1/4. Cortical blindness: an unusual complication after removal of a ganglioneuroma of the neck.A 5-year-old girl was operated upon after a huge mass had been found on the left side of her neck. Preoperatively the anatomy was studied using MRI, including 3D-reconstruction of the tumor. The left vertebral artery was seen to cross the tumor, and during the operation the vessel was preserved. Postoperatively it thrombosed and a permanent cortical blindness developed. One year later MRI angiography of the intracerebral vessels was performed and a pre-existing anomaly of the circle of willis was demonstrated, which had contributed to the development of the cortical blindness.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/4. Blue rubber bleb naevus syndrome associated with cortical blindness.An 83-year-old woman was admitted for investigation of sudden loss of vision. Extensive plum-purple papules and nodules involved her skin and lips but not mucosae. A cutaneous biopsy demonstrated irregular vascular cavernous channels in the dermis and subcutis; deeper vessels displayed smooth muscle. Blue rubber bleb naevus syndrome was diagnosed. This patient had no gastrointestinal symptoms, no family history of blue rubber bleb naevus syndrome, and only developed cutaneous signs after 60 years of age. magnetic resonance imaging of the brain found multiple cerebral and cerebellar cavernomas with two larger foci of haemorrhage in both occipital lobes, with the largest in the right occipital lobe being associated with calcification. These most likely represent bleeding in relation to cavernomas believed to be the cause of decreased vision, predominantly in the left eye.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/4. Obstetrical anaesthesia for a parturient with preeclampsia, hellp syndrome and acute cortical blindness.PURPOSE: To report the management of a multigravida presenting with preeclampsia, hellp syndrome and acute cortical blindness for Caesarean section. CLINICAL FEATURES: A 39-yr-old woman, with three past uncomplicated pregnancies presented at 33 wk with acute cortical blindness. Based on clinical and laboratory assessment, a diagnosis of preeclampsia with hellp syndrome was made. A CT scan of her head demonstrated ischaemic lesions of her basal ganglia, extending superiorly to involve both posterior parietal and occipital regions. Infusions of magnesium sulphate and hydralazine were started and an urgent Caesarean section was performed under subarachnoid anaesthesia after insertion of an arterial line and intravenous hydration. The course of anaesthesia and surgery was uneventful and she delivered a live 1540 g female infant. By the following morning, she had recovered some vision and visual recovery was complete by 72 hr postpartum. She underwent an MRI with angiography on the first postpartum day. Ischaemic lesions were confirmed in the same sites identified on CT scan but all major cerebral vessels were patent and no significant vascular abnormality was noted. Her postoperative course was uneventful and she was discharged home seven days postpartum after being prescribed labetalol for continued hypertension. CONCLUSION: The anaesthetic management of a parturient with acute cortical blindness and hellp syndrome is modeled on the underlying preeclamptic condition. Invasive monitoring is not routinely indicated but is specifically indicated in some cases. Provided that it is not contraindicated because of prohibitive risk to the mother, regional anaesthesia has particular advantage in these patients. In particular, the use of spinal anaesthesia, which has been discouraged by some for this patient population, should be re-evaluated.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/4. Delayed cortical blindness and recurrent quadriplegia after cervical trauma.In a retrospective, single-patient case report, we report on a 56-year-old woman with delayed cortical blindness and recurrent quadriplegia after a comminuted C1 burst fracture and a type II odontoid fracture. The vertebral artery is susceptible to injury during trauma to the cervical spine. The resulting vascular compromise may be responsible for a variety of neurologic outcomes. The patient was followed up through personal examination and chart review from initial presentation to 6 months after the injury. Three months after cervical fusion and anticoagulation therapy, the patient was noted to have marked improvement of her visual acuity with almost complete return of strength, as well as normalization of vertebral vessel size. Because of the proximity of the vertebral artery to the atlantoaxial complex, it is susceptible to injury during trauma to the cervical spine. Injury to the vasculature supplying the brain may result in both immediate and delayed neurologic consequences.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |