1/29. pituitary apoplexy after cardiac surgery presenting as deep coma with dilated pupils.Acute clinical deterioration due to infarction or haemorrhage of an existing, often previously unrecognized, pituitary tumour is a rare but well-described complication. It can occur spontaneously or may be caused e.g. by mechanical ventilation, infection or surgical procedures. We report on a case of pituitary apoplexy occurring in a 64-year-old patient 3 weeks after cardiac surgery. The patient presented with deep coma and dilated pupils. magnetic resonance imaging revealed a haemorrhagic pituitary tumour. After prompt endocrinologic replacement therapy with levothyroxine and hydrocortisone the patient regained consciousness. Neurological examination revealed right oculomotor nerve palsy and bilateral cranial nerve VI palsy. Subsequent trans-sphenoidal removal of a nonfunctional macroadenoma with large necrotic areas was performed. The patient recovered completely. To our knowledge, pituitary tumours presenting with a combination of deep coma and dilated pupils must be considered exceedingly rare. Possible pathophysiologic mechanisms are discussed. As our case illustrates, even in severe cases complete recovery is possible if the diagnosis is suspected, and diagnostic and therapeutic measures are initiated in time.- - - - - - - - - - ranking = 1keywords = oculomotor nerve, nerve, cranial nerve, palsy (Clic here for more details about this article) |
2/29. association of high-dose intravenous methylprednisolone with reversal of blindness from lightning in two patients.OBJECTIVE: To report possibly beneficial effects of treatment with high-dose corticosteroids given intravenously to two patients with loss of vision after lightning strikes. DESIGN: case reports. PARTICIPANTS: Two patients who suffered the effects of a lightning strike. INTERVENTION: High-dose intravenous methylprednisolone (NASCIS-2 Protocol). MAIN OUTCOME MEASURES: Vision recovery, pupil responses, and optic nerve appearance. RESULTS: One patient had unilateral ophthalmoscopically visible abnormality with light perception vision and a relative afferent defect in that eye; vision recovered to 20/25. The other patient had no light perception, nonreactive pupils, and normal fundus examinations in both eyes; vision recovered bilaterally to normal (20/20). CONCLUSIONS: High-dose intravenous corticosteroid treatment in these patients may have had a role in their visual recovery.- - - - - - - - - - ranking = 0.022392734825651keywords = nerve (Clic here for more details about this article) |
3/29. Afferent pupillary defect associated with optic nerve head drusen.BACKGROUND: optic nerve head drusen (ONHD) are a relatively uncommon finding with an estimated prevalence of anywhere from 0.3% to 2%. Reports of relative afferent pupillary defects (RAPDs) associated with ONHD are scarce. CASE REPORT: A patient with an RAPD was found to have ONHD as the only apparent etiology of the RAPD. The various diagnostic tests relevant to the case, the differential diagnosis, and the pathological features of ONHD are discussed. CONCLUSIONS: It is important for the clinician to consider an RAPD as a possible pathological feature of ONHD--especially with an asymmetric presentation.- - - - - - - - - - ranking = 0.11196367412826keywords = nerve (Clic here for more details about this article) |
4/29. Superior oblique paresis with contralateral relative afferent pupillary defect.BACKGROUND: The purpose of this study is to report a case of superior oblique paresis and contralateral relative afferent pupillary defect (RAPD) with normal vision in a patient with brainstem astrocytoma. methods: We correlated the patient's clinical findings with anatomical substrates on magnetic resonance imaging (MRI) findings. RESULTS: The patient had right-sided superior oblique paresis. There was a left-sided RAPD, although visual acuities and visual fields were normal in both eyes. T1-weighted, gadolinium-enhanced MRI demonstrated a hyperintense area in the right dorsal midbrain. CONCLUSION: It is suggested that the lesion damaged both the pretectal afferent pupillary pathway and fascicles of the trochlear nerve, causing a unique combination of neuro-ophthalmologic findings.- - - - - - - - - - ranking = 0.022392734825651keywords = nerve (Clic here for more details about this article) |
5/29. Laser in situ keratomileusis-induced optic neuropathy.OBJECTIVE: To report a case of bilateral optic neuropathy after bilateral laser-assisted in situ keratomileusis (LASIK) surgery. DESIGN: Observational case report. methods: Complete eye examination with detailed evaluation of the optic nerve, detailed medical history, stereo disc photographs, GDx Nerve Fiber Analyzer testing, Humphrey 24-2 SITA visual field testing, diurnal intraocular pressure measurement, serologic evaluation, and magnetic resonance imaging of the brain and orbits. MAIN OUTCOME MEASURES: optic nerve status, visual field status, and visual acuity. RESULTS: A subject with previously healthy optic nerves had bilateral optic neuropathy develop after LASIK surgery. This neuropathy manifested with a subjective decrease in visual field, normal visual acuity, normal color vision, relative afferent pupillary defect, increased cupping of the optic nerve with focal neuroretinal rim defects, decreased nerve fiber layer thickness, and nerve fiber bundle-type visual field defects. The subject had no other risk factors for optic neuropathy. No other cause of neuropathy was identified. CONCLUSIONS: Optic neuropathy is a potential vision-threatening complication of LASIK surgery. This complication may be due to barotrauma or ischemia related to extreme elevation of intraocular pressure by the suction ring. Careful examination of the optic nerve before and after LASIK surgery is warranted.- - - - - - - - - - ranking = 0.15674914377956keywords = nerve (Clic here for more details about this article) |
