Optic Nerve Swelling Research Articles

Intracranial Extraskeletal Mesenchymal Chondrosarcoma: Case Report

We present a patient with a dural-based intracranial extraskeletal mesenchymal chondrosarcoma, which was initially thought to be an atypical meningioma. This rare tumor should be considered in the differential diagnosis of young adults with an aggressive-appearing dural-based lesion. A 21-year-old woman reported a 3-week history of severe headaches and intermittent nausea and vomiting. Neurological examination revealed right optic nerve swelling. Magnetic resonance imaging demonstrated a large, intensely enhancing extra-axial mass, which appeared to originate from the right side of the falx cerebri with significant mass effect. A presumptive diagnosis of meningioma was made. The patient underwent preoperative embolization of the lesion and then underwent a bicoronal craniotomy, gross total resection of the tumor, removal of invaded calvarial bone, and cranioplasty. Pathological examination revealed an extraskeletal mesenchymal chondrosarcoma. Because of the potential for recurrence, the patient received subsequent radiotherapy. She remains free of recurrence 18 months after surgery. Intracranial mesenchymal chondrosarcoma is a rare neoplasm that can mimic a meningioma radiographically. We present the first patient in whom this lesion has been documented with computed tomography, cardiography, magnetic resonance imaging, and pathological findings. We emphasize the importance of gross total resection and close follow-up for this potentially aggressive tumor, and we present a review of the literature.

Optic Nerve and Orbital Tumors

The close proximity of the orbit to the brain and the high frequency of ocular symptoms in patients with neurosurgical disease make it mandatory for neurosurgeons to be familiar with manifestations of orbital disease. Tumors of the optic nerve and orbit are important causes of vision loss and eye movement abnormalities. Similarly, intracranial tumors frequently present with eye movement abnormalities, vision loss, and optic nerve swelling. This overlap in the clinical characteristics of patients with orbital tumors and patients with neurosurgical problems makes familiarity with the types of clinical presentation of various orbital tumors important to the neurosurgeon. The history and examination of patients with orbital tumors are discussed and the clinical presentation of various orbital tumors is presented.

Multiple evanescent white dot syndrome

Abstract Multiple evanescent white dot syndrome (MEWDS), is a rare, acute clinical disorder of unknown etiology usually resulting in transient visual loss in young and healthy patients. Ocular manifestations may include: characteristic white dots in the fundus, granularity of the macula, retinal vascular sheathing, vitreous cells and optic nerve swelling. MEWDS affects primarily the retinal pigment epithelium and photoreceptors. An overview of this syndrome, clinical features and differential diagnosis from primary optic nerve disease and other white dot syndromes are discussed.

Optic Nerve Sheath Decompression for Progressive Central Retinal Vein Occlusion

To review our results with optic nerve sheath decompression (ONSD) for progressive central retinal vein occlusions (CRVO). Patients selected all had evidence of progressively worsening CRVO, a component of optic nerve swelling, and most were already monocular from prior disease in the contralateral eye. ONSD was performed using a nasal approach under retrobulbar anesthesia. Eight eyes from 8 patients with a mean follow-up of 12 months were analyzed. Six patients improved, 2 worsened. Mean preoperative visual acuity was 20/160, and mean final postoperative visual acuity was 20/70. No complications occurred. Nonischemic CRVOs, patients < 65 years old, and those undergoing ONSD within 3 months of presentation seemed to do better. ONSD may improve vision or stabilize visual loss in patients with progressive CRVO.

Retrobulbar optic nerve cysticercosis with surgical removal: a case report

A 15-year-old boy presented with diminution of vision which rapidly progressed to no perception of light. In the ocular fundus, a neuroretinitis-like picture was seen. On CT-scan & ultrasonography, an optic nerve swelling was detected with a shadow of scolex. Medical therapy in the form of steroids along with albendazole was ineffective. Surgical removal by lateral orbitotomy was done and a complete cyst with scolex was removed, which was confirmed histopathologically as a case of retrobulbar optic nerve cysticercosis.

