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Biomedical subjects

M L Slavin

Publications and source records attributed to M L Slavin.

At least 37 records · Page 2Linked to original sources
PubMed1989

Hyperdeviation associated with isolated unilateral abducens palsy.

Sixteen patients with isolated unilateral abducens palsy were found to have an associated hyperdeviation (HD) in peripheral gaze on Maddox rod examination. In four patients, the chief complaint was vertical as well as horizontal diplopia. Vertical ductions were normal in each case and the maximal HD ranged from 8 to 16 prism diopters (PD) in 10 of 16 patients (62.5%) and from 4 to 7 PD in 6 of 16 patients (37.5%). In ten cases, an HD in primary as well as peripheral gaze was detected. The magnitude of HD did not correlate with the degree of abduction defect, and the HD was maximal to the side of the paretic lateral rectus muscle in 14 of 16 cases, with 2 cases greatest on direct lateral gaze; 6 cases, lateral upgaze; and 6 cases, lateral downgaze. The Bielschowsky head tilt test was positive in 1 of 14 cases, and the double Maddox rod test showed the absence of cyclodeviation in 10 of 12 cases tested. A variable HD was present in six cases. In two cases, up and downshooting of the paretic eye, respectively, was noted on attempted abduction. The HD diminished in synchrony with abduction improvement. Mechanical factors and vertical substitution movements may explain the HD.

Abducens Nerve↗
PubMed1989

Eyelid swelling and erythema as the only signs of subperiosteal abscess.

On clinical grounds it is usually easy to distinguish between preseptal cellulitis, a cutaneous infection not threatening to vision, and orbital cellulitis, a potentially vision threatening infection of the orbital tissues generally arising from paranasal sinusitis. We recently cared for two patients with a clinical diagnosis of preseptal cellulitis who had CT scan evidence of subperiosteal abscess. Antibiotic therapy alone resulted in clinical resolution in each case.

Abscess↗
PubMed1989

Metastatic malignant meningioma.

The onset of a rapidly progressive abducens and trigeminal neuropathy, third-order neuron Horner's syndrome, and decreased lacrimation clinically suggest a malignant lesion at the base of the middle cranial fossa, commonly a metastatic process. A case is reported in which computed tomography and magnetic resonance imaging failed to image the lesion but a bone scan clearly depicted the abnormal area. A malignant meningioma (en plaque) was evident on biopsy, and pulmonary metastases later ensued. Common histological patterns of meningioma (often thought of as a benign tumor) include meningothelial, fibrous, and transitional types. The association of cellular atypia, nuclear pleomorphism, marked mitoses, and brain invasion warrants the designation of malignant meningioma. The incidence of malignancy in meningioma ranges from 2 to 10% with reported metastases occurring in 0.1%.

Abducens Nerve↗
PubMed1988

Asymptomatic physiologic hyperdeviation in peripheral gaze.

Asymptomatic hyperdeviation (HD) in peripheral gaze may be caused by muscle paresis, restrictive orbital diseases, cranial neuropathy, or skew deviation. The authors suspected that this finding was often physiologic and therefore examined 61 normal subjects with the Maddox rod. Forty-seven of 61 patients (77%) showed an HD of 2 prism diopters (PD) or greater in any field of gaze; 22 of these 47 patients (47%) showed an isolated left HD in right upgaze and right HD in left upgaze; an additional 15 of the 47 patients (32%) had either a right HD in left upgaze or a left HD in right upgaze. In only one patient was a vertical phoria evident in primary gaze. Ninety-four percent noted vertical diplopia where the deviation was found. In 40 of 47 patients (85%), a "V" pattern of less than 15 PD was detected. No HD in primary gaze on head tilt was elicited in those tested. Awareness of this highly prevalent physiologic HD, which follows the pattern of primary overaction of the inferior oblique muscle, may ward off erroneous neurologic diagnoses.

Adult↗
PubMed1987

Acute severe irreversible visual loss with sphenoethmoiditis-'posterior' orbital cellulitis.

Orbital cellulitis secondary to adjacent paranasal sinusitis presents with marked proptosis, ophthalmoplegia, eyelid edema, chemosis, and/or conjunctival hyperemia. These conditions often precede visual dysfunction. "Posterior" orbital cellulitis secondary to sphenoethmoidal sinusitis may be defined as the clinical syndrome in which early severe visual loss overshadows or precedes accompanying inflammatory orbital signs. The visual loss may be attributed to involvement of the intracanalicular or orbital apical segment of the optic nerve. Total irreversible unilateral visual loss developed in three patients with this syndrome. Severe visual loss was preceded by diplopia in one patient and by bilateral eyelid edema in another. One patient with chronic panparanasal sinusitis with acute visual loss presented with isolated optic disc edema. Proptosis and ductional restriction subsequently developed. The irreversible blindness in these cases may be due to a combination of intracanalicular edema and vasculitis causing optic nerve infarction.

Acute Disease↗
PubMed1987

Isolated environmental tilt associated with lateral medullary compression by dolichoectasia of the vertebral artery. Is there a cause and effect relationship?

An elderly woman with the persistent isolated symptom of monocular and binocular tilting of environmental objects, was found on magnetic resonance imaging to have compression of the lateral medulla by an ectatic vertebral artery. The double Maddox rod test showed no relative torsion of either globe although 5 degrees of right excyclotorsion and left incyclotorsion (rightward ocular counter-rolling) was detected on testing with monocular viewing. There was no accompanying hyperdeviation, nystagmus or other neurologic signs. Symmetrical tilting of each globe associated with head tilt and skew deviation (the ocular tilt reflex) may be caused by lesions involving otolith connections. Isolated environmental tilt may herald the onset of lateral medullary infarction (Wallenberg's syndrome), or may be associated with vertebro-basilar insufficiency. Could compression of otolith connections in the medulla cause persistent ocular counter-rolling without accompanying neurologic signs?

Aged↗