1/30. Fourth cranial nerve palsy in pediatric patients with pseudotumor cerebri.PURPOSE: To describe three children with acute fourth cranial nerve palsy secondary to pseudotumor cerebri. methods: We reviewed the medical records of children younger than 18 years who were diagnosed with pseudotumor cerebri between 1977 and 1997. pseudotumor cerebri was defined by normal neuro-imaging, elevated intracranial pressure measured by lumbar puncture, and normal cerebrospinal fluid composition. RESULTS: Three children with pseudotumor cerebri presented with vertical diplopia and clinical signs of fourth cranial nerve palsy including a hypertropia of the affected eye, which increased with adduction and ipsilateral head tilt. The fourth cranial nerve palsy resolved after reduction of the intracranial pressure in all three children. CONCLUSIONS: Fourth cranial nerve palsy may occur in children with pseudotumor cerebri and may be a nonspecific sign of elevated intracranial pressure.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/30. Spontaneous intracranial hypotension.PURPOSE: To describe a patient with classic presentation of spontaneous intracranial hypotension and subsequent improvement with targeted epidural blood patch. methods: Report of one case and review of the literature. RESULTS: Examination of cerebrospinal fluid after lumbar puncture disclosed a reduced opening pressure, an increased level of protein, and lymphocytic pleocytosis. magnetic resonance imaging of the brain with gadolinium showed diffuse enhancement of the pachymeninges, no evidence of leptomeningeal enhancement, and chronic subdural fluid collection. Radionuclide cisternography demonstrated reduced activity over the cerebral convexities, early accumulation of radiotracer in the urinary bladder, and direct evidence of leakage at the cervicothoracic junction (C7-T1). Clinical, laboratory, and radiologic features were consistent with the diagnosis of spontaneous intracranial hypotension. Therapy with a targeted epidural blood patch resulted in the rapid resolution of symptoms. CONCLUSIONS: In this report, we describe a classic case of spontaneous intracranial hypotension in a 63-year-old man with an initial presentation of postural headaches, blurred vision, pain in the left eye, diplopia on left gaze, and neck soreness.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
3/30. Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device.BACKGROUND AND OBJECTIVES: Complications related to cerebrospinal fluid (CSF) leak and low CSF pressure can occur following placement of an intrathecal drug delivery device. methods: A 58-year-old man with chronic, intractable lower back pain underwent implantation of an intrathecal drug delivery device. On the fourth postoperative day, he developed a postural headache and diplopia with findings compatible with left sixth cranial nerve palsy. The headache subsequently became constant and nonpostural. Cranial magnetic resonance imaging was obtained that showed the presence of a posterior subdural intracranial hematoma. Conservative treatment for postdural puncture headache did not improve the symptomatology. Therefore, an epidural blood patch was performed that produced rapid improvement and eventual resolution of symptoms. CONCLUSIONS: Intrathecal catheter implantation can result in CSF loss that might not resolve promptly with conservative therapy. In this case, epidural blood patch proved to be a safe and effective form of treatment.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
4/30. Extramedullary plasmacytoma of the orbit.PURPOSE: To report a case of extramedullary plasmacytoma of the orbit. methods: A 71-year-old patient presented with diplopia eyelid fullness and limitation of ocular motility in the left eye. visual acuity was counting fingers, intraocular pressure 34 mmHg and fundus eye examination showed choroidal folds in the involved eye. RESULTS: CT scan showed a mass filling the superior and external left orbit without bone destruction. A biopsy was performed revealing that the tumour was composed of plasmacytoid cells positive with immunohistochemical stains for Kappa light chains and epithelial membrane antigen. Systemic work up was negative. The diagnosis of extramedullary orbital plasmacytoma was made. The patient was treated with external beam radiotherapy (40 Gy) and has remained disease free for four years (49 months). CONCLUSION: Extramedullary plasmacytomas of the orbit are extremely rare tumours. Accurate and early diagnosis is essential for the therapeutic approach. Extensive medical work up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving the orbit is needed when the diagnosis of orbital extramedullary plasmacytoma is suspected because treatment and prognosis are very different.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
5/30. Subarachnoid cyst and ascent to high altitude--a problem?A 31-year-old man suffered diplopia and ataxia on two occasions when he ascended from sea level to 4,000 m. Evaluation revealed a moderate-sized subarachnoid cyst in the left frontal region, which did not communicate with the cerebral ventricles. The cyst might have acted as a space-occupying lesion, and caused symptoms on ascent due to hypoxic brain swelling, brain compression against the cyst, and elevated intracranial pressure. Subarachnoid cysts are common, and they should be considered in the differential diagnosis of neurological problems at high altitude.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
