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W T Cornblath

Publications and source records attributed to W T Cornblath.

16 recordsLinked to original sources
PubMed1998

Minocycline treatment and pseudotumor cerebri syndrome.

PURPOSE: To demonstrate the association between minocycline treatment and development of the pseudotumor cerebri syndrome. METHODS: A retrospective study was conducted of 12 patients from five neuro-ophthalmic referral centers who developed pseudotumor cerebri syndrome after being treated with standard doses of minocycline for refractory acne vulgaris. The main outcome measures included resolution of headaches, transient visual obscurations, diplopia, papilledema, and visual fields static thresholds after withdrawal of minocycline and treatment for increased intracranial pressure. RESULTS: Nine (75%) of the 12 patients developed symptoms of the pseudotumor cerebri syndrome syndrome within 8 weeks of starting minocycline therapy; six were not obese. Two patients developed symptoms only after a year had elapsed because of commencement of treatment with minocycline. One patient was asymptomatic, and pseudotumor cerebri syndrome was diagnosed by finding papilledema on routine examination 1 year after minocycline was started. None of the patients developed recurrences for at least 1 year after the discontinuation of minocycline and treatment for increased intracranial pressure, but three (25%) of the 12 patients had substantial residual visual field loss. CONCLUSION: Minocycline is a cause or precipitating factor in pseudotumor cerebri syndrome. Although most patients have prominent symptoms and are diagnosed promptly, others are asymptomatic and may have optic disk edema for a long period of time before diagnosis. Withdrawal of minocycline and treatment for increased intracranial pressure lead to resolution of the pseudotumor cerebri syndrome, but visual field loss may persist.

Acne Vulgaris↗
PubMed1998

Scalp necrosis with giant cell arteritis.

OBJECTIVE: Giant cell arteritis (GCA) often presents with devastating visual loss in the elderly, yet early diagnosis and treatment can prevent visual loss. The authors report two cases of GCA in which scalp necrosis, a rare finding not reported previously in the ophthalmic literature, played an important role in diagnosis. DESIGN: Observational case reports and literature review. PARTICIPANTS: Two patients with GCA had scalp necrosis. INTERVENTION: Intravenous steroid administration was performed. MAIN OUTCOME MEASURE: Vision and healing of scalp necrosis were measured. RESULTS: One patient had scalp necrosis that was diagnosed incorrectly preceding visual loss. Another patient had visual loss in one eye diagnosed as nonarteritic anterior ischemic optic neuropathy. He had scalp necrosis develop 2 weeks later, leading to the correct diagnosis of GCA. There are 21 previously reported cases of scalp necrosis with GCA, none in the ophthalmic literature, most of which were undiagnosed until the onset of visual loss. In addition, a higher rate of visual loss is seen in GCA with scalp necrosis. CONCLUSIONS: Scalp necrosis is a valuable sign that frequently is misdiagnosed until visual loss occurs. In addition, it may indicate a more severe vasculitis. This finding should be added to the list of signs evaluated in patients for whom GCA is in the differential diagnosis.

Aged↗
PubMed1997

Dose-volume complication analysis for visual pathway structures of patients with advanced paranasal sinus tumors.

PURPOSE: The purpose of the present work was to relate dose and volume information to complication data for visual pathway structures in patients with advanced paranasal sinus tumors. METHODS AND MATERIALS: Three-dimensional (3D) dose distributions for chiasm, optic nerve, and retina were calculated and analyzed for 20 patients with advanced paranasal sinus malignant tumors. 3D treatment planning with beam's eye view capability was used to design beam and block arrangements, striving to spare the contralateral orbit (to lessen the chance of unilateral blindness) and frequently the ipsilateral orbit (to help prevent bilateral blindness). Point doses, dose-volume histogram analysis, and normal tissue complication probability (NTCP) calculations were performed. Published tolerance doses that indicate significant risk of complications were used as guidelines for analysis of the 3D dose distributions. RESULTS: Point doses, percent volume exceeding a specified published tolerance dose, and NTCP calculations are given in detail for patients with complications versus patients without complications. Two optic nerves receiving maximum doses below the published tolerance dose sustained damage (mild vision loss). Three patients (of 13) without optic nerve sparing and/or chiasm sparing had moderate or severe vision loss. Complication data, including individual patient analysis to estimate overall risk for loss of vision, are given. CONCLUSION: 3D treatment planning techniques were used successfully to provide bilateral sparing of the globe for most patients. It was more difficult to spare the optic nerves, especially on the ipsilateral side, when prescription dose exceeded the normal tissue tolerance doses. NTCP calculations may be useful in assessing complication risk better than point dose tolerance criteria for the chiasm, optic nerve, and retina. It is important to assess the overall risk of blindness for the patient in addition to the risk for individual visual pathway structures.

