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Biomedical subjects

J L Crompton

Publications and source records attributed to J L Crompton.

At least 19 recordsLinked to original sources
PubMed2001

Neuro-ophthalmological sequelae of horse-related accidents.

PURPOSE: The aim of this study was to highlight the neuro-ophthalmological dangers associated with horse riding, and working around horses, and the importance of wearing adequate headgear to protect the rider from neuro-ophthalmic injuries. It raises the questions of whether the current laws regarding helmet use are satisfactory, and whether helmets currently used are of an adequate standard. METHODS: The records over a 20-year period of one neuro-ophthalmologist in Adelaide were reviewed producing 22 patients with neuro-ophthalmological sequelae of head injuries as a result of horse-related accidents. RESULTS: There were 22 patients (16 female, six male), one of whom was involved in three separate accidents, Of these, seven were professional riders and 15 amateur. In 20 of the 24 accidents, patients were either thrown or fell from the horse. Helmets were worn in 15 of the accidents. All the patients had closed head injuries of varying severity. The most common neuro-ophthalmological complication found was a fourth-nerve palsy in 11 patients. Five patients had a significant loss of vision and two of these were severe enough to warrant a blind pension. CONCLUSIONS: Horse riding and working around horses constitute an occupation or recreation with inherent dangers. Previous studies have shown that wearing of protective headgear reduces the risk and severity of head injuries, and helmet use should be vigorously promoted. The current laws and practices regarding helmet use are not uniform and seem to be inadequate. The current standard for equestrian safety helmets (AS/NZS 3838:1998) embodies improvements on earlier helmet standards and certainly increases the rider's chances of surviving a severe impact. Nevertheless, serious brain injuries have occurred in wearers of approved helmets, and further research is desirable to ensure the optimum degree of protection compatible with rider acceptance.

Accidental Falls↗
PubMed2000

Hypovitaminosis A in metropolitan Adelaide.

Hypovitaminosis A is a well-recognized condition in many developing countries. However, in the developed world the diagnosis is frequently missed or delayed because of its rarity. A 67-year-old man from metropolitan Adelaide presented to us with gradual but severe bilateral visual loss. He had marked punctate epithelial keratopathy in both eyes. Hypovitaminosis was suspected because of his bizarre dietary habit, and this was confirmed by a combination of impression cytology of the ocular surface and biochemical testing of his venous blood. His vision responded dramatically to vitamin A supplementation. Hypovitaminosis A should be suspected in severe cases of 'dry-eye', especially in those patients with unusual dietary habit or malabsorption.

Aged↗
PubMed1999

Leber's idiopathic stellate neuroretinitis: differential diagnosis and approach to management.

BACKGROUND: Leber's idiopathic stellate neuroretinitis (LISN) is a relatively uncommon clinical entity that is characterized by optic disc oedema and associated macular hard exudates. A broad range of causes can produce such a fundus appearance. METHODS: The clinical experience of the authors is combined with a review of the pertinent literature to describe the features of LISN and its differential diagnosis. CONCLUSION: A knowledge of the potential causes of neuroretinitis is important in order to formulate an effective management strategy.

Cat-Scratch Disease↗
PubMed1998

Optic disc swelling in Crohn's disease.

PURPOSE: To provide a review of the causes of optic disc swelling in patients suffering from inflammatory bowel disease. METHODS: Two illustrative cases of bilateral optic disc swelling are presented: one in a patient known to have Crohn's disease and the other in a patient whose investigations revealed the disease. The possible causes of optic disc swelling in inflammatory bowel disease, based on a literature review, are tabulated and discussed with reference to the presented cases. RESULTS/CONCLUSIONS: Optic disc swelling is a rare complication of inflammatory bowel disease. Previously reported cases have been attributed to peripapillary inflammation, optic disc ischaemia or intracranial hypertension. Postulated causes of optic nerve ischaemia include a local vasculitis or general hypercoagulability. The underlying aetiology of intracranial hypertension is often elusive. Older studies suggest a relationship between corticosteroid treatment and/or iron deficiency anaemia, while modern imaging emphasises the need to exclude dural venous sinus thrombosis.

Adult↗
PubMed1997

Perineural spread of cutaneous squamous cell carcinoma via the orbit. Clinical features and outcome in 21 cases.

OBJECTIVE: To describe the clinical features, treatment, and outcome of a series of patients with perineural spread (PNS) of cutaneous squamous cell carcinoma (SCC) via the orbit. DESIGN: A cohort study. PARTICIPANTS: Twenty-one patients identified with PNS of cutaneous SCC via the orbit. INTERVENTION: Patients were treated with various combinations of conservative or radical surgery, external beam radiation therapy, and chemotherapy. RESULTS: Of 21 cases, 17 (81%) were male. Age at presentation with PNS ranged from 38 to 82 years (median, 66 years). The forehead and eyebrow were the most common site of the primary lesion. All but one had altered or decreased sensation, but only nine presented with pain. Fourteen (67%) had ophthalmoplegia at presentation, and 14 (67%) had evidence of PNS involving branches of the facial nerve. Despite combinations of radical surgery, conservative surgery, and radiation therapy, no method of treatment appeared more effective, and 14 patients died from 9 months to 5 years after presentation with PNS (median, 3 years), usually from local and intracranial disease. Two survived to 14 and 18 years, one is alive at 3 years with recurrent local and distant disease, and four are alive without evidence of disease at 2, 3, 4 and 12 months after radiation therapy. CONCLUSIONS: Perineural spread of cutaneous SCC via the orbit carries a poor prognosis. Early radiation therapy may offer the best form of palliation. The role of radical surgery probably is limited once orbital involvement is apparent, as the cavernous sinus and facial nerve branches usually are involved.

