- Unilateral localized extraocular muscle metastasis by lobular breast carcinoma. [Journal Article]
- BCBMJ Case Rep 2018 Oct 12; 2018
- Here is a case of an isolated orbital metastasis in a previously diagnosed metastatic breast cancer of a 46-year-old woman presenting diplopia and pain in her left eye. The magnetic resonance showed ...
Here is a case of an isolated orbital metastasis in a previously diagnosed metastatic breast cancer of a 46-year-old woman presenting diplopia and pain in her left eye. The magnetic resonance showed a suspected metastatic localisation in the upper left oblique muscle, which was confirmed by the fine-needle aspiration biopsy. The systemic therapy with liposomal doxorubicin as well as local stereotactic radiotherapy showed a gradual improvement of the local symptoms and signs.
- A rare and symptomatic Cavernous Donut-shaped Aneurysm treated by Flow Diverter Deployment. [Journal Article]
- WNWorld Neurosurg 2018 Oct 09
- We describe the case of a 62-year-old woman, who was admitted at our center for acute diplopia secondary to a left III cranial nerve palsy, left eyelid swelling and ptosis, and mild ipsilateral retro...
We describe the case of a 62-year-old woman, who was admitted at our center for acute diplopia secondary to a left III cranial nerve palsy, left eyelid swelling and ptosis, and mild ipsilateral retro-orbital pain. No other motor or sensitive deficits were observed. A CT-Angiography (CTA) and a Digital Subtraction Angiography (DSA) were performed, showing a 25 mm left intra-cavernous aneurysm with a central intrasaccular thrombus, an intra-saccular "swirling" flow with a donut-shape appearance. A flow-diverter stent (FD) was deployed bridging the aneurysmal neck. Twelve months after the procedure the aneurysm was completely occluded and the patient had totally recovered the cavernous syndrome. A careful literature review has been performed and the different endovascular approaches analyzed.
- Application of three-dimensional printing technology in orbital floor fracture reconstruction. [Journal Article]
- TCTrauma Case Rep 2018; 17:23-28
- CONCLUSIONS: Application of 3D printing in medical specialties is rapidly developing in the past few years. In orbital floor fracture reconstruction, 3D printed model provides a customized solution, decreases operative time and duration of anaesthesia.
- Sinusitis in Children. [Journal Article]
- PAPediatr Ann 2018 Oct 01; 47(10):e396-e401
- Acute bacterial sinusitis (ABS) mostly occurs as a complication of acute viral upper respiratory tract infection (URI), which is a common condition encountered in an outpatient setting. ABS manifests...
Acute bacterial sinusitis (ABS) mostly occurs as a complication of acute viral upper respiratory tract infection (URI), which is a common condition encountered in an outpatient setting. ABS manifests with three different presentations, most commonly as persistent symptoms of viral URI (nasal drainage and or cough) for more than 10 days. ABS is also diagnosed when the patient presents with severe symptoms of a URI accompanied by fever >102.2°F and purulent nasal drainage for at least 3 days. Lastly, ABS can complicate viral URI around day 6 or 7 of illness after initial improvement in the symptoms of URI. Imaging studies are not recommended for diagnosing ABS, unless intracranial or orbital complications are suspected. Signs of proptosis, restriction of eye movements, ophthalmoplegia, and visual impairment are very specific for orbital involvement. Treatment of ABS with antibiotics is recommended based on the clinical scenario and has been shown to have higher cure rates as compared to placebo. [Pediatr Ann. 2018;47(10):e396-e401.].
- Physiotherapy in postinfection injury to cranial nerves III, IV, and VI: a case study. [Journal Article]
- AJAm J Phys Med Rehabil 2018 Oct 08
- The patient with bacterial infection sequelae in the form of damage to cranial nerves (CN) III, IV, and VI was followed-up. He had exhibited clinical and radiographic signs of paranasal sinusitis. Pr...
