Burkitt lymphoma presenting with gingival pain and a cavernous sinus syndrome in an adult.
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Aged↗
Biomedical subjects
Michael S Vaphiades
Publications and source records attributed to Michael S Vaphiades.
Sphenoid sinus mucocele presenting as a third cranial nerve palsy.
A 90-year-old woman developed an acute left third cranial nerve palsy. Brain imaging revealed a left sphenoid sinus mucocele. Endoscopic marsupialization of the mucocele led to complete resolution of the third cranial nerve palsy.
Aged, 80 and over↗
Imaging the neurovisual system.
This article reviews the neuroimaging modalities commonly used in neuro-ophthalmology. These modalities are illustrated with several cases in an atlas format to highlight the differences between each technique. The focus is a review of MRI, MR angiography, CT,CT angiography, and digital subtraction angiography.
Angiography↗
Optic nerve enhancement in hypotensive ischemic optic neuropathy.
A 57-year-old woman who had hypotension and cardiac arrest during coronary artery bypass grafting developed hypotensive ischemic optic neuropathy with no light perception vision OU. Bilateral mid-orbital optic nerve enhancement was found on magnetic resonance imaging (MRI) eight weeks after surgery. Re-examination 16 weeks after surgery showed no light perception vision, dilated un-reactive pupils, and pale optic discs. Bilateral optic nerve enhancement persisted on MRI. Optic nerve enhancement has been reported commonly in radiation-induced ischemic optic neuropathy, occasionally in arteritic ischemic optic neuropathy, and rarely in nonarteritic ischemic optic neuropathy. It has never been reported in hypotensive ischemic optic neuropathy.
Blindness↗
Magnetic resonance imaging of choroidal inflammation in Vogt-Koyanagi-Harada disease.
Acute binocular visual loss, photophobia, headache, and pulsatile tinnitus developed in a 51-year-old woman. Ophthalmologic examination showed bilateral optic disc edema with peripapillary nerve fiber layer hemorrhages. Lumbar puncture disclosed a monocytic pleocytosis. A diagnosis of Vogt-Koyanagi-Harada disease was made. Magnetic resonance imaging showed striking enhancement and thickening of the posterior ocular wall. A macular star figure appeared several days after prednisone treatment was begun. Laboratory evaluation was entirely negative. Within weeks, the clinical manifestations had resolved except for retinal striae. This is the third report of the magnetic resonance imaging visualization of choroidal inflammation in Vogt-Koyanagi-Harada disease and shows the imaging abnormalities in finer detail than earlier reports.
Choroid↗
The cost of living in purgatory's shadow.
A 40-year-old alcoholic man developed Wernicke-Korsakoff syndrome. His examination showed ophthalmoplegia, ataxia and memory difficulties. His cranial magnetic resonance imaging scan showed increased signal in the paraventricular regions of the thalamus on T-2 weighted, diffusion and axial fluid-attenuated inversion recovery sequences consistent with the syndrome. The ophthalmoplegia resolved with thiamine administration; however, his memory did not improve.
Adult↗
Optic nerve and chiasmal enhancement in leber hereditary optic neuropathy.
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Adolescent↗
Rocky Mountain Spotted Fever as a cause of macular star figure.
An 86-year-old woman with a history of tick bites in the previous months developed subnormal visual acuity in both eyes, keratic precipitates, anterior chamber and vitreous cells, optic disc edema, retinal hemorrhages, and retinal arteriolar sheathing. She had no fever or skin rash. Three weeks later, binocular macular star figures appeared. Brain imaging was negative; cerebrospinal fluid disclosed a lymphocytic pleocytosis and elevated protein. The serum Rickettsia rickettsii antibody test was markedly positive, establishing a diagnosis of Rocky Mountain Spotted Fever (RMSF) as the cause of the ophthalmic findings. Despite treatment with oral doxycycline, these findings improved only modestly. Although neuroretinitis has been previously described in RMSF, macular star has not been documented.
Administration, Oral↗
Case of the month. Acute frosted angiitis.
A 42-year-old woman presented with acute visual loss in the left eye with funduscopic evidence of marked retinal periphlebitis (frosted angiitis) and a macular star. Extensive serologic testing identified no etiology. The purpose of this report is to review the clinical features and systemic associations of acute frosted angiitis, a rare ophthalmologic entity.
Adult↗
Infusion misdirection syndrome during trabeculectomy for primary trabeculodysgenesis.
PURPOSE: To report a case of infusion misdirection syndrome, simulating an intraoperative suprachoroidal hemorrhage, in an eye undergoing trabeculectomy for primary trabeculodysgenesis. METHODS: A 21-year-old woman underwent trabeculectomy for primary trabeculodysgenesis. Congenitally abnormal intraocular anatomy led to intraoperative and postoperative complications. RESULTS: Intraoperative anterior chamber irrigation was followed by vitreous prolapse. Eye pain, globe hardening, and shallowing of the anterior chamber were caused by infusion misdirection into the posterior segment. The eye was rapidly closed after a limited wound-site vitrectomy. Intraoperative and postoperative management led to a successful outcome. CONCLUSION: Altered intraocular anatomy set the stage for infusion misdirection syndrome, a rare but manageable complication that mimicked an expulsive suprachoroidal hemorrhage.
Adult↗
Motor neuron disease presenting with slow saccades and dementia.
A 46-year-old man with a 2-year history of dementia presented with very slow saccades and tongue fasciculations. The diagnosis of amyotrophic lateral sclerosis (ALS) was established by electrophysiologic studies and ultimately on autopsy. Rarely, slowed saccades may be present in ALS, and slow saccades in a relatively young demented patient should prompt consideration of ALS.
Amyotrophic Lateral Sclerosis↗
Optic nerve enhancement in leber hereditary optic neuropathy: four years later.
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Adolescent↗
Sprint car visual loss.
A 16-year-old boy developed bilateral visual loss 24 hours after a sprint car accident. Bilateral central scotomas were demonstrated but were unexplained by a thorough eye examination and neuro-imaging. A diagnosis of commotio retinae was established by multi-focal ERG testing. This relatively new technique is discussed, including comparison to full-field ERG and clinical applications.
Accidents, Traffic↗
MRA or CTA, that's the question.
A 26-year-old woman developed a painful left pupil-involving oculomotor palsy. Magnetic resonance imaging of the brain and orbits with and without fat suppression and gadolinium and magnetic resonance angiography of the head were normal. A computed tomographic angiogram showed a left 7-mm posterior communicating artery aneurysm. The different neuroimaging modalities used to diagnose intracranial aneurysms are discussed.
Adult↗
Optic neuritis is nothing to sneeze at.
A 36-year-old man developed acute visual loss, mimicking an optic neuritis in the left eye. Cranial magnetic resonance imaging revealed a sphenoid sinus mucocele with extension into the anterior clinoid process abutting the left optic nerve. Endoscopic marsupialization of the mucocele led to marked improvement of vision. Sphenoid sinus mucocele is discussed, as is the differential diagnosis of optic neuritis.
Adult↗
The disk edema dilemma.
A 33-year-old diabetic woman experienced visual loss OS and disk edema OU. Extensive evaluation led to the diagnosis of diabetic papillopathy. Appropriate evaluation and management of diabetic papillopathy is discussed.
Adult↗
The double vision decision.
A 50-year-old man experienced the acute onset of ophthalmoplegia, ataxia, and hyporeflexia. Evaluation led to the diagnosis of Miller Fisher syndrome (MFS). Appropriate evaluation and management of MFS is discussed.
Ataxia↗