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Biomedical subjects

L B Kline

Publications and source records attributed to L B Kline.

At least 19 recordsLinked to original sources
PubMed1992

Craniopharyngioma: pitfalls in diagnosis.

A 28-year old man presented with decreased vision and a bitemporal hemianopia. Magnetic resonance (MR) imaging demonstrated what appeared to be an enlarged optic chiasm and, on T2-weighted images, hypersignal extending along the optic tracts. This was felt to represent an intrinsic chiasmal mass, most likely a chiasmal glioma. Biopsy specimens from the first craniotomy were nondiagnostic. With continued visual failure, the patient underwent a second operation, and the correct diagnosis of craniopharyngioma was established. This article emphasizes the difficulties encountered with neuroradiologic evaluation and histopathologic study of craniopharyngioma.

Adult↗
PubMed1990

Acquired trigemino-abducens synkinesis.

A 26-year-old woman sustained closed head trauma following a motor vehicle accident. Her injuries included complete trigeminal and abducens nerve palsies. Eleven months later eye muscle surgery succeeded in making her orthophoric in primary gaze although her right abduction deficit persisted. Eighteen months after injury the patient was able to fully abduct her right eye with jaw thrust to the left. With abduction of the right eye there was associated globe retraction and narrowing of the palpebral fissure. This is the second reported case of trigemino-abducens synkinesis. Mechanisms to explain this phenomenon are discussed.

Abducens Nerve↗
PubMed1989

Ocular stroke and carotid artery dissection.

Carotid artery dissection frequently causes transient ipsilateral visual impairment. We present 2 cases of permanent ocular vaso-occlusion sequelae consequent to dissection of the ipsilateral internal carotid, definite in one and probable in the other. In both, the ocular strokes led to the recognition of the underlying carotid vasculopathy.

Adult↗
PubMed1988

Progression of visual defects in ischemic optic neuropathy.

Six patients with nonarteritic ischemic optic neuropathy experienced worsening of visual acuity and field loss during the six-week period after onset (range, three to six weeks), without apparent ophthalmoscopic changes. Thereafter, visual function remained unchanged. Various medications were used, but none prevented deterioration of visual function. Although not a widely recognized phenomenon, progression of visual deficit occurred in these patients in the early weeks after onset of ischemic optic neuropathy.

Female↗
PubMed1988

Bilateral cavernous sinus thrombosis due to mucormycosis.

A 49-year-old man requiring hemodialysis for end-stage renal disease developed orbital cellulitis and bilateral central retinal artery occlusions. Although cranial computed tomography demonstrated ethmoid and sphenoid sinusitis, two surgical biopsy specimens of sinus mucosa were nondiagnostic. Autopsy findings confirmed cerebral mucormycosis with bilateral cavernous sinus and carotid artery thrombosis. The patient had been taking deferoxamine for hemochromatosis, and this chelating agent may have been the predisposing factor in developing mucormycosis. We discuss the limitations of current neuroimaging techniques in establishing the diagnosis of both cerebral mucormycosis and cavernous sinus thrombosis.

Brain Diseases↗
PubMed1987

Recovery of vision after presumed direct optic nerve injury.

Immediate loss of light perception after direct optic nerve injury is usually irreversible. Our patient sustained presumed direct optic nerve injury because of a shotgun injury with loss of light perception, absent pupillary response, and absent visual-evoked potential. A small pupillary response was noted 12 days after injury, light perception returned by 15 days, and visual acuity was 20/100 at 4 months. A variety of pathophysiologic mechanisms may lead to visual loss after direct optic nerve injury. It is important to recognize that blindness is not always permanent in these cases despite the results of initial clinical and electrophysiologic testing.

Adolescent↗
PubMed1987

Painful Horner's syndrome due to spontaneous carotid artery dissection.

