1/11. Isolated bilateral abducens nerve palsy in primary sphenoidal sinus non-Hodgkin lymphoma.Isolated bilateral abducens nerve palsy is a rare complication of intracavernous tumors. A middle-aged man complaining of chronic horizontal diplopia was found to have bilateral abducens palsy as an initial manifestation of a massive non-Hodgkin lymphoma, originating from the sphenoidal sinus. This case is unique in two respects: the initial clinical presentation of isolated bilateral abducens involvement and the nature of the tumor, since only two cases of sphenoidal sinus lymphoma have been reported.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/11. Embolization of arteriovenous malformations with Onyx: clinicopathological experience in 23 patients.OBJECTIVE: To report our experience in treatment of arteriovenous malformations (AVMs) using a new liquid embolic agent, Onyx (Micro therapeutics, Inc., Irvine, CA). methods: Between January 1998 and May 1999, 23 patients (8 men and 15 women) were treated. The patients' average age was 40 years, with seizure being the most common presenting symptom (39%). The average Spetzler-Martin grade on presentation was 3. The average AVM volume before embolization was 14.5 cm3. RESULTS: We observed an average 63% reduction in AVM volume after 129 arterial feeders were embolized. There were four adverse events. Two patients experienced ischemia because of inadvertent occlusion of an arterial feeder. One of these patients made a full recovery, but the other patient had a permanent deficit. Two other patients experienced transient neurological deficits that resolved within 1 week of embolization. Permanent morbidity was thus 4% (1 of 23 patients). There were no deaths. Twelve patients underwent subsequent radiosurgery, and 11 patients had surgery that resulted in complete resection of their AVMs. Histopathological examinations showed mild acute inflammation in specimens resected 1 day after embolization. Chronic inflammatory changes were observed in specimens resected more than 4 days after embolization. In two patients, angionecrosis of the embolized vessels was noted. No evidence of parenchymal hemorrhage was observed in these patients, and vessel wall integrity was maintained as well. CONCLUSION: Onyx is a new nonadhesive liquid embolic agent that has been used to treat 23 patients at our institution with good results. Its nonadhesive nature and ease of use make it a promising agent in the future treatment of AVMs.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/11. presbyopia complicating pre-existing strabismus.BACKGROUND: presbyopia may affect pre-existing sensory adaptations or aggravate previously asymptomatic heterophoria. We describe the presentation, underlying problem and management of 11 patients with pre-existing strabismus or heterophoria who presented with new symptoms of double vision attributable to presbyopic change, an association not previously reported. methods: patients with new strabismic symptoms attributable to presbyopia were recruited prospectively over a 1-year period. RESULTS: The 11 patients had had a recent decrease of accommodative amplitude that resulted in blurred vision at near with a breakdown of pre-existing heterophoria (2 patients), alteration of fixation pattern (6 patients), symptomatic alternating fixation (2 patients) or intolerance to correction owing to restrictive strabismus (1 patient). INTERPRETATION: At the onset of presbyopia, symptoms may be varied and subtle. Ophthalmologists and orthoptists should carefully determine the exact nature of the symptoms. Any pre-existing fixation pattern should then be established from the history, old photographs or suppression characteristics. Refractive or surgical management should be aimed at returning the patient to his or her long-standing sensory adaptation. Other important issues, such as incomplete correction of hypermetropia by refractive surgery and problems using bifocals with vertical restrictive strabismus, should be noted.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/11. Isolated sixth nerve palsy due to intracavernous carotid aneurysm in a young woman.A large intracavernous carotid aneurysm was angiographically demonstrated in a 29 years old woman suffering from a persistent isolated abducens nerve palsy. CT brain scan failed to reveal the lesion. The usefulness of performing angiography in the cases of isolated abducens palsy of undetermined nature, is stressed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/11. Isolated sixth nerve palsy as initial manifestation of systemic lupus erythematosus. A case report.A 35-year-old woman with an isolated, transient sixth cranial nerve palsy was found to have a positive fluorescent antinuclear antibody test with a pattern and titer most consistent with systemic lupus erythematosus. Mild anemia and leukopenia were also present. Over 2 months she improved without treatment. nervous system disease in systemic lupus erythematosus and the unusual nature of presentation in this case are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/11. Metastatic anaerobic orbital subperiosteal abscess: value of CT scanning.A case of subperiosteal abscess associated with acute sinusitis is reported. The case is remarkable in that anaerobic organisms played a major role in the pathologic process. In addition, the unusual superolateral position of the abscess in the absence of any defect in the bony sinus walls suggests the hematogenous spread of the sinus infection. The use of Ct scanning proved to be essential in determining the true nature of the orbital pathology.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/11. Ptosis with contralateral lid retraction due to excessive innervation of the levator palpebrae superiorus.Two patients are presented with unilateral ptosis and contralateral lid retraction. The lid retraction disappears upon manual elevation of the ptotic lid. Each patient with this phenomenon would be expected to have a frank tropia, or monofixation syndrome and prefer to fix with the ptotic eye. Extraordinary innervation is transmitted to the levator of the ptotic eye and, since we believe the levators follow Hering's law, this excessive innervation is also transmitted to the contralateral levator. This results in lid retraction in the second eye. If the ptotic lid is manually elevated, levator innervation decreases and the contralateral lid retraction disappears. This previously unreported maneuver of manually elevating the ptotic lid is superior to patching the ptotic eye for a period of days, the previous method for demonstrating this phenomenon. These considerations are important in the evaluation of lid retraction, and in determining the nature and extent of corrective surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/11. Concurrent trigeminal, abducens, and facial nerve palsies presenting as false localizing signs: case report.Multiple cranial nerve dysfunction presenting as false localizing signs is rare. We report a 20-year-old woman who had concurrent trigeminal sensory disturbance, abducens, and peripheral facial nerve palsies in association with a contralateral acoustic neuroma. After surgery, the trigeminal nerve disturbance and the abducens nerve palsy completely recovered, but the peripheral facial nerve palsy persisted. The nature of tumor, the presence of brain stem distortion, the anatomic variation of posterior fossa, and the relationships of cranial nerves and nearby blood vessels, which are factors influencing the occurrence of false localizing, are briefly discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/11. Skew deviation after vestibular neuritis.We treated five patients with vestibular neuritis who had strabismus. Three of them spontaneously noted vertical diplopia. During the following weeks and months, strabismus progressively resolved, indicating the recently acquired nature of the oculomotor condition. In three of these individuals, a change in visual vertical and cyclo-torsion of the globes suggested that strabismus was a form of skew deviation that occurred as a part of an ocular tilt reaction resulting from the peripheral vestibular lesion. strabismus appears to occur frequently in this common vestibular condition.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/11. Brown's syndrome. An unusual manifestation of rheumatoid arthritis.Two patients presented with an ocular complication of rheumatoid arthritis that was extraocular in location. Clinical manifestations include vertical diplopia, an intermittent nature, a clicking sensation, and apparent inferior oblique palsy. A stenosing tenovaginitis of the superior oblique tendon and its sheath is the probable underlying pathologic mechanism.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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