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At least 1,621 records · Page 90Linked to original sources
PubMed1997

Management-related morbidity in unselected aneurysms of the upper basilar artery.

A series of 49 consecutively treated patients with 52 aneurysms of the upper basilar artery (BA) is presented. Thirty-nine aneurysms arose at the BA bifurcation, 11 at the origin of the superior cerebellar artery (SCA), and two from the upper BA trunk just below the SCA. The patient population consisted of 36 women and 13 men, with a mean age of 50 years (range 23-74 years). Of the 35 patients presenting with subarachnoid hemorrhage, 10 were Grade I, 10 were Grade II, 11 were Grade III, and four were Grade IV according to the Hunt and Hess scale. Treatment consisted of aneurysm neck clipping in 28, proximal occlusion of the BA in three, and endovascular therapy with coils in four patients. The remaining 14 patients with unruptured aneurysms underwent direct neck clipping. Postoperatively, 38 patients developed diplopia in at least one direction of gaze but this had resolved in 31 of them at the last follow-up evaluation. There were four deaths (8.2%): two as a result of rebleeding following coil compaction at 8 days and 9 months posttreatment, respectively; one as a result of vasospasm; and one as a result of brainstem infarction after proximal occlusion of the BA in a giant bifurcation aneurysm. Of the surviving patients, 33 (67.3%) made an excellent recovery, seven (14.3%) made a good recovery, and five (10.2%) were in poor condition at the last follow-up review. Direct microsurgical clipping of most aneurysms of the BA apex region can be performed with acceptable rates of morbidity. These data from an unselected series of patients in a general hospital provide a basis for comparison with developing alternative techniques.

Adult↗
PubMed1998

Malignant meningioma of the oculomotor nerve without dural attachment. Case report and review of the literature.

Meningiomas, thought to arise from arachnoid cap cells, are usually attached to the dura. Malignancy is present in approximately 1% of these tumors. The authors report the case of a patient with a malignant meningioma arising from the oculomotor nerve with no dural attachment. The patient presented with a 7-month history of left-sided ptosis and diplopia. Magnetic resonance imaging demonstrated an extrinsic mass compressing the root of the oculomotor nerve at its exit from the midbrain. During surgery, a left-sided subtemporal approach revealed the tumor to be arising from the oculomotor nerve. Histological investigation showed a malignant spindle cell lesion with an immunohistochemical profile that was consistent with malignant meningioma. To the authors' knowledge, this is the first documented case of a malignant meningioma arising from the oculomotor nerve.

Adult↗
PubMed1999

Rosai-Dorfman disease presenting multiple intracranial lesions with unique findings on magnetic resonance imaging. Case report.

Rosai-Dorfman disease (RDD) is a rare idiopathic histoproliferative disease affecting the systemic lymph nodes. Although an extranodal lesion has also been recognized, central nervous system involvement is extremely rare. To the authors' knowledge, only 20 cases of intracranial lesions have been reported previously. Intracranial RDD is clinically and radiologically difficult to distinguish from meningioma, and histological examination is essential for a definitive diagnosis. The authors treated a large frontal lobe tumor associated with multiple meningeal nodules in a 67-year-old patient presenting with diplopia and headache. Radiological examination indicated that the mass was an inflammatory lesion rather than a meningioma. Microscopically the lesion consisted of mixed inflammatory infiltrate with marked emperipolesis, which is characteristic of RDD. A review of the literature and a discussion of the differential diagnosis of this rare lesion are also presented.

Aged↗
PubMed1999

Pineal epidermoid cysts: diagnosis and management.

OBJECT: The results of surgical treatment of epidermoid cysts of the pineal region in six cases are presented. METHODS: Six patients with pineal epidermoid cysts underwent surgery at the Institute of Neurosurgery "N. N. Burdenko," in Moscow, during the period 1976 to 1995. The duration of the patients' preadmission clinical history varied from 6 months to 2 years (average 1.4 years). Headache, diplopia, and vertigo were the most frequently occurring symptoms. Neurological examination demonstrated papilledema, impaired pupillary reaction, ataxia, and long-pathways deficit; Parinaud's syndrome was found in only one case. Computerized tomography and magnetic resonance imaging constituted the primary diagnostic tools. Surgery was performed using either an infratentorial-supracerebellar approach (two cases) or an occipital-transtentorial approach (four cases). CONCLUSIONS: Surgical results can be excellent if a removal, as extensive as possible, is performed using either the supracerebellar or occipital-transtentorial approach.

Adult↗
PubMedDate not supplied

Metastatic islet cell carcinoma: a potentially treatable cause of "carcinoma of unknown origin.".

A 55-year-old woman presented with diplopia secondary to an orbital mass. Physical examination showed a large ovarian mass. Further evaluation revealed these lesions to be metastases from a nonfunctioning pancreatic islet cell carcinoma, the first such case reported. Since these tumors can be responsive to chemotherapy, it is important to consider islet cell cancers in patients presenting with "metastatic carcinoma of unknown origin.

Adenoma, Islet Cell↗
PubMed2005

Acquired simulated brown syndrome following surgical repair of medial orbital wall fracture.

Simulated Brown syndrome is a term applied to a myriad of disorders that cause a Brown syndrome-like motility. We encountered a case of acquired simulated Brown syndrome in a 41-year-old man following surgical repair of fractures of both medial orbital walls. He suffered from diplopia in primary gaze, associated with hypotropia of the affected eye. We performed an ipsilateral recession of the left inferior rectus muscle as a single-stage intraoperative adjustment procedure under topical anesthesia, rather than the direct approach to the superior oblique tendon. Postoperatively, the patient was asymptomatic in all diagnostic gaze positions.

Adult↗
PubMed2000

Ocular deviation after unilateral laser in situ keratomileusis.

Laser keratomileusis and excimer laser photorefractive keratectomy in situ are widely used therapies for treating myopia. The corrections of refractive error by glasses or contact lens result in a relatively equal refractive correction on both eyes. However, refractive surgery on a single eye can cause a focus disparity between both eyes and may result in the impairment of fusion leading to strabismus. This article aims to report a case where diplopia and esotropia occurred 1 month after laser keratomileusis (LASIK) in situ for the correction of myopia.

Adult↗
PubMedDate not supplied

Acquired "double elevator" palsy and polycythemia vera.

A 67-year-old woman had the acute onset of vertical diplopia. Examination revealed that she had a "double elevator" palsy of the fixing left eye which resulted in a right hypertropia. During the medical evaluation of the patient it was established that she had polycythemia vera. It is suggested that the ocular movement disorder seen in this patient resulted from a small lesion adjacent to and including the right superior rectus subnucleus. The increased blood viscosity resulting from the patient's polycythemic state may have been a significant predisposition in the development of an occlusive vascular episode involving this area of the midbrain.

Aged↗
PubMedDate not supplied

Surgical therapy of convergence insufficiency.

Fourteen cases of intractable convergence insufficiency were surgically treated by resection of both medial rectus muscles. All 14 patients showed dramatic relief of severe asthenopic symptoms. Temporary diplopia due to consecutive esotropia is a necessary part of this surgery and is relieved by fresnel prisms. Exophoria at near will return, occasionally to the original angle of deviation, but the symptoms do not return. The preoperative symptoms can be of severity out of proportion to the deviation. Bimedial resection is a most efficacious surgical method for treatment of intractable convergence insufficiency.

Accommodation, Ocular↗
PubMedDate not supplied

Think superior oblique palsy.

Superior oblique palsy is thought to be the most frequent cause of acquired vertical diplopia. It is often the result of blunt head trauma but may also be caused by brain tumor, meningitis, diabetes, lesions of the cavernous sinus, and superior orbital fissure as well as arteriosclerosis. The characteristics frequently include a small vertical strabismus in primary gaze, ipsilateral inferior oblique overaction with an increased hypertropia to the contralateral side, a "V" pattern, excyclotorsion, and a positive Bielschowsky head tilt test to the ipsilateral side. In a typical case, it is not difficult to make the proper diagnosis. Several patients will be described whose superior oblique palsy was marked by an association with another motility disturbance.

Abducens Nerve↗
PubMedDate not supplied

A cluster of patients with inferior rectus restriction following local anesthesia for cataract surgery.

