Cases reported "Papilledema"

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1/95. papilledema associated with a sacral intraspinal cyst.

    A rare case of papilledema associated with a large sacral intraspinal cyst is described in a 34-year-old male. Symptoms were aggravated by heavy work and consisted of low back pain, headache, dizziness and episodic vomiting. papilledema was observed on ophthalmological examination. A valvular mechanism was found to exist between the normal spinal sac and the huge sacral cyst. Division of the valvular fistula combined with a dural plastic operation brought complete relief of all symptoms.
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2/95. pseudotumor cerebri in children receiving recombinant human growth hormone.

    PURPOSE: This article represents the first report in the ophthalmology literature of an association between pseudotumor cerebri (PTC) and recombinant human growth hormone (rhGH). DESIGN: Noncomparative case series. PARTICIPANTS: Three children receiving rhGH for short stature with turner syndrome, Jeune syndrome, or down syndrome. methods: Children underwent full ocular examination. After papilledema was identified, patients underwent lumbar puncture and imaging with either magnetic resonance imaging or computerized tomography. Treatment was under the guidance of the primary physician or neurosurgeon. The rhGH was discontinued in all children. MAIN OUTCOME MEASURES: visual acuity and evaluation of the optic nerve for resolution of papilledema were followed at each examination. RESULTS: In all three cases, papilledema resolved with the cessation of rhGH, and treatment with acetazolamide or prednisone. visual acuity was unchanged in case 1, decreased by two to three lines in case 2, and was inconsistent in case 3. One child (case 2) required a ventriculoperitoneal shunt for persistent elevation of intracranial pressure. CONCLUSION: There appears to be a causal relationship between the initiation of rhGH with the development of PTC. Children should have a complete ophthalmic evaluation if they report headache or visual disturbances. Baseline examination with routine follow-up should be instituted when children cannot adequately communicate.
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3/95. Divergence paralysis & intracranial hypertension due to neurobrucellosis. A case report.

    CASE REPORT: A 22 year old female presented with sudden onset of uncrossed diplopia at distance, intracranial hypertension, esotropia and was evaluated. Microbiological tests of CSF and sera showed for brucellosis and the patient received therapy for this and her intracranial hypertension. The papilledema, headache, esotropia and diplopia all disappeared after therapy. CONCLUSIONS: Diagnostic tests for brucella must be considered for patients who have divergence palsy and papilledema, especially those living in endemic areas.
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4/95. Visual loss in idiopathic intracranial hypertension after resolution of papilledema.

    PURPOSE: To demonstrate that progressive visual field loss may occur after resolution of papilledema in patients with idiopathic intracranial hypertension and persistently elevated intracranial pressure. methods: A patient with idiopathic intracranial hypertension was evaluated with serial Humphrey automated static perimetry after initial treatment and resolution of papilledema. RESULTS: The patient developed recurrent headache and elevated cerebrospinal fluid pressure. optic nerve head appearance did not change. Automated perimetry demonstrated reproducible, worsening visual field loss; mean deviation decreased 11 dB in each eye. Visual field defects resolved after optic nerve sheath fenestration. CONCLUSIONS: Increased intracranial pressure caused visual field loss after resolution of papilledema. optic nerve sheath fenestration improved visual function in this patient.
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5/95. Neurologic, ophthalmic, and neuropsychiatric manifestations of pediatric systemic lupus erythematosus.

    BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune, multisystem disorder with diverse manifestations. There are limited reports on the neuro-ophthalmic and neuropsychiatric findings in childhood SLE. CASE REPORT: An 8-year-old patient with suspected SLE with a history of skin rash, joint pain, transient hematologic abnormality, headaches, seizures, and psychosis, presented with papilledema secondary to acquired, obstructive hydrocephalus. DISCUSSION: SLE-related ocular and neuropsychiatric findings are reviewed. Proposed mechanisms for ocular and cerebral lupus include immune complex deposition, vascular thrombosis, and postinflammatory lesions. CONCLUSION: The prevalent neurologic and neuropsychiatric complications of pediatric SLE require close follow-up and interdisciplinary management.
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6/95. Pachymeningitis with pseudo-Foster Kennedy syndrome.

