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Biomedical subjects

S Lessell

Publications and source records attributed to S Lessell.

At least 73 records · Page 4Linked to original sources
PubMed1992

Bilateral optic neuropathies with remission in two HIV-positive men.

Two patients seropositive for the human immunodeficiency virus (HIV) developed bilateral optic neuropathies. Evaluations failed to identify an infectious or neoplastic etiology. Both patients improved, one in temporal relation to treatment with azidothymidine (AZT), the other during oral steroid therapy. Optic neuropathy in HIV-positive patients does not necessarily carry a poor prognosis even when a treatable cause is not found. A role for primary HIV infection in the pathogenesis remains speculative.

Adult↗
PubMed1991

Recurrent idiopathic lateral rectus muscle palsy in adults.

Recurrent, unilateral, isolated, idiopathic lateral rectus muscle palsy is an uncommon but well-recognized disorder in children that has not been recognized as well in other age groups. We studied five cases of this uncommon entity that we encountered in adults and adolescents. Ages at onset ranged from 15 to 72 years and there were three to eight episodes per patient. Most of the patients shared the following features with the previously reported pediatric cases: ipsilateral recurrence, lack of pain, spontaneous recovery within six months, and no clear cause. Unlike the children, females or left-eye involvement was not preponderant in adults.

Adolescent↗
PubMed1991

Horner's syndrome from hypothalamic infarction.

We report a case of Horner's syndrome due to ipsilateral posterior hypothalamic infarction, occurring in the absence of other signs of hypothalamic dysfunction. Associated symptoms of contralateral faciobrachial weakness and dysarthria correlated with the extension of the infarct into the posterior limb of the internal capsule seen by magnetic resonance imaging. The likely vascular anatomy of this lesion is discussed.

Cerebral Infarction↗
PubMed1991

Optic neuritis and ischemic optic neuropathy. Overlapping clinical profiles.

A retrospective analysis of the clinical features of 81 patients with acute idiopathic optic neuritis and 58 patients with nonarteritic anterior ischemic optic neuropathy revealed a surprising overlap of manifestations. The rate of visual decline and the range of visual acuities were the same for both. Central scotomas and improvement in acuity were more common in optic neuritis, but occurred often enough in nonarteritic anterior ischemic optic neuropathy to limit their value as single diagnostic criteria. The similarities observed in this study suggest that it may be difficult to differentiate between optic neuritis and nonarteritic anterior ischemic optic neuropathy solely on nosologic grounds in some instances of acute, unilateral optic neuropathy.

Adult↗
PubMed1991

Mitogenic effects of excitatory amino acids in the adult rat retina.

We studied the retinas of adult rats after the intravitreal injection of excitatory amino acids and ouabain. Kainic acid, domoic acid, N-methyl D-asparate and ouabain produced swelling and vacuolization of the outer plexiform, inner nuclear and inner plexiform layers and pyknosis. Mitoses were present in retinas treated with all agents other than N-methyl D-asparate. Rompun ketamine anesthesia blocked the mitogenic effects. Immunohistochemical labeling of both glial fibrillary acidic protein and S100 protein would indicate that the mitoses are occurring in glial cells. We suggest that the mitogenic effects are mediated through action on glial cationic channels, and might account for the reactive gliosis observed in some retinal lesions.

Animals↗
PubMed1991

Optic chiasmal neuritis.

In four of six patients with clinical optic chiasmal neuritis, MRI demonstrated abnormalities of the chiasm. Optic chiasmal neuritis may be the initial manifestation of multiple sclerosis, a reflection of established CNS demyelination, or an isolated clinical finding.

Adolescent↗
PubMed1991

Steroid-induced visual recovery in fibrous dysplasia.

Fibrous dysplasia is a rare disorder of bone that may be associated with acute loss of vision. Surgical intervention is generally advocated and sometimes restores vision in these patients. We report a case of a patient with unilateral optic neuropathy from fibrous dysplasia who suffered two acute episodes of visual impairment. The first episode of vision loss was reversed by surgery and the second by corticosteroid treatment. A trial of corticosteroid therapy may be beneficial in cases of acute vision loss due to fibrous dysplasia.

Adult↗
PubMed1990

Isolated pupil-sparing third-nerve palsy as the presenting sign of multiple sclerosis.