During a 5-month period, four patients developed contracture of the inferior rectus muscle following local anesthesia for cataract surgery in the practice of one ophthalmologist. Two anesthesiologists administered retrobulbar anesthesia. All patients had persistent vertical diplopia caused by a large hypotropia of the operated eye. Forced duction testing revealed marked restriction to elevation of the eye. In two patients, MRI demonstrated segmental thickening of the inferior rectus muscle, just posterior to the globe. All patients had normal thyroid function tests. No patient had a previous history of strabismus. Three of the four have had strabismus surgery consisting of recession of the markedly restricted inferior rectus muscle on an adjustable suture. These three patients have regained fusion and are now asymptomatic.

Aged↗
PubMedDate not supplied

Acquired central fusion disruption following cataract extraction.

Central sensory and motor fusion of images, once established, is usually maintained throughout life. Under certain circumstances, this ability may be lost. This gives rise to the syndrome known as horror fusionis, or acquired disruption of central fusion. We report the development of central fusion disruption in three patients with uniocular mature senile cataract. We postulate that this is the result of prolonged sensory deprivation in the cataractous eye. The loss of fusion results in a particularly troublesome type of intractable diplopia, characterized by the inability to either fuse or suppress images. To the best of the authors' knowledge, this is the first report of central fusion disruption following cataract surgery for senile cataract.

Aged↗
PubMedDate not supplied

Downgaze restriction after placement of superior oblique tendon spacer for Brown syndrome.

Diplopia in the reading position developed in two patients with unilateral Brown syndrome after a 7-millimeter section of #240 silicone retinal band was sewn between the cut ends of the superior oblique tendon at tenotomy. In both cases, forced ductions were positive, indicating a restrictive downgaze deficit. Surgical exploration revealed adhesions that prevented the normal sliding of the superior oblique tendon beneath the superior rectus muscle. Forced ductions became normal and downgaze improved after removal of the silicone band. Secondary superior oblique muscle paresis was also evident at the time of reoperation, requiring recession of the contralateral inferior rectus muscle (cases 1 and 2) and recession of the ipsilateral inferior oblique muscle (case 1). A restrictive downgaze deficit and a paretic overcorrection must be recognized as possible complications of the superior oblique tendon silicone "expander" operation.

Adult↗
PubMedDate not supplied

Effectiveness of inferior transposition of the horizontal rectus muscles for acquired inferior rectus paresis.

Full inferior transposition of the horizontal recti (inverse Knapp procedure) was performed on four patients with unilateral inferior rectus muscle weakness. The patients were followed up over time to determine the medium- and long-term effectiveness of the procedure. All of the patients had single binocular vision without the use of prisms in the primary position of gaze and three in the reading position after a mean postoperative follow-up interval of 21/2 years. The mean primary position preoperative vertical deviation was 20.3 delta and the mean primary position postoperative vertical correction was 19.5 (range, 16 to 24) delta. The field of binocular single vision was assessed quantitatively and scored 2.4% preoperatively compared with 52.3% postoperatively. There was no decrease in the effect of the procedure over time. Additional surgery may still be required to correct symptomatic residual vertical down-gaze diplopia.

Adolescent↗
PubMedDate not supplied

Brown's syndrome with cyclic characteristic: case report and review of physiopathologic mechanism.

This article reports on an acquired Brown's syndrome case presenting with cyclic characteristics. Restriction of elevation in adduction was observed in the right eye of a 15-year-old boy who had been referred with a complaint of diplopia that occurred on waking in the morning and continuing until noon. The same situation was noted following afternoon naps. The patient was able to improve his complaint by performing a forced elevation in adduction while massaging his right trochlear region and the restriction did not recur until the next morning.

Adolescent↗
PubMedDate not supplied

20th annual Frank Costenbader Lecture--adult strabismus.

