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PubMed1988

Intracranial hypertension causing visual failure in cryptococcus meningitis.

Thirty four patients with cryptococcal meningitis seen in the University of Malaya medical centre since 1980 were reviewed. Eleven patients had bilateral papilloedema and visual impairment but eventually survived. Seven patients had intensive aggressive measures, including shunting to reduce intracranial hypertension irrespective of ventricular size shown in CT scan, and showed substantial improvement in vision. It is concluded that papilloedema and visual failure in cryptococcal meningitis reflects raised intracranial pressure and that this should be treated vigorously.

Adolescent↗
PubMed1993

Pseudotumor cerebri: CT findings and correlation with vision loss.

OBJECTIVE: The purpose of this study was to determine if orbital and cerebral CT can be used to distinguish normal patients from those with pseudotumor cerebri, and to correlate CT findings with the severity of visual impairment. SUBJECTS AND METHODS: Seventeen patients with a clinical diagnosis of pseudotumor cerebri were compared with 20 age- and sex-matched control subjects. Thin-section coronal and axial CT scans of the orbit and whole-brain axial CT scans were available for all subjects. The diameter of the optic nerve sheath, the degree of reversal of the optic nerve head, the presence and degree of empty sellae, and ventricular and sulcal sizes were evaluated without knowledge of whether or not the subject had pseudotumor cerebri. The same parameters were compared for two subgroups of patients with pseudotumor cerebri: those with mild vision loss and those with severe vision loss. RESULTS: Patients with pseudotumor cerebri had significantly larger optic nerve sheaths than did control subjects (6.5 +/- 0.83 mm vs 5.4 +/- 0.69 mm). Radiologic evidence of papilledema with reversal of the optic nerve head was found in 12 of 17 patients compared with one of 20 control subjects. An empty sella was seen more frequently and to a greater degree in patients with pseudotumor cerebri than in control subjects (16 vs seven). Eight of nine patients with severe vision loss and four of eight patients with mild to moderate vision loss had reversal of the optic nerve head; the degree was greater in the group with severe vision loss. No difference in ventricular size or sulcal enlargement was seen between any of the groups. The opening CSF pressures of the two groups with vision loss were not significantly different (348 +/- 80 mm H2O vs 391 +/- 98 mm H2O). CONCLUSION: In addition to the role of CT in excluding intracranial disease as a basis for the clinical syndrome of pseudotumor cerebri, thin-section CT of the orbits reveals a constellation of findings, including enlarged optic nerve sheaths, reversal of the optic nerve head, and empty sellae in patients with pseudotumor cerebri. Furthermore, severe vision loss in these patients correlates with more frequent and more severe reversal of the optic nerve head.

Adolescent↗
PubMed1990

Clinical features of occipital infarction.

Occipital infarction may only cause visual symptoms. A homonymous visual field defect of various configurations is the most common clinical finding. Additionally, central vision, color vision and visual associative function also may be impaired. In this paper three cases of occipital infarction are presented and the clinical features of this condition discussed.

Aged↗
PubMed1994

Alzheimer's disease and the eye.

AD patients may have substantial defects in the visual system despite a normal routine eye exam. Specific methods should be utilized to assess the ability of these patients to understand what they see and read. Subtle defects of eye movements may be present. Problems with contrast sensitivity, color vision, and stereo vision may be also be present, as well as early signs of optic atrophy. An awareness of the specific problems that AD patients present will lead the clinician to accurate diagnosis.

Alzheimer Disease↗
PubMed1987

A 16 year old boy with poor vision and nasal obstruction.

A 16 year old boy presented with visual deterioration and nasal obstruction. Investigations revealed a destructive pituitary tumour with extension into his skull base and nasopharynx. This unusual prolactin-secreting adenoma was treated by both surgery and bromocriptine.

Adenoma↗
PubMed2003

Bilateral occipital-parietal hemorrhagic infarctions following chiropractic cervical manipulation.

A 26-year-old woman presented with acute headache and hand-motion vision in both eyes. One day prior to presentation she went to her chiropractor for cervical manipulation. The patient had received 20 chiropractic manipulations over the previous two years. CT scan and MRI showed bilateral, symmetric occipital-parietal hemorrhagic infarctions. Angiography revealed severe focal stenosis in the distal vertebral arteries bilaterally at the superior C1 level possibly representing dissections. There was also a pseudoaneurysm of the left vertebral artery at the C1 level. Risk factors included chiropractic manipulation, recent fever, and therapies for polycystic ovarian disease. The patient showed slow, steady improvement in her vision. Twenty days following admission, vision was 20/20 OU. The improvement in her vision most likely reflects the reduction in swelling and absorption of blood at the site of the strokes.

