Search PubMed⌕ Search

Biomedical subjects

R C Sergott

Publications and source records attributed to R C Sergott.

At least 91 records · Page 5Linked to original sources
PubMed1989

Positron emission tomography to study the effect of eye closure and optic nerve damage on human cerebral glucose metabolism.

We used 18F-2-fluoro-2-deoxyglucose and positron emission tomography to evaluate the effect of visual deprivation on brain glucose metabolism. In experiment 1, we compared local cerebral metabolic rates for glucose in seven normal volunteers studied with eyes closed to 11 age- and sex-matched normal volunteers studied with eyes open. Whole brain metabolism was similar in the two groups, and region/whole brain analysis of metabolic data showed that metabolism in the calcarine posterior cortex was decreased by 14% (P less than .05) with eye closure. Glucose metabolism in other regions was not different between the two groups. In experiment 2, we compared glucose metabolism in six patients with severe bilateral optic neuropathies to 12 age- and sex-matched normal controls. Whole brain glucose metabolism was unchanged in the optic neuropathy group compared to controls. However, statistically significant reductions in glucose metabolism in the optic neuropathy group were found in anterior calcarine cortex (17%), posterior calcarine cortex (27%), peristriate cortex (27%), and lateral occipital cortex (15%). The metabolic effects of damage to the pregeniculate visual system went well beyond those of simple eye closure.

Adolescent↗
PubMed1989

Abnormal ocular pneumoplethysmographic results in unilateral neovascular glaucoma.

Little is known about the predictive value of ocular pneumoplethysmography in patients with ophthalmic disease. We evaluated eight patients with unilateral increased intraocular pressure due to neovascular glaucoma who did not have evidence of severe extracranial carotid stenosis by duplex scanning and continuous-wave Doppler ultrasound. The ophthalmic systolic pressure measured by ocular pneumoplethysmography was decreased in the affected eye of all eight patients, indicating that neovascular glaucoma may be a cause of abnormal ocular pneumoplethysmographic results. Patients with neovascular glaucoma tended to have larger interocular ophthalmic systolic pressure differences than other patients with false-positive ocular pneumoplethysmographic results by noninvasive criteria.

Aged↗
PubMed1989

Ocular pneumoplethysmography can help in the diagnosis of giant-cell arteritis.

We compared the results of ocular pneumoplethysmography in nine patients who had a temporal artery biopsy (TAB) diagnostic of giant-cell arteritis with results of ocular pneumoplethysmography in nine patients with normal TAB results and 112 patients with anterior ischemic optic neuropathy or central retinal artery occlusion assumed to be nonarteritic. The mean +/- SD ocular pulse amplitude with ocular pneumoplethysmography was 3.9 +/- 1.8 mm in the group with abnormal TAB results and 10.6 +/- 4.0 mm in the group with normal TAB results. Every patient with abnormal TAB results had an average calculated ocular blood flow less than 0.60 mL/min, while only one patient with normal TAB results fell in this range. The average calculated ocular blood flow had a sensitivity of 100% and a specificity of 93.4% in the diagnosis of giant-cell arteritis, with a diagnostic accuracy of 93.9%. These results rival the diagnostic accuracy of the erythrocyte sedimentation rate and TAB results.

Aged↗
PubMed1989

Cryptogenic oculomotor nerve palsy. The need for repeated neuroimaging studies.

Five children between ages 3 and 17 years developed slowly progressive oculomotor nerve palsies. No cause was found on initial clinical or neuroradiologic investigations. Subsequent computed tomography or 1.5-T magnetic resonance imaging revealed a mass along the course of the involved oculomotor nerve in three of the five cases. The clinical and radiologic characteristics of these tumors are consistent with the diagnosis of schwannoma or, less likely, meningioma. Children with acquired oculomotor nerve palsies of initially unknown etiology should undergo imaging every two years with the expectation of eventually detecting a small tumor somewhere along the course of the oculomotor nerve.

Adolescent↗
PubMed1989

Acute retinal necrosis neuropathy. Clinical profile and surgical therapy.

Twelve patients (17 eyes) with the acute retinal necrosis syndrome were analyzed with special reference to the development of an acute optic neuropathy. Six patients (9 eyes) without acute optic nerve involvement were treated with intravenous acyclovir sodium and/or vitreoretinal surgery (group 1). Six patients (8 eyes) fulfilling absolute and relative criteria for acute retinal necrosis optic neuropathy were treated with intravenous acyclovir as well as optic nerve sheath decompression, and, in addition, some of these patients also underwent vitreoretinal surgery. Despite more pronounced initial visual loss compared with group 1, six eyes in group 2 regained visual acuity of 20/400 or better. In contrast, only 2 of 9 eyes in group 1 maintained their entry level visual acuity, and the visual acuities of the remaining 7 eyes deteriorated to counting fingers or worse. Therefore, the acute optic neuropathy complicating the acute retinal necrosis syndrome appears to benefit from prompt recognition and surgical decompression of the intraorbital optic nerve meninges in conjunction with intravenous acyclovir.

