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Biomedical subjects

R S Hepler

Publications and source records attributed to R S Hepler.

At least 37 records · Page 2Linked to original sources
PubMed1988

Contact-lens correction of aphakic infants and children: early behavioral and VEP results.

We studied 11 infants and young children fitted with contact lenses for correction of unilateral or bilateral aphakia. The visual-acuity estimates obtained from behavioral cues (alternate-cover test and central-fixation monitoring) were compared with results obtained from pattern-reversal visual-evoked potentials (VEP). We conclude that VEP may be more sensitive than behavioral observation for monitoring the visual progress in certain aphakic children.

Aphakia↗
PubMed1987

Alteration of the visual evoked potential by macular holes: comparison with optic neuritis.

Nine patients with maculopathy (macular holes, macular cysts, and lamellar holes) and ten patients with optic neuritis were examined in order to determine changes in the visual evoked potential (VEP) in response to pattern-reversal stimulation. Eyes with lamellar holes had normal P100 latency, but eyes with macular cysts and macular holes had prolonged P100 latency. Eyes with optic neuritis exhibited greater prolongation of the P100 latency than eyes with macular holes. In contrast, eyes with macular holes had a greater reduction in the steady-state VEP amplitude than eyes with optic neuritis. The prolonged latency occurring in maculopathy may be due to a peculiar amplitude summation noted with half-field VEP, rather than to a true conduction delay like that seen in eyes with optic neuritis. The amplitude slope, which is usually positive in normal controls, was negative for 85.7% of eyes with macular holes and 69.2% of eyes with optic neuritis. The negative amplitude slope may represent a subtle defect in retinal ganglion X cells. Eyes with significantly lower values for four or more of the nine central test points on quantitative automated perimetry had negative amplitude slopes and prolonged P100 latency.

Adult↗
PubMed1986

Magnetic resonance imaging of craniopharyngioma.

Craniopharyngiomas are common tumors located in the suprasellar region. Contrast enhancement, cyst formation, and calcification are the three characteristic features of craniopharyngiomas on computed tomographic scan. More than 90% of suprasellar craniopharyngiomas exhibit at least two of these three features, thus providing easy radiologic detection. We treated a 41-year-old man in whom a large suprasellar craniopharyngioma producing severe visual loss was not detected by computed tomography but was easily identified with magnetic resonance imaging. Thus, despite high-resolution computed tomographic scan, large suprasellar craniopharyngiomas can be missed. Magnetic resonance imaging may be superior to computed tomography in detecting these tumors.

Adult↗
PubMed1986

Sphenoid sinus mucocele (anterior clinoid variant) mimicking diabetic ophthalmoplegia and retrobulbar neuritis.

Two patients (two men, 56 and 59 years old) had sphenoid sinus mucocele originating in the anterior clinoid process. In one case the mucocele initially mimicked diabetic ophthalmoplegia with pupil-sparing palsy of the oculomotor (third) nerve. After resolution of the palsy, severe visual loss developed with minimal recovery of vision after surgery. The second patient had recurrent episodes of retrobulbar optic neuropathy with optic atrophy and decreased vision. Visual loss from sphenoid sinus mucoceles is usually associated with a poor prognosis if surgical treatment is delayed more than seven to ten days.

Diabetes Complications↗
PubMed1986

Ocular Munchausen's syndrome.

Patients with contrived histories and/or self-induced physical abnormalities (Munchausen's syndrome) are often successful in deceiving physicians. We recently cared for four patients with ocular Munchausen's syndrome. Self-induced ocular manifestations included voluntary nystagmus, subconjunctival hemorrhages, chronic orbital emphysema requiring exenteration, corneal alkali burns, erosions and ulcerations, and abscesses of the periorbital area. Correct diagnoses of ocular Munchausen's syndrome were made only after extensive medical and surgical investigations. Suggestions for evaluation and treatment will also be discussed.

Adult↗
PubMed1985

Methyl bromide optic atrophy.

A 32-year-old fumigation assistant developed systemic and neuro-ophthalmic manifestations of methyl bromide poisoning, including increased serum bromide level (6.6 mg/100 ml), paresthesias and burning dysesthesia on his hands and feet, and visual impairment. Ocular examination showed mild bilateral decrease in vision, temporal optic nerve head pallor, severely attenuated visual-evoked response amplitudes and normal latencies, a normal electroretinogram, an abnormal electrooculogram, and a severe deuteranomalous (green) defect on Farnsworth-Munsell 100-hue testing. His vision had not improved 12 months after the initial exposure.

Adult↗
PubMed1984

Retinal periphlebitis and retinitis in multiple sclerosis. I. Pathologic characteristics.

Eyes from 47 autopsy cases of multiple sclerosis were studied pathologically. Lymphocytic or granulomatous retinal periphlebitis was found in four cases (seven eyes); focal lymphocytic or granulomatous retinitis was present in three cases (five eyes). These findings were correlated with optic nerve changes (periphlebitis, neuritis, leptomeningitis, and atrophy), retinal venous sclerosis, uveitis, central nervous system involvement, clinical activity of disease at death, and with ultrastructural and immunopathological retinal findings.

