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Biomedical subjects

J S Elston

Publications and source records attributed to J S Elston.

At least 19 recordsLinked to original sources
PubMed2001

Abnormal pupillary activity in a brainstem-dead patient.

The pupils in brainstem-dead patients are classically fixed and dilated. We present a case of a brainstem-dead patient whose pupils displayed persistent asynchronous pupillary constriction and dilatation independent of external physical stimuli. Central causes for the phenomenon were excluded leaving an unexplained peripheral cause as the most likely explanation. Early recognition of this phenomenon prevents delay in the diagnosis of brainstem death, lessening to some extent the distress for the family, and facilitating earlier organ donation and allowing the better use of resources.

Adult↗
PubMed1999

Do the same genes predispose to Gilles de la Tourette syndrome and dystonia? Report of a new family and review of the literature.

Gilles de la Tourette syndrome (TS) and idiopathic focal torsion dystonia are both movement disorders in which the pathologic process is thought to arise within the basal ganglia. However, despite their possible functional links, they are clinically distinct and are generally considered to have different underlying etiologies. There are several reports in the literature that suggest a relationship between eye winking tics, excessive blinking, and blepharospasm and a report of the coexistence of tics and dystonia. We describe a three-generation family in which TS and dystonias cosegregate. In total, eight patients were affected, five with dystonia and three with TS/facial tics. One of the patients with historic evidence of dystonia subsequently died of motor neuron disease. The identification of this family further strengthens the evidence in favor of an etiologic relationship between some cases of Gilles de la Tourette syndrome and focal dystonia.

Adult↗
PubMed1999

Is sphenoid sinus opacity significant in patients with optic neuritis?

PURPOSE: Optic neuritis secondary to sinus disease is an infrequent but well-documented association. When a patient presents with signs of optic nerve dysfunction and orbital inflammation the significance of widespread sinus disease on radiology is clear and the management is straightforward. We present a group of patients with isolated optic neuritis and radiological evidence of spheno-ethmoiditis and discuss the clinical relevance of this finding. METHODS: We reviewed the notes of 11 patients with optic neuritis who, because of atypical headache, underwent neuroimaging revealing sphenoid sinus opacity. Six patients had endoscopic drainage of the sphenoid sinus; 4 were treated medically. RESULTS: Sinus contents included fungal infection (2), mucopurulent material (5), polyps (1) and necrotic tumour (1). Narrowing of the optic canal due to chronic osteomyelitis was found in 1 patient with irreversible optic atrophy. Visual loss was reversible in 6 patients. Four patients had normal radiological findings after treatment. Two patients had recurrent optic neuritis with sphenoid sinusitis on MRI scan, resolving on treatment, during the 4 year follow-up period. CONCLUSIONS: Possible mechanisms of nerve damage in this situation include direct spread of infection, occlusive vasculitis and bony deficiency in the wall of the sinus. Patients presenting with isolated optic neuritis and atypical headache should be scanned; an opaque sphenoid sinus in the context of visual loss should not be dismissed as coincidental but assumed to be pathological and the patient referred for drainage. Sphenoid sinusitis is an uncommon but treatable cause of optic neuritis.

Adult↗
PubMed1998

The contribution of macular changes to visual loss in benign intracranial hypertension.

PURPOSE: To describe the significance of macular changes to visual outcome in benign intracranial hypertension (BIH). METHOD: The clinical and photographic records of 24 patients with BIH who required optic nerve sheath fenestration were analysed. RESULTS: Macular changes were found in 21 of 48 (44%) eyes. These were: choroidal folds 9; circumferential lines (Paton's lines) 4; nerve fibre layer haemorrhage 3; macular stars 5; macular oedema 6; retinal pigment epithelial changes 4; subretinal haemorrhage leading to a macular scar 1. Significant visual loss attributable to the macular changes was found in 5 eyes in the short term and 3 in the long term. The 2 eyes that improved had macular stars. Of the 3 eyes that did not improve, 2 eyes had retinal pigment epithelial changes and 1 a large subretinal haemorrhage that led to a macular scar. These 3 cases had long-standing BIH. CONCLUSIONS: The majority of macular changes resolve and do not add to visual loss from optic nerve damage. Patients with marked macular oedema are at most risk of permanent visual loss and should be considered for early treatment such as optic nerve sheath fenestration.

Adult↗
PubMed1998

Endoscopic orbital decompression for thyroid eye disease.

BACKGROUND: Thyroid eye disease is a disorder of immune function resulting in extraocular myopathy and an increase in retrobulbar fat. These changes lead to the clinical features found in thyroid eye disease including proptosis, eyelid retraction, restrictive myopathy and sometimes compressive optic neuropathy. Orbital decompression is undertaken for optic nerve compression, exposure keratopathy or cosmesis. Previously this involved an external approach with the removal of the medial orbital wall along with the floor. An intranasal endoscopic approach with the removal of the medial orbital wall and part of the floor has recently been advocated as an alternative procedure. METHODS: We present the results of 7 patients who underwent endoscopic orbital decompression. The effects on optic nerve function, proptosis and ocular motility were assessed. Symptoms before and after surgery were monitored. RESULTS: The surgery was found to be successful in all cases with a reduction in proptosis and minimal effect on ocular motility. The surgery was also associated with a low post-operative morbidity. CONCLUSION: We suggest endoscopic orbital decompression is an effective and safe treatment for dysthyroid eye disease.

Adult↗
PubMed1998

Paralytic strabismus.

