Biomedical subjects

Paul W Brazis

Publications and source records attributed to Paul W Brazis.

15 recordsLinked to original sources

PubMed2006

Localizing forms of nystagmus: symptoms, diagnosis, and treatment.

Nystagmus is a rhythmic oscillation of the eyes that may be acquired or congenital. The symptoms of acquired nystagmus include blurred vision and oscillopsia. Most patients with congenital nystagmus do not have oscillopsia symptoms. Several forms of nystagmus have localizing value and any neuroimaging should be directed to the topographic localization suggested by the morphology of the nystagmus and any accompanying localizing signs. Several optical, medical, and surgical treatments have been used with some success in specific forms of nystagmus.

Electronystagmography↗

PubMed2006

Case studies in neuro-ophthalmology for the neurologist.

In summary, neurologists should be aware of emergent neuro-ophthalmic conditions: (1) temporal arteritis (GCA), (2) IIH, (3) intracranial shunt malfunction, (4) pituitary apoplexy, and (5) pupil-involved TNP. Earlier recognition and treatment of these disorders makes a difference in final out-come. Appropriate evaluation and management may be vision or life saving.

Adult↗

PubMed2005

Optical coherence tomography in a case of bilateral neuroretinitis.

A 42-year-old man had fever, chills, and bilateral visual loss. Visual acuity was markedly subnormal OU and ophthalmoscopy disclosed optic disc swelling with retinal thickening extending into the macula OU, findings consistent with neuroretinitis. Fluorescein angiography revealed optic disc leakage and submacular accumulation of dye OU without retinal vascular leakage. Optical coherence tomography (OCT) showed outer plexiform layer retinal edema and subfoveal detachments. There was evidence of active human immune deficiency virus and cytomegalovirus infections. Several weeks after multidrug therapy, sequential OCT scans documented resolution of the outer plexiform edema and submacular detachments in parallel with improved visual acuity. The OCT findings support the theory that submacular detachments in neuroretinitis result from diffusion of fluid from the optic disc to the outer plexiform layer and through the outer limiting membrane to the subretinal space.

Adult↗

PubMed2004

Pseudotumor cerebri.

Pseudotumor cerebri (PTC) is a syndrome of increased intracranial pressure without hydrocephalus or mass lesion and with normal cerebrospinal fluid (CSF) composition. Although often considered to be "idiopathic," detailed investigation has revealed a high incidence of venous outflow abnormalities in PTC syndrome patients. The thought that elevated intracranial venous sinus pressure is a "universal mechanism" for PTC syndrome of varying etiologies has been called into question by a study indicating that the increased venous pressure in idiopathic PTC patients is caused by the elevated intracranial pressure and not the reverse, suggesting that "the chicken is the CSF pressure elevation and the egg is the venous sinus pressure elevation." Vitamin A toxicity may play a role in the pathogenesis of idiopathic PTC. The treatment of PTC has two major goals: the alleviation of symptoms and preservation of visual function. When medical therapy fails or when visual dysfunction deteriorates, surgical therapies for PTC should be considered. The two main procedures performed include lumboperitoneal shunt and optic nerve sheath fenestration. Because of the association of PTC with venous sinus hypertension, some authors are considering venous sinus stenting for refractory cases of PTC. It is still unclear if primary treatment of the observed venous stenosis benefits patients with idiopathic PTC. This should be no surprise, as it is not certain whether the stenoses are the cause or the result of idiopathic PTC.

Humans↗

PubMed2004

Imaging for neuro-ophthalmic and orbital disease.

PURPOSE: To provide an update on imaging of the brain and orbit for ophthalmologists. DESIGN: Literature review. METHODS: A systematic English-language medline search and summary of recent literature on imaging of brain and orbit was performed. RESULTS: Computed tomography and magnetic resonance (MR) scanning are the mainstays for the evaluation of most disorders involving the brain and orbit. Computed tomography angiography and magnetic resonance angiography are relatively newer applications that are useful for the evaluation of arterial and venous disorders. Special sequences such as fat suppression and fluid attenuation inversion recovery are useful techniques for specific ophthalmic indications. Diffusion weighted imaging and perfusion-weighted imaging are improving the evaluation of acute stroke. Functional MRI, positron emission tomography scanning and single photon emission computed tomography may provide useful information regarding brain or tumor metabolism. Magnetic resonance spectroscopy has expanded our knowledge of brain function. Newer imaging studies have improved our diagnostic abilities on many fronts, including new sequences, new applications of imaging studies, and functional imaging of brain. CONCLUSION: New imaging techniques for brain and orbit have an increased potential for improving diagnostic yield. Accurate and timely communication with the neuroradiologist can optimize the prescription and interpretation of imaging in ophthalmology.

