Hysterical bitemporal hemianopia "cured" with contact lenses.
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Adolescent↗
Biomedical subjects
L B Kline
Publications and source records attributed to L B Kline.
Acquired trigemino-abducens synkinesis.
A 26-year-old woman sustained closed head trauma following a motor vehicle accident. Her injuries included complete trigeminal and abducens nerve palsies. Eleven months later eye muscle surgery succeeded in making her orthophoric in primary gaze although her right abduction deficit persisted. Eighteen months after injury the patient was able to fully abduct her right eye with jaw thrust to the left. With abduction of the right eye there was associated globe retraction and narrowing of the palpebral fissure. This is the second reported case of trigemino-abducens synkinesis. Mechanisms to explain this phenomenon are discussed.
Abducens Nerve↗
Ocular stroke and carotid artery dissection.
Carotid artery dissection frequently causes transient ipsilateral visual impairment. We present 2 cases of permanent ocular vaso-occlusion sequelae consequent to dissection of the ipsilateral internal carotid, definite in one and probable in the other. In both, the ocular strokes led to the recognition of the underlying carotid vasculopathy.
Adult↗
Progression of visual defects in ischemic optic neuropathy.
Six patients with nonarteritic ischemic optic neuropathy experienced worsening of visual acuity and field loss during the six-week period after onset (range, three to six weeks), without apparent ophthalmoscopic changes. Thereafter, visual function remained unchanged. Various medications were used, but none prevented deterioration of visual function. Although not a widely recognized phenomenon, progression of visual deficit occurred in these patients in the early weeks after onset of ischemic optic neuropathy.
Female↗
Bilateral cavernous sinus thrombosis due to mucormycosis.
A 49-year-old man requiring hemodialysis for end-stage renal disease developed orbital cellulitis and bilateral central retinal artery occlusions. Although cranial computed tomography demonstrated ethmoid and sphenoid sinusitis, two surgical biopsy specimens of sinus mucosa were nondiagnostic. Autopsy findings confirmed cerebral mucormycosis with bilateral cavernous sinus and carotid artery thrombosis. The patient had been taking deferoxamine for hemochromatosis, and this chelating agent may have been the predisposing factor in developing mucormycosis. We discuss the limitations of current neuroimaging techniques in establishing the diagnosis of both cerebral mucormycosis and cavernous sinus thrombosis.
Brain Diseases↗
Imaging techniques in optic nerve evulsion.
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Craniocerebral Trauma↗
Recovery of vision after presumed direct optic nerve injury.
Immediate loss of light perception after direct optic nerve injury is usually irreversible. Our patient sustained presumed direct optic nerve injury because of a shotgun injury with loss of light perception, absent pupillary response, and absent visual-evoked potential. A small pupillary response was noted 12 days after injury, light perception returned by 15 days, and visual acuity was 20/100 at 4 months. A variety of pathophysiologic mechanisms may lead to visual loss after direct optic nerve injury. It is important to recognize that blindness is not always permanent in these cases despite the results of initial clinical and electrophysiologic testing.
Adolescent↗
Painful Horner's syndrome due to spontaneous carotid artery dissection.
Spontaneous dissection of the internal carotid artery as a cause of Horner's syndrome has only been recognized in recent years. The authors describe three patients with this condition. Associated symptoms included ipsilateral orbital and frontal headache (3 patients), neck and facial pain (2), amaurosis fugax (1), and dysgeusia (1). The symptoms resolved in all patients within three months, yet oculosympathetic paralysis has persisted. Diagnosis of carotid dissection required cerebral arteriography, and the angiographic features are presented. Patients were treated with platelet antiaggregants, and they have remained neurologically stable during follow-up (mean, 12 months; range, 10-14 months).
Adult↗
Bilateral internuclear ophthalmoplegia in systemic lupus erythematosus.
Internuclear ophthalmoplegia has been infrequently described in patients with systemic lupus erythematosus. We report a 23-year-old woman with lupus who presented with bilateral internuclear ophthalmoplegia and skew deviation. Additional neurologic findings included dysarthria, hemifacial weakness, hemiparesis, and dysmetria. Computed tomography of the patient's brainstem was unremarkable while magnetic resonance scanning demonstrated two areas of infarction. Magnetic resonance imaging is superior to computed tomography in both neuroradiographic study of the brainstem as well as evaluation of patients with neurologic complications of lupus.
Adult↗
Electrical cataracts: a case report and review of the literature.
A case report of electrically-induced cataracts and a review of the literature is presented. Awareness of the possibility of this complication and screening of high-risk patients is stressed. The majority of cases respond well to surgery, but final visual acuity may be decreased secondary to retinal or optic nerve injury caused by the electrical current.
Adult↗
Aneurysmal compression of the anterior visual pathways.
