Biomedical subjects
Publications and source records attributed to H S Thompson.
We present magnetic resonance features of a case of bilateral microphthalmos with orbital cysts, a rare congenital anomaly resulting from defects in closure of the embryonic fissure of the optic disk.
Fifty-nine patients had arteriography because of episodes of amaurosis fugax. Only one third of them had atherosclerotic lesions potentially treatable by carotid endarterectomy. Another third had normal arteriograms, some of these had migraine, heart disease or platelet disorders presumed to be the cause of their symptoms. Patients with amaurosis fugax are a heterogeneous group, and their visual symptoms should not be considered a specific indicator of stenosis of the internal carotid artery.
Seven of eight patients presented initially or were followed for decreased acuity and nystagmus without complaints of night blindness. The diagnosis of congenital stationary night blindness was established with electroretinogram and dark adaptation testing. Careful electrodiagnostic testing is needed to provide accurate genetic counseling. Two patients showed pupillary constriction to darkness which is a sign of retinal disease in young patients.
PURPOSE: To assess the usefulness of MR in the evaluation of patients with Horner's syndrome. PATIENTS AND METHODS: We prospectively performed MR imaging in 33 patients with Horner's syndrome (13 preganglionic and 20 postganglionic) using a protocol specifically designed for pre- and postganglionic varieties of this syndrome. Assignment of patients to pre- or postganglionic categories was performed on the basis of pharmacologic testing. RESULTS: Abnormalities in one-half of the patients with preganglionic Horner's syndrome included lateral medullary infarct, spinal cord/root disease, apical lung tumor, and paravertebral metastatic mass. Three of 20 patients with postganglionic Horner's syndrome had carotid artery dissection. CONCLUSION: Routine scanning of patients who have postganglionic Horner's syndrome with cluster headaches was not helpful in our small series.
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The diagnosis of Horner's syndrome is divided into two stages: (1) the recognition of the sympathetic deficit, and (2) the localization of the lesion. The second step is of vital importance in the management of the patient with Horner's syndrome. If the lesion is preganglionic, the risk of malignancy is high; the patient should have cervical spine and chest roentgenograms (PA, lateral and apical lordotic) and perhaps a referral to a surgeon. If the lesion is postganglionic, it is most likely a benign vascular headache syndrome and the patient should go to a neurologist.
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