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Biomedical subjects

T M Bosley

Publications and source records attributed to T M Bosley.

At least 73 records · Page 4Linked to original sources
PubMed1989

Syphilitic uveitis in human immunodeficiency virus-infected and noninfected patients.

Seventeen patients with luetic uveitis had human immunodeficiency virus (HIV) testing and lumbar puncture to determine if the HIV-positive status altered the clinical profile of syphilis. Twelve of the 17 patients tested positive for HIV. All 12 patients had abnormal lumbar punctures, but only two of the five HIV-negative patients had abnormal results of spinal taps. Ocular disease also was more severe in the HIV-positive group.

Adult↗
PubMed1989

Alzheimer's disease with prominent visual symptoms. Clinical and metabolic evaluation.

The authors examined eight patients with dementia of the Alzheimer's type (DAT), five with prominent visual symptoms early in the illness (VS) and three with no visual symptoms (NVS). Results of neuro-ophthalmologic examinations on VS patients showed relatively consistent abnormalities in figure copying, color vision tested by isochromatic plates, and stereopsis. Cerebral glucose metabolism determined by 18F-fluoro-2-deoxyglucose positron emission tomography (PET) was unchanged in primary visual cortex of VS and NVS patients compared with 12 normal volunteers of similar age and sex. Glucose metabolism in VS patients was decreased by 45 and 34% in left and right visual association cortex (P less than 0.01 and P less than 0.05, respectively) and 34 and 37% in left and right inferior parietal cortex (P less than 0.05) compared with controls; NVS patients had no significant metabolic alteration in these areas. Symptoms, physical examination, and metabolic imaging imply that these patients are a heterogenous but distinct clinical subgroup of DAT often with mild dementia who have visual symptoms due primarily to visual agnosia.

Aged↗
PubMed1989

Optic neuritis with secondary retinal venous stasis.

The authors report five cases of optic neuritis accompanied by secondary impairment of retinal venous outflow producing the clinical appearance of impending or actual central retinal vein occlusion. In four of five cases, intravenous fluorescein angiography showed delayed venous filling with venous dilation and tortuosity. Decreased visual function was entirely attributable to optic nerve involvement because the clinical and angiographic examinations revealed no evidence of capillary nonperfusion, macular edema, or macular hemorrhage. The visual outcome of the patients paralleled that expected with optic neuritis. The authors believe that optic nerve inflammation associated with secondary impairment of retinal venous outflow is a distinct but uncommon entity. Because of its ophthalmoscopic appearance, this variety of optic neuritis may be confused with either papillophlebitis or central retinal venous occlusion in young patients.

Adolescent↗
PubMed1988

Low-contrast letter charts to detect subtle optic [corrected] neuropathies.

We performed visual contrast sensitivity testing with Regan's low-contrast letter charts on 30 patients with optic neuropathies and good Snellen visual acuity. Results of this testing were compared with color vision and the presence of an afferent pupillary defect. Regan's low-contrast letter charts were found to be 93% sensitive for detecting subtle optic neuropathies, with the apparent false-negative findings being readily explainable. Color vision testing was abnormal in only 49% of eyes with known optic neuropathies.

Adolescent↗
PubMed1988

Modified optic nerve sheath decompression provides long-term visual improvement for pseudotumor cerebri.

Twenty-three patients with chronic papilledema associated with pseudotumor cerebri underwent "modified" optic nerve sheath decompression for treatment of visual acuity and visual field loss. Instead of removing a single, rectangular section of optic nerve meninges, the operation was modified by making at least three longitudinal incisions in the sheath and then lysing arachnoid adhesions with a tenotomy hook. Twenty-one of the 23 patients demonstrated improved visual function after the initial surgery for a mean (+/- SD) follow-up of 21.5 +/- 12.3 months (median, 25 months; range, three to 45 months) without reoperation or reinstitution or oral corticosteroid and diuretic therapies. The two patients failing to improve after the first surgical procedure initially had a single meningeal window created and subsequently improved following reoperation with the modified procedure. Twelve of 21 patients with bilateral visual loss had improved visual function bilaterally after unilateral surgery. Six of the 21 patients needed bilateral surgery, and the other three had minor visual field defects in the second eye not severe enough to warrant surgery. Preoperative optic disc pallor did not predict a poor postoperative result. Optic nerve surgery improved the visual function in six patients who had failed to recover vision after one or more lumbar-peritoneal shunts.