BACKGROUND: A retrospective analysis of adults with strabismus was done to examine the potential risks and the possible benefits of surgical treatment and to describe the types of adult strabismus. METHODS: Eight hundred ninety-two patients were analyzed. Age at time of surgery ranged from 9 years to 89 years. The average follow up was 34 months. Major types of strabismus were grouped by their original diagnoses. The group of patients with horizontal strabismus, which usually had an onset before 9, was termed the before visual maturity (BVM) group. The group of patients with paretic or restrictive strabismus usually had the onset of strabismus after age 9 and was termed the after visual maturity (AVM) group. RESULTS: Patients with adult strabismus can gain restoration of alignment, as well as binocular function. At the last postoperative visit, 74% of the BVM group were aligned within 15 prism diopters. Not only was restoration of alignment accomplished, many of them gained some degree of sensory fusion as measured by the Worth 4-Dot (W4D) or Titmus stereoacuity. Twenty-nine percent of patients with congenital esotropia had some sensory fusion. The other subtypes in the BVM group had even higher percentages of patients with postoperative stereoacuity. In the AVM group, 92% had fusion at the last postoperative visit. CONCLUSIONS: The outcomes of adult strabismics in our study show that certain benefits can be gained from correction of ocular alignment. Restoration of alignment, elimination of diplopia and sensory fusion are functional benefits that can be obtained through strabismus surgery in the adult patient. It is clear that adult strabismus is more than just a cosmetic problem and treatment is worthwhile.

Adolescent↗
PubMedDate not supplied

Subtenon injection of botulinum toxin for treatment of traumatic sixth nerve palsy.

PURPOSE: Subtenon injection of botulinum toxin may produce results similar to intramuscular injection of the medial rectus muscle for the treatment of acute traumatic sixth nerve palsy. This study was designed to evaluate the clinical efficacy of subtenon injection and to compare our results with those in previously published reports. METHODS: During 3 years at a single institution, 13 patients with traumatic sixth nerve palsy of less than 6 months' duration were treated with subtenon injection of botulinum toxin. The deviation angles before and after injection were recorded. A distance esotropia of less than 10 prism diopters (PD) in the primary position or absence of diplopia at 3 months was defined as recovery. RESULTS: Of the 13 patients treated, 11 (84.5%) had unilateral palsy and 2 (15.4%) had bilateral palsy. The average pre-injection deviation was 39.5 PD of esotropia, and the average post-injection deviation was 17.0 PD. Seven patients experienced recovery and regained binocular single vision; the overall recovery rate was 53.8% (unilateral, 63.6%; bilateral, 0%). Six patients did not recover and subsequently underwent strabismus surgery. CONCLUSION: Patients with traumatic sixth nerve palsy treated with subtenon injection of botulinum toxin showed higher recovery rates than did most patients treated with conservative measures in published reports. The result of subtenon injection of botulinum toxin without electromyography (EMG) guidance was comparable to that obtained using EMG-guided intramuscular injection of botulinum toxin. Patients with unilateral palsy demonstrated a better recovery rate than did patients with bilateral palsy.

Abducens Nerve Diseases↗
PubMedDate not supplied

Correlation of aberrations with visual symptoms using wavefront analysis in eyes after laser in situ keratomileusis.

PURPOSE: To evaluate the information assessed with the Alcon LADARWave wavefront measurement device and correlate it with visual symptoms in eyes previously treated with laser in situ keratomileusis (LASIK), and to analyze the influence of scotopic pupil size on visual symptoms. METHODS: One hundred and five eyes of 58 patients who underwent LASIK were evaluated. Wavefront measurements were assessed using the Alcon LADARWave device. Visual symptoms were correlated to higher order aberrations in three different pupil sizes (5 mm, 7 mm, and scotopic pupil size). Generalized estimating equations were used for statistical analysis. RESULTS: In eyes after LASIK, visual symptoms analysis showed positive correlation of double vision with total coma and with horizontal coma for the 5-mm and 7-mm pupil sizes, negative correlation between starburst and total coma for the 7-mm pupil size, positive correlation of double vision with horizontal coma, and glare and starburst with spherical aberration and with total aberrations. Scotopic pupil size had a positive association with starburst and negative association with double vision. CONCLUSION: The LADARWave wavefront measurement device is a valuable diagnostic tool in measuring ocular aberrations in eyes after LASIK. A strong correlation between visual symptoms and ocular aberrations, such as monocular diplopia with coma, and starburst and glare with spherical aberration, suggest this device is valuable in diagnosing symptomatic LASIK-induced aberrations. Horizontal coma was correlated with double vision, while vertical coma was not, demonstrating a greater sensitivity with horizontally oriented multifocality.

Adult↗