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Biomedical subjects

M C Brodsky

Publications and source records attributed to M C Brodsky.

At least 37 records · Page 2Linked to original sources
PubMed2000

Complete resolution of hypertension after decompression of Chiari I malformation.

The Chiari I malformation has not been previously linked to sustained hypertension. Other forms of medullary compression have, however, been shown to be associated with elevated arterial pressure. This association has been demonstrated through numerous studies that have implicated compression of the rostral ventrolateral medulla, usually by vascular structures, as a factor responsible for hypertension. We present a case of a young man with a 2-year history of hypertension who was found to have a Chiari I malformation. No other cause for hypertension was found. After subsequent surgical decompression, his hypertension resolved immediately. No other therapeutic options were activated. This is the first reported case linking Chiari I malformation and sustained hypertension. This case presents further evidence linking medullary compression and elevation of hemodynamic tone.

Case Reports↗
PubMed2000

The role of volitional effort in the Bielschowsky head tilt test: a clinical and oculographic assessment.

PURPOSE: To determine whether volitional effort on the part of the subject can influence the results of the Bielschowsky Head Tilt Test. PATIENTS AND METHODS: Bielschowsky Head Tilt testing was performed in five normal subjects. Vertical amplitudes were measured with prism alternate cover testing when the head tilt was voluntary (volitionally maintained in a tilted position by the subject), forced (restrained in the tilted position by the examiner while the patient actively resisted) and active (restrained in a tilted position by the examiner with the subject actively trying to increase the tilt). Three-dimensional scleral search coil recordings were performed in three additional normal subjects using the same paradigm to determine the effect of volition on the torsional positions of the eyes. RESULTS: No vertical deviation of the eyes was detectable with prism alternate cover testing in any position of tilt, regardless of whether the tilt was voluntary, forced, or active. Volitional attempts to tilt the head were preceded by a transient ipsiversive torsional movement of the measured eye, which was quickly followed by a normal ocular counterroll. Following completion of the counterroll, the position of the eyes was constant for any position of head tilt, regardless of whether the tilt was forced, active, or voluntary. CONCLUSION: Anticipatory torsional movements of the eyes are evoked by an attempted volitional head movement in the roll plane and its associated innervation to the cervical musculature. However, these volitional movements do not alter the final torsional position of the eyes, which is a function of the degree of head tilt and the normal ocular counterroll. These anticipatory torsional movements do not influence the results of the Bielschowsky Head Tilt Test clinically by prism alternate cover testing.

Adult↗
PubMed1999

Dissociated vertical divergence: a righting reflex gone wrong.

Dissociated vertical divergence (DVD) is an ocular motor disorder characterized by a slow, upward drift of 1 eye when the other eye is fixating a target. I propose that DVD is a dorsal light reflex in which asymmetrical visual input to the 2 eyes evokes a vertical divergence movement of the eyes. This primitive visuo-vestibular reflex functions as a righting response to restore vertical orientation in lower lateral-eyed animals by equalizing binocular visual input. The dorsal light reflex is suppressed in humans but can manifest as DVD when early-onset strabismus precludes normal binocular development.

Animals↗
PubMed1999

Optic nerve hypoplasia with posterior pituitary ectopia: male predominance and nonassociation with breech delivery.

PURPOSE: To determine whether posterior pituitary ectopia in children with optic nerve hypoplasia has a male predominance or an increased incidence of breech delivery. METHOD: Retrospective analysis of 12 children with optic nerve hypoplasia and posterior pituitary ectopia. RESULTS: Eleven of 12 patients with posterior pituitary ectopia were boys. No child had a history of breech delivery. Two children had a history of breech positioning but were delivered by cesarean section. CONCLUSION: Posterior pituitary ectopia with optic nerve hypoplasia shows a strong male predominance but no association with breech delivery.

