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Biomedical subjects

Neil R Miller

Publications and source records attributed to Neil R Miller.

50 records · Page 3Linked to original sources
PubMed2003

Visual outcome in surgically treated suprasellar meningiomas.

OBJECTIVE To determine long-term (>10 years) visual outcome in patients with suprasellar meningiomas. METHODS Retrospective case series.RESULTS Among 18 patients who underwent surgery for suprasellar meningioma (1 patient died postoperatively), 1 experienced initial improvement in vision in both eyes, 8 experienced improvement in vision in one eye and maintained stable vision in the other eye, 2 experienced improvement in vision in one eye and worsening of vision in the other, 3 experienced worsening of vision in one eye and stable vision in one eye, and 4 maintained stable visual acuity in both eyes. No patient experienced postoperative worsening of vision in both eyes. During 10 years or more of follow-up, 10 of the patients (56%) maintained stable vision in both eyes, 6 patients (33%) experienced loss of vision in one eye while maintaining stable vision in the other, and 2 patients (11%) experienced loss of vision in both eyes. During this period, 7 of the 18 patients (39%) developed neuroimaging evidence of tumor growth or recurrence, with a mean time of 10.7 years. Four of these patients were thought to have had gross total resection of their tumor. Patients who experienced worsening of vision during the follow-up period were more likely to have developed neuroimaging evidence of growth or recurrence (five patients) than patients without such evidence (two patients), and such patients did not regain vision following subsequent surgery or radiation therapy. Nevertheless, at final examination, 13 patients (72%) had visual acuity of 20/40 or better in at least one eye. CONCLUSIONS The long-term visual prognosis for patients who undergo surgery for suprasellar meningioma is excellent, although tumor recurrence is common, even in patients thought to have undergone gross total removal of their tumor, and often occurs more than 10 years after surgery. Patients who develop tumor recurrence are likely to lose vision in at least one eye and are unlikely to achieve improvement in vision with subsequent surgery or radiation therapy. Thus, patients with suprasellar meningiomas believed to have been completely resected should undergo long-term, serial postoperative clinical examinations and neuroimaging to allow detection and further treatment of recurrences as early as possible. Postoperative radiation therapy should be considered for patients whose suprasellar meningiomas have been incompletely resected.

Adult↗
PubMed2003

Giant cavernous malformation of the occipital lobe.

A 15-year-old boy who developed severe headaches and an incomplete homonymous hemianopia was found to have a large, well-circumscribed, multilobulated intracranial mass in the contralateral occipital lobe. The initial impression was that of a low-grade glioma or a vascular malformation. When the lesion increased in size and complexity, concern arose about the possibility of a malignant glioma. Upon craniotomy, it proved to be a giant cerebral cavernous malformation. This case is remarkable in that most cavernous malformations do not become symptomatic before the third decade of life and rarely attain such a large size.

Adolescent↗
PubMed2002

Resolution of papilledema after neurosurgical decompression for primary Chiari I malformation.

PURPOSE: To report a causal relationship between Chiari I malformation and its rare, but recognized manifestation of bilateral papilledema. DESIGN: Interventional case series. METHODS: Four adult female patients (mean age, 48, age range 25-59 years) with bilateral papilledema, signs and symptoms of increased intracranial pressure, and cranial magnetic resonance imaging (MRI) evidence of a Chiari I malformation ranging from 7 to 22 mm of tonsillar herniation underwent suboccipital decompression. RESULTS: In all four patients, suboccipital decompression was followed by resolution of bilateral papilledema and signs and symptoms of increased intracranial pressure. CONCLUSION: Patients with bilateral papilledema and presumed pseudotumor cerebri require a cranial MRI to determine if they have a Chiari I malformation, because patients with increased intracranial pressure and papilledema from a Chiari I malformation may benefit from suboccipital decompression.

Adult↗
PubMed2002

Herpes zoster vasculitis presenting as giant cell arteritis with bilateral internuclear ophthalmoplegia.

PURPOSE: To present a case of herpes zoster vasculitis presenting as giant cell arteritis. DESIGN: Interventional case report. METHODS: A 77-year-old woman presented with sudden onset of diplopia associated with temple headaches and a previous history of herpes zoster ophthalmicus. A temporal artery biopsy was obtained and in-situ hybridization performed for herpes zoster DNA. RESULTS: The patient presented with a bilateral internuclear ophthalmoplegia. Initial diagnostic evaluation, including erythrocyte sedimentation rate, C-reactive protein, and temporal artery biopsy, was consistent with giant cell arteritis. However, in-situ hybridization of the temporal artery specimen was positive for herpes zoster DNA. CONCLUSIONS: Herpes zoster vasculitis may mimic giant cell arteritis and should be considered in the differential of any patient with presumed giant cell arteritis with suspicious findings, central nervous system involvement, or previous herpes zoster infection.

Aged↗
PubMed2002

Isolated acquired unilateral horizontal gaze paresis from a putative lesion of the abducens nucleus.

In three patients, acute horizontal gaze pareses developed that could not be overcome with the oculocephalic maneuver, indicating a putative lesion of the ipsilateral abducens nerve nucleus. None of the patients had a facial nerve paresis or evidence of a trigeminal sensory neuropathy. Although most lesions that affect the abducens nerve nucleus also damage the ipsilateral fasciculus of the facial nerve, small lesions in this region can produce an isolated horizontal gaze paresis.

