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Macroprolactinomas commonly cause pressure effects on immediate parasellar structures, in particular on the optic chiasm to cause visual field defects. Pressure on more distant brain structures is rarely reported. We describe two massive prolactinomas presenting with neurological signs, including signs of hemiparesis which, to our knowledge, has not been reported previously.
The authors analyze the data of computer-aided tomography, neurosonography, and visual evoked potentials to chess pattern reversal in 14 infants aged 6 to 11 months with partial atrophy of the optic nerve and/or visual cortex involvement before and in various periods after transcutaneous electric stimulation combined with neurotrophic drug therapy. The advantages of comprehensive examinations in neuroophthalmological diagnosis in infants are shown, as is the possibility of using electrophysiological and neuroradiological methods for prediction of functional outcomes in the said patient population.
We report a new case of Marchiafava-Bignami disease with favourable outcome. This case is particular on several scores. The interhemispheric disconnection syndrome was associated with Balint's syndrome, and this had apparently never been reported in this context previously. Despite the intensity and diffusion of white matter lesions in both hemispheres, and in the absence of vitamin treatment, the clinical and neuroradiological (CT, MRI) improvement occurred early and rapidly. This course, similar to that of toxic drug withdrawal, suggested that this was not a process of vitamin deficiency. Data from the literature indicate that a wide extension of corpus callosum lesions to the semi-ovale centre has a poor vital and functional prognosis. Our case shows that this is not always correct and that the appearance of intralesional necrosis and cavitation is not the rule. We consider that the most reliable factor of poor prognosis seems to be an initial coma.
Visual perseveration and palinopsia are defined as the persistence or the reappearance of the visual image. These infrequent symptoms are thought to be linked to the right hemisphere posterior areas. We report a case of this syndrome in which the initial fixation was foveal. The palinoptic image was sometimes moving. This suggests that palinopsia is due to a dysfunction of the visual memory, rather than of the visual system: this dysfunction may be related to hyperactivity of the visual buffer.
During the years 1990-92 three patients with dynamically developing paranasal sinuses infections and orbital complications were treated in ENT Department of Medical Academy in Cracow. In two cases sinuses were early opened and drained, resulting in improvement in local and main status of the patients. Delayed surgical treatment in third patient caused visual loss in ipsilateral side. Indications for sinuses opening were based on the CT examination.
There are several objections to the need for the designation 'Bálint's syndrome'. The full syndrome is generally associated with a wide variety of behavioural disturbances outside Bálint's original triad that may confound the interpretation of their supposed defect. It embeds itself in the hemineglect syndrome, violating the principle of autonomy for a syndrome. Individual components of the triad, particularly simultanagnosia, may represent relatively broad categories that subsume other combinations of defects of widely different degrees of severity. The diagnosis fails to predict a consistent site of anatomical impairment, and the main proposed mechanism is not sound. Our experience with a registry of patients with focal brain lesions and well-documented behavioural impairments (Palca, 1990), now numbering over 1500 individuals, tends to support these generalizations.
STUDY OBJECTIVES: The mechanism by which the fluorinated quinolones produce central nervous system effects is unknown. Using positron emission tomography (PET), we evaluated the effects of two quinolones on brain blood flow as well as on oxygen and glucose metabolism. These determinations were done in conjunction with ophthalmologic and neuro-ophthalmologic testing. DESIGN: Randomized, double-blind, placebo-controlled, 7-day course of ciprofloxacin 750 mg (C750) or 500 mg (C500) every 12 hours, or nalidixic acid (NA) 1 g every 6 hours. POPULATION: Twenty-four healthy male volunteers, six in each treatment arm. RESULTS: [table: see text] CONCLUSIONS: Compared with baseline values, NA significantly reduced brain glucose uptake, whereas C500, C750, and placebo produced no detectable effect. No compound significantly altered brain blood flow or oxygen metabolism compared with baseline or other treatments. No significant effect on electroretinographic, electro-oculographic, or other neuro-ophthalmologic tests was observed.
