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Biomedical subjects

J A Rush

Publications and source records attributed to J A Rush.

At least 37 records · Page 2Linked to original sources
PubMed1982

Spontaneous nonpigmented iris cyst.

A histologically proved nonpigmented iris cyst was seen spontaneously in a 22-year-old woman and was removed 14 years later because it enlarged and compromised her vision. The controversy involving the cause and tissue origin of these cysts is discussed. The late age of manifestation together with the histologic characteristics of this cyst favor a "spontaneous" cause arising from tissue of neuroectodermal origin, eg, the nonpigmented ciliary epithelium. The nonpigmented ciliary epithelium. The clinical characteristics of this disorder and means of treatment are reviewed.

Adult↗
PubMed1982

Primary idiopathic inflammation of the optic nerve.

A 50-year-old woman with progressive right-sided visual loss had severely reduced visual acuity in the right eye and an upper temporal visual field defect in the left eye. Extensive neuroradiologic studies disclosed an enlarged right optic nerve, and a transfrontal craniotomy. Biopsy of the right optic nerve showed perivascular lymphocytic infiltration and a few atypical astrocytes. A complete medical evaluation gave no evidence of systemic vasculitis or lymphoreticular malignancy. Oral corticosteroids were administered for two months, and no further deterioration of vision occurred. Two years later, although the right eye was blind, the visual acuity of the left eye was 6/2 (20/20), and the patient had no clinical or radiologic evidence of optic chiasm tumor.

Adrenal Cortex Hormones↗
PubMed1982

Noninvasive carotid evaluation using pulsed Doppler imaging for patients with ophthalmic disorders.

Pulsed Doppler imaging provides an accurate, noninvasive technique for evaluation of the carotid bifurcation. We have found it useful in evaluating patients with amaurosis fugax and ocular emboli. It can also be used to evaluate blood flow within ocular and orbital tumors. The continuous wave Doppler is useful for detection of abnormal orbital blood flow in patients with dural-cavernous fistulae.

Adolescent↗
PubMed1982

The neurosurgical management of optic glioma. Results in 104 patients.

A series of 104 patients with surgically verified optic nerve gliomas is presented. Anterior lesions primarily affecting the optic nerve were present in 42 patients, who have a long-term survival rate of 85.5%. Posterior lesions primarily affecting the optic chiasm were present in 62 patients, most of whom underwent radiation therapy postoperatively, and they have a long-term survival rate of 50%. Unequivocal signs of neurofibromatosis were present in 14%. On the basis of these findings and a review of the literature, recommendations are made for the surgical management of these tumors.

Adolescent↗
PubMed1982

Doppler sonography in the diagnosis of dural carotidcavernous fistula.

Intracranial dural fistulas in the region of the cavernous sinus usually occur in middle-aged or elderly women in whom physical findings of ocular pulsation, orbital bruit, and ocular injection are subtle or absent. We examined a 19-year-old man with hemophilia who had a red, mildly proptosed left eye. Typical features of a carotidcavernous sinus fistula were absent except for the presence of dilated, tortuous episcleral vessels. Directional Doppler ultrasound evaluation detected retrograde blood flow in the left frontal vein and thus confirmed the presence of an arteriovenous shunt. After a selective internal carotid angiogram demonstrated a shunt from a dural branch of the internal carotid artery, the patient's symptoms remitted spontaneously. Directional Doppler ultrasonography is a noninvasive test that can detect the presence of a low flow, retrobulbar arteriovenous shunt in the region of the cavernous sinus.

Adult↗
PubMed1982

Ocular myasthenia presenting as superior oblique weakness.

We diagnosed ocular myasthenia in a 39-year-old man whose presenting symptom was vertical diplopia. Unrecognized weakness of the right superior oblique and secondary overaction of the right inferior oblique caused a right hypertropia, which was worse on left gaze. One week later left blepharoptosis, right medial rectus weakness, and bilateral obicularis oculi weakness were found on ocular examination. All findings were partially reversed by the injection of Tensilon. Superior oblique muscle palsy simulating a fourth cranial nerve palsy is infrequently reported in patients with ocular myasthenia. Pseudofourth nerve palsy is another sign of myasthenia gravis.

Adult↗
PubMed1982

Hard Retinal exudates and visual loss due to papilledema.