Humans↗
PubMed1983

Analysis of characteristic eye movement abnormalities in internuclear ophthalmoplegia.

Quantitative electro-oculographic recording techniques were used to analyze four characteristic eye movement abnormalities in 21 patients with internuclear ophthalmoplegia (INO). The frequency of each of the abnormalities was determined to suggest a pattern that is the most sensitive in detecting the syndrome of INO. Slowing of the adducting saccade was the most frequently found abnormality, being present in all patients. The other characteristic eye movement disorders were found less frequently: dissociated nystagmus at 30 degrees of eccentric gaze, dysmetria of the abducting eye, and limitation of adduction. The most sensitive pattern for detecting an INO seems to be slowing of the adducting saccade combined with either dissociated nystagmus or dysmetria of the abducting eye. Limitation of adduction was seen much less frequently.

Adult↗
PubMed1982

Clinical manifestations and radiologic findings in craniopharyngiomas in adults.

The clinical and histopathologic findings in two adults with craniopharyngioma emphasized the wide age range and diverse initial manifestations of this tumor. A retrospective clinical review of 49 additional patients substantiated these points and disclosed that over 40% were initially examined by ophthalmologists. The initial manifestations fell into four broad categories: (1) visual system abnormalities (77% of the cases), (2) headache (67%), (3) endocrinologic abnormalities (57%), and (4) mental status abnormalities (19%). The frequency of these manifestations varied slightly among different age groups. The radiologic features in the two patients described (a 75-year-old man and a 38-year-old woman) included a distinct appearance on computed tomographic scans. These craniopharyngioma were not calcified and were isodense without contrast but enhanced densely and uniformly with contrast, simulating an aneurysm of the circle of Willis.

Adolescent↗
PubMed1980

Ocular lateropulsion. A sign of lateral medullary disease.

Four patients with clinically localized lesions in the lateral medulla exhibited a tonic bias of their eyes toward the damaged side despite full extracular movements. Each reported that his eyes were being pulled toward the involved side. Although the tonic bias was most prominent when fixation was inhibited, it also occurred with fixation and interfered with saccadic and smooth-pursuit eye movements. Saccades were hypometric when directed against the bias, whereas they were hypermetric when directed toward the side of the lesion. Smooth pursuit toward the intact side was severely impaired, whereas pursuit in the direction of the bias was normal or near normal. Lateropulsion of the eyes seems to be a unique sign of disease in the lateral medullary region of the brainstem.

Adult↗
PubMed1980

Burkitt's lymphoma with cranial nerve involvement.

A 22-year-old white native Californian acquired multiple cranial nerve palsies. He was found to have a Burkitt's-type lymphoma involving the ethmoid and sphenoid sinuses, with orbital invasion. Bone marrow involvement developed. Despite aggressive therapy, he died 18 weeks after the onset of his illness. Poor prognostic indicators included CNS symptoms at the time of initial onset, bone marrow involvement, and postadolescent occurrence. The absence of viable tumor at autopsy indicates sensitivity of Burkitt's lymphoma cells to combination chemotherapy and irradiation treatment.

Adult↗
PubMed1980

Mydriatic effect of phenylephrine 10% (aq) vs phenylephrine 2.5% (aq).

Pupil dilation from commercially available phenylephrine compounds was studied in a group of 11 subjects. Phenylephrine 10% (aq) did not produce significantly more mydriasis than phenylephrine 2.5% (aq) in the general population (P less than 0.05). This suggests that phenylephrine 2.5% can be used instead of phenylephrine 10% for diagnostic dilation.

Adult↗
PubMed1979

Orbital embryonal rhabdomyosarcoma and intracranial schwannoma.

A 39-year-old woman had a large benign intracranial schwannoma of the Gasserian ganglion. Thirty-two years previously, she had an embryonal rhabdomyosarcoma of the orbit. She had been treated by enucleation, local excision, and low-dose supplemental irradiation (1,400 rads). This is the longest survival of which we are aware following any treatment modality in such tumors. No correlation between the two tumors has been established.

Adult↗
PubMed1979

Arachnoidal cyst invading the orbit.

Ipsilateral glaucoma developed in a 51-year-old man with a left-sided temporal lobe arachnoidal cyst. Ultrasonic examination disclosed a cystic orbital lesion adjacent to the optic nerve. Following intracranial decompensation of the arachnoidal cyst, the intraocular pressure dropped markedly. Ultrasonography showed a collapse of the presumed optic nerve sheath cyst. While the exact mechanism producing glaucoma in this patient remains unclear, there was an apparent relationship between the elevated intraocular pressure and the arachnoidal cyst.

Arachnoid↗
PubMed1977

Atypical fibrous histiocytoma of the orbit: an electron-microscopic study.

A young woman developed progressive proptosis of her right eye, accompanied by retinal striae, exposure keratopathy and a severe decrease in visual acuity, reflecting optic neuropathy. An atypical fibrous histiocytoma was found within the orbit. She received orbital exenteration and irradiation. 2 years later she is free of clinical recurrence.

Adult↗