1/8. Typical and atypical Carney's triad presenting with malignant hypertension and papilledema.This report encourages clinicians to consider a diagnosis of Carney's triad in patients with multifocal gastric stromal sarcoma, extraadrenal paraganglioma (predominantly mediastinal), or pulmonary chondroma. The authors conducted a retrospective 20-year survey at the Hospital for Sick Children and identified two children with Carney's triad. One child, presenting atypically with papilledema and fundal hemorrhages from malignant hypertension and benign intracranial hypertension from chronic iron-deficiency anemia, is the second patient ever to date be described with the complete Carney's triad of neoplasms at diagnosis. Another child presented more typically with gastric stromal sarcoma and pulmonary chondroma without paraganglioma. Carney's triad is a rare differential diagnosis for "idiopathic" hypertension or iron-deficiency anemia from chronic gastrointestinal bleeding. If missed, patients with Carney's triad may have the debilitating physical and mental consequences of chronic iron deficiency and may die of untreated prolonged hypertension and metastatic leiomyosarcoma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Unusual manifestation of subacute sclerosing panencephalitis: case with intracranial high-pressure symptoms.subacute sclerosing panencephalitis can show variations in clinical course, and some ophthalmologic abnormalities can be seen as cortical blindness and optic atrophy. A 4-year-old girl was referred to our hospital with a complaint of diplopia, vomiting, and ataxia. On physical examination, she was found to have stage IV papilledema with retinal hemorrhage. She was diagnosed as having idiopathic intracranial high pressure until magnetic resonance imaging demonstrated T2-weighted hyperintense lesions. After observation of head drop attacks and detection of elevated antimeasles antibodies in cerebrospinal fluid, the diagnosis of subacute sclerosing panencephalitis was established, and isoprinosine and carbamazepine were started for treatment. However, because carbamazepine failed to control the head drop attacks, topiramate was also included, and the attacks were kept under control with topiramate. The case presented in this article is a good example of subacute sclerosing panencephalitis in which, at early stages, some of the signs and symptoms can lead to an erroneous diagnosis. In addition, we have demonstrated that topiramate might be a good choice for treatment for the persistent myoclonus seen in this type of patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. Colloid cyst of the third ventricle.Colloid cyst of the third ventricle is a rare, histologically benign but potentially lethal tumor. Two cases reflecting the variability in symptoms, physical findings, and outcome seen with these rare tumors are presented. One patient with classic age of onset in the third to fifth decade of life, symptoms of escalating intermittent headaches, and signs of papilledema and altered level of consciousness had successful surgical removal of the cyst. Another patient with nonspecific symptoms well outside the usual age of onset and without papilledema succumbed to sudden, complete impaction and was not diagnosed until autopsy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Papilloedema delaying diagnosis of Wernicke's encephalopathy in a comatose patient.A case of acute Wernicke's encephalopathy due to hyperemesis gravidarum is described. Florid bilateral papilloedema was present, resulting in diagnostic uncertainty and delay in treatment. attention is drawn to the rare occurrence of papilloedema in Wernicke's encephalopathy, and possible underlying mechanisms for this physical finding are considered.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/8. pregnancy and acute optic disc edema of juvenile-onset diabetes.Acute optic disc edema is a recently recognized, relatively benign manifestation of juvenile-onset diabetes mellitus. Twenty-three cases have been reported in the ophthalmology literature, two occurring during pregnancy. The authors present an additional case recognized in a pregnant patient and review the literature. The disorder manifests physical findings similar to those of papilledema, proliferative retinopathy with optic disc edema, inflammatory papillitis, and ischemic optic neuropathy, but has a benign course that requires no treatment and is not adversely affected by pregnancy. It is important to recognize this syndrome because failure to make the correct diagnosis in pregnancy may lead to inappropriate treatment, including therapeutic abortion.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. GAPO syndrome: report on the first case in japan.We studied a 3.5-year-old Japanese boy with growth retardation, alopecia, pseudoanodontia, and bilateral papilledema. He was born of nonconsanguineous parents, but his paternal grandparents were related. From his characteristic physical manifestations, we diagnosed him as the first known case of GAPO syndrome in japan and perhaps in the Mongoloid race. Our case had prominent dilatation of scalp veins and an audible intracranial bruit. Cranial angiography documented a narrowing of the sigmoid sinuses, with no flow to either jugular vein. We discuss here the relationships between optic atrophy and intracranial vascular changes in this syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Colloid cyst of the third ventricle.BACKGROUND: Colloid cyst of the third ventricle has rarely been reported in the ophthalmic literature. The incidence is about one per 1000 in asymptomatic patients and accounts for 0.55 to 2 percent of all intracranial tumors. Although it is an uncommon benign tumor, nearly half of symptomatic patients present with papilledema and hydrocephalus. Consideration of this intracranial tumor should be included in the differential diagnosis of papilledema and apparent unilateral disc edema. methods: A patient with highly asymmetrical papilledema and vague visual symptomatology involving the right eye was studied. Computer axial tomography (CT) without contrast enhancement revealed a colloid cyst of the third ventricle. Typical symptoms of the condition include headaches, nausea, vomiting, visual obscuration, transient diplopia and weakness of the lower extremities, which are due to acute hydrocephalus caused by increased intracranial pressure from cystic obstruction of the foramen of Monro. Intermittency of symptoms is characteristic of this lesion. RESULTS: The patient underwent frontal craniotomy with total tumor excision and reopening of the cerebrospinal fluid pathway. CONCLUSIONS: Colloid cyst of the third ventricle discovered incidentally on CT in asymptomatic patients with no evidence of hydrocephalus can be monitored periodically. If symptomatic, neurosurgery is usually indicated since prolonged increased intracranial pressure can lead to mental and physical deterioration as well as sudden death.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. Pseudopapilledema and congenital disc anomalies in growth hormone deficiency.optic nerve hypoplasia is a congenital disc anomaly associated with growth hormone deficiency (GHD). pseudotumor cerebri is an adverse event associated with growth hormone treatment (hGH) and manifested by increased intracranial pressure and papilledema. Pseudopapilledema is a generic ophthalmologic term encompassing several conditions, including congenital disc anomalies. It is benign and can be distinguished from papilledema by physical examination. The objective of this report is to document that congenital disc abnormalities, which can be confused with papilledema, occur in children with GHD. Three patients with GHD had fundoscopic examinations suggestive of papilledema and possibly pseudotumor cerebri. The abnormal optic nerves were characteristic of pseudo-papilledema, and appear to be a variant of optic nerve hypoplasia. The finding of optic disc abnormality during hGH may reflect pseudo-papilledema and not pseudotumor cerebri. Of equal importance, the reported patients indicate that the finding of pseudopapilledema in short children should suggest the possibility of GHD.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |