Imaging of adult ocular and orbital pathology - a pictorial review

Orbital pathology often presents a diagnostic challenge to the reporting radiologist. The aetiology is protean, and clinical input is therefore often necessary to narrow the differential diagnosis. With this manuscript, we provide a pictorial review of adult ocular and orbital pathology.peer-reviewe

Bilateral diffuse choroidal hemangioma in Sturge Weber syndrome: a case report highlighting the role of multimodal imaging and a brief review of the literature

Purpose: The purpose of this paper is to present a patient with bilateral choroidal hemangioma in Sturge-Weber syndrome (SWS) and highlight multimodal imaging techniques for early detection and management of ocular alterations. Methods: A 37-year-old woman with diagnosis of SWS presented to our unit. The patient had been treated with pulsed dye laser for bilateral nevus flammeus and had right leptomeningeal angiomatosis. She had glaucoma, but ultrasound biomicroscopy did not show anterior chamber or ciliary body alterations. Results: Enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT) showed bilateral diffuse choroidal hemangiomas in both eyes with choroidal thickness above 1000 μm. B-scan ultrasound examination showed diffuse choroidal hemangioma in both eyes, with a choroidal thickness of 1.53 mm and 1.94 mm in the right and left eye (RE, LE), respectively. Peripapillary retinal nerve fiber evaluation showed thinning of the retinal nerve fiber layer in both eyes. Conclusions: This report highlights multimodal imaging techniques for the critical assessment of patients with SWS, especially in rare cases with bilateral choroidal hemangioma of the choroid. Novel imaging modalities enable optimal management and follow-up of rare conditions, and our case adds further evidence to the existing literature

Twenty-seven years follow-up of a patient with congenital retinocephalofacial vascular malformation syndrome and additional congenital malformations (Bonnet-Dechaume-Blanc syndrome or Wyburn-Mason syndrome)

<p>Abstract</p> <p>Purpose</p> <p>Follow-up of vascular changes in a patient with congenital retinocephalofacial vascular malformation syndrome.</p> <p>Methods</p> <p>MRI and cerebral angiography.</p> <p>Results</p> <p>In a 36-year-old man, magnetic resonance im aging of the skull and cerebral angiography revealed left intracranial arteriovenous malformations. Follow-up observation of 27 years revealed no essential change of retinal and cerebral arteriovenous malformations. Additional congenital deficits in this patient were described.</p> <p>Conclusion</p> <p>Patients with retinal arteriovenous malformations should be early examined with neuroradiological methods.</p

Unilateral abducens nerve palsy: A presenting sign of sphenoid sinus mucocoeles

Sphenoid sinus mucocoeles can stimulate a variety of pathological conditions and patients can present to a range of specialists. Because of the relative rarity of sphenoid sinus mucocoeles, diagnosis is often delayed and these lesions can progressively expand and cause direct mechanical compression on adjacent structures. We present three cases which presented with an abducens nerve palsy. Early surgical intervention is advocated and these patients' symptoms resolved following surgery. Although several conditions can present with an abducens nerve palsy, it is important to consider a sphenoid sinus mucocoele in the differential diagnosis

Clinical analysis of papilledema.

INTRODUCTION: Papilledema is one of the true neuroophthalmic emergencies. Patients may present to ophthalmologist with signs and symptoms of raised intracranial pressure, such as headache, nausea, vomiting, and abducens paresis, or may be referred by another physician or may be detected accidently during a routine ophthalmic check up. Papilledema serves as an important indicator and warning signal of intracranial pathology. It can also help in finding the severity and management of systemic disease such as hypertension and preeclampsia and preventing further vascular crisis in other organs. AIMS OF THE STUDY: 1. To study the aetiological pattern in Papilledema 2. To study the involvement of 6th cranial Nerve in Papilledema 3. To study the visual acuity pattern in papilledema 4. To study the visual field and colour vision pattern in Papilledema. 41 MATERIALS AND METHODS: The cases studied were the patients with Papilledema who presented to department of neuro ophthalmology at the Regional Institute of Ophthalmology and Govt. Ophthalmic Hospital. All the age groups and both sexes were included. A complete ophthalmological workup was done. INCLUSION CRITERIA: 1. All cases of papilledema. EXCLUSION CRITERIA: All cases of post papilledemic optic atrophy, papilledema due to grade IV hypertensive retinopathy, and papilledema due to grade IV hypertensive retinopathy in pregnancy induced hypertensive patients were excluded. CONCLUSION: 1.Papilledema occur in a wide range of age but are more common in the age group of 21-30 years. 2. Overall, females were affected more than males. 3. Bilateral papilledema was most common than unilateral papilledema like Foster Kennedy syndrome. 4. The common aetiological factor for papilledema was space occupying lesion. 5. 44.4% of the patients had sixth cranial nerve paresis in papilledema. 6. More than three forth of patients had normal visual acuity in papilledema. 7. Less than half of the patients had visual field involvement in papilledema. 8. All the patients had normal colour vision pattern in papilledema. 9. A careful history, general and complete ophthalmological workup with necessary investigations like CT, MRI/MRV are mandatory to diagnose patients with papilledema. Since papilledema can be manifestations of life threatening condition, the ophthalmologist should be able to detect early papilledema and refer them immediately

