Biomedical subjects
Publications and source records attributed to J L Keltner.
A patient was referred to the neuro-ophthalmology unit with a diagnosis of Foster-Kennedy syndrome; "papilledema" had been noted in the right eye and optic atrophy in the left. Results of radiographic examinations and lumbar puncture had been normal. The considerations and procedures leading to a correct diagnosis of giant cell arteritis are discussed.
A patient with progressive visual loss associated with swelling of the disc presented the classic clinical picture of Leber's optic neuropathy. The hereditary patterns, diagnostic characteristics and natural history of the disease are discussed. Although there is no efficacious treatment for Leber's optic neuropathy available at this time, correct diagnosis is important for purposes of genetic counseling and avoidance of unnecessary neuroradiologic and surgical procedures.
The authors evaluate the case of a 20-year-old, four-month-pregnant woman who presented with papilledema and visual field loss, and developed headache, intermittent diplopia and impairment of color vision over the next month. The procedures and considerations leading to the diagnosis of pseudotumor cerebri are discussed, as are the various modes of therapy and their indications.
A 44-year-old otherwise healthy woman was referred to Washington University with previous diagnoses of para planitis and retrobulbar neuritis, and with a current complaint of markedly decreased vision (light perception only) in the right eye. Among the findings at the time of this evaluation were posterior uveitis and evidence of optic neuropathy and of a disordered immune system. The patient responded to pulsed high-dose corticosteroid therapy. A subsequent similar episode in the left eye also was resolved with such treatment. Dr. Burde describes the case in detail and asks Drs. Keltner, Gittinger and Miller to offer diagnoses. Their answers vary considerably.
A 72-year-old man presented with transient episodes of gradually descending vision loss in either eye. Both discs showed marked cupping, but applanation tensions were normal. Carotid occlusions were present. The etiology of the transient visual disturbances, the relationship of carotid disease to low tension glaucoma, and the management of such patients are discussed.
A patient with downbeating nystagmus in the primary position and vertical saccadic pursuit is presented. The possible etiologies of these features and their diagnostic significance is discussed.
A healthy 17-year-old white male suffered sudden painless onset of visual loss in the right eye. The affected eye had a cecocentral scotoma, marked disc swelling with hyperemia and flame-shaped hemorrhages, and subretinal fluid extending into the macular area. The authors each consider the differential diagnosis, indications for treatment, the natural course, and the likelihood of association with various systemic diseases.
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A case is presented in which a 49-year-old man has had progressive proptosis and diplopia over a six-week period without pain, loss of vision, or history of other ophthalmic or systemic disorders. The diagnostic work-up leading to a diagnosis of thyroid ophthalmopathy in such cases is discussed. Although the orbitopathy usually has a self-limited course, major complications are corneal exposure and optic neuropathy. The several modes of therapy available to treat these complications (systemic corticosteroids, orbital radiation, and orbital decompression are described.
Recent studies indicate that automated perimetry can serve as an effective method of screening for visual field abnormalities associated with ophthalmologic and neurologic disorders. The techniques have been successfully applied to the private practitioner's office for screening of patients and to mass visual field screening of the general population. This paper describes the principles underlying automated perimetric screening, evaluates the capabilities and limitations of such techniques, and provides some general guidelines for using automated perimetric screening procedures.
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A 31-year-old woman presented with signs and symptoms of anterior and posterior cerebral circulatory insufficiency. The differential diagnosis and therapeutic options are discussed. The most likely cause is a cardiogenic source of emboli.
A nine-and-one-half month old boy with poor visual function was found to have bilaterally small optic discs. He subsequently demonstrated a retarded growth pattern. A series of photographs revealing part of the spectrum of optic disc hypoplasia are included. Associated structural and endocrine defects as well as various opinions concerning the appropriate approach to these patients are discussed.
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A 28-year-old woman presented with a history of unilateral throbbing headache associated intermittently with transient pupillary dilation. The differential diagnosis and suggested method of investigation are discussed. Therapeutic recommendations are mentioned for the treatment of common migraine.
A 68-year-old woman experienced rapid progressive visual loss to blindness over a seven-week period. Inadequate clinical and diagnostic testing masked the diagnosis of a malignant glioma of adulthood.
A 39-year-old woman presented to her ophthalmologist complaining of floaters. This was associated with elevation of the optic disc and late staining of the retinal veins. The differential diagnosis of venous occlusive disease is discussed.