Asymptomatic Optic Disc Edema

Non-arteritic anterior ischemic optic neuropathy (AION-na) classically presents with visual loss, altitudinal visual field defects, and optic nerve swelling. AION-na presumably occurs secondary to an ischemic event. Two patients are described who were at risk for developing AION-na. Both patients presented with optic disc edema but did not have visual loss or visual field defects. Neither patient developed visual loss or visual field defects in the affected eye throughout one and two years of follow-up respectively. The optic disc edema resolved spontaneously in both affected eyes. The clinical spectrum of AION-na could range from a "full-blown" classic attack to a minimal attack characterized by disc swelling without visual loss. The amount and distribution of disc ischemia determines the individual clinical picture. The failure of either affected eye in this study to develop symptoms likely represents a graded axonal atrophy with mechanical decompression of the optic nerve.

Ultrasonographic investigation of optic neuritis.

A pilot echographic study was conducted to determine the incidence and severity of optic nerve swelling in acute 'idiopathic' optic neuritis and to examine cerebrospinal fluid dynamics in the subarachnoid space, employing the method of standardised echography and the '30 degrees test'. An attempt was made to correlate the degree of nerve swelling with the initial visual loss and with the rate and extent of recovery of vision. The visual function and echographic features of the optic nerve in 27 patients with the diagnosis of acute optic neuritis were assessed with standardised echography. A significant increase in nerve diameter was found in 74% of cases. There was a correlation between nerve swelling and the severity of initial visual loss. The authors conclude that standardised echography is a useful tool in the diagnosis of optic neuritis and may play a role in predicting the visual outcome.

ДВУСТОРОННИЙ ОТЁК ДИСКА ЗРИТЕЛЬНОГО НЕРВА ПОСЛЕ ТИРЕОИДЭКТОМИИ С ПОСЛЕДУЮЩИМ КУРСОМ РАДИОЙОДТЕРАПИИ

The most common cancer of the endocrine system is thyroid cancer, representing 1.0-1.5 % all newly diagnosed cases of cancer. According to the cancer society of Russia, the thyroid cancer in children is much rarer than in adults. Thyroid cancer in children and adolescents is characterized by an adverse clinical course and a high risk of developing metastases in the lymph nodes. The main method of treatment for pediatric thyroid cancer is total thyroidectomy with central neck lymph node dissection followed by radioactive iodine therapy. In foreign and domestic literature, complications of the organ of vision, namely, changes of the optic disc, after surgical treatment for thyroid cancer are poorly understood. The risk of transient hypocalcemia and hypothyroidism increases after thyroidectomy. In the literature, there are two reported cases of the optic nerve swelling combined with hypoparathyroidism and hypocalcemia. While hypocalcemia intracranial hypertension and swelling of the optic nerves are often recorded. In this article, the authors present their own clinical observation of a 13-year-old patient after thyroidectomy and radioactive iodine therapy with detailed analysis of the clinical data and study results. According to the survey of the patient, bilateral swelling of the optic disc was revealed, which could occur due to hypothyroid state. Objective: to identify the cause of the development of bilateral optic nerve swelling in a patient after thyroidectomy and treatment course with radioactive iodine.

Exophthalmos in Myelodysplastic syndrome

A case of myelodysplastic syndrome (MDS) who suffered alternating proptosis was reported. A 57-year-old Japanese man with MDS developed acute painful left proptosis with eyelid edema, conjunctival injection, visual disturbance, and restriction of eye movements. This lasted for 3 weeks. Computerized tomography (CT) showed swelling of the lateral and medial rectus muscles and the optic nerve, as well as a retrobulbar mass. Later, a similar painful right proptosis with severe conjunctival chemosis developed. CT showed only bilateral mild optic nerve swelling. The visual acuity of the right eye decreased to null even after remission of the proptosis. The patient died due to myocardial infarction and underwent autopsy. The right optic nerve stroma was found to be increased over that of the left. Cellular infiltration was noted in the left optic nerve and the retrobulbar connective tissue. This self-limiting and relapsing proptosis was apparently related to MDS. This is only the second MDS case with such severe ophthalmological symptoms reported in the literature.