6/30. diplopia and ptosis following injection of local anesthesia without hyaluronidase.In a university ophthalmology department, a cluster of postoperative diplopia and ptosis cases occurred in the initial 3 months after hyaluronidase (Wydase) became unavailable for use with injection anesthesia. These cases suggest that hyaluronidase, when used with injection anesthesia, may protect extraocular muscles and nerves from the toxic effects of local anesthetic agents. The spreading action of hyaluronidase facilitates uniform diffusion of anesthetic agents. This prevents elevated extracellular tissue pressure, a cause of ischemic damage to extraocular muscles or nerves. Hyaluronidase may also prevent focal accumulations and concentrations of local anesthetic agents, which at high enough levels may cause myotoxic or neurotoxic damage, fibrosis, and contracture of extraocular muscles or nerves.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
7/30. Posttraumatic carotid-cavernous sinus fistula.BACKGROUND AND OBJECTIVES: Posttraumatic carotid-cavernous sinus fistula is a rare complication of maxillofacial trauma and is seldom discussed in the literature. Motor vehicle accidents, falls, and other crush injuries contribute to the incidence of basilar skull fractures and the formation of fistulae. When injuries occur in the vessel wall, the carotid artery has the potential to fill the low-pressure cavernous sinus. The symptoms include chemosis, proptosis, pulsating exophthalmos, diplopia, ophthalmoplegia, orbital pain, audible bruits, and blindness. methods AND MATERIALS: The conventional treatments include carotid ligation and embolization. These techniques have often proved to be ineffective. A new method--the occlusive balloon technique--has been developed and is described in this article. A clinical case is used to illustrate the procedure. RESULTS AND/OR CONCLUSIONS: Utilization of balloon catheters provides a minimally invasive technique to treat patients, without significant morbidity or mortality. The procedure is found to be successful and predictable.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
8/30. Hemorrhagic cyst following remote alloplastic implantation for orbital floor fracture repair.Hemorrhagic cyst formation may occur within months or years following repair of orbital fractures with alloplastic materials. patients present with a sensation of pressure in the involved orbit, double vision, and globe displacement. Evaluation must rule out infectious, inflammatory, and vascular etiologies. Computerized tomography scans reveal a soft tissue density surrounding the alloplastic implant. drainage of the cyst and fibrous capsule, with excision of the capsule and removal of the alloplastic implant, is curative. This article presents three clinical cases, highlighting the evaluation and management of this postsurgical development. Use of the protocol described resulted in complete resolution of all clinical symptoms, and the CT scans were normal. As these materials will continue to be utilized, surgeons should be aware of this potential delayed complication and its management.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
9/30. Orbital emphysema during air travel: a case report.Orbital emphysema is a well-recognized complication of fractures involving the orbit. Commonly, this follows nose blowing and occurs in the subcutaneous tissues. A case of emphysema within the orbital cavity caused by the pressure changes during air travel is presented. The clinical picture was similar to that seen in retrobulbar haemorrhage and required early surgical intervention. Circumstances where patients at risk may be exposed to abnormal atmospheric pressures are highlighted and the management of the condition is discussed.- - - - - - - - - - ranking = 0.66666666666667keywords = pressure (Clic here for more details about this article) |
10/30. pseudotumor cerebri in a pre-pubescent child--case report.BACKGROUND: pseudotumor cerebri (PT) is a disease characterized by elevated intracranial pressure with no apparent etiology. A majority of cases of PTC occur in adults, with a distinct predilection for obese women of childbearing age. On rare occasions, PTC will affect children and is associated with different patient characteristics. CASE REPORT: A slender 10-year-old boy was brought to clinic with a one-day history of intermittent horizontal diplopia and a two-week history of severe headaches on awakening. visual acuity, pupil function, and color vision were all normal. Cover test revealed an intermittent esotropia at distance, with full ocular motilities. Fundus examination revealed swelling of the optic disks OU. Further diagnostic testing, treatment, and followup are discussed. CONCLUSIONS: pseudotumor cerebri in children is rare. When present, PTC in children often manifests different characteristics than adults. First, no clear sexual predilection exists for PTC in children. Second, the role of associated illnesses and medications is stronger in children than in adults. Third, the extent of neurologic deficit present in children with PTC is broader than in adults. All children with swollen optic disks warrant a thorough diagnostic evaluation. In the absence of obvious neuropathology, knowledge of the differences between adult and pediatric PTC can help avoid a diagnostic dilemma.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
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