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Biomedical subjects

M J Kupersmith

Publications and source records attributed to M J Kupersmith.

At least 37 records · Page 2Linked to original sources
PubMed1998

Effects of weight loss on the course of idiopathic intracranial hypertension in women.

OBJECTIVE: To determine the role of weight loss in the treatment of idiopathic intracranial hypertension (IIH) in obese women. METHODS: Chart review of 250 patients with suspected IIH revealed 58 women who met our criteria, did not undergo early surgical intervention, and had adequate documentation of visual status, papilledema, and weight at the baseline evaluation and at 6 months or longer. Patients were divided into two groups based on whether weight loss > or = 2.5 kg occurred during any 3-month interval. Papilledema grade, visual acuity, and visual field grade at 6 months or longer and the time to improve each were recorded. RESULTS: Mean time in months to improve one grade for papilledema and visual field in one eye was 4.0 versus 6.7 (p = 0.013) and 4.6 versus 12.2 (p = 0.032), respectively, for the 38 patients with weight loss compared with the 20 patients with no weight loss. Papilledema resolved in 28/38 with weight loss (mean, 7.6 months) and 8/20 without weight loss (mean, 10.2 months; p = 0.352). There were no differences in final visual acuity or visual field between the two groups, but the papilledema grade was slightly better in the worst eye in each patient at baseline in the weight loss group (p = 0.03). CONCLUSIONS: Weight reduction is associated with more rapid recovery of both papilledema and visual field dysfunction in patients with IIH compared with those who do not lose weight.

Adolescent↗
PubMed1998

Monocular band optic atrophy.

Band or "bow tie" optic atrophy is characterized by well-described ophthalmoscopic findings in the optic nerve and nerve fiber layer and homonymous hemianopia. It is typically associated with compressive lesions of the pregeniculate postchiasmal visual pathway or, less commonly, congenital malformations affecting the postgeniculate radiations or cortex. A unique case with band optic atrophy is described because of the unilateral visual defect. The optic atrophy is strictly unilateral and without an obvious structural lesion that could explain the optic disc damage. However, incidental cerebral gray matter cortical heterotopia may mark a congenital insult that contributed to both of these abnormal findings.

Child↗
PubMed1997

Craniopharyngioma arising de novo in middle age. Case report.

The authors report the case of a 55-year-old woman who developed a symptomatic craniopharyngioma within 2 years of obtaining a normal magnetic resonance image of her brain. Craniopharyngiomas are histologically benign tumors. They are thought to arise from embryonic remnants of Rathke's pouch and sac and to manifest themselves clinically after a steady growth that commences in fetal life. To the authors' knowledge, this is the first report that documents a tumor arising de novo in the sixth decade of life. This report appears to challenge the concept of the origin and natural history of craniopharyngiomas.

Craniopharyngioma↗
PubMed1997

Aspirin reduces the incidence of second eye NAION: a retrospective study.

The objective of this study was to determine if aspirin reduces the incidence of second eye involvement after nonarteritic anterior ischemic optic neuropathy (NAION) in one eye. Records were reviewed of 131 patients who sustained unilateral NAION. Of these, the 33 patients who sustained second eye NAION were compared to those followed for a minimum of 2 years without sustaining a second eye NAION (67). Thirty-one of the 131 patients were excluded because of inadequate follow-up. Except for diabetes (relative risk [RR] 1.43, p = 0.05), the incidence of second eye NAION was independent of gender, age, cup/disk, hypertension, anemia, and migraine. The degree of visual acuity or field dysfunction in the first eye correlated poorly with the acuity (r = 0.28) and field (r = 0.33) loss in the second eye. Aspirin (65-1,300 mg) taken two or more times per week decreased the incidence (17.5% vs. 53.5%) and relative risk (RR = 0.44, p = 0.0002) of second eye AION regardless of the usual risk factors. Even after eliminating those patients who had bilateral disease when first referred, ASA still reduced the incidence of second eye involvement (35% vs. 13%, RR = 0.74, p = 0.01). Aspirin may be an effective means of reducing second eye NAION.

Aged↗
PubMed1996

Beneficial effects of corticosteroids on ocular myasthenia gravis.

OBJECTIVE: To determine if moderate-or low-dose corticosteroid therapy can reduce the diplopia and frequency of deterioration to generalized disease in ocular myasthenia gravis. DESIGN: Retrospective record review. SETTING: Two university-based neuro-ophthalmology services. PATIENTS: All 32 patients with ocular myasthenia gravis, treated with prednisone, followed up for a minimum of 2 years were included. Patients were treated with 1 or more courses of daily prednisone (highest initial dose, 40-80 mg) gradually withdrawn over 4 to 6 weeks. Subsequently, in 6 patients, 2.5 to 20 mg of prednisone was given on alternate day. OUTCOME MEASURES: Diplopia in the primary position or downgaze diplopia and generalized myasthenia gravis after 2 years of follow-up. RESULTS: Diplopia, which was initially found in the primary position in 29 patients and in the downgaze position in 26 patients, was absent in 21 patients at 2 years. Generalized myasthenia gravis occurred in 3 patients at 2 years. Elevated serum acetylcholine receptor antibody levels and abnormal electromyography findings were not predictive of worsening. No patient experienced a major steroid complication. CONCLUSIONS: Moderate-dose daily prednisone for 4 to 6 weeks, followed by low-dose alternate-day therapy as needed, can control the diplopia in patients with ocular myasthenia gravis. The frequency of deterioration to generalized myasthenia gravis at 2 years may be reduced; 9.4% in this study compared with more than 40% previously reported frequency. Corticosteroids may be useful even when ocular motor dysfunction is not normalized.

Adrenal Cortex Hormones↗
PubMed1996

Occipital arteriovenous malformations: visual disturbances and presentation.

BACKGROUND: Occipital arteriovenous malformations (AVMs) cause a variety of visual disturbances and headaches. Early diagnosis may lead to treatment that reduces the risk of hemorrhages, visual field loss and other neurologic deficits, and death. METHODS: We reviewed the records of the 70 patients with occipital AVMs referred to New York University Medical Center to investigate the mode of presentation and the outcome of treatment. RESULTS: Sixty-eight patients presented with one or more symptoms, including homonymous visual disturbances in 39, headache in 39, seizures in 20, and hemorrhage in twenty-six. Visual field loss was more common (p = 0.0007) and more severe (p = 0.0002) in patients who bled than in those with unruptured AVMs (16/44). The frequency of visual field loss was not associated with calcarine artery supply to the AVM. Prior to treatment, the fields improved in five patients with visual loss associated with a hemorrhage. Forty-six patients were treated with embolization, surgery, radiosurgery, or a combination of therapies. The AVM was eliminated in 19 of 20 patients (nine with preoperative partial embolization) treated with surgery versus in 4 of 27 patients treated only with embolization. There were two AVM-associated deaths, two subarachnoid hemorrhages, and four new neurologic deficits after treatment. Visual fields were worse in 15 patients, unchanged in 22, and improved in eight. CONCLUSIONS: Whereas some features of headache and visual symptoms are similar for occipital AVMs and migraine, the two disorders are usually distinguishable. Visual field improvement can spontaneously occur in patients who have had loss secondary to an intracerebral bleed. Treatment with embolization or surgery, particularly with surgical excision of the AVM, can result in new or worse visual field loss.

Adolescent↗
PubMed1996

Venous obstruction as the cause of retinal/choroidal dysfunction associated with arteriovenous shunts in the cavernous sinus.

OBJECTIVE: To determine the hemodynamic abnormalities that result in visual acuity loss because of retinal or choroidal dysfunction associated with arteriovenous shunts (AVS) that involve the cavernous sinus. METHODS: Retrospective study of the records of 250 patients with either a carotid cavernous fistula or dural arteriovenous malformation revealed a total of 10 patients with vision loss secondary to retinopathy (group I) or choroidal effusion (group II). The cerebral angiograms of these 10 patients and 10 additional patients with visual dysfunction due to elevated intraocular pressure (group III) were evaluated to determine whether the three groups could be distinguished by a specific vasculopathic pattern. Particular attention was given to the extent of thrombosis in the ophthalmic venous system and cavernous sinus. RESULTS: There were angiographic signs of severe thrombosis in the ophthalmic vein in nine patients and in the cavernous sinus in seven patients ipsilateral to the retinal or choroidal lesion. In contrast, in group III, severe thrombosis in the ipsilateral ophthalmic vein and in the cavernous sinus occurred in one and two patients, respectively. Closure of the AVS improved the visual acuity in 1 of 4 patients in group I and in 4 of 5 patients in group II, and normalized the intraocular pressure in all patients. CONCLUSIONS: Ophthalmic vein thrombosis, rather than arterialization of the venous system or an arterial "steal, " is the principal cause of retinal or choroidal dysfunction associated with AVS to the cavernous sinus. Following AVS closure, visual recovery is more frequent with choroidal effusion or detachment rather than with retinopathy.

Adult↗
PubMed1995

Homonymous field defect as the first manifestation of Creutzfeldt-Jakob disease.

PURPOSE: Although in the early stage of Creutzfeldt-Jakob disease most patients have obvious dementia, we found that the disease can be diagnosed in patients solely on the basis of a visual system disorder. METHODS: We examined three patients who initially complained of a nonspecific, insidious visual disturbance. RESULTS: The three patients were found to have Creutzfeldt-Jakob disease, confirmed by histopathologic analysis. Each patient had a homonymous hemianopsia on the first neuro-ophthalmologic examination. The initial neurologic, neuroimaging, and electrophysiologic examinations were not conclusive. The subsequent rapid deterioration in the neurologic status, including dementia and typical electroencephalographic changes, was suggestive of Creutzfeldt-Jakob disease. CONCLUSION: At onset of Creutzfeldt-Jakob disease, patients may have a homonymous hemianopsia despite normal results of magnetic resonance imaging of the brain and neurologic examination.

Aged↗
PubMed1995

Comparison of visual evoked potential and psychophysical contrast sensitivity.

We measured contrast processing as a function of spatial and temporal frequency using three measurement techniques: psychophysical thresholds, visual evoked potential (VEP) thresholds and VEP amplitudes. Measurements were made using the same stimulus parameters and on the same group of subjects. The agreement among these functions depended upon the particular spatio-temporal stimulus employed and in general, there were more differences than similarities among these measures. For example, VEP derived functions (both amplitude and threshold) peaked at 4 c/deg, whereas, the psychophysical functions peaked at 1 c/deg. VEP amplitude functions were maximum at > or = 3.5 Hz, whereas both psychophysical and VEP sensitivity were maximum at < or = 2.5 Hz. VEP thresholds were broad and low pass in shape and in contrast, the psychophysical and VEP amplitude functions were band pass. In summary, comparisons among these measures of contrast processing must be made with caution.

Adult↗
PubMed1995

Deep central arteriovenous malformations of the brain: the role of endovascular treatment.

Cerebral deep central arteriovenous malformations (AVMs) are uncommon lesions associated with considerable difficulty in treatment. The authors report a series of 14 deep central AVMs treated by endovascular methods and examine the present role of endovascular treatment. This treatment used alone resulted in complete obliteration of AVMs in approximately 15% of case and reduction in 50% to a size permitting treatment by means of radiosurgery. Reversal of previous neurological signs and symptoms occurred in 35.7% of embolized patients. Overall, nearly 80% of patients had either complete obliteration of the lesion, reduction to a size allowing radiosurgical treatment, or reversal of previous neurological deficits. There were treatment complications in 14.3% of the cases. Endovascular treatment methods may make a significant contribution to the therapy of AVMs that have a particularly poor course and are difficult to treat by other means.

Adult↗
PubMed1995

Neuro-ophthalmologic presentations of functional visual disorders.

Functional or nonorganic visual loss is a common problem that requires an active diagnosis. A complete neuro-ophthalmologic examination of the afferent and efferent visual system is essential to eliminate the possibility of organic causes of visual loss. With a sound knowledge of the anatomic, physiologic, and optical basis of the tests used to evaluate the visual pathway, the physician can detect the inconsistencies in visual performance that secure the diagnosis. The majority of patients will resolve their symptoms with time and reassurance.

Adult↗
PubMed1994

Visual loss in pregnant women with pituitary adenomas.

OBJECTIVE: To investigate the potential risk for developing visual loss during single or multiple pregnancies in women with pituitary adenomas. DESIGN: Cohort study. SETTING: Referral center of a neuro-ophthalmology service. PATIENTS: 65 consecutive women with pituitary adenomas who had not been previously treated with surgery or radiation were monitored during 111 pregnancies. Sixty had increased levels of serum prolactin or growth hormone and 5 did not. MAIN OUTCOME MEASURES: Visual field or acuity loss was compared with the baseline size of the adenoma measured on the coronal view of the computed tomographic or magnetic resonance image. RESULTS: Computed tomography or magnetic resonance imaging showed a definitive tumor (> 0.3 cm, vertical height) in 57 patients, 8 of whom had macroadenomas (> or = 1.1 cm). Visual field loss occurred in 6 of 8 primiparous patients, all with adenomas greater than 1.1 cm (range, 1.2 to 2.5 cm). None of the 57 patients (95% CI, 0% to 6.3%) with a microadenoma or presumed microadenoma of 1 cm or smaller developed visual loss after as many as four full-term pregnancies. CONCLUSIONS: The risk for developing visual loss during single or multiple pregnancies in patients with microadenomas was small. Six of eight pregnant women with macroadenomas, however, developed visual field loss during pregnancy.

Acromegaly↗
PubMed1994

The effects of dopamine blockade on the human flash electroretinogram.

Single-cell electrophysiologic studies have shown that dopamine modulates retinal activity, but its role in human retinal processing is unclear. We investigated the effects of short-term oral administration of dopaminergic receptor blocking agents on the flash electroretinogram in humans. Both chlorpromazine (25 and 50 mg) and fluphenazine (1 and 2 mg) significantly reduced electroretinogram b-wave amplitudes and also selectively reduced the amplitude of the first oscillatory potential. Implicit times were not altered. Metoclopramide (10 and 20 mg) had no effect on any electroretinographic variable. Our study indicates that dopamine receptor blocking agents with both D-1 and D-2 receptor affinities reduce the amplitude of the electroretinogram in humans.

Administration, Oral↗
PubMed1994

Visual evoked potentials following abrupt contrast changes.

The timing of visual evoked potential (VEP) amplitude and phase changes following abrupt increases or decreases in contrast was examined. Gratings (1 c/deg) were presented at a low contrast for 8 sec, increased to a higher contrast for 8 sec, and then decreased to the initial lower contrast for another 8 sec. Second harmonic VEP amplitude and phase were recorded continuously and averaged in 1 sec epochs. Both amplitude and phase exhibited delays in reaching a stable level following the contrast change. For amplitude, the length of the delay was dependent on the magnitude and direction of the contrast step and on the spatial frequency of the stimulus. Time constants for the change in amplitude following step increases in contrast ranged from 0.2 sec for a 12% contrast step to 1.34 sec for a 37% contrast step. The timing of phase changes, however, was independent of the size of the contrast increases (tau = 0.7 sec). For step decreases in contrast, both amplitude and phase were relatively independent of the size of the change (tau = approx. 0.9 sec for amplitude and tau = 0.15 sec for phase). Amplitude time constants also increased with increasing spatial frequency (tau = 1.2 sec for 1 c/deg, tau = 1.6 sec for 4 c/deg and tau = 2.3 sec for 8 c/deg); phase time constants, however, did not change as a function of spatial frequency (tau = 0.7 for all spatial frequencies). These findings demonstrate that a unitary process may not always be tapped by signal averaging techniques. Additionally, swept stimulus VEP techniques may produce considerable errors in threshold estimation depending on the stimulus spatial frequency and on the slope and direction of the contrast change.

Contrast Sensitivity↗
PubMed1994

Endovascular treatment of giant aneurysms which cause visual loss.