Spontaneous dissection of the internal carotid artery as a cause of Horner's syndrome has only been recognized in recent years. The authors describe three patients with this condition. Associated symptoms included ipsilateral orbital and frontal headache (3 patients), neck and facial pain (2), amaurosis fugax (1), and dysgeusia (1). The symptoms resolved in all patients within three months, yet oculosympathetic paralysis has persisted. Diagnosis of carotid dissection required cerebral arteriography, and the angiographic features are presented. Patients were treated with platelet antiaggregants, and they have remained neurologically stable during follow-up (mean, 12 months; range, 10-14 months).

Adult↗
PubMed1987

Bilateral internuclear ophthalmoplegia in systemic lupus erythematosus.

Internuclear ophthalmoplegia has been infrequently described in patients with systemic lupus erythematosus. We report a 23-year-old woman with lupus who presented with bilateral internuclear ophthalmoplegia and skew deviation. Additional neurologic findings included dysarthria, hemifacial weakness, hemiparesis, and dysmetria. Computed tomography of the patient's brainstem was unremarkable while magnetic resonance scanning demonstrated two areas of infarction. Magnetic resonance imaging is superior to computed tomography in both neuroradiographic study of the brainstem as well as evaluation of patients with neurologic complications of lupus.

Adult↗
PubMed1987

Electrical cataracts: a case report and review of the literature.

A case report of electrically-induced cataracts and a review of the literature is presented. Awareness of the possibility of this complication and screening of high-risk patients is stressed. The majority of cases respond well to surgery, but final visual acuity may be decreased secondary to retinal or optic nerve injury caused by the electrical current.

Adult↗
PubMed1986

Aneurysmal compression of the anterior visual pathways.

Ten patients with aneurysmal compression of the anterior visual pathways had visual loss, unilateral in 4 and bilateral in 6. There was no typical clinical presentation. Visual loss was acute or gradual, acuity sometimes fluctuated, and visual field testing was highly variable. The aneurysms were supraclinoid (four patients), carotid-ophthalmic (two), anterior communicating-anterior cerebral (three), and intracavernous carotid (one). Nine patients had successful clipping of their aneurysm, and in one, ipsilateral common carotid ligation was performed. Postoperatively, visual acuity was improved in six cases, unchanged in three, and worse in one.

Adult↗
PubMed1985

Radiation optic neuropathy.

Following surgery for pituitary adenoma, radiation therapy is an accepted treatment in reducing tumor recurrence. However, a potential therapeutic complication is delayed radionecrosis of perisellar neural structures, including the optic nerves and chiasm. This particular cause of visual loss, radiation optic neuropathy (RON), has not been emphasized in the ophthalmologic literature. Four cases of RON seen in the past five years are reported. Diagnostic criteria include: (1) acute visual loss (monocular or binocular), (2) visual field defects indicating optic nerve or chiasmal dysfunction, (3) absence of optic disc edema, (4) onset usually within three years of therapy (peak: 1-1 1/2 years), and (5) no computed tomographic evidence of visual pathway compression. Pathologic findings, differential diagnosis and therapy will be discussed in outlining the clinical profile of RON.

Adenoma↗
PubMed1979

Dominant optic atrophy. The clinical profile.

We examined 24 individuals in four family pedigrees with dominantly inherited optic atrophy (DOA); 12 patients met the criteria for diagnosis of DOA and two were suspect. Our data indicate that (1) insidious onset usually occurred in childhood, but subjective visual symptoms may evolve in adulthood; (2) visual function was minimally (20/25) to moderately (20/400) abnormal, could be strikingly asymmetric in an individual (eg, 20/30 in the right eye and 20/200 in the left eye), and showed considerable intrafamilial and interfamilial variation; (3) visual field defects consisted of central and centrocecal scotomas, but no peripheral isopter abnormalities were found; (4) color-vision screening with Hardy-Rand-Rittler plates revealed dyschromotopsias, but only Farnsworth-Munsell 100-hue examination disclosed the typical tritan defects; (5) pattern-reversal visual-evoked responses were characterized by diminished amplitudes and prolonged latencies, consistent with neural conduction defects; (6) disc pallor was limited to the temporal segment in all cases, and 16 of 24 eyes showed focal temporal excavation, which is probably pathognomonic of DOA.

Adolescent↗