1/9. Bulbar presentations of myasthenia gravis in the elderly patient.We report on three cases of patients whose primary symptoms of myasthenia gravis were related to the upper aerodigestive tract. Symptoms had been present unrecognized in all patients for up to three years, and one patient subsequently developed a myasthenic crisis. We highlight the clinical features of myasthenia gravis to allow its prompt recognition in patients presenting to the ENT surgeon or physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. Orbital hemorrhage following face-mask barotrauma.A 41-yr-old female recreational diver suffered an orbital hemorrhage following face-mask barotrauma This case illustrates the potential for significant orbital injury to occur as a result of face-mask barotrauma Barotraumatic orbital hemorrhage is an unusual disorder, but recognition of this entity is important for diving physicians. The signs and symptoms should not be mistaken for decompression sickness or arterial gas embolism. patients with barotraumatic orbital hemorrhage require emergency referral to an ophthalmologist so that potentially vision-threatening ocular complications may be identified and treated. barotrauma may result in several different types of cranial neuropathies and should be recognized as another possible cause for neurologic deficits following a dive.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Bilateral sixth nerve palsy after head trauma.Gaze deficits are not uncommon after head trauma and might be caused by injury to the central nervous system, the peripheral nerve, or the motor unit. Traumatic bilateral sixth cranial nerve palsies are a rare condition and are typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of a complete bilateral sixth nerve palsy in a 44-year-old male patient with trauma with no intracranial lesion, no associated skull or cervical spine fracture, and no altered level of consciousness. The emergency physician should be aware of the differential diagnosis, initial workup, and injuries associated with a traumatic gaze deficit.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. diplopia - an unusual primary manifestation of metastatic renal cell carcinoma.It is relatively unusual that initial symptoms of renal cell cancer begin with the metastatic involvement of other sites. Intracranial metastases especially in the paranasal sinuses may be unusual not only to surgeons but also to physicians. In this report, we present a case where a metastasis was first manifest as a sphenoid sinus secondary with ocular and visual disturbances prior to the demonstration of the primary tumor site. It turned out to be a case of diplopia masquerading as a metastatic renal cell cancer.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. multiple sclerosis, euthyroid restrictive Grave's ophthalmopathy, and myasthenia gravis. A case report.A 53-year-old physician with a 13-year history of multiple sclerosis presented with the subacute onset of an atypical, restrictive, euthyroid Grave's ophthalmopathy. The hypotropia and monocular upgaze restriction responded to a course of systemic and local steroids. Three months later, the patient developed ocular and systemic features of myasthenia gravis. This is the second reported case of coincident multiple sclerosis, myasthenia gravis, and thyroid-related disease complex.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. diplopia resolution.After having a radial keratotomy, a physician developed binocular diplopia. The differential diagnosis and management of symptoms by appropriate spectacles is described.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Encephalopathy and cranial nerve palsies caused by intentional trichloroethylene inhalation.This report describes an acute intentional trichloroethylene exposure that developed neurological and cardiovascular toxicity. The patient presented with palsies of the third, fifth, and sixth cranial nerves. Clinical manifestations, laboratory values, and treatment plans are discussed. Emergency physicians should be aware of the complications of trichloroethylene exposure and consider the diagnosis in patients with similar symptoms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Percutaneous treatment of an orbital hydatid cyst: a new therapeutic approach.PURPOSE: To describe the percutaneous treatment of an orbital hydatid cyst as an alternative approach to conventional surgery. methods: In a 21-year-old man with diplopia and right proptosis, radiologic studies disclosed a 25 x 25 x 20-mm purely cystic mass in the right retrobulbar area. Based on the presumptive diagnosis of hydatid cyst, the cyst was treated percutaneously under ultrasonographic guidance with aspiration, 15% hypertonic saline injection, and reaspiration without any complication. RESULTS: A substantial decrease in the size of the cyst was observed in the 3 months after treatment. Nine months after treatment, the shrunken cyst had a volume of only 0.5 ml, and the patient was asymptomatic. Twenty-one months after the procedure, the findings were consistent with those at 9 months of follow-up. CONCLUSION: Percutaneous treatment of orbital hydatid cysts, which is more satisfactory to both the patient and the physician, may be a safe and effective alternative to surgical extirpation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Isolated medial orbital blow-out fracture with medial rectus entrapment.PURPOSE: The authors report on three cases of isolated medial orbital blow-out fracture with medial rectus entrapment which occurred in black males. Only a few similar cases have been reported in the literature. methods: The diagnosis was established with the help of tomography and CT scan of the orbit. RESULTS: The diagnosis could be expected from the clinical signs occurring after blow-out trauma mechanisms: eyelid emphysema, nasal subconjunctival haemorrhage, motility disturbance, enophthalmos. CONCLUSION: An ethnic anatomic hypothesis could explain the predominance of this fracture in blacks. This fracture often remains undiagnosed. The diagnosis was based on axial and especially coronal CT scan of the orbit. The physician should be alerted by some clinical signs that justify these radiographic techniques.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |