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Biomedical subjects

Rod Foroozan

Publications and source records attributed to Rod Foroozan.

At least 19 recordsLinked to original sources
PubMed2007

Decreased retinal nerve fibre layer thickness detected by optical coherence tomography in patients with ethambutol-induced optic neuropathy.

BACKGROUND: It is difficult to assess the degree of optic nerve damage in patients with ethambutol-induced optic neuropathy, especially just after the onset of visual loss, when the optic disc typically looks normal. AIM: To evaluate changes in retinal nerve fibre layer thickness (RNFLT) using optical coherence tomography (OCT) in patients with optic neuropathy within 3 months of cessation of ethambutol treatment. DESIGN: A retrospective observational case series from a single neuro-ophthalmology practice. METHODS: 8 patients with a history of ethambutol-induced optic neuropathy were examined within 3 months after stopping ethambutol treatment. All patients underwent a neuro-ophthalmologic examination, including visual acuity, colour vision, visual fields and funduscopy. OCT was performed on both eyes of each patient using the retinal nerve fibre layer analysis protocol. RESULTS: The interval between cessation of ethambutol treatment and the initial visit ranged from 1 week to 3 months. All patients had visual deficits characteristic of ethambutol-induced optic neuropathy at their initial visit, and the follow-up examination was performed within 12 months. Compared with the initial RNFLT, there was a statistically significant decrease in the mean RNFLT of the temporal, superior and nasal quadrants (p = 0.009, 0.019 and 0.025, respectively), with the greatest decrease in the temporal quadrant (mean decrease 26.5 mum). CONCLUSIONS: A decrease in RNFLT is observed in all quadrants in patients with ethambutol-induced optic neuropathy who have recently discontinued the medication. This decrease is most pronounced in the temporal quadrant of the optic disc.

Aged↗
PubMed2006

Occurrence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension.

PURPOSE: To report the rate of occurrence of cerebral venous sinus thrombosis (CVST) in patients with presumed idiopathic intracranial hypertension (IIH). DESIGN: Retrospective chart review. PARTICIPANTS: All patients diagnosed with papilledema from November 1, 2002, through October 31, 2003, at 3 tertiary care neuro-ophthalmology centers. METHODS: Consecutive patients with a diagnosis of papilledema from 3 tertiary care neuro-ophthalmology centers were identified. Patients with space-occupying lesions, hydrocephalus, or meningitis were excluded. The remaining patients were evaluated with lumbar puncture, magnetic resonance imaging (MRI), and magnetic resonance venography (MRV). MAIN OUTCOME MEASURES: The rate of occurrence of CVST in patients with presumed IIH. RESULTS: One hundred thirty-one patients with papilledema were identified. Excluding patients with mass lesions, meningitis, or hydrocephalus, the occurrence of CVST was 10 (9.4%) of 106 patients with presumed IIH. Two additional patients had a diagnosis of suspected CVST. Cerebral venous sinus thrombosis was diagnosed in 1 of the 10 patients with MRI alone, whereas it was evident in all 10 patients with MRV. Underlying risk factors for CVST were identified in 9 of 10 patients. CONCLUSIONS: Cerebral venous sinus thrombosis accounts for 9.4% of patients with presumed IIH in 3 tertiary care neuro-ophthalmology services. Magnetic resonance venography in combination with MRI is recommended to identify this subgroup of patients.

Adolescent↗
PubMed2006

Quantitative analysis of temporal artery contraction after biopsy for evaluation of giant cell arteritis.

BACKGROUND: Although the degree of contraction of temporal artery biopsy specimens after formalin fixation has been previously reported to range from 6% to 13%, the degree of contraction before fixation has not been previously studied. The aim of this study was to quantify the postexcision (prefixation) contraction of temporal artery biopsy specimens and to determine the relationship between contraction and the result of the biopsy. METHODS: All patients undergoing temporal artery biopsies from February 2003 through May 2004 were retrospectively reviewed. Contraction was determined by subtracting the in vivo and ex vivo lengths, then dividing the difference by the in vivo length to obtain a percentage of contraction. Statistical analysis was performed with the unpaired t test and Fisher exact test. RESULTS: We reviewed 37 negative and 7 positive biopsies for giant cell arteritis (GCA). For specimens positive for GCA, the mean contraction was 12%, whereas for negative specimens, mean contraction was 22%. There was a significant difference in the contraction between the specimens positive and negative for GCA (p = 0.009). The Fisher exact test revealed that GCA was positively associated with arterial contraction of less than 15% (p = 0.002). INTERPRETATION: The temporal artery can contract substantially after excision and before tissue fixation. GCA-positive specimens exhibit statistically less contractility than negative specimens.

Biopsy↗
PubMed2006

Cortical visual impairment in children.

PURPOSE OF REVIEW: Cortical visual impairment is rapidly becoming a leading cause of visual loss in children in developed countries predominately because of the improved survival rates of premature infants over the past decade. RECENT FINDINGS: Most cases of cortical visual impairment arise from hypoxic ischemic injury to watershed areas of the brain. In the preterm infant the watershed areas are in the subcortex around the ventricles, while in the term infant the watershed areas are between the major arteries with injury to the subcortex and cortex. Therefore, preterm and term injury will manifest different ocular and visual system abnormalities as a result of this damage. Cognitive visual dysfunction, a type of cortical visual impairment, may occur in cases of damage to the peristriate cortex (association areas of the brain). The anterior visual pathways may also be damaged in a retrograde, transsynaptic fashion in cases of cortical visual impairment. SUMMARY: Cortical visual impairment is a prevalent cause of visual loss in children. It encompasses a wide range of visual disabilities from no light reception to normal visual acuity with cognitive visual dysfunction.

Blindness, Cortical↗
PubMed2006

Relationship between retinal nerve fiber layer and visual field sensitivity as measured by optical coherence tomography in chiasmal compression.

PURPOSE: To investigate the spatial relationship between retinal nerve fiber layer (RNFL) thickness measured with optical coherence tomography (OCT) and visual field sensitivity (VFS) measured by standard automated perimetry (SAP) in chiasmal compression. METHODS: Twenty-six patients with chiasmal compression were enrolled. RNFL thickness was measured with the StratusOCT and VFS with SAP (Humphrey Field Analyzer; both from Carl Zeiss Meditec, Dublin, CA). Relationships between RNFL thickness (in clock hours, hemifields, and sectors) and VFS (zones were divided into hemifields, quadrants, and sectors based on a validated visual field map) expressed in a decibel scale and 1/lambert (L) were evaluated by linear and nonlinear regression. Coefficients of determination (R(2)) were calculated by using a multivariate model. RESULTS: Average RNFL thickness correlated strongly with pattern standard deviation (PSD; R = 0.622) and mean deviation (MD; R = 0.413). The four strongest correlations were between the 8 o'clock OCT position (temporal disc), with the temporal hemifield (R = -0.813), the superotemporal quadrant (R = -0.847), the inferotemporal quadrant (R = -0.855), and the field sector representing the papillomacular bundle (R = -0.809). Coefficients of determination improved significantly in all sectors when time since surgery was included in the regression model-most notably, average thickness and 1/L (R(2) = 0.35-0.49), the decibels (R(2) = 0.31-0.47), and the temporal sector (R(2) = 0.44-0.57). CONCLUSIONS: This is the first study to compare the structure-function correlation of RNFL measured by OCT with SAP in patients with chiasmal compression. RNFL is topographically related globally and sectorally to decreased SAP, with the temporal sectors showing the strongest correlations. The correlation between RNFL and VFS strengthens as the time from surgical intervention increases.

Adolescent↗
PubMed2005

Macular hole in cat scratch disease.

PURPOSE: To report the development of a macular hole as a complication of cat scratch disease. DESIGN: Case report. METHODS: A 10-year-old girl was seen with unilateral neuroretinitis from serologically confirmed cat scratch disease. Twelve days later, she developed a macular hole in the involved eye. Fundus photography and optical coherence tomography (OCT) were obtained at presentation and after the development of a macular hole. RESULTS: Fundus photography and OCT on presentation revealed a nasal neurosensory detachment and multiple inflammatory foci throughout the macula, including a subfoveal lesion. Fundus photography and OCT 12 days later revealed the development of a partial posterior vitreous detachment and a full thickness macular hole. CONCLUSIONS: Macular hole should be included among posterior segment complications of cat scratch disease. In this case, the macular hole was associated with partial vitreous detachment and a preexisting subfoveal lesion, likely representing an inflammatory focus.

Antibodies, Bacterial↗
PubMed2005

Optic neuropathy associated with linezolid treatment.

Two patients undergoing long-term treatment with linezolid for pneumonia had decreased visual acuity, dyschromatopsia, and cecocentral scotomas characteristic of toxic optic neuropathy. Visual function slowly recovered 3 to 4 months after discontinuation of the antibiotic treatment in both patients. Toxic optic neuropathy may occur from linezolid. Early withdrawal of the antibiotic may be associated with visual recovery.

Acetamides↗
PubMed2004

Diagnosis of metastatic carcinoma to the cavernous sinus by computed tomograpy-guided fine-needle aspiration.

PURPOSE: To describe a case of metastatic lung carcinoma to the cavernous sinus and orbital apex diagnosed by fine-needle aspiration guided by computed tomography. DESIGN: Case report. METHOD: A 52-year-old man who presented with right-sided ptosis and ophthalmoplegia was found to have an enhancing mass of the right orbital apex and cavernous sinus extending into the temporal fossa on magnetic resonance imaging. Chest computed tomography revealed hilar adenopathy and a lesion of the right lower lobe of the lung. Bronchial washings and transbronchial needle biopsies of the lung were nondiagnostic. Computed tomography-guided fine-needle aspiration of the temporal fossa portion of the mass was performed. RESULT: Biopsy of the mass showed malignant cells consistent with metastatic non-small cell lung carcinoma. CONCLUSION: Computed tomography-guided fine-needle aspiration can be useful in the diagnosis and management of some masses involving the cavernous sinus.