Acute Disease↗
PubMed1989

Optic nerve decompression may improve the progressive form of nonarteritic ischemic optic neuropathy.

Optic nerve sheath decompression surgery improved visual function for 12 of 14 patients with progressive nonarteritic ischemic optic neuropathy (NAION). Visual recovery was maintained in all patients during a follow-up period of 6 to 18 months (average, 11 months). Seven patients had experienced a previous NAION in the eye that was not operated on that did not improve spontaneously. Surprisingly, 2 of these 7 eyes with long-standing decreased vision demonstrated some visual improvement after surgery on the contralateral, acutely affected eye. Spontaneous visual improvement did not occur in an age- and sex-matched control group of 12 patients with similar entry-level visual acuity and field loss. Only 1 of 3 patients with sudden, nonprogressive visual loss secondary to NAION improved after surgery. In a control group with nonprogressive NAION, 2 of 15 eyes (14 patients) demonstrated spontaneous improvement. Optic nerve sheath decompression improves visual loss due to progressive NAION, a disorder without any previously effective therapy. However, for acute, nonprogressive NAION, surgery for a small number of patients did not improve the natural history of the disease.

Adult↗
PubMed1989

Hereditary retinal vasculopathy with cerebral white matter lesions.

We report on a syndrome of progressive visual loss and leukoencephalopathy affecting several relatives. Affected individuals had evidence of retinal vasculopathy on fluorescein angiogram and periventricular white matter lesions on brain magnetic resonance imaging. The clinical manifestations in this family suggest transmission of an autosomal dominant vasculopathy affecting both retinal and intracranial vessels.

Adult↗
PubMed1989

Intermittent obstructive hydrocephalus in the Arnold-Chiari malformation.

A 26-year-old woman with a Chiari-I malformation and intermittent symptoms of intracranial pressure elevation is described. Clinically, papilledema was accompanied by midperipheral retinal hemorrhages. Repeat computed tomographic scans and lumbar puncture showed normal results. Posterior fossa-directed magnetic resonance image scanning revealed the Chiari-I malformation. Intraventricular monitoring was necessary to demonstrate the marked but unsustained elevation of intracranial pressure.

Adult↗
PubMed1989

Divisional oculomotor nerve paresis caused by intrinsic brainstem disease.

Two patients with findings ascribable to superior branch oculomotor nerve paresis and one patient with findings ascribable to an inferior branch paresis are described. In each patient the paresis was caused by an intra-axial midbrain lesion. These patients represent the first described cases of divisional oculomotor nerve paresis caused by intrinsic brainstem disease.

Adult↗
PubMed1989

Results of radiotherapy for thyroid ophthalmopathy.

Between October, 1978 and August, 1986, 35 patients with thyroid ophthalmopathy were treated with radiotherapy. Twenty-eight patients had treatment with corticosteroids prior to radiotherapy and either progressed on steroids or relapsed during tapering. Seven patients with contraindications to steroids were treated primarily with radiotherapy. After radiotherapy, 25 patients (71%) did not require any further steroids or orbital decompression and ten (29%) failed. Patients who required steroids or decompression for active disease after radiotherapy were considered treatment failures. A total of 14 (40%) patients required eye muscle or lid surgery for correction of stable soft tissue defects after radiotherapy, more commonly in patients treated with radiotherapy after steroids or decompression than those irradiated primarily; the median time between radiotherapy and surgery was 8 months (range 1-48). Various factors were examined for prognostic significance in predicting radiotherapy failure. Review of the interval between onset of eye disease and radiotherapy demonstrated that six of ten (60%) failures versus only five of 25 (20%) successful treatments received radiotherapy within 6 months of onset of eye disease. No relation between outcome and sex, age or hyperthyroid versus euthyroid Graves' disease was apparent. Radiotherapy has been used for patients with thyroid ophthalmopathy who failed steroids, decompression, or had steroid contraindications. Morbidity of radiotherapy was minimal and most patients were spared the morbidity of continued steroid therapy.

Adult↗
PubMed1989

Syphilitic uveitis in human immunodeficiency virus-infected and noninfected patients.

Seventeen patients with luetic uveitis had human immunodeficiency virus (HIV) testing and lumbar puncture to determine if the HIV-positive status altered the clinical profile of syphilis. Twelve of the 17 patients tested positive for HIV. All 12 patients had abnormal lumbar punctures, but only two of the five HIV-negative patients had abnormal results of spinal taps. Ocular disease also was more severe in the HIV-positive group.

Adult↗
PubMed1989

Alzheimer's disease with prominent visual symptoms. Clinical and metabolic evaluation.

