191 research outputs found
A Losing Battle
No full textProgressive loss of vision OSAn 81-year old male with progressive, painless loss of vision OS. Previous history significant for diabetes, hypertension, arthritis, dyschromatopsia and carcinoma of the bladder.VA: 20/25 OD, HM OSMRIGlial neoplasm1. Dutton JJ. Gliomas of the anterior visual pathway. Surg Ophthalmol 1994;38:427-52. 2. Barbaro NM, Rosenblum ML, Maitland CG et al. Malignant optic glioma presenting radiologically as a \u27cystic\u27 suprasellar mass: case report and review of the literature. Neurosurgery 1982;11:787-89. 3. Bradovsky S, ten Hove MW, Pinkerton RM et al. An enhancing optic nerve lesion: malignant glioma of adulthood. Can J Ophthalmol 1997;32:409-13. 4. Friedman DP, Hollander MD. Neuroradiology case of the day. Malignant optic glioma of adul-hood. Radiographics 1998;18:1046-8. 5. Joran DR. An enhancing optic nerve lesion: malignant glioma of adulthood (letter). Can J Ophthalmol 1998;33:306-7. 6. Millar WS, Tartaglino LM, Sergott RC et al. MR of malignant optic glioma of adulthood. AJNR Am J Neuradiol 1995;16:1673-6. 7. Shapiro SK, Shapiry I, Wirtschafter JD et al. Malignant optic glioma in an adult: initial CT abnor-mality limited to the posterior orbit, leptomeningeal seeding of the tumor. Minn Med 1982;65:155-9. 8. Woiciechowsky C, Vogel S, Meyer et al. Magnetic resonance imaging of a glioblastoma of the optic chiasm. Case report (see comments) J. Neurosurg 1995;83:923-5. 9. Hoyt WF, Meshel LG, Lessell S et al. Malignant optic glioma of adulthood. Brain 1973;96:121-32. 10. Spoor TC, Kennerdell JS, Martinez AJ et al. Malignant gliomas of the optic nerve pathways. Am J Ophthalmol 1980;89:284-92. 11. Djalilian HR, Shah MV, Hall WA. Radiographic incidence of multicentric malignant glioma. Surg Neurol 1999;51:554-7. 12. Van Tassel P, Lee YY, Bruner JM. Synchronous and metachronous malignant gliomas: CT find-ings. AJNR: AM J Neurorad 1988;9(4):725-32. 13. Sneed PK, Gutin PH, Larson DA et al. Patterns of recurrence of glioblastoma multiform after exter-nal irradiation followed by implant boost. Int J Rad Oncol Biol Phys 1994;29:719-27.IC-D1ci1-optic-nerve-tumors-diagnosis-and-therap
When Small Is Big
No full textLoss of depth perception with loss of vision ODA 44-year-old male with a 1-day history of loss of depth perception and visual loss OD. Previous history significant for Lyme disease and Bell palsy.VA: NLP OD, 20/50 OS; RAPD ODCT; MRISmall cell carcinomaIV steroids; Surgery; XRT; Antineoplastic agents1. Koss LG, Spiro RH, Hajdu S. Small cell (oat cell) carcinoma of minor salivary gland origin. Cancer 1972; 30: 737-741. 2. Weiss MD, Defries HO, Taxy JB et al. Primary small cell carcinoma of the paranasal sinuses. Arch Otolaryngol 1983; 109:341-343. 3. Rejowski JE, Campanella RS, Block LJ. Small cell carcinoma of the nose and paranasal sinuses. Otolaryngol Head Neck Surg 1982; 90:516-517. 4. Galanis E, Frytak S, Lloyd RV. Extrapulmonary small cell carcinoma. Cancer 1997; 79:1729-1736. 5. Raychowdhuri RN. Oat cell carcinoma of the paranasal sinuses. J Laryngol Otol 1965; 79:253-255. 6. Perez-Ordonez B, Caruana SM, Huvos AG, Shah JP. Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses. Human Pathology 1998; 29(8): 826-32
Walsh & Hoyt: Thyroid Eye Disease
No full textApproximately 6% of patients with thyroid eye disease develop evidence of a compressive optic neuropathy, some associated with optic disc swelling. Dysthyroid optic neuropathy is a compressive optic neuropathy caused by pressure on the optic nerve by enlarged extraocular muscles. In such patients, congestive symptoms almost always precede visual loss, which is usually bilateral, symmetric, and gradual in onset. Of the 36 eyes of 21 patients with dysthyroid optic neuropathy examined by Trobe et al., 12 (33%) had mild to marked disc swelling. Presenting visual acuities were 20/60 or worse in these patients, who usually had central scotomas, often combined with arcuate defects. Kennerdell et al.emphasized the compressive etiology of the optic neuropathy in their report of the CT findings in seven patients with dysthyroid optic neuropathy, four of whom had evidence of optic disc swelling. In all cases, there was moderate to severe enlargement of the extraocular muscles at the orbital apex. Direct measurement of orbital pressure and tissue compliance through manometry demonstrates higher orbital tissue tension and lower orbital compliance in patients with thyroid eye disease. Optic neuropathy can even occur as a late complication several years after initial presentation without evidence of progressive orbitopathy or recurrent inflammation
Walsh & Hoyt: Compressive Optic Neuropathies with Optic Disc Swelling (Anterior Compressive Optic Neuropathies)
No full textCompressive lesions within the orbit, the optic canal and, rarely, intracranially, may result in disc swelling. Most compressive optic neuropathies, whether they result from orbital or intracranial lesions, are not associated with optic disc swelling. However tumors, infections, and inflammations, and even adnexal structures that have become swollen or enlarged by disease, can all cause an optic neuropathy associated with optic disc swelling