Brain Diseases↗

PubMed2004

Systemic infections of neuro-ophthalmic significance.

Systemic infectious disease may present with or include neuro-ophthalmic findings. Many of these signs and symptoms are related to topographical location of the infectious process,but some entities have distinctive and characteristic features that allow specific diagnosis. This article updates and reviews the neuro-ophthalmic features of infectious disease.

Eye Diseases↗

PubMed2004

Painful ophthalmologic disorders and eye pain for the neurologist.

Neurologists should be aware of the following causes of eye pain: (1)ocular and orbital disorders with or without visible pathology of the eye (eg,redness, corneal opacity, or proptosis); (2) ophthalmologic syndromes associated with headache; and (3) headache syndromes associated with ophthalmologic findings.

Diagnosis, Differential↗

PubMed2004

The uveo-meningeal syndromes.

BACKGROUND: The uveo-meningeal syndromes are a group of disorders that share involvement of the uvea, retina, and meninges. REVIEW SUMMARY: We review the clinical manifestations of uveitis and describe the infectious, inflammatory, and neoplastic conditions associated with the uveo-meningeal syndrome. CONCLUSIONS: Inflammatory or autoimmune diseases are probably the most common clinically recognized causes of true uveo-meningeal syndromes. These entities often cause inflammation of various tissues in the body, including ocular structures and the meninges (eg, Wegener granulomatosis, sarcoidosis, Behcet disease, Vogt-Koyanagi-Harada syndrome, and acute posterior multifocal placoid pigment epitheliopathy). The association of an infectious uveitis with an acute or chronic meningoencephalitis is unusual but occasionally the eye examination may suggest an infectious etiology or even a specific organism responsible for a meningeal syndrome. One should consider the diagnosis of primary ocular-CNS lymphoma in patients 40 years of age or older with bilateral uveitis, especially with prominent vitritis, that fails to respond to treatment or who has associated neurologic findings. A paraneoplastic disorder has been described in patients who have combined optic neuritis and retinitis defined serologically by the presence of a paraneoplastic IgG autoantibody CRMP-5-IgG. These patients may have an inflammatory vitritis and may have signs of cerebrospinal fluid inflammation.

Humans↗

PubMed2003

The evaluation of eye pain with a normal ocular exam.

Eye pain with or without associated head or face pain is a common complaint to the ophthalmologist. The ocular exam may reveal the etiology (e.g., corneal disease, angle closure glaucoma) but typically the exam is normal. This paper reviews the evaluation and management of eye pain with a "normal" ocular exam, including: 1) subtle findings on ocular exam; 2) transient findings on exam, and 3) no abnormal ocular findings. Ophthalmologists should be aware of the various etiologies for eye pain and the specific and distinctive features that make the diagnosis.

Diagnostic Techniques, Ophthalmological↗

PubMed2003

Whipple's disease with destructive arthritis, abdominal lymphadenopathy, and central nervous system involvement.

We describe a patient with Whipple's disease who had an unusual erosive and destructive polyarthritis, massive abdominal lymphadenopathy, asymptomatic central nervous system involvement, and rare manifestations of orbital pseudotumor and orchitis with epididymitis. Taking oral therapy with trimethoprim-sulfamethoxazole he had recurrent flares of orbital pseudotumor, an episode of orchitis with epididymitis, and persistent polymerase chain reaction T. whipplei-positive cerebrospinal fluid. Resolution was achieved with a one month course of intravenous ceftriaxone and a 6 month course of azithromycin, and no relapse occurred during 24 months of followup.

Abdomen↗

PubMed2002

Chronic progressive external ophthalmoplegia.

Chronic progressive external ophthalmoplegia (CPEO) is a descriptive term for a heterogenous group of disorders characterized by chronic, progressive, bilateral, and usually symmetric ocular motility deficit and ptosis. Significant pain, proptosis, or pupil involvement are not features of CPEO and should prompt evaluation for alternative etiologies. Mitochondrial DNA mutations are increasingly being recognized as the etiology for CPEO syndromes. Clinicians should recognize the specific syndromes associated with CPEO, characterized by variable systemic, neurologic, or other findings. Treatment is limited, but newer therapies are being investigated.

DNA, Mitochondrial↗

PubMed2002

Occipital condyle syndrome.

OBJECTIVE: Review the clinical features of occipital condyle syndrome. BACKGROUND: Occipital condyle syndrome consists of unilateral occipital region pain associated with ipsilateral 12th cranial nerve paresis. It is typically due to metastasis to the skull base and is underdiagnosed. DESIGN: We report a retrospective case series of 11 patients (8 men, 3 women), aged 32 to 72 years. RESULTS: Eleven cases of occipital condyle syndrome were identified. All patients complained of severe occipital region pain. In addition, 2 patients complained of ipsilateral ear or mastoid pain, 2 noted associated vertex pain, and 2 had frontal region pain. Six of the 11 cases involved the right side. In all patients, the occipital pain was ipsilateral to the 12th nerve paresis. All patients were mildly dysarthric, and 3 had dysphagia. In 7 of the 11 patients, occipital region pain preceded the hypoglossal paresis by several days to 10 weeks. On examination, tenderness to palpation of the occipital region was noted in all patients. All 11 patients had unilateral hypoglossal paresis. Skull films were abnormal in 2 of 5 patients for whom they were obtained, and tomograms were abnormal in 1 of 2 patients. High-quality computed tomography, bone scanning, and magnetic resonance imaging were abnormal in all cases in which they were performed. Nine patients had a known primary malignancy. The most common malignancies were breast cancer in women (2 of 3) and prostate cancer in men (4 of 8). In 2 patients, occipital condyle syndrome was the initial manifestation of a metastatic lesion. Radiation therapy was the treatment of choice for the occipital region pain. CONCLUSION: Occipital condyle syndrome is a rare, but stereotypic syndrome. Early detection has important therapeutic implications. Evaluation of the craniovertebral junction with special attention to the occipital condyles should be a routine part of all brain and cervical spine radiologic examinations, and the possibility of occipital condyle syndrome, particularly when patients have persistent occipital pain and a history of cancer, should be considered.

Adult↗

PubMed2002

Clinical review: the differential diagnosis of pain in the quiet eye.

BACKGROUND: Eye pain, periorbital and retro-orbital pain, and headache or facial pain referred to the orbital region are common presenting complaints. REVIEW SUMMARY: In this review, we discuss the etiologies of eye pain in the quiet eye, which is defined clinically as one with a clear cornea without redness or irritation of the conjunctiva or sclera. CONCLUSIONS: The causes of eye pain may be divided into two groups: (1) those associated with abnormal localizing ophthalmologic and neuro-ophthalmologic findings (including trigeminal neuropathies);(2) those with a normal ophthalmologic and neurologic examinations. The latter group is further divided into the following subgroups: (1) specific short-lasting or long-lasting headache or eye pain syndromes; (2) pain referred to the eye from other pathologic processes (secondary eye pain) sometimes distant from structures concerned with vision; and (3) pain from orbital, superior orbital fissure, cavernous sinus, or intracranial infiltrative, neoplastic, or inflammatory disease processes with normal ophthalmologic and neuro-ophthalmologic exam. Unfortunately, in some patients, no etiology for the pain syndrome is discerned and one is left with a diagnosis of idiopathic eye pain, eye strain, or atypical facial pain.

Journal Article↗

PubMed2002

Aspergillosis related to long-term nasal corticosteroid use.

Aspergillus is a ubiquitous mold that can cause several types of symptomatic infections: allergic aspergillosis, typically in young atopic patients; aspergillomas (often referred to as fungus balls); and invasive aspergillosis, typically seen in debilitated or immunocompromised patients. We describe an 85-year-old woman who was not immunocompromised but had invasive aspergillosis of the paranasal sinus that resulted in unilateral headache and retrobulbar optic neuropathy. After extensive differential diagnostic examination, we concluded that the condition was possibly related to the long-term use of nasal corticosteroids (fluticasone propionate aqueous nasal spray). Surgical removal of solid masses of Aspergillus organisms followed by extended treatment with antifungal agents resulted in a favorable outcome.

Administration, Topical↗

PubMedDate not supplied

The evaluation of isolated third nerve palsy revisited: an update on the evolving role of magnetic resonance, computed tomography, and catheter angiography.

The evaluation and management of the neurologically isolated third nerve palsy continues to evolve. The major concern for the clinician confronted with a patient with a third nerve palsy has been the exclusion of an intracranial aneurysm. The evolution of new imaging techniques, such as computed tomography angiography and magnetic resonance angiography, have provided new imaging options for clinicians. This article reviews the pertinent recent literature on the use of these imaging studies in evaluating the patient with a third nerve palsy.

Angiography↗