Biomedical subjects
Publications and source records attributed to W B Wilson.
A 36-year-old obese woman with hyperglycemia and immunosuppression died of bilateral internal carotid artery occlusion associated with mucormycosis. This report describes a rare case in which cerebral mucormycosis occurred without the usual preceding clinical evidence of nasal and orbital infection.
A quantitatives assessment of the pathological changes in extraocular muscle is presented in 8 patients with chronic progressive external ophthalmoplegia (CPEO). Serial cross-sections of extraocular muscle were stained with a battery of histochemical and immunohistochemical techniques and compared with 36 normal extraocular muscles and 1 muscle from a patient who had longstanding third nerve plasy with anomalous reinnervation. Several of the patients had a striking increase in the number of ragged-red fibers in extraocular muscle, particularly if frequent ragged-red fibers also were found on limb muscle biopsy. One patients demonstrated extrajunctional acetylcholine receptor (AChR) in a small percentage of fibers, although this finding was not present in the reinnervated muscle. Numerous darkly staining central regions were noted in the ocular muscle fibers of a patient with Stephens syndrome (CPEO, peripheral neuropathy, and cerebellar disease) and in the reinnervated muscle. A patient with myotubular myopathy had single central nuclei in both limb and ocular muscle. All patients demonstrated in their extraocular muscles variation in both the size and distribution of each of the three histochemical fiber types. Extraocular muscle biopsy proved to be a safe, reliable technique. As a similar quantitative analysis is applied to the study of further patients, a better understanding of the pathogenesis of CPEO should be possible.
We present two cases, each with a small meningioma arising from the sheath of an optic nerve in the canal. Both cases demonstrate the paucity of clinical and radiographic signs occurring with these tumors. The diagnosis must be strongly suspected when a middle aged white woman slowly and progressively loses vision in one eye in the absence of remission or other neurological findings. We review similar cases reported in the literature that have been proven by biopsy.
A reliable method for evaluating biopsy specimens of human extraocular muscles is presented to better understand the pathological responses of these highly organized striated muscles. Three muscle fiber types and their distribution are described with morphological and histochemical measurements used commonly for limb muscle. The granular and fine fibers have single end plates and may be comparable to limb-twitch fibers (type 2 and type 1 fibers). The coarse fibers have multiple end plates and may correspond to multiple end plated tonic fibers found in avian and amphibian limb muscles. The fibers of extraocular muscles are arranged in three concentric zones. Because of the zonal arrangement, a complete cross section should be evaluated in diseases of the ocular muscles to estimate any changes in fiber type distribution.
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Fifteen patients with ischemic optic neuritis studied electrophysiologically had a characteristic change of marked reduction in the amplitude of the visual-evoked response even when loss of vision was moderate. The optic neuritis of multiple sclerosis rarely produced this change. Occasionally, small increases in the latent period of the visual-evoked response were recorded from the patients with ischemic optic neuritis. The optic neuritis of multiple sclerosis usually produced significant increases in the latent period. When the normal nerve was tested in patients with ischemic optic neuritis, the visual evoked response was normal. In patients with optic neuritis of multiple sclerosis, stimulation of the "normal" nerve usually produced an increase in the latent period similar to that seen when the involved nerve was stimulated.
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This study was undertaken to determine a method of amino infusion that would 1) produce abortion within 12 hours; 2) be relatively free from risks of coagulapathy and electrolyte imbalance; 3) not result in delivery of liveborns; and 4) incur minimal gastrointestinal side effects from prostaglandin. Patients were randomly assigned to 1 of 3 groups unless history and examination revealed a contraindication to the use of prostaglandin. Three infusions were used: prostaglandin alone, urea alone, and a combination of urea and prostaglandin. All patients had pre-infusion laminaria inserted and all received oxytocin following infusion. There was a significant difference in instillation to abortion time when comparing the three groups and a marked reduction in gastrointestinal side effects using a lower dosage of prostaglandin. The synergistic effect of urea and prostaglandin F2alpha, previously demonstrated was further enhanced by the use of oxytocin and laminaria. This produced a mean instillation to abortion time significantly shorter than previous studies have shown and, indeed, offers a means of second trimester abortion suitable for use in ambulatory surgery facilities, precluding the high cost of inpatient care.
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Seven cases of infantile osteopetrosis are presented. Five of these were available for detailed clinical examination and 2 for retrospective review, including autopsy slides. Neurological deficits in these patients are reviewed. Involvement of the central nervous system parenchyma was suggested by observations of delayed development, ocular abnormalities, and reflex changes as well as radiographic and autopsy findings. Cerebral atrophy was present in several of our patients as well as some reported in the literature and may account for the ventricular enlargement found in many of these patients. Though hydrocephalus may be present, it is unclear that this is frequent or that it can occur without antecedent intracranial hemorrhage. The large head size is not accounted for by calvarial thickening or by hydrocephalus. Despite our patients' small stature, pituitary function appeared to be normal. Surgical decompression may stabilize cranial nerve function, particularly when the optic nerves are involved.
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Evaluation of subjective visual complaints unassociated with objective signs is a frequent problem in neurologic and ophthalmic practice. The visually evoked response (VER) is an important tool for separating the functional from the organic in patients claiming visual disturbance. In visual complaints associated with late posttraumatic epileptic activity, the VER can demonstrate an abnormality even in asymptomatic intervals. In complaints due to concussion, it demonstrates disorganized evoked responses initially and later a return of the normal resonse. It shows an abnormality in the occipital lobes during and after transient compression of the vertebral artery. A normal VER excludes all but trivial involvement of the visual system, symptomatic claims of the patient notwithstanding.
Three patients had oculomotor nerve palsy as a complication of the treatment of carotid cavernous fistulae by electrometallicthrombosis of the cavernous sinus. In two, third nerve function returned without misdirection in two months or less. One was left with a partial third nerve palsy, also without misdirection.
A 27-year-old obese mentally retarded woman showed progression of antisocial behavior with periodic somnolence 18 years after biopsy and irradiation of a large pilocytic astrocytoma of the chiasm and adjacent structures. Visual function, although impaired, had not changed during the long period of postoperative observation. Before she died, the tumor showed angiographic and histologic features of malignant glioma, but neuroradiologic and neuropathologic studies did not establish conclusively that it involved new areas of the brain. This report documents a rare case in which an irradiated childhood optic glioma underwent delayed malignant evolution.
Damage to the visual system is an unfortunate complication of surgery in the area of the optic chiasm. It is now possible tomonitor the functional status of the visual system intreoperatively at regulat intervals. This is accomplished by recording the Visual Evoked Response to flashes of light from light-emitting-eiodes. These diodes are embedded in a special plastic shell which inserts under the eye lids of each eye. Since the light comes from the diodes in the plastic shell, there is no need to disturb the surgical procedure when a test run is desired. A record is obtained by averaging 100 three-per-second flashes.
Visual evoked responses (VER) in four cases of occipital apoplexy supplemented perimetric diagnosis with new electrophysiologic parameters. These included diagnosis of (1) optic radiation involvement by delay in the initial VER component; (2) stirate cortical involvement by obliteration of the initial and late VER components; (3) suprastriate involvement by selective loss of the late VER components, and (4) recovery at one or more of the above levels in the visual process by follow-up examination.