Walsh & Hoyt: Visual Recovery Following Decompression
No full textIn 1915, Cushing and Walker analyzed 81 cases of chiasmal compression and showed that restoration of visual function was not only possible following surgical decompression but it began within days after surgery. Pennybacker also described a dramatic response to surgical treatment in patients with loss of vision from pituitary adenoma and commented on the possibility of full recovery within a few days postoperatively. In a recent series of 27 patients undergoing decompression of the optic nerve, 47% showed improvement which, in two-thirds of the patients happened almost immediately. Zevgaridis and associates reported on 65 patients with meningiomas in the sellar region, and found that 39 (65%) of patients had improved vision after surgery on long-term follow-up (average 5 years). Favorable prognostic indicators included younger age, shorter duration of symptoms and an intact arachnoid membrane around the lesion. Li et al. reported on 30 patients with biopsy proven tumors and optic nerve compression that underwent optic canal decompression via an external ethmoidectomy approach, with 20 (67%) demonstrating improved visual function. Medical decompression of the optic nerve with bromocriptine in patients with prolactinsecreting pituitary tumors has yielded similar improvements in visual function. On the other hand, patients undergoing surgery for aneurysms involving the anterior visual pathways may experience sudden and severe vision loss presumed secondary to either optic nerve manipulation or ischemia
Walsh & Hoyt: Sarcoidosis
No full textOptic nerve dysfunction probably is the most common neuro-ophthalmologic manifestation of sarcoidosis
Walsh & Hoyt: Orbital Inflammatory Syndrome
No full textInflammatory conditions involving the orbit, including abscesses and the nonspecific condition called idiopathic inflammatory pseudotumor or idiopathic orbital inflammatory syndrome, may also cause anterior compression of the proximal optic nerve and secondary disc swelling that can be confused with primary optic nerve tumors. Associated posterior scleritis may also cause disc swelling. Affected patients usually experience acute or subacute visual loss, pain, proptosis, and congestion associated with the optic disc swelling, possibly with retinal vein occlusion. The presence of an orbital process is rarely in question. Infrequently, meningiomas of the orbital apex produce a similar clinical picture. CT scanning and MR scanning usually show thickening and enhancement of normal tissues or a mass lesion. Ultrasound can be very helpful in the identification of posterior scleritis and thickening of Tenons capsule and the sclera. The pain and rapid evolution of symptoms generally distinguish orbital inflammatory disease from the more indolent course characteristic of most orbital tumors. Most of these patients respond rapidly to systemic steroid treatment
Walsh & Hoyt: Infiltrative Optic Neuropathies
No full textThe optic nerve can become infiltrated by tumors and by various inflammatory processes. Such processes typically produce one of three clinical pictures: (a) optic disc elevation or swelling with evidence of an optic neuropathy; (b) optic disc elevation or swelling with no evidence of optic nerve dysfunction; and (c) a normal-appearing optic disc associated with evidence of an optic neuropathy
Walsh & Hoyt: Inflammatory and Infectious Infiltrative Optic Neuropathies
No full textThe intraocular, intraorbital, intracanalicular, and intracranial segments of the optic nerve can all be infiltrated by inflammatory and infectious processes. The most common inflammatory process that produces an infiltrative optic neuropathy is sarcoidosis. The most common infectious processes that produce an infiltrative optic neuropathy are syphilis, tuberculosis, and opportunistic fungal infections, such as cryptococcosis. These conditions are all discussed in greater detail in other chapters in this text. Perioptic neuritis
Walsh & Hoyt: Compressive Optic Neuropathies without Optic Disc Swelling (Retrobulbar Compressive Optic Neuropathies)
No full textThe importance of early diagnosis of compressive lesions that affect the retrobulbar portions of the optic nerve and do not cause optic disc swelling cannot be overemphasized. Early decompression of the optic nerves or chiasm may result in significant return of visual function, whereas misdiagnosis may result in progressive visual failure and irreversible visual loss, neurologic dysfunction, or death. Unfortunately, intracranial, intracanalicular, and occasionally, posterior orbital compressive lesions, usually do not produce disc swelling or significant neurologic or systemic manifestations. Thus, by the time such lesions cause visible optic pallor, significant damage to the optic nerve has often already occurred, preventing return of visual function even with otherwise successful decompression. The physician managing a patient with unexplained unilateral visual loss therefore must be aware of the characteristic history and early findings in patients with a retrobulbar compressive optic neuropathy
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