- ALK-positive adenocarcinoma of the lung expressing neuroendocrine markers and presenting as a "pituitary adenoma". [Journal Article]
- PPathologica 2017; 109(4):408-411
- We report an ALK-rearranged adenocarcinoma of the lung presenting as a pituitary metastasis, clinically simulating a pituitary adenoma. The patient, a 50 year-old, former-smoking woman was admitted w...
We report an ALK-rearranged adenocarcinoma of the lung presenting as a pituitary metastasis, clinically simulating a pituitary adenoma. The patient, a 50 year-old, former-smoking woman was admitted with a Parinaud's syndrome characterized by progressive oculomotor impairment of visual verticality, bitemporal hemianopsia and nystagmus. Imaging studies showed a sellar tumor and the biopsy revealed a TTF-1 and napsin positive lung adenocarcinoma strongly expressing synaptophysin and CD56, also harboring ALK rearrangement. A subsequent CT scan disclosed the primary lung mass of the left upper lobe. The patient progressed after 4 cycles of cisplatin/pemetrexed as first line treatment, but showed a partial response and a significant clinical benefit from the combination of ceritinib and nivolumab in a phase Ib trial. Despite its central nervous system tropism, ALK-rearranged adenocarcinoma manifesting with pituitary gland involvement was never reported. Second generation ALK inhibitors seem the best therapeutic strategy.
- Rapid progressive visual decline and visual field defects in two patients with the Heidenhain variant of Creutzfeld-Jakob disease. [Journal Article]
- JCJ Clin Neurosci 2018 Feb 08
- CONCLUSIONS: Loss of visual acuity and a decline in visual fields without corresponding MRI findings and marked changes in behaviour should lead to a diagnosis of HvCJD. Corresponding diagnostic tests should be performed for confirmation. The prognosis for survival is poor and should be immediately communicated to affected patients and their relatives.
- Statokinetic Dissociation (Riddoch Phenomenon) in a Patient with Homonymous Hemianopsia as the First Sign of Posterior Cortical Atrophy. [Journal Article]
- CRCase Rep Neurol 2017 Sep-Dec; 9(3):256-260
- We report a 60-year-old woman with posterior cortical atrophy (PCA) who presented with left homonymous hemianopsia persisting for 5 years; the patient's condition was observed using static, but not k...
We report a 60-year-old woman with posterior cortical atrophy (PCA) who presented with left homonymous hemianopsia persisting for 5 years; the patient's condition was observed using static, but not kinetic, perimetry. This statokinetic dissociation of hemianopsia, which is often called Riddoch syndrome, might have been caused by a dysfunction of the right primary visual and visual association cortices, representing a functional imbalance within a disturbed visual cortex. In patients with PCA and visual field defects, both static and kinetic perimetry may be useful for understanding the extent of degeneration in the visual cortex, in addition to examinations of unilateral neglect.
- Transnasal transphenoidal elevation of optic chiasm in secondary empty sella syndrome following prolactinoma treatment. [Journal Article]
- WNWorld Neurosurg 2018 Feb 05
- CONCLUSIONS: We review here secondary empty sella syndrome and discuss surgical strategies for optic chiasmapexy.
- Extended Endoscopic Approach for Resection of Craniopharyngiomas. [Journal Article]
- JNJ Neurol Surg B Skull Base 2018; 79(2):S201-S202
- Objectives Extended endoscopic approaches are useful for resection of selected craniopharyngiomas. Midline, extraventricular, and predominantly cystic lesions are good candidates for endoscopic rese...
Objectives Extended endoscopic approaches are useful for resection of selected craniopharyngiomas. Midline, extraventricular, and predominantly cystic lesions are good candidates for endoscopic resection. In this video, we demonstrate the endoscopic endonasal resection of a large suprasellar craniopharyngioma and discuss the nuances of the surgical technique. Design/Setting Surgical video of an extended endoscopic approach for resection of a suprasellar craniopharyngioma. Results We report the case of a 56-year-old woman who presented with bitemporal hemianopsia and visual acuity deterioration secondary to a large suprasellar solid-cystic lesion. The patient underwent an extended endoscopic transtuberculum approach for resection of the lesion, which was diagnosed as a papillary craniopharyngioma. This video discusses the anatomy and surgical technique applied for endoscopic resection of such lesions. Conclusion Endoscopic endonasal surgery is a useful technique for management of craniopharyngiomas. It is associated with good clinical outcomes in selected cases. Complications, such as postoperative CSF leak, may occur and should be carefully managed. The link to the video can be found at: https://youtu.be/EneOCiQE7yo .
- Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma with Fascia Lata Button and Nasoseptal Flap Reconstruction. [Journal Article]
- JNJ Neurol Surg B Skull Base 2018; 79(2):S191-S193
- Surgery for craniopharyngiomas can be challenging due to the involvement of multiple critical neurovascular structures. The expanded endoscopic endonasal approach can provide superior access to supra...
