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Biomedical subjects

Simmons Lessell

Publications and source records attributed to Simmons Lessell.

At least 19 recordsLinked to original sources
PubMed2006

Visual outcome of accelerated fractionated radiation for advanced sinonasal malignancies employing photons/protons.

PURPOSE: To investigate the visual outcomes of patients with advanced sinonasal malignancies treated with proton/photon accelerated fractionated radiation (AFR). PATIENTS AND METHODS: Between 1991 and 2001, AFR was used to treat 36 patients with advanced stage primary (n=33) or recurrent (n=3) nasal or paranasal malignant tumors. Full ophthalmologic follow-up was documented. The median dose to the gross tumor volume (GTV) was 69.6 CGE (range 60.8-77). Visual complications were graded according to the National Cancer Institute Common Toxicity Criteria (CTC) and the late effects of normal tissue (LENT) scoring systems. The median follow-up was 52.4 months (range 17-122.8). RESULTS: Thirteen patients developed late visual/ocular toxicity. Cataracts were LENT grade 1 and 3 in 2 patients and 1 patient, respectively. One LENT grade 1 vascular retinopathy and 1 optic neuropathy were also observed. Three and five patients presented with nasolacrimal duct stenosis (CTC grade 2, 2 patients; CTC grade 3, 1 patient) and dry-eye syndrome (CTC grade 1, 1 patient; CTC grade 2, 4 patients), respectively. The 3- and 5-year probability of LENT/CTC grade > or =2 visual toxicity were 15.8+/-6.7% and 20.7+/-7.8%, respectively. CONCLUSIONS: AFR for locally advanced nasal cavity and paranasal sinus tumors enables delivery of 70 CGE to the tumor with acceptable ophthalmologic complications.

Adult↗
PubMed2006

Ischemic optic neuropathy following spine surgery in a 16-year-old patient and a ten-year-old patient.

Peri-operative ischemic optic neuropathy typically occurs in middle-aged or older patients. We report this condition in two patients aged 16 and 10 years. Only six other cases of peri-operative ischemic optic neuropathy have been reported in patients aged less than 30 years, all but one occurring after spinal surgery. Although the visual prognosis appears to be more favorable in younger patients, the pathogenesis of this rare complication of surgery is likely to be the same as that affecting older individuals.

Adolescent↗
PubMed2005

Delayed visual decline in patients with "stable" optic neuropathy.

BACKGROUND: Histological studies on the human optic nerve have documented decreasing axonal nerve fiber counts with age. In patients with optic atrophy, a nonpathological dropout of ganglion cell axons as part of the normal aging process may become clinically significant. OBJECTIVE: To describe the occurrence of delayed visual loss in patients with presumably "stable" optic neuropathy. METHODS: We reviewed the medical records of 3 patients who experienced slowly progressive visual loss in adulthood after suffering childhood optic nerve injury. RESULTS: All 3 patients had a monophasic illness in childhood that caused bilateral optic atrophy and visual impairment. Following decades of stability, each suffered a gradual, symptomatic visual decline that extended over years. No new ophthalmologic, systemic, or neurologic disorder was found that explained the visual decline in any of these patients. CONCLUSION: We hypothesize that the late visual decline in these 3 patients resulted from deleterious effects of age-related axonal loss on an already depleted population of neurons.

Age of Onset↗
PubMed2005

Idiopathic repetitive oculomotor nerve palsies in otherwise normal patients.

OBJECTIVE: To describe a unique idiopathic disorder characterized by transient repetitive unilateral oculomotor pareses. DESIGN: Retrospective observational case series. PARTICIPANTS: Three women presenting for tertiary neuro-ophthalmologic evaluation. METHODS: Review of patient records. MAIN OUTCOME MEASURES: Historical information, clinical examination, neuroimaging, and laboratory evaluation for myasthenia gravis. RESULTS: Three 44- to 69-year-old women had recurrent unilateral ptosis over the course of 2 to 4 years. Two had concurrent diplopia with ipsilateral limitation of adduction, and 2 also had a large poorly reactive pupil in the involved eye during the episodes. The attacks lasted between 30 seconds and 4 hours and occurred up to 6 times daily. None of the patients were migraineurs, nor had they received radiation therapy. Neuro-ophthalmologically normal between episodes, all patients had normal magnetic resonance imaging/angiography and testing for myasthenia gravis. CONCLUSION: Transient, recurrent, unilateral oculomotor nerve palsies may occur spontaneously in healthy individuals. The pathogenesis remains obscure, but the multiple recurrences without evident sequelae and the failure to develop any systemic or neurological disorder suggest that this phenomenon is not indicative of a serious underlying disorder.

Adult↗
PubMed2004

Friendly fire: neurogenic visual loss from radiation therapy.

The author's experience and review of the medical literature suggest that radiation-induced neurogenic visual loss presents on average 18 months after treatment and usually after cumulative doses of radiation that exceed 50 Gy or single doses to the visual apparatus of greater than 10 Gy. Visual loss may result from lesions of the disc, retrobulbar segment of the optic nerve, optic chiasm, or retrogeniculate pathways. Magnetic resonance imaging, the best means of demonstrating radiation injury to the visual pathway, may show abnormalities before the loss of vision. The second eye may show clinical manifestations of optic neuropathy many months after the diagnosis in the first involved eye. Spontaneous improvement in visual function may rarely occur. Treatment has been disappointing, but if visual dysfunction is detected early, hyperbaric oxygen might be beneficial. The risk of neurogenic visual loss must be factored into the decision to irradiate the brain.

Humans↗
PubMed2003

Ehrlichiosis optic neuritis.

PURPOSE: To describe a case of ehrlichiosis optic neuritis. DESIGN: Single observational case report. METHODS: A 41-year-old woman with symptoms and clinical and imaging signs consistent with optic neuritis presented to a tertiary care academic center for comprehensive neuro-ophthalmic evaluation. Main outcome measures included preoptic and postoptic neuritis polyvalent ehrlichiosis titers and magnetic resonance imaging (MRI) of orbits with gadolinium. RESULTS: Ehrlichiosis titers drawn 11 days before onset of eye symptoms were negative. Titers drawn 7 days after symptoms began were positive. The optic nerve enhanced with gadolinium on MRI. CONCLUSIONS: Ehrlichiosis can cause optic neuritis and should be considered in patients with optic neuritis after a febrile, flu-like illness in an endemic area.

Adult↗