The use of sophisticated imaging techniques has led to a greater understanding of the mechanisms of some forms of strabismus. In particular, studies of strabismus in high myopia have demonstrated abnormal muscle courses and provided a basis for corrective surgery. Although injection of botulinum toxin has a place in modern strabismus management, there have been few controlled studies validating its use. An important paper in the review period directly compares botulinum with surgery to confirm its effectiveness for at least one indication.

Animals↗
PubMed1997

Cavernous-dural fistula with secondary angle-closure glaucoma.

PURPOSE: To report a rare case of angle-closure glaucoma, secondary to the rapid development of a choroidal effusion, in a patient with a long-standing cavernous-dural shunt. METHODS: Case report. Investigations included computed tomographic scan, magnetic resonance imaging, and carotid angiography. RESULTS: The development of the choroidal effusion occurred because of partial thrombosis of the ipsilateral superior ophthalmic vein and cavernous sinus. Drainage of the choroidal effusion resolved the angle-closure glaucoma. CONCLUSIONS: The combination of worsening signs and evidence of thrombosis indicates impending resolution of a cavernous-dural shunt. However, if a choroidal effusion causes angle-closure glaucoma, prompt surgical drainage should be considered to prevent permanent peripheral anterior synechiae formation, with the expectation that the effusion will not recur.

Aged↗
PubMed1997

Oculopalatal myoclonus: eye movement studies, MRI findings and the difficulty of treatment.

Two cases of oculopalatal myoclonus with bilateral horizontal gaze palsies are presented. The abnormal vertical eye movements developed several months after brain stem haemorrhage. Eye movement measurements showed rhythmical vertical eye movements at similar rates (2.3 Hz and 2.4 Hz), unaffected by attempts to fixate, converge or gaze in any direction. T2-weighted MRI scans showed bilateral enlargement of the inferior olivary nuclei in both cases, which confirms the expected pathology previously demonstrated on autopsy. Both patients had severe oscillopsia and an attempt was made to improve this by bilateral disinsertion of the vertical rectus muscles. The pendular eye movements continued but were greatly reduced, in one case enough to relieve the oscillopsia. However, after 6 months retrobulbar botulinum toxin was required to continue to provide relief from the oscillopsia. Other treatment options, including pharmacological agents, are discussed.

Aged↗
PubMed1997

Surgical treatment of supranuclear and internuclear ocular motility disorders.

Patients with supranuclear and internuclear ocular motility disorders may have nystagmus and oscillopsia, or need to adopt an abnormal head posture to either fixate or maintain binocularity. Many have a cosmetically unsatisfactory appearance. In addition, because of lesions involving ocular motor nuclei or nerve fascicles, double vision is also a common problem. The usual management of these patients is symptomatic with occlusion or prisms. We report on 11 patients who underwent extraocular muscle surgery with the aim of reducing symptoms and restoring or improving binocular single vision. Three patients had bilateral internuclear ophthalmoplegia with exotropia, 3 had dorsal midbrain syndrome, 2 had residual upgaze palsies after cerebral vascular accidents, 2 had oculopalatal myoclonus and one skew deviation. After surgery, symptoms, visual function and cosmesis improved in nearly all patients. We recommend that surgery should be considered more readily in the rehabilitation of these patients.

Diplopia↗
PubMed1997

Paralytic and incomitant strabismus.

In the year under review, published work has concentrated on two main topics. The first is the etiology, pathophysiology, and natural history of paralytic and incomitant strabismus. No major studies were published but some interesting findings are discussed. The second is surgical results, largely assessed by uncontrolled retrospective data analysis. Also, a number of useful tips for patient management have emerged.

Cranial Nerve Diseases↗
PubMed1995

Acute orbital myositis.

We examined 9 consecutive cases of unilateral orbital myositis (7 women and 2 men; age range 15-46 years) presenting to Casualty. Only 3 were correctly diagnosed on the first visit. Eight patients exhibited globe retraction in the acute stages and, after treatment with systemic steroids, all made a full recovery. None of the patients had associated systemic disease and all remain well over a 6-12 month follow-up period. Orbital myositis may be a more common condition than previously thought; it can present with a variety of clinical signs, and may be difficult to diagnose in the early stages. The presence of globe retraction on movement of a painful, injected eye is a useful diagnostic sign which indicates inflammation of extraocular muscles and is present in the acute stages of the disease; we explain how to elicit globe retraction and suggest a management protocol for these patients.

Adolescent↗
PubMed1995

Effect of squint surgery on pupillary diameter.

AIM: To investigate the effect that squint surgery has on pupillary diameter. METHODS: The effect of squint surgery on pupil size was investigated in 19 patients. RESULTS: A significant mydriasis in the operated eye was observed when compared with the unoperated eye. This was independent of the number or type of extraocular muscles operated upon. CONCLUSION: It is hypothesised that this change in pupillary diameter results from the release of neurotransmitters from tissues damaged during surgery.

Adult↗
PubMed1994

The use of botulinum toxin for treatment of acquired nystagmus and oscillopsia.

PURPOSE: To evaluate the role of botulinum toxin A (BTA) in treating patients with diminished visual acuity secondary to acquired nystagmus and oscillopsia. METHODS: Twelve patients with acquired nystagmus causing oscillopsia and reduced vision were treated with injection of BTA. Botulinum toxin A was injected directly into the horizontal recti in three patients, and in nine patients retrobulbar BTA was administered. Injections were given at 3- to 4-month intervals and repeated as long as patients noted improvement in their quality of life. RESULTS: Improvement in visual function varied, and not all patients benefited from the procedure. However, 8 of 12 patients demonstrated a measurable improvement in visual acuity. Transient ptosis was the most common side effect. CONCLUSION: Retrobulbar BTA provides a simple and safe alternative in managing a condition for which alternative treatments are typically unsatisfactory.

Adult↗