Migraine, a clinical syndrome of unknown etiology, is a common cause of a variety of visual disturbances. This review describes the visual alterations associated with migraine syndromes of particular interest to the ophthalmologist; acephalgic, ocular, and ophthalmoplegic. Several current theories of migraine pathophysiology are discussed. Migrainous episodes are common and must be differentiated from neurologic dysfunction due to ischemia, inflammation, seizure, and compression. The differentiating characteristics of these conditions as well as a diagnostic algorithm are presented.

Adolescent↗

PubMedDate not supplied

Diagnosis of the empty sella with intrathecal metrizamide computed tomography.

The empty sella syndrome can be diagnosed with high resolution computed tomography. The addition of intrathecal metrizamide defines the degree of extension of the subarachnoid space into the sella turcica, demonstrates the relationship of surrounding structures, and differentiates the empty sella from other isodense or hypodense intrasellar lesions. Photographs from a case of primary empty sella demonstrate the details of anatomy seen with metrizamide computed tomography combined with sagittal reconstruction.

Adult↗

PubMedDate not supplied

Platelet coagulant activities in arterial occlusive disease of the eye.

Ischemic optic neuropathy and retinal arterial occlusion are 2 forms of arterial occlusive disease affecting the eye. Reports in the literature suggest platelet hyperactivity in acute arterial occlusive diseases affecting other organ systems. Therefore, 14 patients with ischemic optic neuropathy and 17 patients with central or branch retinal artery occlusion were studied to determine whether platelets have a role in the pathogenesis of these vascular occlusive disorders. The results of the following investigations were no different in these patients compared with those in 18 control patients with non-vascular eye diseases: prothrombin times, partial thromboplastin times, plasma fibrinogen, factor V, factor VIII, platelet counts and threshold concentrations of ADP, epinephrine and collagen resulting in secondary platelet aggregation and serotonin release. In contrast, platelet coagulant activities concerned with the early stages of intrinsic coagulation were significantly increased in patients with retinal artery occlusion without hypertension or type IV hyperlipoproteinemia, but generally normal in patients with ischemic optic neuropathy and in patients with retinal artery occlusion associated with hypertension, type IV hyperlipoproteinemia, diabetes mellitus and generalized atherosclerosis. These results are consistent with a platelet contribution to retinal arterial occlusive disease in patients without other known contributing factors such as hypertension, serum lipid abnormalities, diabetes mellitus and generalized atherosclerosis and may have implications regarding prophylaxis.

Adult↗

PubMedDate not supplied

Amaurosis fugax: the results of arteriography in 59 patients.

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.

Adult↗

PubMedDate not supplied

High-resolution computed tomography of the basilar artery: 1. Normal size and position.

Normal high-resolution computed tomographic (CT) scans of 126 patients were reviewed to define the diameter, height of the bifurcation, and transverse position of the normal basilar artery. The mean diameter of the normal basilar artery is 3.17 mm at the level of the pons. In 92% of normal subjects, the basilar bifurcation is located in the interpeduncular cistern adjacent to the dorsum sellae or in the suprasellar cistern below the level of the floor of the third ventricle. In 98% of normal individuals, the basilar artery courses in the midline or in a paramedian position, medial to the lateral margins of the clivus and dorsum sellae.

Adolescent↗

PubMedDate not supplied

High-resolution computed tomography of the basilar artery: 2. Vertebrobasilar dolichoectasia: clinical-pathologic correlation and review.

To better define the clinical significance of vertebrobasilar dolichoectasia, the clinical signs and symptoms and basilar artery parameters of diameter, height, and transverse position were evaluated in two groups of symptomatic patients. Ten patients had isolated involvement of the third, sixth, or seventh cranial nerves. The other 10 patients had multiple neurologic deficits including combinations of compressive cranial nerve deficits, both ischemic and compressive central nervous system deficits, and hydrocephalus. Although significant differences for mean basilar artery diameter and height exist between these two groups, the symptomatology and basilar artery parameters present as a spectrum. A symptomatic patient with a normal-caliber, but tortuous, basilar artery is more likely to have isolated cranial nerve involvement. Conversely, the patient with marked basilar artery dilatation (ectasia) is far more likely to present with multiple compressive or ischemic neurologic deficits. Conventional angiography in patients with dilated basilar arteries carries a significant risk for brainstem ischemia. Most authors agree that when vertebrobasilar dolichoectasia has been demonstrated by computed tomography, additional angiography, if required at all, should be performed by digital subtraction techniques.

Adult↗