Surgery for craniopharyngiomas can be challenging due to the involvement of multiple critical neurovascular structures. The expanded endoscopic endonasal approach can provide superior access to suprasellar craniopharyngiomas, particularly with retrochiasmatic extension and significant hypothalamic involvement. We describe the surgical technique used to treat a 30-year-old patient who presented with 4 weeks of worsening vision, fatigue, and memory loss. His vision was counting fingers at 1 feet on the right and 20/800 on the left with a temporal hemianopsia. Laboratory evaluation demonstrated central hypoadrenalism, hypothyroidism, and hypogonadism. Imaging showed a large solid and cystic suprasellar mass. The transtubercular approach with removal of the lateral tubercular strut can provide wide bilateral access to the opticocarotid region. The superior intercavernous sinus must be coagulated and ligated. Initial arachnoid dissection is centered at the midline, mobilizing the superior hypophyseal branches to the optic apparatus laterally. The cyst capsule is opened and care is taken to minimize spillage of cyst fluid into the subarachnoid space. Central debulking and then extracapsular dissection is performed under direct visualization using sharp dissection. Reconstruction of the dura is performed with an inlay/onlay fascia lata button that is held together with four sutures that hold the graft edges against the native dural edges. This is followed by vascularized nasoseptal flap reconstruction. No lumbar drain or nonabsorbable packing is required. The patient's vision had dramatic improvement and by 1 week postoperatively was 20/20 with full visual fields. Postoperative diabetes insipidus was managed with nasal desmopressin. Postoperative MRI demonstrated complete removal. The link to the video can be found at: https://youtu.be/QQxCNUcq1qg .
- Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms. [Journal Article]
- JNJ Neurosurg 2018 Jan 26; :1-11
- CONCLUSIONS: The most important risk associated with clipping OphA aneurysms is a new visual deficit. Meticulous microsurgical technique is necessary during anterior clinoidectomy, aneurysm dissection, and clip application to optimize visual outcomes, and aggressive medical management postoperatively might potentially decrease the incidence of delayed visual deficits. As the results of endovascular therapy and specifically flow diverters become known, they warrant comparison with these surgical benchmarks to determine best practices.
- Driving With Hemianopia VI: Peripheral Prisms and Perceptual-Motor Training Improve Detection in a Driving Simulator. [Journal Article]
- TVTransl Vis Sci Technol 2018; 7(1):5
- CONCLUSIONS: P-prisms improved detection with no negative effects, and training may provide additional benefit.
- [(Neuro-)ophthalmogical aspects of driving ability]. [Journal Article]
- FNFortschr Neurol Psychiatr 2018; 86(1):28-36
- The requirements regarding visual functioning needed for driving ability are stipulated in Annex 6 of the German driving licence regulations: In case of a visual disorder an ophthalmological assessme...
The requirements regarding visual functioning needed for driving ability are stipulated in Annex 6 of the German driving licence regulations: In case of a visual disorder an ophthalmological assessment is essential: It is of crucial importance for the examining ophthalmologist to exhaust all ocular-medical possibilities to enable the applicant to maintain or regain his driving permission. In the overwhelming majority of the cases this is eminently feasible.However, there is no way to attest driving ability in a patient suffering acute one-sided visual loss for a period of 3 months on the basis of legal recommendations. Concerning oculomotor disturbances, the expansion of the diplopic central visual field and the subjective restriction caused thereby are important: the central 20 degree area must be free of diplopia.According to the German driving license regulations, absolute homonymous visual field defects such as hemianopsia or quadrantic defects affecting the visual centre are incompatible with driving an automobile. Even training measures causing the patient to experience a sense of smooth orientation do nothing to mitigate this fact.Dealing with serious disturbances of visual function, as a matter of principle an ophthalmologist should provide an additional expertise before a positive decision on driving ability is made.
New Search Next
- Neutropenia as a Complication of Tumefactive Demyelinating Disease: A Case Report. [Journal Article]
- PM RPM R 2018 Jan 09
- Tumefactive demyelination is an aggressive, localized, generally solitary area of demyelination that often mimics a neoplasm. We present a case of a 13-year-old female who presented with sudden onset...
Tumefactive demyelination is an aggressive, localized, generally solitary area of demyelination that often mimics a neoplasm. We present a case of a 13-year-old female who presented with sudden onset, progressive hemiplegia and hemianopsia. Brain magnetic resonance imaging showed tumefactive demyelination with partial rim of enhancement. During inpatient rehabilitation, she developed myalgias, rash, abdominal and mouth pain with evidence for severe neutropenia. The neutropenia was determined to be a secondary complication of the tumefactive disease process. This scenario may be concerning in an inpatient rehabilitation setting as patients share common areas, increasing the risk of acquired infection while neutropenic.