1/4. gadolinium-DTPA enhancement of an optic nerve and chiasmal meningioma.The advent of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), a magnetic resonance imaging (MRI) contrast agent, has significantly improved MRI's diagnostic accuracy by enabling the physician to separate magnetically similar but histologically different tissues. A patient with optic nerve meningioma, whose tumor was clearly demonstrated on Gd-DTPA-enhanced MRI but did not appear on noncontrast MRI, is described. The usefulness of contrast agents in MRI diagnosis of neuro-ophthalmologic disorders and ophthalmic tumors is emphasized through this case report.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Migraine optic neuropathy.Transient visual symptoms associated with migraine are a well-described feature of this disease, but permanent visual loss is seen relatively infrequently. Three patients are discussed who experienced permanent visual defects following migraine attacks. Recognition of this syndrome may allow the physician to defer doing an extensive neurological examination of an otherwise neurologically intact patient.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Toxic optic neuropathy associated with ethambutol: implications for current therapy.BACKGROUND: Aside from the direct ocular manifestations of tuberculosis, significant vision loss can occur during treatment with agents that have potential ocular toxicities. Many thoracic specialists and eye care physicians consider these effects rare and readily reversible. With the alarming increase in incidence of tuberculosis in the united states over the past several years a review of anti-tuberculosis medications and their potential side effects is warranted. methods: A patient who developed dramatic, permanent vision loss after a 9-month course of treatment with ethambutol and isoniazid for pulmonary tuberculosis is presented. The medical and ophthalmic literature was reviewed for current use of these medications as well as for the reported incidence of visual side effects. RESULTS: ethambutol, and to a lesser extent isoniazid, are both implicated in the development of visually related side effects. There is documentation of ocular toxicity with ethambutol when administered at dosages generally pronounced as being safe. Controversy as to what constitutes a safe and effective dose of these medications still exists. CONCLUSIONS: Any patient undergoing medical treatment for tuberculosis requires proper education concerning potential drug side effects. Routine ophthalmic observation for the development of optic neuropathy is strongly recommended for patients with significant risk factors that could increase the chance of side effects and those on longer treatment courses. Baseline and follow-up examinations should include: Snellen acuity, Farnsworth D-15 color testing, automated threshold perimetry and optic nerve head photography.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Idiopathic hypertrophic cranial pachymeningitis.We evaluated 3 patients with biopsy-proven hypertrophic cranial pachymeningitis apparently unrelated to any systemic disease. Each patient had chronic headache, cranial neuropathy, an elevated ESR, and a mild CSF pleocytosis. Neuro-ophthalmic findings included bilateral sixth nerve palsies in two patients and the third had bilateral optic neuropathies. MR imaging revealed thickened dura that enhanced with Gd-DTPA administration. Histologic examination showed thickened, fibrotic dura with a sterile, chronic, nongranulomatous inflammation. The response to treatment was variable with corticosteroids, immunosuppressive drugs, or radiation. The distinctive MR appearance should help physicians recognize this rarely reported disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |