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Biomedical subjects

M L Slavin

Publications and source records attributed to M L Slavin.

54 records · Page 3Linked to original sources

Chronic asymptomatic ischemic optic neuropathy. A report of two cases in adults with diabetes mellitus.

Two adult diabetic patients with chronic asymptomatic optic neuropathy attributed to an ischemic etiology are reported. In one case the typical syndrome of ischemic optic neuropathy occurred in one eye, while the fellow eye had asymptomatic hyperemic optic disc edema that persisted for 6 months without optic atrophy. A minor visual field defect initially detected in that eye resolved spontaneously in 1 month. In the second case, a recent onset, middle-aged diabetic developed bilateral optic neuropathy and optic disc edema that persisted for 12 months, with minimal signs of visual dysfunction. Axoplasmic transport blockage from low-grade ischemia to the optic nerve may cause acute or chronic optic disc edema with minimal or no visual symptoms.

Chronic Disease↗

Acute, severe, symmetric visual loss with cecocentral scotomas due to olfactory groove meningioma.

Cecocentral scotomas are a hallmark of toxic, metabolic, and hereditary optic neuropathies, but are rarely associated with compressive processes. Acute visual loss due to a compressive optic neuropathy by a benign tumor is unusual unless intratumoral hemorrhage or infarction occurs. A case of acute, severe, remitting, symmetrical visual loss with cecocentral scotomas, initially thought to be of toxic etiology, proved to be due to a typical suprasellar meningioma originating in the olfactory groove. A history of olfactory disturbance with visual loss should prompt neuroradiologic investigation despite atypical neuro-ophthalmic features.

Adult↗

Squamous cell carcinoma of the pterygopalatine fossa (retroantral space).

A patient developed sensory disturbance and pain in the distribution of the maxillary nerve several months after removal of a statedly benign cutaneous malar lesion. One year later, abducens palsy developed, and computed tomography showed a mass of the pterygopalatine fossa abutting on the superior nasopharynx. Results of examination and multiple biopsies of the nasopharynx were normal. Direct biopsy of the pterygopalatine fossa via a transmaxillary sinus approach revealed squamous cell carcinoma. Extension of malignancy from the adjacent nasopharynx (not detected on biopsy) or sphenoid sinus and perineural spread of an undiagnosed cutaneous squamous cell carcinoma along the maxillary nerve were considered as possibilities. The anatomy of the pterygopalatine fossa and its environs is reviewed with respect to clinical signs of second division trigeminal neuropathy, abducens palsy and diminished ipsilateral tearing.

Biopsy↗

Gaze palsy associated with viral syndrome.

Four cases of gaze paresis occurred in association with viral disease. In three cases the viral prodrome preceded the oculomotor disturbance. In one, gaze palsy was followed several days later by a viral syndrome. One had isolated bilateral horizontal ophthalmoplegia; another patient had motility disturbance with blepharoptosis and peripheral areflexia. Two patients had clinical evidence of brain-stem involvement: unilateral gaze paresis and gaze-evoked nystagmus in one and Parinaud's syndrome in the other. No accompanying long-tract signs or changes in mental status were present in any case. Recovery was complete in all four patients.

Adult↗

Optic disc edema with aphakic cystoid maculopathy masquerading as ischemic optic neuropathy.

Two patients with visual loss after cataract extraction were found to have prominent pallid optic disc edema, peripapillary hemorrhage, and cystoid maculopathy. A diagnosis of anterior ischemic optic neuropathy, with coincidental aphakic cystoid macular edema, was initially considered. The clinical course, however, favored a diagnosis of visual loss secondary to maculopathy. In both cases, fluorescein angiography disclosed leakage of fluorescein dye from macula, optic disc, and peripapillary foci. Fluorescein angiography and stereo color photographs of 51 patients with aphakic cystoid maculopathy were reviewed to determine the incidence of optic disc edema. Although optic disc swelling was rarely recognized on fundus photography, optic disc hyperfluorescence was observed in 75% of cases.

Aged↗

Pituitary apoplexy associated with cardiac surgery.

Two cases of pituitary apoplexy were detected in the immediate postoperative period after cardiac surgery with extracorporeal bypass. Both patients had pituitary adenomas that were asymptomatic and previously undiagnosed. One patient, a 57-year-old man, had unilateral total ophthalmoplegia and blepharoptosis with sparing of the visual system. The second patient, a 55-year-old man, had headache, marked bilateral visual loss, and ophthalmoplegia with subsequent development of a hemiparesis. Pituitary apoplexy was confirmed pathologically in both cases. Hemodynamic instability during and immediately after surgery and anticoagulation are probable precipitating factors.

Coronary Artery Bypass↗

Optic neuropathy and cerebral sarcoidosis.

An intracranial mass lesion is a rare, but reported presenting sign in sarcoidosis. A 39-year-old woman presented with a frontal lobe lesion (pathologically a noncaseating granuloma) associated with chronic progressive visual loss and optic atrophy on the right side. High-resolution axial and coronal computerized tomography revealed a parachiasmal density compatible with the clinical course. Clinical suspicion of granulomatous processes and appropriate workup in all cases of optic neuropathy may allow for early medical therapy in such cases.

Adult↗

Idiopathic orbital myositis: report of six cases.

Idiopathic orbital myositis, a subgroup of inflammatory orbital pseudotumor, occurred in six patients with acute onset periorbital pain, diplopia, and in most cases, eyelid swelling. Proptosis, ductional restrictions, and responsiveness to oral prednisone administration were characteristic. Computed tomography and orbital ultrasonography showed enlargement of one or more extraocular muscles, with sparing of other orbital soft tissues. One patient had involvement of all recti muscles in both orbits. The distinction of orbital myositis from Graves' ophthalmopathy is made on clinical grounds, with acute orbital pain and corticosteroid responsiveness being uncharacteristic of the latter. The possibility of orbital myositis being an immune-mediated process is discussed.

Adult↗

Acute homonymous field loss: really a diagnostic dilemma.

A young woman developed the sudden onset of a congruous right lower quadratic visual field defect two weeks prior to examination. The remainder of her history and physical examination were noncontributory. Discussion revolves around the differential diagnosis of retro chiasmal field defects in young individuals. An MRI scan was most compatible with the diagnosis of disseminated sclerosis.

Adult↗

Sudden visual loss with slow recovery.

A 58-year-old healthy man presented with a history of monocular visual loss with incomplete recovery. The differential diagnosis, evaluation, and possible therapeutic interventions are discussed. The presenter controversially felt that although the source of embolic material was likely ipsilateral carotid artery and no evaluation was necessary.

Blindness↗

Acute unilateral visual loss in the elderly due to retrobulbar optic neuropathy.

A 61-year-old man developed fever and a urinary tract infection followed five days later by acute visual loss in the right eye. Funduscopic examination was normal. A retrobulbar optic neuropathy was diagnosed but careful consideration was given to choroidal ischemia as an etiology. A sphenoidal mucocele was found on emergent MRI scan and drained expeditiously, with marked improvement in visual function. The diagnosis of giant cell arteritis should always be entertained when dealing with visual loss in the elderly.

Acute Disease↗

Amaurosis fugax in the young.

A 36-year-old healthy woman developed amaurosis fugax of the right eye lasting 1 minute. Work-up revealed right carotid stenosis thought most compatible with an atherosclerotic plaque. A carotid endarterectomy was performed which corroborated the radiologic diagnosis. An embolic event from ipsilateral carotid artery disease should be considered as a cause of amaurosis fugax even in the young.

Adult↗

Head nodding associated with intermittent esotropia.

Head nodding (to-and-fro turning about the vertical cervical axis) associated with abnormal eye movements may be seen in spasmus nutans and congenital nystagmus. In the absence of abnormal eye movements, it may be indicative of neurological disease (eg, cerebellar disease, basal ganglia dysfunction). We report a neurologically normal infant without nystagmus but with intermittent head nodding and intermittent esotropia, whose head movements manifested only when his eyes were straight. The head movements ceased with the occlusion of either eye or spontaneous onset of esotropia. When his head was forcibly stabilized, he immediately developed esotropia. The head movement presumably facilitated fusion, although the mechanism of action is unknown.

Esotropia↗