Blindness↗
PubMed1997

Progressive visual loss from giant cell arteritis despite high-dose intravenous methylprednisolone.

BACKGROUND: Giant cell arteritis (GCA) often presents with devastating visual loss in the elderly, yet the ideal treatment is unknown. The disease most often has been treated with oral prednisone, although recently the use of the high-dose intravenous methylprednisolone (IVMP) has been reported to enhance visual recovery. METHODS: The authors reviewed patient charts from two university-based neuroophthalmology services and reviewed all previously reported cases of GCA treated with IVMP. RESULTS: Four patients with GCA exhibited severe, progressive visual loss after at least 48 hours of high-dose IVMP. A fifth patient had further visual loss in one eye and improvement in the other eye after 24 hours of IVMP. In previous reports of IVMP treatment in GCA, four patients lost vision and 14 patients recovered vision. The authors review the details of these reports. CONCLUSIONS: The results of IVMP treatment of patients with visual loss from GCA are similar to the results of treatment with oral corticosteroids, with IVMP treatment being more costly and having a small risk of sudden death. The optimal dosage and route of corticosteroid treatment for GCA with visual loss remain elusive and warrant a treatment trial.

Aged↗
PubMed1997

MRI of optic nerve enlargement in optic neuritis.

We report two cases of optic neuritis with optic nerve enlargement on MRI. Both had a clinical course typical for optic neuritis but also had a neuroradiologic finding most commonly seen with optic nerve glioma or meningioma, which initially led to an incorrect diagnosis. We review the six previous reported cases of optic nerve enlargement in optic neuritis. Including our cases, six of eight reported cases were in children with severe initial visual loss. Optic nerve enlargement is a rare finding in optic neuritis that might be a subtype of optic neuritis.

Child↗
PubMed1997

Local thrombolytic therapy in deep cerebral venous thrombosis.

Thrombosis of the deep cerebral venous system is a rare entity with a very poor prognosis. We report two patients with thrombosis of the internal cerebral veins and vein of Galen who responded to local urokinase. We review all 49 cases of deep cerebral venous thrombosis in the English literature. The mortality rate for patients treated with either IV heparin or local thrombolytics was 13% compared with 48% in untreated patients (p = 0.037). Based on this retrospective review of the literature and our two cases, we support the use of heparin or local thrombolytics in individual cases of deep cerebral venous thrombosis.

Adult↗
PubMed1997

Two types of oscillopsia in a patient with idiopathic vestibulopathy.

A patient with an idiopathic bilateral vestibulopathy described two types of oscillopsia, one induced by head movement, the other induced by changing pressure in the right external auditory canal. This is the first report of both types of oscillopsia occurring in the same individual and illustrates their different mechanisms and symptomatology.

Adult↗
PubMed1996

Oculopalatal myoclonus after the one-and-a-half syndrome with facial nerve palsy.

PURPOSE: The one-and-a-half syndrome is an eye movement disorder characterized by a unilateral gaze palsy and an ipsilateral internuclear ophthalmoplegia. The authors describe a previously unrecognized association between the one-and-a-half syndrome and oculopalatal myoclonus (OPM). METHODS: Five clinical cases are presented, with pertinent physical findings and radiologic studies. RESULTS: A previously unrecognized association of the one-and-a-half syndrome with subsequent development of OPM appears to exist. Involvement of the facial nerve in patients with the one-and-a-half syndrome may be a predictor of the subsequent development of OPM. CONCLUSION: Patients with the one-and-a-half syndrome and facial nerve palsy should be followed closely for possible future development of OPM.

Adult↗
PubMed1995

Painful oculomotor palsy caused by posterior-draining dural carotid cavernous fistulas.

BACKGROUND: Carotid cavernous fistulas cause conjunctival hyperemia and orbital soft-tissue swelling because of increased flow directed anteriorly in ophthalmic veins. Less well recognized is that when fistular flow is directed posteriorly, these congestive features will be absent and the diagnosis of the "white-eyed shunt" will be missed unless angiography is performed. METHODS: Two patients who had oculomotor nerve palsies caused by posteriorly draining dural carotid cavernous fistulas were studied, and the 28 previously described cases were reviewed. RESULTS: One patient had a chronic painful palsy of the sixth cranial nerve, and the other, a palsy of the third cranial nerve. Cerebral angiography disclosed the fistulas. The clinical and imaging features of these cases conform to those of the 28 previously reported white-eyed shunts. Angiographic features do not explain why some posterior-draining fistulas cause sixth-nerve palsies and others cause third- (or rarely, fourth-) nerve palsies. CONCLUSIONS: Dural carotid cavernous fistulas that drain primarily into the inferior petrosal sinus may cause painful oculomotor palsies that elude diagnosis because they lack congestive orbito-ocular features. Treatment by embolization leads to more rapid resolution of manifestations.