The patient with bacterial infection sequelae in the form of damage to cranial nerves (CN) III, IV, and VI was followed-up. He had exhibited clinical and radiographic signs of paranasal sinusitis. Prior to his physiotherapy, the patient received standard treatment with natural and synthetic antibiotics and steroids. After acute signs of infection resolved without any functional improvement, the patient was referred to a rehabilitation unit to undergo neuromuscular re-education of the paralyzed extraocular muscles. Periorbital hydrocortisone iontophoresis and visuomotor exercises with intense ideomotor stimulation led to complete and rapid resolution of extraocular muscle paralysis and diplopia. Physiotherapy can be an effective treatment of choice after failed pharmacological treatment in patients with damage to CN III and VI. It has many theoretical advantages, including non-invasiveness and avoidance of first-pass metabolism of drugs administered systemically.
- Myasthenia gravis crisis coinciding with asthma exacerbation in a patient with recent heroin use: three causes of acute hypercarbic respiratory failure. [Journal Article]
- BCBMJ Case Rep 2018 Oct 07; 2018
- A 57-year-old woman with a history of asthma, hypertension and substance abuse disorder was admitted to the medical intensive care unit with hypercapnic respiratory failure. After the history was obt...
A 57-year-old woman with a history of asthma, hypertension and substance abuse disorder was admitted to the medical intensive care unit with hypercapnic respiratory failure. After the history was obtained, patient admitted heroin use earlier that day. The initial physical examination revealed right eye ptosis, diplopia, fatigability of neck flexion and extension. She also presented with wheezing and a prolonged expiratory phase. Pupils were 4 mm, with sluggish response to light bilaterally. CT chest with contrast showed a large mediastinal mass. Three different processes coexisted in this patient: simultaneous occurrence of a myasthenia gravis crisis, asthma exacerbation and a component of heroin use. This case highlights a series of overlapping clinical features that could lead to potential confounding and misdiagnosis. Respiratory symptoms improved after initial treatment for asthma exacerbation, but ptosis, diplopia and fatigability of neck muscles persisted.
- Bilateral pseudo-internuclear ophthalmoplegia in a patient with myasthenia gravis. [Journal Article]
- AJAm J Ophthalmol Case Rep 2018; 12:76-78
- CONCLUSIONS: Although myasthenia gravis often presents with ptosis or diplopia, rarely patients may develop pseudo-INO secondary to extraocular muscle weakness. True INO occurs with damage to the medial longitudinal fasciculus, a myelinated tract of fibers that controls yoked horizontal eye movements. Clinicians should be suspicious of the false localizing sign of a pseudo-INO associated with myasthenia gravis when more common causes of INO have been excluded.
- Pituitary Apoplexy following Endoscopic Retrograde Cholangiopancreatography. [Journal Article]
- WNWorld Neurosurg 2018 Oct 03
- CONCLUSIONS: Although pituitary apoplexy has been recognized as a sequela of surgical and laparoscopic procedures, it should also be considered in less invasive gastrointestinal (GI) procedures which may alter the intraabdominal pressures, such as ERCP. Early detection of this unusual complication allows for rapid diagnosis and timely surgical intervention in select cases to prevent debilitating cranial nerve palsies, preserve visual function, and retain normal pituitary function.
- Recovery of Oculomotor Nerve Palsy after Endovascular and Surgical Treatment of Posterior Communicating Artery Aneurysms: A Single Institutional Experience. [Journal Article]
- AJAsian J Neurosurg 2018 Jul-Sep; 13(3):555-559
- CONCLUSIONS: Compared to endovascular coiling, surgically clipped PcomA aneurysms are associated with a faster rate of full recovery of ONP.
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- Co-occurrence of acute ophthalmoplegia (without ataxia) and idiopathic intracranial hypertension. [Journal Article]
- EJEur J Ophthalmol 2018 Oct 03; :1120672118803532
- CONCLUSIONS: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.