Biomedical subjects
Publications and source records attributed to N R Miller.
A nine-and-one-half month old boy with poor visual function was found to have bilaterally small optic discs. He subsequently demonstrated a retarded growth pattern. A series of photographs revealing part of the spectrum of optic disc hypoplasia are included. Associated structural and endocrine defects as well as various opinions concerning the appropriate approach to these patients are discussed.
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A 28-year-old woman presented with a history of unilateral throbbing headache associated intermittently with transient pupillary dilation. The differential diagnosis and suggested method of investigation are discussed. Therapeutic recommendations are mentioned for the treatment of common migraine.
A 68-year-old woman experienced rapid progressive visual loss to blindness over a seven-week period. Inadequate clinical and diagnostic testing masked the diagnosis of a malignant glioma of adulthood.
A 39-year-old woman presented to her ophthalmologist complaining of floaters. This was associated with elevation of the optic disc and late staining of the retinal veins. The differential diagnosis of venous occlusive disease is discussed.
Although granular cell tumor (GCT) has been a distinct pathological entity since 1926, confusion and controversy have long existed regarding the nature and histogenesis of the tumor. Twenty-five cases of granular cell tumor involving the orbit and ocular adnexae previously reported in the ophthalmic literature, are reviewed and six additional cases are reported. The histopathological and immunohistochemical characteristics of granular cell tumors in this uncommon location are discussed and their probable origin from Schwann cells is also considered.
A 76-year-old woman presents with the classic findings of a carotid-cavernous fistula, including a red eye due to arterialization of the conjunctival veins, proptosis, retinal venous obstructive disease and elevated intraocular pressure. Enlarged extraocular muscles were found on CT scan leading to the misdiagnosis of thyroid orbitopathy. The differential diagnosis and therapy of the dural cavernous fistula and the intraocular pressure are discussed.
A 70-year-old man presented with mild retrobulbar discomfort and diplopia with a marked left abduction deficit. Three days later the patient noted a sudden decrease of vision in his left eye. A CT scan revealed enhancement of structures of the left orbital apex. A discussion of the differential diagnosis, appropriate testing procedures, and suggested treatment is included. The patient responded to corticosteroid therapy with complete resolution of the problem.
A 42-year-old man developed blurred vision and was found to have a right, incongruous, inferior homonymous quadrantanopia. Neuroimaging disclosed a suprasellar mass. The mass was thought to be a pituitary adenoma that was compressing the left optic tract, and transsphenoidal surgery was planned; however, because the defect was primarily inferior, indicating damage to the superior aspect of the optic tract, it was recommended that a craniotomy be performed. The mass was found at surgery to be a craniopharyngioma.
Over the past 20 years, researchers have discovered over 30 separate visual areas in the cortex of the macaque monkey that exhibit specific responses to visual and environmental stimuli. Many of these areas are homologous to regions of the human visual cortex, and numerous syndromes involving these areas are described in the neurologic and ophthalmic literature. The focus of this review is the anatomy and physiology of these higher cortical visual areas, with special emphasis on their relevance to syndromes in humans. The early visual system processes information primarily by way of two separate systems: parvocellular and magnocellular. Thus, even at this early stage, visual information is functionally segregated. We will trace this segregation to downstream areas involved in increasingly complex visual processing and discuss the results of lesions in these areas in humans. An understanding of these areas is important, as many of these patients will first seek the attention of the ophthalmologist, often with vague, poorly defined complaints that may be difficult to specifically define.
A 75-year-old man suddenly became aware of an inferior right homonymous visual field defect. Although static perimetry suggested a lesion of the left lateral geniculate nucleus, kinetic perimetry indicated that the presumed homonymous horizontal sectoranopia noted on static perimetry was actually an incomplete homonymous hemianopia with incomplete sparing of the temporal crescent. The location of the lesion was subsequently confirmed by magnetic resonance imaging. This case shows the value of kinetic perimetry in assessing homonymous visual field defects.
A prospective, clinical study was performed on patients with suspected carotid artery disease to compare the accuracy of compression and suction ophthalmodynamometry with carotid artery stenosis as determined by arteriography. Results were analyzed with respect to current criteria for classification and determination of "significant" carotid artery disease. Although our results suggest that the best correlation for both procedures with arteriography is a ratio of the corrected intraocular pressure to the systolic brachial blood pressure, these results were not statistically improved over those obtained using uncorrected systolic or diastolic values. Both suction and compression ophthalmodynamometry are equally accurate with levels approaching 80 percent; however, neither test is sensitive enough to be used alone as a screening technique. Arteriography remains the best procedure for the determination of carotid artery disease.
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Symptomatic patients with dural carotid-cavernous fistulas often require treatment. Traditional therapies, which often are not completely successful, include manual common carotid artery compression and embolization via transarterial routes. This report describes four symptomatic patients with spontaneous dural carotid-cavernous fistulas who were treated unsuccessfully with transarterial embolotherapy and subsequently treated successfully by having a detachable balloon introduced into the cavernous sinus via the superior ophthalmic vein, which was surgically exposed. The fistulas resolved without complications. Treatment of dural carotid-cavernous fistulas by means of the transvenous approach via the superior ophthalmic vein may be of benefit in selected patients.
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