Biomedical subjects
Publications and source records attributed to H R Krauss.
Spontaneous dural carotid-cavernous fistulas are dural vascular malformations that usually run a benign course. We present a case of a spontaneously occurring dural carotid-cavernous fistula complicated by central retinal vein occlusion and iris neovascularization that led to progressive visual failure.
Three cases of long-standing intranasal cocaine abuse were associated with orbitopathy or optic neuropathy. All three cases were characterized by chronic sinusitis. Histopathologic examination of involved sinus and orbital tissues revealed chronic and acute nonspecific inflammation, with no evidence of unusual infections or of idiopathic midline destructive disease. In two of the cases, there was radiographic evidence of contiguous orbital inflammation associated with sinusitis. The inflammatory orbital process in these two cases was steroid responsive, but in one case recurrent inflammation occurred in response to steroid tapering. One patient suffered a complete loss of vision in the involved eye due to fulminant orbital inflammation and optic nerve dysfunction.
Intrapapillary refractile bodies were observed in seven of 13 patients with chronic optic disc edema secondary to optic nerve sheath meningioma. The observation of refractile bodies preceded or coincided with decline in vision and disappeared as optic atrophy supervened. Intrapapillary refractile bodies appear to be a nonspecific sign of chronic optic disc edema.
A retrospective clinical study of optic nerve sheath meningiomas based on 22 patients showed that symptoms most commonly develop in women between the ages of 35 and 60 years. The most common presenting symptoms were decreased vision and transient visual obscurations. In the earliest stages, many patients presented with normal to mildly impaired acuity (despite subjectively decreased vision), optic disc edema and enlargement of the blind spot. Optic disc edema was frequently associated with refractile bodies indicative of chronic swelling. Optic disc edema preceded the development of optic atrophy. Another group of patients presented with a history of longstanding vision loss, visual acuity of 20/200 or worse and optic atrophy. Optociliary shunt vessels were late findings only seen in five patients. The most consistent visual field abnormality was peripheral constriction. Cecocentral scotomas were uncommon. Intracranial involvement was present in five patients. There were two patients with bilateral optic nerve sheath meningiomas without CT evidence of intracranial involvement. Computerized tomography was found to be indispensable in the diagnosis of optic nerve sheath meningiomas and the detection of intracranial involvement.
The visual field test results from 20 patients with con-rod degeneration (CRD) from all inheritance patterns were reviewed. Typical fundus findings of CRD included optic disc pseudoedema, temporal disc atrophy, parapapillary and disc telangiectasis, and few to no retinal pigmentary deposits. Visual field changes were seen to be distinctive and, like electrophysiologic tests, were helpful in pointing to a retinal degenerative process rather than an optic neuropathy.
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Fifteen cases of orbital abscess were reviewed. Significant morbidity occurred despite treatment with intravenous antibiotics and surgical drainage. The complications included visual loss to less than 20/200 (four patients), residual proptosis (two patients), residual diplopia (two patients), osteomyelitis (one patient), and death (one patient). Seven patients reported no pain. Fever was absent in eight patients. Four patients had normal white blood cell counts. Many of these patients had received inappropriate or inadequate doses of oral antibiotics before referral. Partially treated cases of orbital abscess may not manifest the expected clinical findings of orbital infection. Four patients presented in an insidious fashion with symptoms evolving over weeks to months. Their subacute presentations in the absence of fever, pain, or elevated white blood cell count mimicked the onset of orbital tumors. CT scan failed to detect an abscess in two cases. Conjunctival and nasal cultures were not helpful in determining the bacteriologic etiology of these infections. Surgical drainage and appropriate antibiotic therapy is the definitive treatment of orbital abscess.
We describe a case of a giant carotid artery aneurysm presenting as an intrasellar mass with suprasellar extension, with radiographic and endocrinologic findings suggestive of pituitary tumor. This case emphasizes that elevated prolactin is not specific for prolactinoma. This case also supports consideration of angiography before proceeding with transsphenoidal surgery for presumed pituitary adenoma.
A staphylococcal orbital abscess developed in a 55-year-old diabetic woman. Initial antibiotic therapy was apparently incomplete and resulted in an unusual clinical manifestation for an orbital infection. These unusual features included an insidious course of monocular visual loss and proptosis in the absence of fever, substantial orbital pain, and evidence of sinus disease; pancytopenia rather than leukocytosis was present. Surgical drainage followed by intravenous and oral antibiotic therapy resulted in marked clinical improvement, including a partial return of visual acuity. In the patient, however, a staphylococcal osteomyelitis of the shoulder and subsequent fatal septicemia developed several months later. Orbital infection continues to be a life-threatening condition, especially in debilitated patients.
Autoenucleation is a rare occurrence. An unusual case is presented of a young woman who manually extracted her right globe and was left with a temporal hemianopsia in the remaining eye. Legends surrounding autoenucleation and the medical literature are reviewed, with emphasis on psychiatric aspects and pathologic findings in ocular avulsion.