Adolescent↗
PubMed1988

Alternating skew on lateral gaze (bilateral abducting hypertropia).

We report thirty-three patients with alternating skew deviation on lateral gaze. The right eye was hypertropic in right gaze, and the left eye was hypertropic in left gaze. Most patients had associated downbeat nystagmus and ataxia and were diagnosed as having lesions of the cerebellar pathways or the cervicomedullary junction. This contrasts with a previous report in which alternating skew was seen mainly in lesions of the midbrain pretectum.

Adolescent↗
PubMed1988

Pigmentary epitheliopathy, disc edema, and lead intoxication.

A 52-year-old lead-exposed worker presented with disc edema, nerve fiber layer infarcts, and an acute bilateral pigment epitheliopathy that phenotypically resembled APMPPE. The patient had definite laboratory evidence of increased total body lead burden. The simultaneous involvement of retina, disc, and choriocapillaris suggests that what has been reported as the spectrum of APMPPE may represent a nonspecific vascular response to multiple injurious stimuli, including lead.

Edema↗
PubMed1988

Positron emission tomography in a patient with progressive multifocal leukoencephalopathy.

A 56-year-old man with chronic lymphocytic leukemia, progressive multifocal leukoencephalopathy, and a dense left homonymous hemianopia had 18F-fluorodeoxyglucose positron emission tomography. Cortical glucose metabolism was decreased in the right cerebral hemisphere and the left cerebellar hemisphere. To our knowledge, this is the first demonstration of cerebral and cerebellar hypometabolism due solely to white matter disease.

Aged↗
PubMed1988

Resolving metabolic abnormalities in a case of pure alexia.

We report resolving metabolic abnormalities corresponding to clinical improvement in a patient with pure alexia secondary to acute cerebral infarction. Local cerebral glucose metabolism (lCMRgl) was measured with positron emission tomography (PET) using 18F-fluorodeoxyglucose (18F-FDG) close to ictus and 4 1/2 months later. Serial CTs and a subsequent MRI demonstrated small, unchanging left-hemispheric lesions involving the area of the lateral geniculate body and the splenium of the corpus callosum. PET demonstrated the evolution of the metabolic abnormality resulting from intrahemispheric (lateral geniculate) and interhemispheric (splenium) disconnection in the absence of occipital lobe infarction. This case illustrates that cerebral disconnection can result in the syndrome of pure alexia. The factors accounting for focal hypometabolism in the absence of cerebral infarction are discussed.

Brain↗
PubMed1988

Atherosclerotic carotid artery disease in patients with retinal ischemic syndromes.

The extracranial carotid systems of 105 patients with retinal ischemia were examined using B-mode ultrasonography with integrated pulsed Doppler. Sixty-four patients had amaurosis fugax (AF), 17 central retinal artery occlusions (CRAO), and 21 branch retinal artery occlusions (BRAO). The prevalence of carotid stenosis (greater than or equal to 60%) ipsilateral to the symptomatic eye was low (16%). Eighty-six percent of AF patients had either no plaque causing less than a 60% stenosis. A significant proportion of subjects with normal duplex scans had alternative explanations for their retinal ischemia (eg, migraine, cardiac embolus). Patients with Hollenhorst plaques were more likely to have stenotic or ulcerated plaque (p = 0.04). The degree of carotid stenosis correlated significantly with the number of vascular risk factors identified in individual patients (p = 0.02). The presence of risk factors was more common in CRAO and BRAO patients compared with the AF group. Combined ultrasound-Doppler investigations of the carotid bifurcation are valuable noninvasive tools for the screening of patients with retinal ischemia.

Arteriosclerosis↗
PubMed1987

Recovery of vision after ischemic lesions: positron emission tomography.

We used [18F]fluoro-2-deoxyglucose positron emission tomography (PET) to study serial changes in the local cerebral metabolic rate of glucose in 5 patients with ischemic lesions of the posterior afferent visual system causing homonymous visual field defects. All 5 patients had striking impairment of glucose metabolism in the striate cortex shortly after ictus. In 2 patients, visual field defects abated, and repeat PET scans showed reduced size of the metabolic lesion and improvement of striate metabolism. Three patients did not recover vision, and repeat PET scans did not show improvement. Patients who recovered vision had ischemic lesions outside the occipital lobe, while those who did not experience improvement had primary damage to the occipital lobe itself.