Bilateral papilledema developed in a patient with a cystic, grade 3 astrocytoma of the right frontal lobe. Despite successful neurosurgical treatment, 60Co radiotherapy, and oral corticosteroid therapy, progressive visual loss occurred. At examination one year later, visual activity was 20/200 and 20/70, and extensive lipid exudates in the peripapillary retina and central macula of each eye were noted. Retinal lipid exudates rarely complicate the course of surviving patients who had papilledema from intracranial tumor; physicians involved in the multispecialty care of such patients should be aware of the possible ocular residuals of persistent papilledema in an otherwise successfully treated patient.

Adrenal Cortex Hormones↗
PubMed1982

Optic glioma. Long-term follow-up of 85 histopathologically verified cases.

Eighty-five cases of histologically verified gliomas of the optic nerve or chiasm were studied retrospectively. Patient survival was analyzed according to location of tumor, treatment received, presence of neurofibromatosis, and degree of histologic anaplasia. Thirty-three patients had optic nerve tumors, and 52 had tumors involving the chiasm. Follow-up ranged from 6 days to 43.7 years. Of the 33 patients with optic nerve tumors, 28 (85%) survived a mean duration of 17 years, and survival was significantly associated with completeness of surgical excision. Twenty-three of the 52 patients (44%) with chiasmal tumors survived a mean duration of 19 years. Survival among patients with chiasmal tumors was unrelated to therapy received and was affected adversely by concomitant involvement of adjacent brain structures. The presence of neurofibromatosis conferred a protective benefit to patients with chiasmal tumors. No other significant factors could be statistically identified to influence the prognosis of patients with optic gliomas.

Adolescent↗
PubMed1981

Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases.

An unselected series of 1,000 cases of paralysis of cranial nerves III, IV, and VI was retrospectively analyzed regarding ultimate recovery and final causal diagnosis. The frequency of involvement of the third, fourth, and sixth cranial nerves was relatively unchanged from earlier similar reports. The number of patients (263) whose cranial nerve paralysis was initially of undetermined cause was surprisingly high despite the availability of computerized tomographic scanning. Subsequently, the cause for the paralysis was diagnosed in only ten of the 127 patients who could be traced. About half (51%) of the patients with no known cause for paralysis underwent spontaneous remission. Forty-eight percent of all patients recovered. Cranial nerve impairment due to vascular disease (diabetes mellitus, atherosclerosis, or hypertension) was temporary in 71% of the patients, regardless of the cranial nerve affected. Patients with palsies caused by aneurysm, trauma, and neoplasm was predictably less likely to recover.

Abducens Nerve↗
PubMed1981

Testicular seminoma metastatic to the orbit.

Painful exophthalmos, ophthalmoplegia, and visual loss in the right eye developed in a 28-year-old man four months after he underwent a radical orchiectomy and irradiation for a seminoma of the right testicle. Prednisone therapy failed to relieve the symptoms, and an orbital biopsy found a metastatic testicular seminoma. Orbital irradiation with radioactive cobalt reduced the exophthalmos, reversed the ophthalmoplegia, and improved his visual acuity. Previous cases of nonmetastatic exophthalmos in patients who had testicular seminoma have been reported, but, to the best of our knowledge, this is the first report of a patient who had orbital seminoma metastatic from the testis. Successful irradiation of the orbital focus can minimize ocular morbidity and may improve the prognosis.

Adult↗
PubMed1981

Syphilitic optic perineuritis.

We examined a patient who had syphilitic perioptic neuritis, a rarely diagnosed inflammation of the sheaths of the optic nerves that may be confused with papilledema caused by brain tumor or pseudotumor cerebri. The visual acuity was typically normal, and the only visual-field abnormality was enlargement of the blind spots. After we excluded an intracranial mass lesion, the diagnosis was confirmed by cerebrospinal fluid serologic findings positive for syphilis and normal intracranial pressure. Anti-inflammatory and antisyphilitic therapy resolved all the symptoms in our patient.

Adult↗
PubMed1981

Graves' orbitopathy and the thyrotropin-releasing hormone (TRH) test.

The value of the thyrotropin-releasing hormone (TRH) test may be insufficiently emphasized in the diagnosis of patients with euthyroid Graves' disease who have unexplained proptosis or vertical diplopia. We saw three patients who had these orbital symptoms and normal routine serum thyroid studies. The orbital computed tomograms (CT) found an orbital myopathy in all, and the diagnosis of Graves' orbitopathy was made by an abnormal TRH test. Not all euthyroid Graves' patients will show a positive result, but in those who do, the test is diagnostic. The clinical summaries of our three patients and the applications of the thyrotropin-releasing hormone test in ophthalmic practice are reviewed.

