1/27. mucormycosis manifesting as proptosis and unilateral blindness.A 51-year-old woman presented to the emergency department (ED) of another institution with sudden onset of blindness in the left eye. The patient was found to have no light perception in the left eye and a marked chemosis occurring several days after a fall. She was transferred to the hospital for ophthalmologic evaluation. Upon careful history and physical examination, the diagnosis of rhinocerebral mucormycosis was considered and urgent ophthalmology and otolaryngology consults were obtained. The patient underwent extensive surgical debridement and pharmacologic treatment. The diagnosis was confirmed by pathological specimens. In this case report, the clinical presentation, pathogenesis, diagnostic workup, and ED management of mucormycosis are discussed, highlighting the possible diagnostic and therapeutic pitfalls that are most pertinent to the emergency physician.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/27. Can a motion-blind patient reach for moving objects?It has been claimed that the visual brain is organized in two separate processing streams for spatial vision: one for perception and one for action. To determine whether motion vision is also divided into vision for action and for perception we examined the interceptive behaviour of the motion-blind patient LM. The task for LM and three age-matched control subjects was to reach-and-grasp for an object that moved away. Three experiments were conducted to examine the effects on perfomance of target speed (Expt 1), observation time (Expt 2) and visual feedback (Expt 3). As LM is only able to reach for objects which move at 0.5 m/s or less, her performance is inferior to that of controls who can reach for objects moving at 1.0 m/s, but it is better than would be expected from her performance in psychophysical experiments on her motion vision. Kinematic analysis of LM's reaching movements showed that she adapted the speed of her moving hand to the speed of the target but only when full vision was available. In contrast to normal subjects, LM required long observation times and vision of her moving hand to produce successful reaching responses. Thus, the impairment of both perception and action in LM suggests that the motion area MT/V5 is located at an early stage of the extrastriate hierarchy and provides input to both the perception and the action processing streams.- - - - - - - - - - ranking = 0.28878677220811keywords = physical (Clic here for more details about this article) |
3/27. Vision loss associated with a stiff neck complicating strabismus surgery.An exotropic 60 year old suffered a scleral-choroidal penetration and vitreous hemorrhage during and after strabismus surgery on a highly myopic eye when her anesthetic airway management was complicated by her previously asymptomatic and unrecognized rigid cervical spine which placed both the surgeon and the anesthetist in disadvantaged positions both physically and medically. Restoration of vision and binocularity ultimately required vitrectomy and intraocular lens implantation.- - - - - - - - - - ranking = 0.28878677220811keywords = physical (Clic here for more details about this article) |
4/27. Superior orbital 'petrositis' and late ischaemic monocular blindness induced by intense UV radiation exposure.Many physical agents cause neuropathies. The most common are chronic pressure, vibration and temperature. In general, these lesions occur at work, as a result of accidents or through chronic exposure to the physical agent. radiation leading to peripheral neuropathy is also related to radiotherapy in cancer treatment, as an undesirable side-effect. We present here a case report of short, intense UV radiation exposure at work, leading to delayed-onset ocular neuropathy. A clear cause-effect relationship is shown, demonstrated using magnetic resonance imaging scans. We suggest that the mechanism was thermal and ischaemic.- - - - - - - - - - ranking = 0.57757354441622keywords = physical (Clic here for more details about this article) |
5/27. Late onset seizures, hemiparesis and blindness in hemolytic uremic syndrome.Neurologic complications of hemolytic uremic syndrome, including seizures, usually occur early during the acute phase of the illness. We report a3-year-old girl with classic diarrhea-associated hemolytic uremic syndrome who developed late onset seizures, hemiparesis and transient blindness on the 17th hospital day, at which time her recovery was characterized by improvement in her blood pressure, serum electrolytes, renal function, hematocrit and platelet count. A CT and MR revealed brainstem and posterior parietal and occipital infarct/edema. The association of these radiologic findings within the posterior distribution along with visual loss and seizures are unique to posterior reversible encephalopathy syndrome. Within 7 days, she regained motor function and vision and had no further seizure activity. At 6 months follow-up, physical examination revealed normal motor function and vision and a repeat MR showed near resolution of the previous findings with minimal occipital lobe gliosis. This case report describes the uncommon finding of late onset seizures occurring during the recovery phase of hemolytic uremic syndrome with MR findings consistent with posterior reversible encephalopathy syndrome.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/27. Extrascleral malignant melanoma.We present two cases of anterior extrascleral extension of malignant melanoma in eyes previously blind from other causes. In both cases, the tumor was not detected by the physician but rather by the patient himself (case 1) or his wife (case 2). In one case, the tumor became manifest more than 60 years after the eye became blind from trauma. Although blind eyes may harbor lethal tumors and, therefore, need regular examinations, this simple part of the physical examination frequently remains neglected by ophthalmologists as well as by primary care physicians. We wish to emphasize the potential life-saving importance of regular examinations of blind eyes.