6/29. Absent relative afferent pupillary defect in an asymptomatic case of lateral chiasmal syndrome from cerebral aneurysm.INTRODUCTION: This report documents a case of an asymptomatic 34-year-old female who had right eye subtle temporal optic nerve pallor with absent clinically detectable relative afferent pupillary defect. CASE REPORT: This presentation was secondary to a fusiform paraclinoid aneurysm resulting in lateral chiasmal syndrome. visual fields demonstrated a nasal depression OD. neuroimaging studies revealed the presence of a fusiform paraclinoid aneurysm compressing the right optic nerve and optic chiasm. The lesion was treated surgically without additional visual loss nor systemic and neurological complications. CONCLUSIONS: A clinically detectable relative afferent pupillary defect may be absent in unilateral optic nerve pallor and/or visual field loss and does not preclude the need to attempt to identify an underlying etiology. Neuroradiological examination of orbital and cranial structures is an imperative protocol in the appropriate management of this potential life- and vision-threatening condition.- - - - - - - - - - ranking = 0.067178204476954keywords = nerve (Clic here for more details about this article) |
7/29. Sneeze-induced visual and ocular motor dysfunction.PURPOSE: The purpose of this report is to describe two neuroophthalmic complications that are related by their temporal association with a sneeze. DESIGN: We describe observational case reports of two patients. methods: Both patients were examined, and their conditions were diagnosed and treated according to standard indications for each neuroophthalmic condition. RESULTS: The first case describes a patient who had previously undergone intracranial surgery, including removal of the clivus and later developed a trochlear nerve paresis after a sneeze. The second case describes a patient who repeatedly demonstrates transient decreased perfusion to his right central retinal artery and an associated afferent papillary defect after sneezing. CONCLUSION: The mechanical and hemodynamic forces involved in sneezing are formidable and may cause permanent cranial neuropathy or temporarily alter ocular blood flow in certain patients.- - - - - - - - - - ranking = 0.022392734825651keywords = nerve (Clic here for more details about this article) |
8/29. Unilateral leukocoria in off axis flash photographs of normal eyes.PURPOSE: To describe an optical phenomenon producing leukocoria in off axis flash photographs of children who have a normal ophthalmic examination. DESIGN: Observational case series. methods: Description of three otherwise well children who presented to a pediatric ophthalmologist with unilateral leukocoria seen in flash photographs. The children underwent a full ophthalmic examination, including dilated fundus examination. RESULTS: All ophthalmic examinations were normal. The photographs were all found to be approximately 15 degrees off axis with the leukocoria seen in the eyes where the flash illuminated the nasal retina. CONCLUSIONS: Leukocoria can be seen in normal eyes when the child is not fixing directly on the camera. That is due to reflection off the optic nerve head.- - - - - - - - - - ranking = 0.022392734825651keywords = nerve (Clic here for more details about this article) |
9/29. A rare presentation of posterior communicating artery aneurysm.This is a report of a successfully treated case of a 55-year-old woman with posterior communicating artery aneurysm who had a partial 3rd nerve palsy with pupillary sparing, temporal lobe intracerebral hematoma and a subdural hematoma. Such an association has not been reported earlier.- - - - - - - - - - ranking = 0.024002081436479keywords = nerve, palsy (Clic here for more details about this article) |
10/29. Hypovolemic ischemic optic neuropathy.BACKGROUND: Ischemic optic neuropathy refers to an acute event of ischemia, or decreased blood flow, to the optic nerve resulting in varying degrees of vision loss and visual field defects. Typically this disease affects the elderly population who experience systemic diseases that compromise the blood flow efficiency of the optic nerve head (e.g., giant-cell arteritis, hypertension, diabetes, etc.). However, cases of blood loss to the optic nerve, secondary to traumatic injuries or surgeries, have also been shown to result in ischemic optic neuropathy, regardless of age. It seems that in these cases, the resulting anemia and hypotension play contributing roles in the development of ischemic optic neuropathy. methods: A 41-year-old black man came to us with optic nerve head pallor O.S., count-fingers vision O.S., positive afferent pupillary defect O.S., and a central scotoma O.S. after being hospitalized and treated for a stab wound to his left neck that severed his left carotid artery at the bifurcation. RESULTS: This patient had been seen in the optometry Clinic two years before the stab-wound incident. At that time, he had 20/20 vision in his left eye and no remarkable neurological deficits. His ocular presentation after the traumatic hypovolemic event was probably a direct result of the hypoperfusion to the left optic nerve head. This patient was diagnosed with a hypovolemic, or blood loss-related, ischemic optic neuropathy (O.S.). CONCLUSIONS: patients who experience large amounts of blood loss due to trauma, surgery, internal bleeding, etc. and report vision loss should be screened for possible optic nerve ischemia. As eye care providers, when we are presented with patients who have optic nerve head atrophy, we should inquire about events that may have precipitated blood loss, potentially triggering ischemic optic neuropathy.- - - - - - - - - - ranking = 0.15674914377956keywords = nerve (Clic here for more details about this article) |
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