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Neurology Research International 2013Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting... (Review)
Review
Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. Materials and Methods. We report the case of a 52-year old lady with optic neuritis as isolated manifestation of neoplastic meningitis and a review of ocular involvement in neoplastic meningitis. Ocular symptoms were the presenting clinical feature in 34 patients (83%) out of 41 included in our review, the unique manifestation of meningeal carcinomatosis in 3 patients (7%). Visual loss was the presenting clinical manifestation in 17 patients (50%) and was the most common ocular symptom (70%). Other ocular signs were diplopia, ptosis, papilledema, anisocoria, exophthalmos, orbital pain, scotomas, hemianopsia, and nystagmus. Associated clinical symptoms were headache, altered consciousness, meningism, limb weakness, ataxia, dizziness, seizures, and other cranial nerves involvement. All patients except five underwent CSF examination which was normal in 1 patient, pleocytosis was found in 11 patients, increased protein levels were observed in 16 patients, and decreased glucose levels were found in 8 patients. Cytology was positive in 29 patients (76%). Conclusion. Meningeal carcinomatosis should be considered in patients with ocular symptoms even in the absence of other suggestive clinical symptoms.
PubMed: 24223306
DOI: 10.1155/2013/892523 -
Annals of Medicine and Surgery (2012) Feb 2022and importance: Contralateral epidural hematoma (EDH) after decompressive surgery for acute subdural hematoma (ASDH) is uncommon. If unrecognized, this delayed hematoma...
INTRODUCTION
and importance: Contralateral epidural hematoma (EDH) after decompressive surgery for acute subdural hematoma (ASDH) is uncommon. If unrecognized, this delayed hematoma can lead to devastating consequences.
CASE PRESENTATION
A 30-year-old patient with no past medical history, was brought to the emergency after a severe brain injury secondary to an aggression, Glasgow coma scale was 6 (E1V1 M4) with a left anisocoria. The CT scan revealed a left acute subdural hematoma with midline shift superior than 10 mm, and a non-surgical contralateral EDH was also identified. The patient was operated on urgently. Post-operatively, the pupils became equal sized and reactive. A right anisocoria was noticed 12 h later, with a large contralateral EDH on CT scan associated to a gross midline shift. A second operation was performed immediately with a good recovery and the patient was extubated one week post-operatively.
CLINICAL DISCUSSION
The most common surgical complications after a decompressive craniectomy for an acute subdural hematoma noted in literature are surgical site herniation, post-operative infections, epilepsy, and subdural effusions with or without hydrocephalus. Contralateral epidural hematoma (EDH) after decompressive craniectomy is also documented (Ban et al., 2010; Nadig and King, 2012) [3,15]
CONCLUSIONS
Delayed contralateral EDH after decompressive surgery should be anticipated in the presence of contralateral skull fracture and/or intraoperative brain swelling and immediate postoperative scan is indicated. Early detection of this fatal complication and prompt treatment may improve the poor outcome in this group of patients.
PubMed: 35145655
DOI: 10.1016/j.amsu.2021.103233 -
Diagnostics (Basel, Switzerland) May 2021We reviewed the evidence on features of central nervous system (CNS) involvement in trichinellosis, systematically searching five databases (to January 2021). We... (Review)
Review
We reviewed the evidence on features of central nervous system (CNS) involvement in trichinellosis, systematically searching five databases (to January 2021). We categorized clinical features based on their diagnostic value as warning signs for severe CNS infection (with outcome death) or non-specific signs (outcome improvement). They were suggestive of severe infection if they substantially raised death probability. The review included 87 papers published from 1906 through 2019, with data on 168 patients. Mydriasis, paraparesis, dysphagia, psychomotor seizures, or delirium present a 30-45% increased death likelihood. The best poor prognosis predictor is mydriasis (positive likelihood ratio 9.08). Slow/absent light reflex, diminished/absent knee reflexes, globally decreased tendon reflexes present a moderate increase (20-25%) of death risk. Anisocoria, acalculia, or seizures could also indicate an increased death risk. We provided a detailed presentation of clinical and paraclinical signs that alert physicians of a possible neurotrichinellosis, emphasizing signs that might indicate a poor prognosis.
PubMed: 34070586
DOI: 10.3390/diagnostics11060945 -
European Journal of Medical Genetics Jun 2021Kabuki syndrome (KS) is a genetic disorder caused by pathogenic variants in KMT2D or KDM6A, and manifesting with multi-systemic involvement, including recognizable...
Kabuki syndrome (KS) is a genetic disorder caused by pathogenic variants in KMT2D or KDM6A, and manifesting with multi-systemic involvement, including recognizable facial features, developmental delay and multiple congenital anomalies. Ophthalmological involvement has been described in varying rates in several studies. We aimed to evaluate the prevalence and nature of ophthalmological findings in a cohort of KS patients in Israel. Medical records of all patients diagnosed with KS in our tertiary center between 2004 and 2020 were retrospectively reviewed. Data collected included physical examination findings, molecular analysis as well as comprehensive ophthalmic characteristics including visual acuity, ocular alignment and motility, ocular adnexa, anterior segments and dilated fundus exams. Finally, an updated systematic review of the literature was performed. Thirteen unrelated patients were included in the study, diagnosed at an age raging from the first months of life to 20 years. Of these, three (23%) showed significant ophthalmological abnormalities, beyond the characteristic structural findings of long palpebral fissures and lower eyelid eversion. These included bilateral posterior colobomata in the first patient; bilateral ptosis, hypermetropia, esotropia, blue sclera and anisocoria in the second; and bilateral congenital cataracts in the third. To conclude, our findings underscore the importance of a comprehensive ophthalmological evaluation as part of the routine multidisciplinary assessment of children suspected/diagnosed with KS.
Topics: Abnormalities, Multiple; Adolescent; Child; Child, Preschool; DNA-Binding Proteins; Eye Abnormalities; Face; Hematologic Diseases; Histone Demethylases; Humans; Infant; Neoplasm Proteins; Vestibular Diseases; Visual Acuity
PubMed: 33794347
DOI: 10.1016/j.ejmg.2021.104210 -
The American Journal of Medicine Nov 2015In patients with red eye, traditional teachings suggest that photophobia, visual blurring, and eye pain indicate serious eye disease; in patients with presumed... (Review)
Review
BACKGROUND
In patients with red eye, traditional teachings suggest that photophobia, visual blurring, and eye pain indicate serious eye disease; in patients with presumed conjunctivitis, the finding of purulent drainage traditionally indicates a bacterial cause. The accuracy of these teachings is unknown.
METHODS
A MEDLINE search was performed to retrieve articles published between 1966 and April 2014 relevant to the bedside diagnosis of serious eye disease and bacterial conjunctivitis.
RESULTS
In patients with red eye, the most useful findings indicating serious eye disease are anisocoria (with the smaller pupil in the red eye and difference between pupil diameters >1 mm; likelihood ratio [LR], 6.5; 95% confidence interval [CI], 2.6-16.3) and photophobia, elicited by direct illumination (LR, 8.3; 95% CI, 2.7-25.9), indirect illumination (LR, 28.8; 95% CI, 1.8-459), or near synkinesis test ("finger-to-nose convergence test," LR, 21.4; 95% CI, 12-38.2). In patients with presumed conjunctivitis, complete redness of the conjunctival membrane obscuring tarsal vessels (LR, 4.6; 95% CI, 1.2-17.1), observed purulent discharge (LR, 3.9; 95% CI, 1.7-9.1), and matting of both eyes in the morning (LR, 3.6; 95% CI, 1.9-6.5) increase the probability of a bacterial cause; failure to observe a red eye at 20 feet (LR, 0.2; 95% CI, 0-0.8) and absence of morning gluing of either eye (LR, 0.3; 95% CI, 0.1-0.8) decrease the probability of a bacterial cause.
CONCLUSIONS
Several bedside findings accurately distinguish serious from benign eye disease in patients with red eye and, in patients with presumed conjunctivitis, distinguish bacterial from viral or allergic causes.
Topics: Conjunctivitis; Diagnosis, Differential; Eye Diseases; Humans; Physical Examination
PubMed: 26169885
DOI: 10.1016/j.amjmed.2015.06.026 -
Oral Surgery, Oral Medicine, Oral... Mar 2016The aim of this review was to investigate the association between the occurrence of ocular adverse events and dental local anesthesia, the most plausible anatomic... (Review)
Review
OBJECTIVE
The aim of this review was to investigate the association between the occurrence of ocular adverse events and dental local anesthesia, the most plausible anatomic mechanisms, and the measures that offer patients a restitutio ad integrum.
STUDY DESIGN
This systematic review adopted a structured protocol to access available publications and followed the PRISMA statement.
RESULTS
Eighty-nine cases of patients experiencing ocular adverse events after administration of dental local anesthesia have been reported in the literature. Most of the complications manifested as double vision. Only 8% of the complications caused permanent functional damage, either as vision deficit or anisocoria. Complete permanent blindness was not reported.
CONCLUSIONS
Ocular complications as a result of dental local anesthesia may be seen as rare occurrences with usually low intensity. However, visual function may become permanently impaired and serious medical conditions may obscure ocular dysfunction.
Topics: Anesthesia, Dental; Anesthetics, Local; Diplopia; Humans; Vision Disorders
PubMed: 26768073
DOI: 10.1016/j.oooo.2015.10.023 -
Annals of Medicine and Surgery (2012) Jul 2022Kernohan Woltman Notch Phenomenon (KWNP) is caused by a supratentorial lesion pressing the contralateral cerebral peduncle against the free edge of the tentorium of the...
Kernohan Woltman Notch Phenomenon (KWNP) is caused by a supratentorial lesion pressing the contralateral cerebral peduncle against the free edge of the tentorium of the cerebellum. It is manifested by neurological signs of ipsilateral localization; cerebral MRI is the most sensitive examination for KWNP. Our patient is a 50-year-old woman, operated in 2011 for aortic and mitral valve replacement by mechanical prosthesis, under oral anticoagulant, consults for headaches evolving for 20 days without any notion of head trauma with installation of a progressively worsening left hemibody deficit. Glasgow coma scale was 14 (E3 V5 M6) with left anisocoria 4mm left/2mm right with left hemiplegia. CT shows a chronic left hemispheric subdural hematoma 13.5mm thick with subfalcorial and ipsilateral temporal involvement of the deficit. The cardiovascular examination as well as the biological assessment was unremarkable. The patient was operated on with a total recovery in 12 days, the anticoagulant is resumed on day 20 postoperatively, with close monitoring. KWNP may contribute to misdiagnosis in patients with bilateral corticospinal tract lesions, and anticoagulation poses a problem in stopping and restarting treatment due to the risk of bleeding on one side and thrombosis on the other side.
PubMed: 35860133
DOI: 10.1016/j.amsu.2022.104006