Biomedical subjects
R W Beck
Publications and source records attributed to R W Beck.
Orbital involvement in mycosis fungoides.
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Structural factors in the pathogenesis of ischemic optic neuropathy.
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Orbital emphysema as an ophthalmologic emergency.
Orbital emphysema is generally a benign, self-limited condition. However, if a fracture produces a ball-valve effect allowing air to enter but not to leave the orbit, and if the orbital septum remains intact, then extremely high intraorbital pressure and visual loss is possible. Two cases are described of visual loss from orbital emphysema, in a 33-year-old man and a 28-year-old man, which were successfully treated by a lateral canthotomy and cantholysis.
Optic disc structure in anterior ischemic optic neuropathy.
The etiology of anterior ischemic optic neuropathy (AION), when not associated with giant cell arteritis, is usually unknown. Clinical, pathologic, and experimental studies have not determined a cause. The optic disc appearance in both the involved and normal fellow eye was studied in 51 patients with acute nonarteritic AION. The number of discs (both involved and fellow) without a physiologic cup was significantly greater than would be expected from normal population studies. The etiology of nonarteritic AION may be related to the anatomic configuration of the optic nerve.
Optic disc edema in the presumed ocular histoplasmosis syndrome.
Two patients with presumed ocular histoplasmosis syndrome developed optic disc edema. In both cases the edema resolved without residual impairment of visual function. Although peripapillary changes in ocular histoplasmosis are common, optic disc edema is rare. The pathogenesis of the edema is unknown.
Contrast sensitivity measurements in acute and resolved optic neuritis.
We measured contrast sensitivity by means of Arden grating plates in 41 eyes with acute optic neuritis and in 51 eyes with resolved optic neuritis. The scores were abnormal in 93% of eyes in the acute phase and 78% in the resolved phase irrespective of visual acuity. Even when acuity improved to 6/7.5 or better with resolution of the neuritis, 67% of eyes still showed abnormal contrast sensitivity. Since Snellen acuity represents just one point at the high spatial frequency end of the contrast sensitivity function, a patient in whom acuity improves to 6/6 with resolution of optic neuritis may still have difficulty seeing objects of lower relative contrast or at lower spatial frequencies.
Melioidosis and bilateral third-nerve palsies.
Central nervous system involvement in melioidosis is unusual. We describe a 34-year-old man who developed a Pseudomonas pseudomallei meningitis, manifested as bilateral third-nerve palsies, 13 years after having been in southeast Asia. Diagnosis was established by a fourfold rise in the serum antibody titer for the bacterium. Recovery occurred after treatment with rifampin, isoniazid hydrochloride, ethambutol, and trimethoprim-sulfamethoxazole. Since a long latent period from exposure to overt infection is possible, additional cases of melioidosis in the United States can still be expected in veterans of the Vietnam War.
Acute posterior multifocal placoid pigment epitheliopathy and cerebral vasculitis.
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Anterior ischaemic optic neuropathy: recurrent episodes in the same eye.
Anterior ischaemic optic neuropathy is characterised by a sudden, painless loss of vision, optic disc oedema, and nerve fibre bundle visual field defects. It may be associated with giant cell arteritis but is usually idiopathic. Although subsequent involvement of the second eye is common, more than one episode in the same eye is extremely rare. Four patients with recurrent anterior ischaemic optic neuropathy in the same eye are described.
Iatrogenic Horner's syndrome secondary to chest tube thoracostomy.
We report a 22-year-old male who underwent a left thoracostomy and left lower lobectomy for a shotgun wound of the left anterior chest. During surgery, two chest tubes were placed in the left hemithorax at the level of the first and second intervertebral spaces. On the 10th postoperative day, the patient developed a left-sided miosis and ptosis. The diagnosis of a left preganglionic Horner's syndrome was confirmed by pharmacologic testing. The Horner's syndrome was unchanged 3 months after discharge. We conclude that the chest tubes damaged the preganglionic sympathetic fibers of the left orbit resulting in this patient's Horner's syndrome.
Functional disease in neuro-ophthalmology.
Techniques for assessment of the functional basis for neuro-ophthalmic complaints are given. By use of these techniques, most neurologists will discover that the majority of patients will resolve their symptoms without unwarranted medical procedures.
Involvement of the optic chiasm, optic tract and geniculo-calcarine visual system in multiple sclerosis.
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The neuro-ophthalmic examination.
A properly performed history and examination are essential to diagnosing correctly neuro-ophthalmic disorders. Aspects of the neuro-ophthalmic history and examination, particularly those dealing with evaluation of visual loss, are reviewed.
Plaque causing homonymous hemianopsia in multiple sclerosis identified by computed tomography.
Three patients with multiple sclerosis (women 20, 24, and 30 years old) had demyelinative plaques that produced homonymous hemianopsia. These lesions were identified by computed tomography which showed the plaques as hypodense areas. All patients with homonymous hemianopsia should undergo computed tomography; if a hypodense or enhancing lesion is identified, the diagnosis of multiple sclerosis must be considered.
Conjunctival, corneal involvement accompanying erosive-ulcerative blepharitis.
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Internuclear ophthalmoplegia after head trauma.
Internuclear ophthalmoplegia results from impairment of the medial longitudinal fasciculus. Multiple sclerosis is usually the cause in bilateral cases while a vascular lesion is commonly implicated in unilateral cases. Head trauma is a rare cause. We describe the case of a 52-year-old man who developed unilateral internuclear ophthalmoplegia following a head injury suffered in an automobile accident. Gradual improvement in the internuclear ophthalmoplegia occurred over a six-month follow-up period. Review of the literature reveals only ten previous reports of internuclear ophthalmoplegia secondary to head injury. In seven of these cases the internuclear ophthalmoplegia was the direct result of the trauma and in three it occurred only after subdural hematoma formation. These ten cases are summarized. Several theories for the pathophysiology of trauma-induced internuclear ophthalmoplegia are presented.
Acute ischemic optic neuropathy in severe preeclampsia.
A 32-year-old woman developed bilateral blindness along with severe preeclampsia of pregnancy. Ophthalmoscopic examination disclosed chalky-white optic disks with only minimal changes in the retinal vasculature. After caesarean section, the preeclampsia improved, and complete return of visual acuity occurred during a three-day period. Blindness has rarely been reported as a complication of preeclampsia. In almost all cases it has been associated with severe compromise of the retinal vasculature. conversely, the ophthalmoscopic findings in our case strongly support acute ischemic optic neuropathy as the cause of blindness.