    PURPOSE: To report a case of pachymeningitis with pseudo-Foster Kennedy syndrome in a patient who was positive for perinuclear antineutrophil cytoplasmic antibody. methods: Case report. A 44-year-old man was examined for headache and diplopia. RESULTS: Left eye showed limitation of abduction. Ocular fundus, computed tomography (CT), and magnetic resonance imaging (MRI) of the head and orbits were normal. The diplopia subsided spontaneously. Six months later, he noticed sudden visual loss in the left eye. The left eye showed optic disk atrophy and episcleritis, and the right eye showed papilloedema. Computed tomography and MRI exhibited thickened dura mater. serum perinuclear antineutrophil cytoplasmic antibody level was highly increased. CONCLUSION: Pachymeningitis with ocular involvement sometimes requires repeated CT or MRI for diagnosis. This disorder may be caused by microvasculitis.
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7/95. ophthalmic artery microembolism in giant cell arteritis.

    A 70-year-old man presented with a history of headache and sudden loss of vision of the left eye. Funduscopic examination showed sector retinal edema and hemorrhage as well as optic disc swelling consistent with anterior ischemic optic neuropathy. The Westergren sedimentation rate was 66 mm/h. Temporal artery biopsy was consistent with giant cell arteritis. Routine transcranial Doppler testing performed on a Pioneer 2020 instrument (Nicolet Vascular, Inc., Golden, CO) equipped with special software for microembolus detection showed a microembolic signal in the left ophthalmic artery. During a subsequent monitoring study, microembolic signals were detected in the anterior and middle cerebral arteries, bilaterally. Microembolism can occur in giant cell arteritis. ophthalmic artery microembolism can be detected in vivo by transcranial Doppler ultrasonography. This new imaging capability can potentially be useful when evaluating patients with vascular disorders of the eye.
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8/95. Headaches and papilledema secondary to dural arteriovenous malformation.

    A 21-year-old developed progressive headaches and pulsatile tinnitus. He was found to have papilledema and a pulsatile bruit. A dural arteriovenous malformation was not recognized on brain CT or MRI, but was well documented on magnetic resonance angiography and cerebral angiography. Dural malformations draining into the superior sagittal sinus can cause increased intracranial venous pressure and secondarily increase intracranial pressure even without a mass effect.
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9/95. Macular star associated with posterior hyaloid detachment.

    PURPOSE: To report a patient with a Leber's idiopathic stellate neuroretinitis-like lesion that was caused by vitreous traction accompanying a posterior hyaloid detachment. methods: We present a 49-year-old woman who showed segmental optic disc edema, peripapillary retinal detachment, and a macular star. RESULTS: An incomplete posterior hyaloid detachment was present, and the posterior hyaloid membrane was attached to the nasal margin of the optic disc. fluorescein angiography revealed a bent retinal artery on the upper margin of the optic disc, and leakage of fluorescein was observed from this area. CONCLUSION: Vascular damage to the optic disc due to vitreous traction should also be considered as a mechanism for the ophthalmoscopic appearance of the fundus when lesions suggestive of Leber's idiopathic stellate neuroretinitis are present in an adult.
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10/95. When does low mean high? Isolated cerebral ventricular increased intracranial pressure in a patient with a Chiari I malformation.

    OBJECTIVE: To present an unusual case of pseudotumor cerebri with increased intracranial pressure isolated to the cerebral ventricles resulting from a Chiari I malformation. MATERIALS AND methods: The patient received a complete ophthalmologic examination on initial presentation and subsequent visits, including visual acuity, pupillary examination, intraocular pressures, dilated fundus examination with assessment of degree of papilledema, and visual field testing. intracranial pressure was measured by lumbar puncture and subsequently by intracranial pressure bolt monitoring. magnetic resonance imaging (MRI) was used to diagnose the Chiari I malformation. RESULTS: The patient initially presented with bitemporal headaches, elevated opening pressure on lumbar puncture, and mild papilledema with a normal MRI. After lumboperitoneal shunt placement and several revisions, the patient presented with decreased vision OD secondary to Terson syndrome and worsening papilledema. Subsequent evaluation revealed normal lumbar opening pressures and a Chiari I malformation. She underwent ventriculoperitoneal shunt placement with resolution of her symptoms. CONCLUSIONS: Tonsillar herniation is a well-documented complication of lumboperitoneal shunt revision. Obstruction of cerebrospinal flow through the foramina of Magendie and Luschka can result in increased intracranial pressure isolated to the cerebral ventricles. In a patient with signs and symptoms of increased intracranial pressure but normal lumbar opening pressure, a Chiari I malformation should be suspected, particularly with a history of multiple lumboperitoneal shunt revisions.
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