Biopsy, Fine-Needle↗
PubMed2004

Microsaccadic opsoclonus: an idiopathic cause of oscillopsia and episodic blurred vision.

PURPOSE: To describe the clinical presentation and results of three-dimensional video-oculography of a patient with idiopathic microsaccadic opsoclonus. DESIGN: Observational case report. METHODS: Neuro-ophthalmologic examination and video-oculographic recording of horizontal, vertical, and torsional eye movements. RESULTS: A 67-year-old man with intermittent blurred vision and oscillopsia, which persisted with monocular occlusion, over a five year period was found to have high frequency, small amplitude back-to-back multivectorial saccadic movements which were visible with slit lamp biomicroscopy and direct ophthalmoscopy. Video-oculography showed a 20 Hz, 0.2 to 1 degree pattern of horizontal, vertical, and torsional microsaccades. This microsaccadic disorder has persisted for five years with no etiology. CONCLUSIONS: Microsaccadic opsoclonus is an idiopathic disorder that presents with oscillopsia and intermittent blurred vision. The diagnosis can be confirmed with three-dimensional eye movement recordings.

Aged↗
PubMed2004

Voluntary suppression of the multifocal electroretinogram.

OBJECTIVE: To describe multifocal electroretinogram (mfERG) responses in 2 patients with nonorganic visual loss and in 11 eyes of 6 healthy persons who suppressed their mfERG responses. DESIGN: Observational case series. METHODS: The mfERG results were recorded in all individuals using the Veris Science 4.2 instrument. All subjects were instructed to adjust the hexagonal test pattern so that it was in best focus. A second mfERG was recorded subsequently in volunteers who attempted suppression with inattention and poor fixation and by adjusting the focus to greatest blur. MAIN OUTCOME MEASURES: Amplitude and latency of mfERG responses. RESULTS: Suppressed mfERGs in patients with nonorganic visual loss and healthy volunteers demonstrated reduced amplitude, especially centrally. Amplitude reduction was statistically significant in the postsuppression as compared with the presuppression recordings in wave forms N1 and N2. Statistically significant shortening of postsuppression implicit times of P1 and N2 waveforms also was demonstrated. CONCLUSIONS: The mfERG responses may be suppressed voluntarily. Amplitude may be reduced. In contrast to most reported pathologic conditions, the implicit time is shortened.

Adult↗
PubMed2004

Transient visual loss may anticipate occipital infarction from hemodialysis.

BACKGROUND: The aim of this study was to report on a patient who had occipital infarction from intradialytic hypotension and review the literature on hemodialysis and visual loss. METHODS: Neuro-ophthalmologic examination and magnetic resonance imaging (MRI) of the brain were conducted. RESULTS: A 61-year-old woman had acute onset of a right homonymous superior quadrantic visual field defect during dialysis after several episodes of transient visual loss associated with symptomatic intradialytic hypotension. MRI showed acute infarction in the left occipital lobe. CONCLUSION: Visual loss is an uncommon complication of hemodialysis. The mechanism usually is related to hypotension and is usually from anterior ischemic optic neuropathy. Although cortical blindness secondary to stroke has been reported as a complication after hemodialysis, we were unable to find another report of visual loss secondary to stroke attributed to intradialytic hypotension with preceding episodes of transient visual loss. Transient visual loss may be a risk factor for stroke during hemodialysis.

Blindness↗
PubMed2004

Bilateral anterior ischemic optic neuropathy after liposuction.

A 30-year-old woman had bilateral anterior ischemic optic neuropathy after undergoing large-volume liposuction. Visual function remained stable over a four-month follow-up, with decreased visual acuity and marked constriction of the visual fields. To our knowledge, this is the second reported case of ischemic optic neuropathy in this setting.

Acetazolamide↗
PubMed2004

Orbital apex syndrome.

PURPOSE OF REVIEW: Visual loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves are the hallmarks of an orbital apex syndrome. Historically, the terms superior orbital fissure, orbital apex, and cavernous sinus have been used to define the anatomic locations of a disease process. However, the diagnostic evaluation and management is similar for each of these entities. The authors reviewed the literature on the diagnosis and evaluation of disorders involving the orbital apex. RECENT FINDINGS: High-resolution MRI is the preferred modality for evaluating most lesions involving the orbital apex. CT is a useful tool in the setting of trauma, to evaluate bone involvement, or when MRI is contraindicated. Although laboratory studies may be useful adjuncts in the diagnostic evaluation of lesions involving the orbital apex, surgical biopsy is often required for definitive diagnosis. SUMMARY: Orbital apex syndromes may result from a variety of inflammatory, infectious, neoplastic, iatrogenic/traumatic, and vascular conditions. A detailed history with review of systems is important in narrowing the differential diagnosis. Management is directed at the underlying cause and may be guided by surgical biopsy. Corticosteroids may be useful if an inflammatory etiology is suspected, but should be used with caution.

Cranial Nerves↗