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Biomedical subjects

M S Gans

Publications and source records attributed to M S Gans.

5 recordsLinked to original sources
PubMed1999

The perils of a sneeze.

A 51-year-old woman had a 3-day history of severe left supraorbital pain associated with blurred vision of the left eye. Examination revealed visual acuity of 20/20 OD and 20/100 OS. A left relative afferent pupillary defect was present. Neuroimaging revealed a large intra-, supra-, and parasellar mass that had eroded through the sphenoid sinus into the maxillary sinus. Secondary pneumocephalus was present. Pathologic examination of the tissue revealed a pituitary adenoma of the null cell type. To the best of our knowledge, there is only one other case in the literature in which a spontaneous pneumatocele represents the initial manifestation of a pituitary adenoma.

Adenoma↗
PubMed1999

The prognosis of amaurosis fugax and hemispheric transient ischemic attacks.

BACKGROUND: The natural history of amaurosis fugax and of hemispheric transient ischemic attacks (TIAs) may be different. We analysed the ischemic risk factors, carotid status and prognosis with respect to future ischemic events in a cohort of patients who presented with either of these transient ischemic episodes. METHODS: The charts of patients who presented to our institution between February 1983 and April 1995 with amaurosis fugax or hemispheric TIAs were reviewed. Patients under the age of 45 years with a history of migraine or previous carotid surgery were excluded. Follow-up by a clinical visit or telephone interview was performed. Information was obtained regarding demographic features, presenting symptoms, ischemic risk factors, carotid status (as measured by duplex ultrasonography), type of medical treatment prescribed and occurrence of subsequent ischemic events. Outcome ischemic events were graded as major (myocardial infarction, cerebrovascular accident or death due to either of these) or minor (recurrent amaurosis fugax or hemispheric TIA). RESULTS: A total of 141 patients were followed for a mean of 47 months. Risk factors were more prevalent in patients with hemispheric TIAs than in those with amaurosis fugax. Most patients had a low degree of carotid stenosis. There was no statistically significant difference in the occurrence of major outcome events between the two groups. Kaplan-Meier survival curves were similar for the two groups. INTERPRETATION: Amaurosis fugax and hemispheric TIA both carry a risk for future ischemic events. However, we did not find a statistically significant difference in prognosis between the two groups.

Aged↗
PubMed1998

Neuro-ophthalmic findings in progressive multifocal leukoencephalopathy.

BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disorder of the central nervous system found in immunodeficient patients, most frequently now in those infected with HIV. It may represent the initial manifestation of HIV infection. Since the central visual pathways may be affected, a variety of neuro-ophthalmic signs and symptoms can manifest. We studied the clinical, radiographic and histopathological characteristics of patients with PML. METHODS: The charts of 13 patients in whom PML was diagnosed in the Neuro-AIDS clinic at the Montreal Neurological Institute between November 1987 and March 1995 were reviewed. The diagnosis of PML was established by characteristic clinical features together with typical computed tomographic or magnetic resonance imaging findings, such as nonenhancing low-density (on computed tomography) or hyperintense (on T2-weighted magnetic resonance imaging) white-matter lesions, without mass effect. Neuro-ophthalmic findings were based on clinical examination by an ophthalmologist, neuro-ophthalmologist or neurologist. Tissue for pathological examination was obtained by biopsy in one case and at postmortem study in a second case. RESULTS: The most common finding was homonymous hemianopia, in five patients (38%). Other features included nystagmus (in two patients), diplopia with cranial nerve palsy (in one) and cortical blindness (in one). One of the patients exhibited involvement of the brain stem, a site not usually affected by this demyelinating process. INTERPRETATION: The diagnosis of PML should be considered in immunocompromised patients with neuro-ophthalmic findings, particularly those with homonymous hemianopia.

AIDS Dementia Complex↗
PubMed1987

Standardized A-scan echography in optic nerve disease.

This study documents the results of standardized A-scan examinations performed in 59 cases of optic nerve lesions (15 perioptic meningiomas, four gliomas, 15 acute neuritides, ten optic atrophies, five ischemic optic neuropathies, five acute central retinal vein occlusions, five traumatic optic neuropathies), as compared with 73 normal optic nerves. Analysis included the assessment of reflectivity (spike height) and nerve width (maximal diameter) with the patient fixating in primary gaze and 30 degrees of eccentric gaze; measurements were obtained from the anterior one third and posterior one third of the optic nerves. Increased nerve diameters could be distinguished as noncompressible (a negative 30 degrees test) when due to tumor, or compressible (a positive 30 degrees test) when due to increased subarachnoid fluid, as exemplified by inflammatory optic neuritis or traumatic neuropathy. Moreover, reflectivity patterns regularly differentiated meningioma (medium reflectivity) from optic glioma (low reflectivity). Neither ischemic neuropathy nor vein occlusion altered optic nerve diameter. These results indicate that echographically defined optic nerve diameter, compressibility in eccentric gaze, and reflectivity patterns can be used to effectively distinguish among causes of chronic optic atrophy (tumor vs remote neuropathy) and disc edema (tumor vs neuritis vs ischemic neuropathy).

Adolescent↗