A case of complete operative removal of a neurinoma of the oculomotor nerve with long-time preservation of oculomotor function despite minor signs of aberrant reinnervation is presented. A review of the literature referring to the clinical appearance, radiological features, treatment, and outcome of 22 cases is given, 18 of which involved operations. To our knowledge, this is the first case to prove that complete operative removal of an oculomotor neurinoma without relevant persisting neurological sequelae is possible.
24 cases of orbital tumors misdiagnosed as optic neuritis or optic atrophy were located at the orbital apex or on the optic nerve, comprising meningioma 9 cases, cavernous hemangioma 5 cases, neurilemmoma 5 cases, neogrowths form the nasal cavity or paranasal sinuses 3 cases, leiomyoma 1 case and hemangiopericytoma 1 case. The authors analyzed the causes of CT examination in early differential diagnosis.
Colloid cysts of the third ventricle are rare intracranial lesions which comprise 0.5 to 1% of all intracranial tumors. We describe a patient with a third ventricle colloid cyst who presented with non specific visual deterioration.
Recent developments of medical imaging such as CT scanning with three dimensional reconstruction (3D-CT) and magnetic resonance imaging (MRI), have had a profound impact on the diagnosis of maxillo-facial trauma, including orbital blow-out fractures. The authors discuss the pathology of orbital blow-out fractures, the current views concerning the etiopathogenesis and nowadays clinical and technical investigations. Some important aspects of the assessment of the physical damages according to the Belgian law are discussed.
Radiation-induced cerebral necrosis has been well documented in the literature. Because radiation induced cerebral necrosis can occur to any part of the central nervous system that falls within the irradiated area, the visual pathway is highly susceptible to damage as it passes from the eye to the visual cortex. With proper visual field testing and interpretation, optometrists may serve as primary diagnosticians in radiation-induced cerebral necrosis and actively participate in the long-term management of these patients. This case presents a patient with visual field loss secondary to a temporal lobe lesion whose etiology was thought to be radiation-induced. The incidence, pathophysiology, and clinical features of radiation-induced cerebral necrosis as well as other differential diagnoses are discussed.
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Many diagnostic procedures are available. The main methods are briefly reviewed. Standard X-rays of the skull are always needed. In doubtful cases polytomography is essential. Bone scintigraphy reveals early signs of changes in the bony macrostructures. Brain scintigraphy is still very useful in observing 1. the blood-flow in both intracranial and intraorbital regions, and 2. the cranio-orbital distribution of the radiotracer. Brain scintigraphy is particularly important in detecting meningiomas and vascular lesions. The dynamic study and the comprehensive survey it gives are still not replaced by computer tomography (CT) scanning, which however represents the most powerful advance in this field. The most suitable methods for exploring precise details of vascularisation and structural delineation remain the classical carotid and vertebral angiographies, the orbital and cavernous sinus phlebographies and also the cerebral pneumography. During the last years the accuracy of these methods has greatly increased through technological advance. In many cases they have become indispensable.
True arachnoid cysts of the suprasellar region are uncommon and have rarely been diagnosed pre-operatively. An histologically verified suprasellar arachnoid cyst producing hydrocephalus and visual loss in a 19-year-old man was diagnosed by a combination of pneumoencephalography and computerized tomographic (CT) scanning prior to surgery. The incidence, pathogenesis, signs, and treatment of suprasellar arachnoid cysts are discussed.
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Two cases of radiologically proven primary empty sella syndrome with binasal field defects are described. The association of these two entities is discussed.
We report the case of a 61-year-old man with an unusual intrasellar vascular malformation, who presented with symptoms of hypopituitarism and whose neuroradiologic evaluation mimicked a pituitary macroadenoma. The histopathologic and radiologic findings are discussed. This rare lesion should be considered in the diagnosis of a sellar mass lesion.