The authors examined eight patients with dementia of the Alzheimer's type (DAT), five with prominent visual symptoms early in the illness (VS) and three with no visual symptoms (NVS). Results of neuro-ophthalmologic examinations on VS patients showed relatively consistent abnormalities in figure copying, color vision tested by isochromatic plates, and stereopsis. Cerebral glucose metabolism determined by 18F-fluoro-2-deoxyglucose positron emission tomography (PET) was unchanged in primary visual cortex of VS and NVS patients compared with 12 normal volunteers of similar age and sex. Glucose metabolism in VS patients was decreased by 45 and 34% in left and right visual association cortex (P less than 0.01 and P less than 0.05, respectively) and 34 and 37% in left and right inferior parietal cortex (P less than 0.05) compared with controls; NVS patients had no significant metabolic alteration in these areas. Symptoms, physical examination, and metabolic imaging imply that these patients are a heterogenous but distinct clinical subgroup of DAT often with mild dementia who have visual symptoms due primarily to visual agnosia.

Aged↗
PubMed1989

T-lymphocyte subpopulations in acute unilateral optic neuritis.

The authors prospectively analyzed T-lymphocyte subpopulations in the peripheral blood of nine patients with acute unilateral optic neuritis and compared them with 25 controls without neurologic disease. The presence or absence of alterations in circulating T-cell subsets has not been examined previously in patients with isolated optic neuritis. The authors found the mean ratio of inducer (CD4) to suppressor (CD8) T-lymphocytes was 2.07 +/- 0.51 for the group with optic neuritis, statistically indistinguishable from a value of 1.78 +/- 1.04 for the control group. Multiple sclerosis (MS) subsequently developed in one patient. Her inducer/suppressor T-cell ratio was initially 2.66, but progressively increased to 3.68 concomitant with the clinical manifestation of focal neurologic signs. Although optic neuritis may be the initial clinical sign of MS, the periodic alteration of circulating T-lymphocytes increasing the inducer/suppressor T-cell ratio in MS was not observed in those with isolated optic neuritis.

Adult↗
PubMed1989

Optic neuritis with secondary retinal venous stasis.

The authors report five cases of optic neuritis accompanied by secondary impairment of retinal venous outflow producing the clinical appearance of impending or actual central retinal vein occlusion. In four of five cases, intravenous fluorescein angiography showed delayed venous filling with venous dilation and tortuosity. Decreased visual function was entirely attributable to optic nerve involvement because the clinical and angiographic examinations revealed no evidence of capillary nonperfusion, macular edema, or macular hemorrhage. The visual outcome of the patients paralleled that expected with optic neuritis. The authors believe that optic nerve inflammation associated with secondary impairment of retinal venous outflow is a distinct but uncommon entity. Because of its ophthalmoscopic appearance, this variety of optic neuritis may be confused with either papillophlebitis or central retinal venous occlusion in young patients.

Adolescent↗
PubMed1988

Low-contrast letter charts to detect subtle optic [corrected] neuropathies.

We performed visual contrast sensitivity testing with Regan's low-contrast letter charts on 30 patients with optic neuropathies and good Snellen visual acuity. Results of this testing were compared with color vision and the presence of an afferent pupillary defect. Regan's low-contrast letter charts were found to be 93% sensitive for detecting subtle optic neuropathies, with the apparent false-negative findings being readily explainable. Color vision testing was abnormal in only 49% of eyes with known optic neuropathies.

Adolescent↗
PubMed1988

Modified optic nerve sheath decompression provides long-term visual improvement for pseudotumor cerebri.

Twenty-three patients with chronic papilledema associated with pseudotumor cerebri underwent "modified" optic nerve sheath decompression for treatment of visual acuity and visual field loss. Instead of removing a single, rectangular section of optic nerve meninges, the operation was modified by making at least three longitudinal incisions in the sheath and then lysing arachnoid adhesions with a tenotomy hook. Twenty-one of the 23 patients demonstrated improved visual function after the initial surgery for a mean (+/- SD) follow-up of 21.5 +/- 12.3 months (median, 25 months; range, three to 45 months) without reoperation or reinstitution or oral corticosteroid and diuretic therapies. The two patients failing to improve after the first surgical procedure initially had a single meningeal window created and subsequently improved following reoperation with the modified procedure. Twelve of 21 patients with bilateral visual loss had improved visual function bilaterally after unilateral surgery. Six of the 21 patients needed bilateral surgery, and the other three had minor visual field defects in the second eye not severe enough to warrant surgery. Preoperative optic disc pallor did not predict a poor postoperative result. Optic nerve surgery improved the visual function in six patients who had failed to recover vision after one or more lumbar-peritoneal shunts.

Adolescent↗
PubMed1988

Alternating skew on lateral gaze (bilateral abducting hypertropia).

We report thirty-three patients with alternating skew deviation on lateral gaze. The right eye was hypertropic in right gaze, and the left eye was hypertropic in left gaze. Most patients had associated downbeat nystagmus and ataxia and were diagnosed as having lesions of the cerebellar pathways or the cervicomedullary junction. This contrasts with a previous report in which alternating skew was seen mainly in lesions of the midbrain pretectum.

Adolescent↗