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/27. Blinding keratoconjunctivitis and child abuse.PURPOSE: To report an unusual, blinding inflicted eye injury in young children. DESIGN: Observational case report. methods: Retrospective study in an institutional clinical practice of two families in whom the probands had inferior half keratoconjunctivitis and additional signs of child abuse. RESULTS: Two unrelated infants presented with bilateral, asymmetrical, external eye disease affecting the lower half of the cornea and conjunctiva. One eye had perforated. All eyes recovered quickly while the patients were in the hospital with no specific treatment. There were other signs of child abuse detected by further studies on the patients, and in one case, the younger sibling was the subject of severely damaging physical abuse. CONCLUSIONS: Inflicted corneal injuries are nonspecific, and unexplained keratoconjunctivitis, especially in the lower half of the conjunctiva and cornea in infants should alert the clinician to the possibility child abuse, but, by itself cannot be taken as being pathognomonic of abuse.- - - - - - - - - - ranking = 0.28878677220811keywords = physical (Clic here for more details about this article) |
8/27. autopsy findings of a 37-year-old man with a complex mosaic karyotype involving del(18p), monosomy 13, and trisomy 20.We report on the autopsy findings of a 37-year-old man with a complex karyotype (mos46,XY,del(18)(p11.1)[14]/46,XY, -13, del (18)(p11.1), 20[8]/47,XY,del(18)(p11.1), 20[8]). He was known to be blind, non-ambulatory, have severe mental retardation, and a seizure disorder. External physical findings at the time of autopsy included micrognathia, short stubby fingers, and rocker bottom feet. Left lobe dominance of the liver and mislocation of the ileocecal junction and appendix were noted on internal examination. The brain was small (700 g) and poorly developed. Microscopically it showed an absence of neurons in the olivary and dentate nuclei, absence of purkinje cells in the cerebellum, severe depletion of internal granular cells in the cerebellum, and cerebellar dysplasia. Fat infiltration was noted in an unusual distribution in several organs including a pattern in the heart consistent with arrythmogenic right ventricular dysplasia (ARVD). Findings of this mosaic chromosomal karyotype have not been previously described. This report will discuss this individuals physical findings and their relation to similar monochromosomal aberrations.- - - - - - - - - - ranking = 0.57757354441622keywords = physical (Clic here for more details about this article) |
9/27. Misdiagnosis of olfactory neuroblastoma.OBJECT: Olfactory neuroblastoma (ON) is a rare neoplasm arising from the olfactory epithelium and found in the upper nasal cavity. The authors studied the frequency with which ON is misdiagnosed with other tumors of the paranasal sinuses such as neuroendocrine carcinoma (NEC), pituitary adenoma, melanoma, lymphoma, and sinonasal undifferentiated carcinoma (SNUC). Based on the belief that misdiagnosis commonly occurs, they emphasized the importance of establishing the correct diagnosis, because the treatment regimens and prognosis of these tumor types are often significantly different. methods: Twelve consecutive patients in whom ON was diagnosed were referred to the Department of neurosurgery at the M. D. Anderson Cancer Center between January 1998 and March 2000. Demographic data were collected, physical findings and mode of treatments were documented, and neuroimaging studies were assessed. Pathologists at the authors' institute reviewed the histological specimens. Only in two of 12 patients was the diagnosis of ON confirmed. Lesions in 10 patients were misdiagnosed; there were two cases of melanoma, three cases of NEC, three cases of pituitary adenoma, and two cases of SNUC. Eight of 10 patients in whom lesions were misdiagnosed required significant alteration in the initially proposed treatment plan. CONCLUSIONS: Neurosurgeons should be acutely aware of the variety of neoplasms that occur in the paranasal region. The correct diagnosis should be ensured before initiating treatment to provide the optimum therapy and spare the patients from needless and potentially toxic treatment.- - - - - - - - - - ranking = 0.28878677220811keywords = physical (Clic here for more details about this article) |
10/27. Training the adult amblyopic eye with "perceptual learning" after vision loss in the non-amblyopic eye.We recently reported acuity development in the amblyopic eye of a 60-year-old patient after loss of vision in her non-amblyopic eye. Here, we focus on the training that we implemented, based on new insights from psychophysical procedures aiming at functional visual improvement of adults ("perceptual learning"). We alternately used the following procedures: grating acuity (Teller-Cards); contrast sensitivity (Vistech-charts); two spatial localization tests (vertical alignment, pointing); and labyrinth patterns for a eye-hand coordination exercise. One month without intervention was followed by six months of training and two blocks of pleoptic treatment. Clinical parameters were assessed monthly. Besides acuity gain, we observed enhanced grating resolution and contrast sensitivity, decreased alignment distortions, pointing shifts, mainly after pleoptics, and more efficient labyrinth tracing. A questionnaire reflected the patient's perception of the changes. These data confirm the plasticity of the adult amblyopic system, be it spontaneous due to the loss of the non-amblyopic eye or caused by the intervention or both. Further experience is necessary to isolate the role of the intervention. Our results also underline the limitation of adult plasticity, emphasizing the importance of early diagnosis and treatment of amblyopia.- - - - - - - - - - ranking = 0.28878677220811keywords = physical (Clic here for more details about this article) |
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