Adult↗
PubMed1984

Infarction of FSH-secreting pituitary adenoma.

A patient with an FSH-producing adenoma is reported. Two hours after LRH administration (100 microgram iv) the clinical signs of tumour infarction developed. The patient followed a severe clinical course. FSH levels normalised but further deterioration of pituitary function was documented. Worsening of the vision without improvement after surgical resection of the adenoma was observed. The role of LRH testing in adenoma infarction is discussed.

Adenoma↗
PubMed1997

Endodermal cyst of the third ventricle: case report.

OBJECTIVE AND IMPORTANCE: Endodermal cysts are rare lesions that primarily affect the spinal cord. Only a few reports have been published that describe intracranial endodermal cysts, and, in most of the cases, the cysts were located in the posterior fossa. To our knowledge, there have been no reports of endodermal cysts of the third ventricle. CLINICAL PRESENTATION: A symptomatic endodermal cyst of the third ventricle in a 28-year-old man is presented. The patient demonstrated signs of increased intracranial pressure and reported a progressive loss of vision in his right eye. Neuroradiological imaging revealed obstructive hydrocephalus and a lesion inside the third ventricle measuring 1.2 cm in diameter and occluding the interventricular foramen. INTERVENTION: The cyst was successfully removed via a transcallosal-transforaminal approach. Postoperatively, the patient developed bifrontal effusions for some days. Hydrocephalus was diminished, but his vision had only slightly improved. CONCLUSION: To our knowledge, this is the first published report of an endodermal cyst occurring in the third ventricle, and represents a further example of the broad spectrum of lesions affecting that location.

Adult↗
PubMed2007

[Wegener's granulomatosis and orbital complications of sino-nasal origin].

Wegener's granulomatosis is an idiopathic, granulomatous disease with the potential for multiple head and neck manifestations (80 % of the patients). Sinonasal symptoms are observed in more than 60 % of the patients. Due to these facts the otorhinolaryngologist plays an essential role in the multidisciplinary team involved in establishing the diagnosis early, initiating immunosuppressive therapy and providing ongoing care. The treatment is based on medical therapy consisting of corticosteroids and immunosuppressive agents, whereas surgery is reserved for selected head and neck manifestations. By means of 3 patients presenting with distinct visual loss in consequence of orbital complications with sinonasal origin the course of disease and theoretical background are reviewed. In our patients Wegener's granulomatosis was diagnosed by histopathological examination and serological detection of ANCA, cANCA. The progression of the granulomatous process and an additional purulent inflammation in 2 cases led to a temporary amaurosis and in another case to a visual loss of 50 %. Immediate orbital decompression in combination with sufficient systemic immunosuppressive treatment relieved the compression of the optical nerve and preserved vision. We conclude that early orbital decompression either by external or endonasal approach and concomitant immunosuppression is necessary to determine or improve rapidly decreasing vision subsequent to high intraorbital pressure produced by a granulomatous process and inflammation.

Anti-Bacterial Agents↗
PubMed1993

Functional topographic mapping of the cortical ribbon in human vision with conventional MRI scanners.

The human brain has anatomically distinct areas in which processing is laid out in space at the millimetre level with substantial variation across individuals. Activity occurs along a cortical ribbon 1.5-3 mm thick in response to specific stimuli. Here we report the first use of cortical ribbon analysis on humans using non-invasive functional magnetic resonance imaging techniques performed with a conventional 1.5 T MRI scanner. Changes in activation were detected using T2*-weighted, gradient echo imaging sequences. Subjects observed partial field, flashing checkerboard patterns (left-right, top-bottom, half rings, and wedges). Stimuli produced magnetic resonance signal changes in the 1-8% range, varying at the millimetre scale, which showed contralateral vertically reflected patterns of activation in the visual cortex. To compare the spatial topographies across subjects, computer algorithms were used to control for the subject-unique folding of cortex, providing a flattened cortical ribbon identifying four topographically distinct areas.

Brain Mapping↗
PubMed1977

Syndrome of agitated delirium and visual impairment: a manifestation of medial temporo-occipital infarction.

Three patients presented with sudden visual impairment followed by agitated delirium one to three days later. Examination revealed marked agitation, dementia, and loss of vision. Computerised axial tomography demonstrated temporo-occipital infarctions. All recovered from the agitated state in four days to two months, but their visual impairment and dementia persisted one to four years later.

Adult↗
PubMed1992

Acute monocular blindness secondary to fibrous dysplasia of the skull: a case report.

An unusual case of acute monocular visual loss secondary to fibrous dysplasia is presented. Orbital and optic canal decompression restored vision completely. A review of the pertinent literature revealed that operative intervention may be curative in patients with acute monocular visual loss. This finding contrasts with the chronic visual decline found secondary to fibrous dysplasia of the skull.

Adult↗
PubMed1982

[Ocular complications in chronic pansinusitis--report of two cases].

Case 1. A 38-year-old male was admitted with an 8-month history of progressive visual disturbance in his right eye. He had a past history of operations for paranasal sinusitis 24 years and 5 years prior to admission. Neurological examination revealed right anosmia, left hyposmia and vision in his right eye reducing to light perception. Case 2. A 61-year-old male was admitted with complaint of headache and a 2-month history of deteriorating vision in his right eye. On admission, vision in his right eye was found to be reduced to hand motions and associated with a concentric contraction of the visual field. Bilateral hyposmia and the right exophthalmos were also noticed. Plain x-ray films, tomography and especially CT scan were useful to demonstrate the definite inflammatory changes of the paranasal sinuses and the extension of the lesion beyond the confines of the sinuses. In both cases, external ethmoidectomy and sphenoidectomy with removal of the infected granulation tissue from the sinuses were performed, but neither mucocele nor pyocele was found. Vision improved postoperatively. Previous reports about ocular complications of infection in the paranasal sinuses without mucocele or pyocele are few. Early diagnosis of ocular complications of sinusitis is important. Once the diagnosis established, a timely surgical approach is essential to prevent visual loss.

Adult↗
PubMedDate not supplied

Development of bilateral, nonarteritic anterior ischemic optic neuropathy in an eye with diabetic papillopathy.

BACKGROUND: Diabetic papillopathy and anterior ischemic optic neuropathy are different clinical entities with different prognoses. We describe a case of diabetic papillopathy that developed into bilateral nonarteritic anterior ischemic optic neuropathy (AION). CASE: A 58-year-old woman with diabetes mellitus had bilateral disc elevation. Goldmann perimetry showed altitudinal hemianopsia in the left eye. The early phase of fluorescein angiography showed hypoperfusion in the superior segment of the left optic disc indicating AION in the left eye. OBSERVATIONS: During the follow-up period, the visual field of the left eye was further constricted and that of the right eye also developed signs of AION, suggesting that bilateral anterior ischemic optic neuropathy had developed. After steroid pulse therapy, her vision recovered slightly, but the visual field remained constricted in both eyes. The optic discs had a low cup/disc ratio. CONCLUSIONS: Our findings demonstrated that diabetic papillopathy can precede the development of nonarteritic anterior ischemic optic neuropathy.

Diabetes Complications↗
PubMed1999

Optic nerve sheath meningiomas. Role of MR imaging.

Optic nerve meningiomas usually are seen in middle-aged and elderly women, and present as a slowly progressing axial proptosis and loss of vision. CT and MR imaging are the most valuable diagnostic tools to evaluate these tumors. This article reviews the MR imaging and CT characteristics of optic nerve sheath meningiomas and discusses features that may distinguish optic nerve sheath meningiomas from simulating lesions.

Aged↗
PubMed2000

The spectrum of presentation of silent sinus syndrome.

The general clinical, ophthalmologic, and radiologic features of three patients with silent sinus syndrome are presented. All three patients were treated surgically. The cases of these patients illustrate the spectrum of presentation of silent sinus syndrome, including enophthalmos, hypophthalmos, transient vertical diplopia, lid retraction, lagophthalmos, and blurred vision. All patients had sinus disease, and all patients improved after surgery using functional endoscopic sinus surgery techniques. The protean manifestations of silent sinus syndrome can be identified, thereby allowing appropriate management.

Adult↗
PubMed1981

Choroid plexus cyst in the lateral ventricle causing obstructive symptoms in an adult.

This case of a rare symptomatic choroid plexus cyst in the lateral ventricle, which presented with papilledema and decreased vision, is the first such lesion found in an adult. Five earlier reported cases, all in children, are discussed, as are the limitations of computerized tomographic (CT) scanning and the need for further radiological studies to establish the diagnosis preoperatively. Metrizamide ventriculography with CT scanning is used to define the lesion and plan an operative approach.

Adult↗