Aged↗
PubMed1987

The syndrome of paradoxical worsening of dural-cavernous sinus arteriovenous malformations.

Three patients with dural arteriovenous malformations contiguous with the cavernous sinus had marked worsening of their neuro-ophthalmic symptoms. Such clinical deterioration has been attributed traditionally to increased blood flow through the malformations into the superior ophthalmic vein. However, arteriography in all three patients and magnetic resonance imaging (MR) in two patients demonstrated thrombosis of the entire superior ophthalmic vein. All patients subsequently underwent spontaneous, complete resolution of symptoms. This report describes a clinical syndrome of paradoxical worsening of cavernous sinus malformations and indicates that MR will aid in the management of these vascular malformations.

Aged↗
PubMed1987

Disseminated aspergillosis in a patient with ocular reticulum cell sarcoma.

A 75-year-old healthy woman developed uveitis and chorioretinal infiltrates OD compatible with reticulum cell sarcoma. She was admitted to hospital 18 months later with somnolence and confusion. Examination revealed diffuse white matter hypodensity on computed tomography and a persistent cerebrospinal fluid pleocytosis. At necropsy reticulum cell sarcoma was found in the right globe and Aspergillus fumigatus was present in almost every other organ, including the brain.

Aged↗
PubMed1987

Surface-coil MR of orbital pseudotumor.

Fifteen patients with clinical presentations compatible with idiopathic inflammatory orbital pseudotumor were examined by CT and MR imaging to determine if MR could add specificity to the CT appearance of this entity. MR was performed on a 1.5 T system, using surface-coil and head-coil techniques. Idiopathic pseudotumor was confirmed in nine patients on the basis of response to steroid therapy in the absence of local cause or systemic illness. One other patient had biopsy-proven idiopathic pseudotumor. Five patients proved to have other orbital entities, including metastases, infectious myositis, hemorrhage, and orbital sarcoid. In all 10 patients with confirmed pseudotumor, CT and MR were abnormal. MR abnormalities in 10 of 10 patients with pseudotumor were hypointense to fat and isointense to muscle on T1-weighted images. On T2-weighted images the lesions of pseudotumor were isointense or only minimally hyperintense to fat in nine of 10 cases; in one case, the enlarged muscle was markedly hyperintense to fat. The MR signal intensity of pseudotumor was similar to that found in infectious myositis and sarcoid. These findings contrasted to the MR appearance of the other disease entities examined. Metastases appeared markedly hyperintense to fat on T2-weighted images, while hematoma was hyperintense to muscle and isointense to fat on T1-weighted images and markedly hyperintense to fat on T2-weighted images. In our preliminary series, surface-coil MR appears to add specificity to the CT appearance of orbital pseudotumor.

Adolescent↗
PubMed1986

The role of carotid noninvasive tests in stroke prevention.

The evaluation of carotid disease is now in turmoil. Part of the problem stems from uncertainty over old issues, such as the role of carotid endarterectomy in the treatment of asymptomatic patients with high-grade carotid stenosis. Part of the problem results from the recent increase in sensitivity of certain carotid noninvasive tests and uncertainty about their role in the rational evaluation of a patient with suspected carotid disease. Finally, at this point, we do not know the true natural history of severe carotid stenosis, plaque ulceration, or wall hemorrhage, although retrospective studies and histologic data imply that these factors increase an individual's risk of stroke. Physicians caring for patients with carotid atherosclerotic disease may find themselves in the unusual situation of having more information from a panel of noninvasive tests than they can analyze. The fault does not lie with noninvasive testing itself, of course, but with our previous dependence on arteriography for anatomic information and the difficulties inherent in obtaining natural history data about any disease process for which there is surgical therapy.

Arteriosclerosis↗
PubMed1986

Nerve fibre bundle visual field defects and intracranial mass lesions.

Nerve fibre bundle visual field defects are the hallmark of pathology at the optic nerve head or retina. In the present series, six eyes of four patients with large intracranial mass lesions demonstrated such field defects with visual acuity spared in three of the involved eyes. In no cases did visual function in the opposite eye offer a clue to the localization of the lesion.

Adult↗