Aminoglycoside Macular Toxicity After Subconjunctival Injection-Reply

In Reply. —I appreciate the careful attention Dr Grizzard gave to my case report. I agree that in some cases there may be no definitive way to distinguish between the clinical and angiographic findings of aminoglycoside macular toxicity and retinal vascular occlusion from traumatic retrobulbar injection of the optic nerve. However, I believe that my report and explanation is correct for the following reasons: (1) There was no resistance to anesthetic injection or retrobulbar hemorrhage or proptosis noted by the referring surgeon. (2) Contact B-scan ultrasonography performed by me showed no thickening of the optic nerve sheath. (3) There was no clinical or angiographic evidence of optic nerve swelling, hemorrhage, or infarction. (4) Most importantly, there does not seem to be another plausible anatomic explanation for the peculiar oval pattern of retinal necrosis manifested by absolute arterial and venous nonperfusion seen on fluorescein angiography, other than by a settling phenomenon

CORRELATION OF ORBITAL COMPUTED TOMOGRAPHY AND ANTIBODIES IN PATIENTS WITH HYPERTHYROID Graves'DISEASE

The purpose of this study was to elucidate the incidence of orbital changes in computed tomography, and the relationships of orbital changes with eye-muscle antibody (EMAb), thyrotrophin-binding inhibitor immunoglobulin (TBII), antithyroglobulin antibody (TgAb) and anti-thyroid microsomal antibody (MsAb), in 55 consecutive patients with hyperthyroid Graves' disease. EMAb was demonstrated by an immunoperoxidase technique. The results showed that the prevalence of orbital fat increase, extraocular muscle enlargement, lacrimal gland enlargement and optic nerve swelling were 54.5, 41.8, 21.8 and 16.5% respectively. There were 32.7% of patients without any orbital changes. The patients with extraocular muscle enlargement, lacrimal gland enlargement and optic nerve swelling had higher titres of EMAb than the patients without these orbital changes. The patients with lacrimal gland enlargement had a lower TBII index than those without. There was no difference in TgAb or MsAb between the patients with extraocular muscle enlargement, lacrimal gland enlargement, optic nerve swelling or orbital fat increase and those patients without these orbital changes. The patients with extraocular muscle enlargement, optic nerve swelling and orbital fat increase had a higher degree of exophthalmos than the patients without these orbital changes. EMAb was negatively correlated with TBII. However, there was no correlation between EMAb and TgAb or MsAb. The degree of exophthalmos was positively correlated with EMAb and negatively correlated with age. There was no correlation between exophthalmos and TBII, TgAb or MsAb. In conclusion, although the pathogenesis of orbital changes and hyperthyroidism is different, a close link between these two entities is suggested by the high incidence of orbital changes in hyperthyroid Graves' disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Unilateral Papilledema in Pseudotumor Cerebri

Pseudotumor cerebri is a condition of uncertain pathogenesis characterized by increased intracranial pressure in the absence of a mass lesion or hydrocephalus and normal cerebrospinal fluid composition. This disorder is associated with numerous conditions, although many cases may have no identifiable cause. The typical clinical picture of pseudotumor cerebri is that of an obese young woman who presents with headaches that are worse in the morning, transient visual obscurations, and bilateral optic nerve swelling. We report a case of pseudotumor cerebri with unilateral papilledema. Report of a Case. —An obese 46-year-old Hispanic woman was seen for evaluation of headaches. Her medical history was significant for hypertension and deep vein thrombosis. On examination, her visual acuity was 20/20 OU. She had normal pupillary responses and color vision. Extraocular motions were full. Anterior segment examination results and intraocular pressure were normal. A dilated fundus examination revealed marked disc edema with dilated capillaries,

Herpes Simplex Chorioretinitis in a Healthy Adult

A previously healthy 20-year-old man developed bilateral chorioretinitis that included mild anterior uveitis, vitreous cells, multifocal chorioretinitis, and optic nerve swelling that progressed to severe optic neuropathy in one eye. Chorioretinal biopsy specimens cultured herpes simplex type 1 from separate chorioretinal and vitreous samples. Although the visual acuity of one eye remained at light perception, sight in the second eye was saved when treatment with systemic acyclovir and corticosteroids led to resolution of the inflammation. A recurrence was successfully treated with acyclovir alone and the patient shows no evidence of active disease.

Optic Nerve Head Involvement With Cytomegalovirus in an Adult With Lymphoma

An optic nerve swelling that was thought clinically to represent a lymphomatous infiltrate of the nerve head developed in a 51-year-old man with histiocytic lymphoma. Histologic examination of the eyes showed the presence of cytomegalovirus (CMV) in the nerve head, but no lymphoma cells. Tru lymphomatous invasion of the nerve head in systemic lymphoma is probably very rare. This case points out an unusual manifestation of adult CMV infection, and a new concern in patients with compromised immune systems.