Adult↗
PubMed1981

Bitemporal hemianopsia in basilar artery aneurysm.

A 10-year-old boy had a 4-month history of blurred vision and severe occipital headaches. Visual acuity was diminished bilaterally, but ophthalmoscopy was normal, and the correct diagnosis was delayed until inferior bitemporal defects were found. Cranial CT scans and vertebral angiograms demonstrated a giant aneurysm at the bifurcation of the basilar artery. Bitemporal hemianopsia occurring in children is usually due to craniopharyngioma or chiasmal glioma. To the best of our knowledge, this is the first report of a patient whose chiasmal syndrome was due to a basilar artery aneurysm and whose visual deficit improved after occlusion of the aneurysm.

Basilar Artery↗
PubMed1980

Cloth-particle retinal emboli from artificial cardiac valves.

Two patients with prosthetic mitral valves had ocular complications. A 28-year-old woman suffered recurrent episodes of bilateral retinal embolization and consequent loss of useful vision over a period of two years despite therapeutic anticoagulation. Replacement of the valve was followed by cessation of the embolization. A 52-year-old man noted the abrupt onset of blurred vision in his right eye. Visual acuity was 6/6 (20/20) bilaterally, but the right eye had many retinal emboli of varying shapes. Both patients had long-standing mitral valve disease, but ocular symptoms developed only after the implantation of a cloth-covered mitral valve prosthesis. To the best of our knowledge, retinal emboli from cloth-covered cardiac valve prostheses have not been previously reported. Patients with such prostheses and ocular complaints who have adequate anticoagulation therapy should be carefully examined for retinal emboli. If emboli are present, valve dysfunction is possible and valve replacement may be necessary.

Adult↗
PubMed1980

Orbital carcinoid tumor metastatic from the colon.

Acute exophthalmos and ophthalmoplegia of the left eye developed in a 58-year-old woman convalescing from a right hemicolectomy for a carcinoid tumor of the colon. Roentgenograms of the orbit and computed tomograms showed a large posterior left orbital mass. Lateral orbitotomy and biopsy confirmed the diagnosis of metastatic carcinoid tumor. Irradiation with radioactive cobalt (60Co) resulted in early relief of the ocular symptoms. To the best of our knowledge, this is the second documented case of orbital metastatic carcinoid tumor and the first patient with orbital involvement from a primary carcinoid tumor of the colon. Orbital irradiation for metastatic orbital carcinoid tumor has not been previously reported and should be used for symptomatic relief, because long-term survival is possible in patients with metastatic carcinoid tumors.

Carcinoid Tumor↗
PubMed1980

Retrobulbar optic neuropathy in sarcoidosis.

Virtually unrecognized as a manifestation of ocular sarcoidosis 15 years ago, optic nerve disease occurs in 5% of patients. Sarcoidosis of the optic nerve has been recognized as papilledema, atrophy, and papillitis, and optic disc infiltration. Although 400 cases of neurologic sarcoidosis have been reported, little mention is made of "retrobulbar neuritis" occurring in sarcoidosis patients. This report documents a black woman whose solitary ocular lesion of sarcoidosis was a retrobulbar neuropathy that responded dramatically to steroid therapy.

Adult↗
PubMed1980

Pseudotumor cerebri: clinical profile and visual outcome in 63 patients.

Few current reports in the ophthalmic literature address the visual prognosis patients with pseudotumor cerebri. The visual status of 63 patients with pseudotumor cerebri, seen at the Mayo Clinic from 1961 through 1978, was retrospectively analyzed. The median interval between first examination and response to a questionnaire was 6 1/4 years. Seven patients (11%) had 6/9 (20/30) or worse visual acuity at least ocular examination. Visual loss was not statistically related to (1) the presence of visual obscurations, (2) the duration of symptoms, (3) the degree of papilledema, or (4) the number of recurrences. Surgical intervention may have prevented further deterioration of vision in several patients, but therapeutic efficacy could not be determined in this study. No patient with visual loss had substantial improvement, regardless of type of treatment.

Adolescent↗