Ten patients with aneurysmal compression of the anterior visual pathways had visual loss, unilateral in 4 and bilateral in 6. There was no typical clinical presentation. Visual loss was acute or gradual, acuity sometimes fluctuated, and visual field testing was highly variable. The aneurysms were supraclinoid (four patients), carotid-ophthalmic (two), anterior communicating-anterior cerebral (three), and intracavernous carotid (one). Nine patients had successful clipping of their aneurysm, and in one, ipsilateral common carotid ligation was performed. Postoperatively, visual acuity was improved in six cases, unchanged in three, and worse in one.
Adult↗
Pure red cell aplasia and protein-losing enteropathy in a patient with systemic lupus erythematosus.
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Adult↗
Radiation optic neuropathy.
Following surgery for pituitary adenoma, radiation therapy is an accepted treatment in reducing tumor recurrence. However, a potential therapeutic complication is delayed radionecrosis of perisellar neural structures, including the optic nerves and chiasm. This particular cause of visual loss, radiation optic neuropathy (RON), has not been emphasized in the ophthalmologic literature. Four cases of RON seen in the past five years are reported. Diagnostic criteria include: (1) acute visual loss (monocular or binocular), (2) visual field defects indicating optic nerve or chiasmal dysfunction, (3) absence of optic disc edema, (4) onset usually within three years of therapy (peak: 1-1 1/2 years), and (5) no computed tomographic evidence of visual pathway compression. Pathologic findings, differential diagnosis and therapy will be discussed in outlining the clinical profile of RON.
Adenoma↗
Oculosympathetic spasm with cervical spinal cord injury.
A 23-year-old man, involved in a motor-vehicle accident, became quadraparetic due to cervical spinal cord injury at the C-4 to C-6 level. Five months later he was noted to have bilateral, asymmetric pupillary mydriasis precipitated by elevation and stretch of an arm or leg. Pharmacologic pupillary testing and ciliospinal reflex responses suggested that the oculosympathetic pathways were intact. Computed tomographic myelography using metrizamide disclosed a posttraumatic syringomyelic cyst at C-4. This pupillary phenomenon has been termed oculosympathetic spasm, and we reviewed four previous reports. While the cause of oculosympathetic spasm remains speculative, it may represent a localized form of autonomic hyperreflexia.
Accidents, Traffic↗
Lymphomatous optic neuropathy.
Optic neuropathy as the first sign of a lymphoreticular neoplasm is rare. A 65-year-old man complained of initially transient and then progressive visual loss in the right eye for two weeks. Computed tomography demonstrated a mass in the region of the intracranial portion of the right optic nerve. Frontal craniotomy was performed and histopathologic examination of the tumor disclosed a granulomatous process. Regrowth of the mass and visual deterioration, despite systemic steroid therapy, prompted surgical reexploration. Histopathologic examination confirmed large cell lymphoma. After local radiotherapy (2,500 rad), the patient is well and free of local or systemic lymphoma one year later. Other reported cases of lymphomatous optic neuropathy are reviewed and the diagnostic difficulties encountered are discussed.
Aged↗
Indirect injury of the optic nerve.
Visual loss due to optic nerve injury after closed head trauma constitutes a formidable diagnostic and therapeutic challenge for the clinician. Assessment must be made of the site of optic nerve injury, and this is often difficult in the patient with an altered level of consciousness. A decision regarding optic nerve decompression must be formulated, yet the literature is confusing with regard to operative indications. In reviewing current pathogenetic theories, clinicopathological data, and therapeutic options, this report attempts to clarify the role of surgical intervention in indirect optic nerve injury.
Blindness↗
Rhabdomyosarcoma causing rapid bilateral visual loss in children.
Rhabdomyosarcoma commonly involves the orbit resulting in unilateral proptosis, swelling, and restricted ocular motility. We saw two unusual cases of children with nasopharyngeal rhabdomyosarcoma which caused rapid bilateral visual loss due to simultaneous spread of the tumor to the orbital apices. Initial CT scans revealed the tumor, but were misinterpreted as "normal," causing a significant delay in diagnosis. We recommend high resolution CT scans of the nasopharynx, orbits, and suprasellar region in any child with rapid bilateral visual loss to rule out this common childhood tumor.
Blindness↗
Bilateral intracavernous carotid aneurysms mimicking a prolactin-secreting pituitary tumor.
The triad of hyperprolactinemia, ophthalmoplegia, and radiologic abnormalities of the sell turcica suggest a tumor in the area of the pituitary gland. A new association--bilateral intracavernous carotid aneurysms--is presented. Two elderly women had extraocular muscle palsies and elevated serum prolactin levels of 71 and 32 ng/ml (normal: less than 20 ng/ml). In the former, a high-resolution computed tomography scan made after contrast medium injection was incorrectly interpreted as demonstrating a pituitary tumor; cerebral arteriography revealed bilateral aneurysms. In the other patient, a computed tomography scan after contrast medium injection demonstrated the bilateral aneurysms, and these were confirmed by radionuclide angiography.
Aged↗