Aged↗
PubMed1994

Ischemic optic neuropathy after lumbar spine surgery.

OBJECTIVE: Study of clinical features of ischemic optic neuropathy (ION) developing as a complication of multilevel lumbar spine surgery. DESIGN: Review of all cases of ION that developed within 2 weeks of spine surgery at two academic institutions from 1990 to 1992, and a review of adequately reported cases of ION after other non-ophthalmic procedures. RESULTS: Four new cases are reported in patients who ranged in age from 41 to 65 years. All four had undergone uneventful but prolonged (8 to 9 hours) spine surgery, during which blood pressure was deliberately maintained between 85 and 100 mm Hg systolic and 45 to 65 mm Hg diastolic to reduce bleeding. Hemoglobin values fell 30 to 78 g/L during surgery. Arteriosclerotic risk factors, including systemic hypertension, diabetes, coronary artery disease, and smoking, were present in three cases. There was no evidence of orbital soft-tissue injury, retinal artery occlusion, or other neurologic deficits. The combination of hypotension and anemia has been noted in most of the 30 previously well-documented cases of ION after other non-ophthalmic procedures. CONCLUSIONS: Multilevel lumbar laminectomy should be added to the list of procedures that may produce ION as an isolated complication. Deliberate hypotension maintained for long operative periods in patients with arteriosclerotic risk factors may be the cause.

Adult↗
PubMed1993

Extraocular muscle involvement in sarcoidosis.

BACKGROUND: Sarcoidosis is a granulomatous inflammatory disease that may have a variety of ocular and orbital manifestations. The most common ocular manifestation is uveitis, and the most common orbital manifestation is dacryoadenitis. Extraocular muscle involvement in sarcoidosis has rarely been reported. The authors report a case of sarcoidosis involving the extraocular muscles of a 15-year-old boy with bilateral, painful, external ophthalmoplegia and enlargement of all extraocular muscles on computed tomography (CT) scan. RESULTS: Lateral rectus muscle biopsy and transbronchial lung biopsy showed noncaseating granulomas characteristic of sarcoidosis. Cultures and serologic studies excluded fungal and mycobacterial diseases. Treatment with oral corticosteroids improved symptoms and signs. CONCLUSIONS: The authors report the first case of sarcoidosis in a patient with symptomatic extraocular muscle involvement, and only the third case in which extraocular muscle involvement has been shown histologically.

Adolescent↗
PubMed1992

Varied clinical spectrum of necrobiotic xanthogranuloma.

Four cases are presented that illustrate a wide spectrum of ophthalmologic and systemic features of necrobiotic xanthogranuloma (NXG). Case 1 initially had signs of Cogan syndrome, and then developed chronic lymphocytic leukemia. Case 2, the first case of NXG to undergo autopsy, had progressive cicatricial lid retraction and corneal perforation. Case 3 had a more typical presentation of diplopia and blepharoptosis caused by orbital and periorbital infiltrative masses. Case 4 had nondeforming periocular skin lesions over a 6-year period. In all four cases, the diagnosis was made on the basis of characteristic histopathologic and laboratory findings. Although the cause of NXG is still obscure, in many cases it appears to be a forerunner of lymphoproliferative diseases.

Aged↗
PubMed1992

Radiation-induced optic neuropathy: correlation of MR imaging and radiation dosimetry.

The authors performed topographic correlation of dosimetric measurements with contrast medium-enhanced magnetic resonance (MR) imaging signal aberration in two cases of radiation optic neuropathy. The region of pathologic contrast enhancement in the optic nerve and chiasm had received 55-62 Gy, which supports the theory that the risk of injury to the optic nerve and chiasm increases steeply with radiation doses above the tolerance level of 50-55 Gy.

Female↗
PubMedDate not supplied

Multiple sclerosis presenting as Parinaud syndrome.

The authors report a patient presenting with a 1-week history of paresis of upward gaze as his initial manifestation of demyelinating disease. They stress that: 1) multiple sclerosis can present as Parinaud syndrome (paralysis of upward gaze); and 2) it is important to rule out a non-contour-deforming intraaxial midbrain lesion if a posterior third ventricle or pineal region mass is not identified on screening studies in these patients.

Humans↗