A 27-year-old man presented with an isolated, pupil-sparing, partial third-nerve palsy. Etiologic investigations proved unrevealing. Subsequent development of an optic neuropathy prompted magnetic resonance imaging, which confirmed the clinical suspicion of multiple sclerosis. Rarely does multiple sclerosis present with oculomotor nerve involvement.

Adult↗
PubMed1990

Corneal surface irregularities and episodic pain in a patient with mucolipidosis IV.

Mucolipidosis IV is a lysosomal storage disease characterized by prominent involvement of the corneal epithelium. A 5-year-old boy with mucolipidosis IV experienced recurrent episodes of severe ocular pain, tearing, and ipsilateral facial flushing. This was suggestive of reflex sympathetic dystrophy, a syndrome of pain and sympathetic hyperactivity. The examination revealed marked corneal surface irregularities, corresponding to massive accumulations of intracytoplasmic storage material in the epithelium. Episodic pain in patients with mucolipidosis IV is an important symptom, presumably reflecting the distinctive corneal ultrastructural abnormality in this disease.

Cataract Extraction↗
PubMed1990

Trazodone-induced palinopsia.

Palinopsia refers to the persistence or reappearance of an image of a recently viewed object. Typically, patients with palinopsia have other visual symptoms or signs, and the underlying cause is a structural lesion of the posterior portions of the cerebral hemispheres. However, we treated three patients who experienced palinopsia as an isolated symptom, apparently as a side effect of trazodone hydrochloride therapy for depression. The palinopsia was dose related and disappeared with reduction or cessation of therapy.

Adult↗
PubMed1990

Extracranial optic nerve decompression for traumatic optic neuropathy.

We examined 14 patients with acute, unilateral optic nerve injury after blunt head trauma. In each patient the optic canal was decompressed through an ipsilateral external ethmoidectomy. The patients also received treatment with dexamethasone during the perioperative period. There was no morbidity or mortality. Eleven of the 14 patients improved, including 3 of the 5 who could not perceive light preoperatively. Transethmoid-sphenoid optic canal decompression is a safe and effective treatment for indirect optic nerve trauma.

Adult↗
PubMed1989

Lithium-induced downbeat nystagmus.

We examined six patients who developed blurring or oscillopsia as a result of downbeat nystagmus while being treated with lithium carbonate. Of these six plus six previously described similar patients, all but two developed downbeat nystagmus insidiously as an isolated disorder in the setting of otherwise satisfactory therapeutic control, without clinical or biochemical evidence of acute lithium intoxication. Only six of these 12 patients were able either to reduce or to stop taking lithium, and in only two of these six did the downbeat nystagmus improve or remit.

Adult↗
PubMed1989

Bilateral central retinal artery occlusions, disk drusen, and migraine.

A central retinal artery occlusion occurred in the left eye of a 25-year-old woman with migraine and bilateral intrapapillary drusen. An extensive investigation failed to establish the presence of any systemic disease or vasculopathy. Eight years later she had a central retinal artery occlusion in her right eye. Optic disk drusen and migraine may have combined to produce this patient's bilateral visual loss consequent to retinal vaso-occlusion.

Adult↗
PubMed1989

Indirect optic nerve trauma.

This report summarizes the details of 33 personal cases of the important but uncommon entity of posttraumatic optic neuropathy, seen during an 11-year interval. Victims were predominantly young males, and bicycles proved the most common source of injury. Severity of visual loss correlated poorly with level of consciousness and presence of craniofacial fractures. Optic canal fractures were found in only seven of the patients. Vision improved in five of 25 untreated patients, one of four treated with corticosteroids, and three of four treated with corticosteroids and transethmoidal decompression of the optic canal. No patients lost vision after their initial examination. Two of six initially blind eyes regained some vision. Management of these injuries is controversial. Hospitals should designate physician teams that should develop and implement a treatment plan for traumatic optic neuropathies.

Accidental Falls↗
PubMed1989

Superior segmental optic hypoplasia. A sign of maternal diabetes.

In a review of 10 patients with superior segmental optic nerve hypoplasia, all of whom were the children of diabetic mothers, 17 of 20 eyes had one or more of four characteristic findings in the optic disc: relative superior entrance of the central retinal artery, pallor of the superior disc, superior peripapillary halo, and thinning of the superior peripapillary nerve fiber layer. We believe that the presence of these four signs of superior segmental optic nerve hypoplasia strongly suggests maternal diabetes.

Adult↗