Adult↗
PubMed1993

Ocular involvement in primary central nervous system lymphoma: an increasing clinical problem?

A case of unilateral vitreous relapse in a patient with primary central nervous system lymphoma (PCNSL) following sequential systemic chemotherapy and radiotherapy is reported. A literature review reveals that ocular involvement may occur in up to 15-25% of cases during the course of this disease. Full ophthalmological assessment, including slit lamp examination, should be included in the routine staging of PCNSL at the time of initial diagnosis and subsequently if relapse occurs.

Central Nervous System Neoplasms↗
PubMed1990

Spasm of the near reflex associated with cerebrovascular accident.

Spasm of the near reflex most often has a functional basis, but may be associated with organic disease. This case report describes a patient with a progressive 11-year history of spasm of the near reflex associated with cerebrovascular accidents and reviews the differential diagnosis, management and aetiology of this disease.

Accommodation, Ocular↗
PubMed1989

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.

Biopsy↗
PubMed1986

Trigemino-abducens synkinesis: an unusual case of aberrant regeneration.

An unusual case of major head trauma is described involving injury to the right third, fifth, sixth and seventh cranial nerves in a basal skull fracture in a young woman. Two years later there persisted a total voluntary abducens nerve palsy, right facial hemianaesthesia and right temporalis and masseter palsy. However, involuntary abduction of the involved eye occurred on eating or chewing. Electromyography of the lateral rectus muscle documented aberrant reinnervation to support the clinical findings. Extraocular muscle surgery improved the compensatory head posture and minimized the chewing-induced abduction. The mechanisms for acquired synkinesis and the anatomy of the involved nerves are reviewed. It is postulated that regenerating motor fibres of the trigeminal nerve were misdirected along proprioceptive channels to the lateral rectus in the case reported here.

Abducens Nerve↗
PubMed1986

Congenital absence of the inferior rectus muscle.

A case of unilateral congenital absence of the inferior rectus muscle is presented. Absences of extraocular muscles, either singly or in combination, are rare, but isolated reports have been published. The abnormalities have been reported as occurring with increased frequency in craniofacial dysostoses, notably Crouzon's disease. In the case reported here, the abnormality was discovered during planned vertical muscle surgery for a large left hypertropia. Infraplacement of the horizontal recti was performed at a later date. Computerised axial tomography (CAT) scanning confirmed the absence of the inferior rectus. The embryogenesis of the extraocular muscles is briefly discussed.

Adult↗
PubMed1985

Hydatid cyst: an unusual cause of diplopia.

A 59-year-old man presented with double vision due to vertical displacement of one eye by an infraorbital mass that indented the globe. Some 10 years previously he had had a Caldwell-Luc antrostomy for chronic sinusitis. Following investigation, the antrostomy was revised and an orbital cyst with a histological appearance suggestive of a mucocele was excised via an anterior inferior orbitotomy. The orbital mass recurred with identical symptoms some 18 months later with a second mass confluent with the first, presenting subcutaneously through his zygoma. A further radical antrostomy was performed enabling a diagnosis of a hydatid cyst of the antrum to be made. The unusual features of this rare cause of diplopia are discussed and illustrated. The literature on orbital hydatid cysts is reviewed and recommendations made as regards adequate surgical exposure and not irrigating orbital cysts with noxious agents.

Diplopia↗
PubMed1981

Ocular lesions in the blue rubber bleb naevus syndrome.

Investigations of a neonate presenting with multiple pleomorphic vascular skin lesions enabled a clinical and histological diagnosis of blue rubber bleb naevus syndrome to be made. This child had lesions in the conjunctiva, iris, and retina, associated with local haemorrhages at the time of birth. All the lesions regressed spontaneously, and a conservative approach to management of the ocular lesions in this syndrome is therefore suggested.

Eye Neoplasms↗
PubMed1980

Vasculitis and ischaemic optic neuropathy associated with rheumatoid arthritis.

Fundus lesions are said not to be found in direct relationship to rheumatoid arthritis. A vasculitis or retinopathy if present is said to be secondary to concomitant hypertension or due to some connective tissue disease other than rheumatoid arthritis. The case is presented of a 64-year-old female with sero-positive rheumatoid arthritis. During a period of exacerbation of her arthritis she developed anterior ischaemic optic neuropathy (A.I.O.N.) resulting in blindness of one eye, followed two weeks later by a temporary occlusive episode in a cilioretinal arteriole in the other eye. The patient was normotensive and had neither clinical nor immunological evidence of other connective tissue disease. The patient died two months later from cardiac arrhythmia. The autopsy findings confirming posterior ciliary arteritis as the cause of the A.I.O.N. are presented. The subject of rheumatoid vasculitis in relation to the eye is reviewed and immunological mechanisms and investigations discussed.

Aged↗
PubMed1976

Giant intracavernous aneurysm: rare cause of isolated sixth cranial nerve palsy in a child.

A boy, aged 7 1/2 years, developed a sixth cranial nerve palsy for which no cause was found until 8 1/2 years later, when he developed a rapidly progressive ophthalmoplegia. A giant intracavernous aneurysm was then demonstrated on carotid angiography and successfully treated by carotid ligation. Radioisotope techniques were of value in diagnosis and follow-up.

Abducens Nerve↗