Abducens Nerve Diseases↗
PubMed2002

Lightning strikes twice: Leber hereditary optic neuropathy families with two pathogenic mtDNA mutations.

OBJECTIVE: To report the clinical and mitochondrial genetic analyses of two families, each of which carries both the 11778 and 14484 Leber hereditary optic neuropathy (LHON) mutations in mitochondrial DNA. METHODS: In addition to detailed clinical histories, the complete sequence of the mitochondrial DNA (mtDNA) from each family was determined. RESULTS: A small Australian LHON family (Vic20) and a family from the United States carry the 11778 and 14484 LHON mutations. In addition to the optic neuropathy, one branch of the Baltimore LHON pedigree had a high incidence of a fatal infantile encephalopathy. In both families, the 14484 LHON mutation was homoplasmic, whereas the 11778 LHON mutation was heteroplasmic. CONCLUSIONS: There are no additional mtDNA sequence changes that explain the encephalopathy in the Baltimore LHON family, and a nuclear gene involvement is an alternative explanation that is supported by the available data. The ophthalmological characteristics and penetrance in the 11778 and 14484 "two-mutation" LHON families are not markedly more severe than those of classic LHON families who carry a single mtDNA mutation.

Adult↗
PubMedDate not supplied

The eye in neurological disease.

Neurological disease can involve the eye in many ways. Every structure--the conjunctiva, cornea, anterior chamber, iris, lens, vitreous humour, retina, choroid, and optic nerve--can be affected. In many cases, ocular involvement is the first manifestation of the underlying disease. In such cases, the ability of the physician to recognise the nature and significance of the ocular abnormality can lead to early diagnosis and successful treatment of the underlying condition. In other cases, recognition of the ocular abnormality can prevent permanent visual dysfunction.

Eye↗
PubMedDate not supplied

Neuro-ophthalmic manifestations of hemangiopericytoma.

PURPOSE: To describe the neuro-ophthalmic presentations of a rare intracranial tumor, hemangiopericytoma. METHODS: Retrospective multicenter case series. RESULTS: The neuro-ophthalmic and radiographic features of hemangiopericytoma are reviewed. The clinical presentation may mimic meningioma and the pre-operative distinction between meningioma and hemangiopericytoma is important because the evaluation, management, treatment, and prognosis differ significantly for the two lesions. CONCLUSION: We report five cases of intracranial hemangiopericytoma and review the neuro-ophthalmic findings of this uncommon entity.

Adult↗
PubMedDate not supplied

Ossifying fibromyxoid tumor of the orbit.

PURPOSE: This report describes the clinical, radiographic, and histopathologic features of the first known case of ossifying fibromyxoid tumor involving the orbit. METHODS: Case report and literature review. RESULTS: An 81-year-old woman presented with a 3-month history of diplopia, pain, and right upper eyelid swelling. CT and MRI of the orbit disclosed a 2.5-cm extra-conal mass superomedially in the right orbit, with displacement of the globe inferiorly and remodeling of the orbital roof. During surgery, the tumor was noted to be firm, gritty, and extra-periosteal in location, and the bone adjacent to the tumor was irregular and abnormal in consistency. The tumor was removed intact without difficulty. Histologic, immunohistochemical, and transmission electron microscopic examination disclosed features consistent with ossifying fibromyxoid tumor. Fourteen months after removal, the tumor recurred and the patient underwent a second excisional biopsy. The tumor recurred a second time 30 months after the first surgery. The patient underwent a third surgery to remove the tumor and received adjuvant radiation therapy. She has been free of disease for more than 18 months. CONCLUSIONS: This is the first known case of ossifying fibromyxoid tumor involving the orbit. Increased cellularity, nuclear atypia, and mitotic activity have been associated with metastatic and recurrent potential. The tumor in this case had moderate cellularity, low nuclear grade, and no mitotic figures. However, the close proximity of the tumor to important structures within the orbit precluded its excision with wide margins and may have predisposed the patient to the two episodes of local recurrence.

Aged, 80 and over↗
PubMedDate not supplied

Optic neuropathy from folic acid deficiency without alcohol abuse.

A 47-year-old woman with a 2-month history of bilateral progressive visual loss was found to have a bilateral retrobulbar optic neuropathy. Her serum vitamin B(12) concentration and hemoglobin level were normal, but her serum folic acid concentration was decreased. The patient had a minimal alcohol intake and moderate tobacco use that had been unchanged for over 20 years; however, she had markedly altered her diet 4 years earlier in the setting of clinical depression. After treatment with oral folic acid and diet modification without change in her tobacco or alcohol use, the patient's visual function returned to normal. This case supports the role of folic acid deficiency as an important cause of some cases of nutritional optic neuropathy.

Diet Therapy↗
PubMedDate not supplied

Resection of an orbital lymphangioma with the aid of an intralesional liquid polymer.

A 28-year-old man with long-standing right proptosis presented with an extensive multilobulated partially cystic orbital mass thought to be a lymphangioma. Because of concern that excision or debulking of the lesion was likely to be complicated by excessive bleeding, the lesion was injected with a mixture of ethiodized oil (Ethiodol) and cyanoacrylate glue under direct observation. The mixture caused the injected lobules to assume a firm, rubbery texture, allowing them to be excised without bleeding.

Adult↗