Adolescent↗
PubMed1998

Hereditary external ophthalmoplegia synergistic divergence, jaw winking, and oculocutaneous hypopigmentation: a congenital fibrosis syndrome caused by deficient innervation to extraocular muscles.

BACKGROUND: The congenital fibrosis syndrome is a hereditary form of external ophthalmoplegia that is considered to be a primary myopathy. PURPOSE: To document the coexistence of two distinct forms of ocular motor synkinesis in a subgroup of patients with congenital fibrosis syndrome. METHODS: Clinical and intraoperative examination results and extraocular muscle biopsy specimens from four patients with congenital fibrosis syndrome were studied. RESULTS: Three patients displayed a variant of synergistic divergence characterized by simultaneous abduction with intorsion and depression of the synkinetically abducting eye. Three patients had variant of Marcus Gunn jaw winking characterized by elevation of a ptotic eyelid during mouth opening. Three patients had oculocutaneous hypopigmentation. CONCLUSIONS: A subgroup of patients with congenital fibrosis syndrome display two distinct synkinetic ocular movements in conjunction with oculocutaneous hypopigmentation. The patterns of neuronal misdirection implicate a regional innervational disturbance involving cranial nerves III through VI as the underlying cause of diffuse hereditary ophthalmoplegia in these patients.

Adult↗
PubMed1998

Magnetic resonance imaging in pseudotumor cerebri.

OBJECTIVE: To determine whether magnetic resonance (MR) imaging can be used to predict the presence of elevated intracranial pressure. DESIGN: Retrospective case series. PARTICIPANTS: Twenty patients with pseudotumor cerebri and 20 control subjects. INTERVENTION: Magnetic resonance imaging. MAIN OUTCOME MEASURES: The presence or absence of the following six neuroimaging signs was measured: (1) flattening of the posterior sclera; (2) enhancement of the prelaminar optic nerve; (3) distension of the perioptic subarachnoid space; (4) intraocular protrusion of the prelaminar optic nerve; (5) vertical tortuosity of the orbital optic nerve; and (6) empty sella. RESULTS: The MR imaging disclosed flattening of the posterior sclera in 80% of patients with pseudotumor cerebri, empty sella in 70%, distension of the perioptic subarachnoid space in 45%, enhancement of the prelaminar optic nerve in 50%, vertical tortuosity of the orbital optic nerve in 40%, and intraocular protrusion of the prelaminar optic nerve in 30%. Each neuroimaging sign was detected in 5% of control subjects, except for enhancement of the prelaminar optic nerve, which was not detected in control subjects. Based on these MR imaging signs, the examiner was able to predict the presence of elevated intracranial pressure in 90% of cases with pseudotumor cerebri and the absence of elevated intracranial pressure in all control subjects. CONCLUSIONS: Elevated intracranial pressure produces a constellation of MR imaging signs that can assist in establishing the diagnosis of pseudotumor cerebri.

Adolescent↗
PubMed1998

Surgical management of intermittent exotropia with high AC/A ratio.

BACKGROUND: A subgroup of patients with intermittent exotropia have a high AC/A ratio, which places them at risk for esotropia at near after surgical treatment of their distance deviation. METHODS: A retrospective review of six patients with intermittent exotropia and a high AC/A ratio who were simultaneously treated with lateral rectus recessions to fully correct their exotropia at distance and placement of posterior fixation sutures on both medial rectus muscles in hopes of preventing an esotropia at near after surgery. RESULTS: Despite the persistence of a high postoperative AC/A ratio as assessed by the gradient method, five of six patients achieved stable postoperative alignment at distance and near without bifocals. One patient required postoperative bifocal correction for intermittent esotropia at near. CONCLUSION: In patients with intermittent exotropia and a high AC/A ratio, posterior fixation of the medial rectus muscles at the time of lateral rectus recessions enables the surgeon to fully correct the distance deviation and minimizes the risk of postoperative esotropia at near.

Accommodation, Ocular↗