BACKGROUND: Progressive visual loss that results when a giant cerebral aneurysm compresses the anterior visual pathway requires treatment. When surgical clipping is not safely feasible, percutaneous methods of embolization of the aneurysm can be visual or life saving. METHODS: Endovascular techniques were used to treat 19 of 26 consecutive inoperable giant aneurysms in patients with visual loss, which included optic neuropathy (monocular in 13 patients and bilateral in 8) and optic tract dysfunction in five patients. Embolization of the aneurysm was performed with detachable balloons in 12 patients and with Guglielmi detachable electrocoils in 7. RESULTS: After treatment, vision improved in 7 patients, was unchanged in 11, and worsened in 1. Neurologic complications with balloons were temporary in four patients and severe and permanent in three. In contrast, only one temporary complication occurred with Guglielmi detachable electrocoils. The treatment results are contrasted with the outcome in the seven patients who refused intervention: three hemorrhaged (1 death); monocular blindness with dementia developed in two; a complete homonymous hemianopia and dementia developed in one; and one became bilaterally blind. CONCLUSION: Inoperable symptomatic giant aneurysms can be successfully treated with endovascular treatment.

Adolescent↗
PubMed1994

Optic tract atrophy with cerebral arteriovenous malformations: direct and transsynaptic degeneration.

Three patients with postgeniculate cerebral arteriovenous malformations (AVM) had band atrophy of the contralateral optic nerve. One patient had homonymous hemioptic hypoplasia. These cases might have been construed as demonstrating transsynaptic degeneration across the lateral geniculate nucleus to the anterior visual pathway. However, neuroimaging studies revealed abnormal deep venous drainage remote from the AVM nidus that directly involved the lateral geniculate nucleus and posterior optic tract.

Adult↗
PubMed1994

Craniopharyngiomas: a clinicopathological analysis of factors predictive of recurrence and functional outcome.

Pathological and clinical data from 56 patients operated on for craniopharyngioma since 1981 were analyzed to determine the utility of dividing patients with this tumor into distinct clinical groups based on recognized pathological type and to determine the prognostic import of brain invasion. Of the tumors in the 30 adult patients, 66% were adamantinomatous, 28% were squamous papillary, and the remainder were mixed. However, of the tumors in the 26 children, 96% were adamantinomatous and none were pure squamous papillary (P < 0.01). Forty-six percent of the children compared with 17% of the adults had brain invasion (P < 0.01). Brain invasion was present in 37% of the adamantinomatous but in only 13% of the squamous papillary tumors. Seventy-seven percent of the children underwent gross total resection (GTR) compared with 27% of the adults (P < 0.01). Sixty-three percent of the squamous papillary tumors underwent GTR compared with 54% of the adamantinomatous and mixed tumors. Follow-up ranged from 7 to 187 months (mean, 49 mo). After subtotal resection, with or without radiation therapy, 58% of the tumors recurred compared with 17% recurrence after GTR (P < 0.01), with a mean time to recurrence of 34 months. In both tumor histological types, subtotal resection was associated with a higher rate of tumor recurrence compared with gross total resection. Among the subtotally resected craniopharyngiomas, 2 of the 3 (67%) squamous papillary and 11 of the 21 (52%) adamantinomatous and mixed tumors recurred. In contrast, among the totally resected tumors, none of the 5 squamous papillary and only 5 of the 25 (20%) adamantinomatous and mixed tumors recurred. There were no significant differences in Karnofsky performance status score, mortality rate, or visual and endocrine outcomes when comparing patients based on histological tumor type. When controlling for age and extent of resection, we found that brain invasion had no significant effect on recurrence rate in totally resected tumors. Based on the limited number of patients in this series, we conclude as follows. 1) Contrary to previous reports, squamous papillary craniopharyngiomas, like adamantinomatous tumors, may recur when subtotally resected. 2) For both tumor variants, the most significant factor associated with craniopharyngioma recurrence is the extent of surgical resection rather than histopathological subtype. 3) Contrary to prior hypotheses, brain invasion in totally resected tumors does not predict higher recurrence. 4) GTR is associated with a significantly lower recurrence rate and can be achieved without sacrificing functional outcome.

Adolescent↗