting optic neuritis are described and five additional cases of optic neuritis occurring after hymenoptera sting are reviewed from the English language literature. These cases share certain characteristics, including acute to subacute onset of symptoms; moderate to severe visual loss followed by significant visual recovery; edematous and hemorrhagic optic discs; and central or cecocentral scotomas. CONCLUSIONS: Acute optic neuropathy may follow hymenoptera sting to the face.- - - - - - - - - - ranking = 0.5keywords = ms (Clic here for more details about this article) |
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