Congenital arterio-venous fistulae and other vascular anomalies

The object of this thesis is to present an extensive survey of some rare congenital vascular anomalies, with special reference to arterio- venous fistulae. Interest was first aroused in those cases which showed a marked hypertrophy of a limb, along with numerous angiomata and varicose veins. Investigations revealed that these features had been described both in the presence and in the absence of arteriovenous fistulae, and, further, that arterio -venous fistulae could be found in the absence of hypertrophy or angiomata. Illustrating many of the varied and bizarre manifestations, a series of twelve cases has been examined and will now be reported, the presence of arterio -venous fistulae being found in nine cases, but not in the other three. These cases will, there - fore, be described in considerable detail, along with brief reports on two other cases which have come to my notice.Though the lesions under review are congenital, there has been much difference of opinion as to the underlying pathology, a haemangioma, indicating a true tumour, being maintained by some, and an actual maldevelopment of the vascular system being supported by others. Such opposing views are shown by the varied and confused nomenclature, the following being examples of names which might be applied to my own series of cases, and which have been freely used in the past : - arterio- venous aneurysm, anastomoses or fistulae; cirsoid or racemose aneurysm; aneurysm by anastomosis; aneurysmal varix; many varieties of haemangioma or naevus, such as cavernous, pulsating, plexiform, arterial or venous; haemangioma of bone or 'muscle; angiosarcoma; phlebarteriectasis; phiebec Itasis; cavernoma; haemangiectatic hypertrophy; hems hypertrophy; generalised angiomatosis

UWOMJ Volume 30, Number 2, March 1960

Schulich School of Medicine & Dentistryhttps://ir.lib.uwo.ca/uwomj/1179/thumbnail.jp

Analysis of 50 cases of Stroke in Young Adults

In this study, 50 young adults with stroke were included. The incidence in men was 64% compared to 36% in women. This is in agreement with studies conducted by other centers. In this study, the peak incidence of stroke was observed in the age group of 36-40 years which was 32%. It was 20% in the age group of 31-35 years. In a study conducted by P.M.Dalal et al, the incidence of stroke was maximum in the age group of 36-40 years which is similar to our study. In our study 52% of patients were above the age of 30 years, compared is 48% patients in the above study. Analysis of Risk factors :- Hypertension : Hypertension is one of the common risk factors associated with stroke. The incidence of hypertension was 18% in this study. In a study conducted by P.G.A.Sander Cock et al81 this incidence was 32%. Diabetes Mellitus : Out of 50 patients studied, 2 patients had diabetes mellitus. Hyperlipidemia : 7 Patients who had abnormal lipid profile were affected by premature atherosclerosis. Transient Ischaemic attack : Incidence of TIA was 10% in this study. In the study conducted by L.N.Jones the incidence of TIA was 14%. Smoking : In this study, out of 22 male patients, 20 were smokers. The remaining 18 patients were female non smokers. It became an important risk factor mainly due to premature atherosclerosis associated with it. Cordiac Source of Emboli : Cordiac source of emboli was observed in 26% of cases. In the study conducted by P.M.Dalal et al, the incidence of cordiac source of emboli was 20%. In our study, 10% of patients had atrial fibrillation. In the oxford shire community stroke project81, the incidence of atrial fibrillation was 17%. 7 Patients had RHD, out of which 5 were in AF. 2 Patients had congenital heart disease (TOF). Alcohol : In this study, 32% of males were alcoholics, out of them one person had stroke followed by an alcoholic binge. Similar observation of stroke in young men after alcoholic binge, was noted by M.R.Wilkins, M.J.Kendall82. 8% of patients who presented with haemorrhagic stroke had arterio venous malformation in the cerebral vascular system. 4% of young patients with stroke had Takayasu’s arteritis involving carotid & Subclavian artery. Cervical arterial Bruit : Cervical arterial bruit was observed in 2% of cases. In the Dalal et al. study, it was observed in 9% of cases. Uncertain Causes : Stroke due to undetermined causes was 6% in our study & in oxford shire community study, it was 5%. A definite risk factor was present in 70% of cases in our study but according to other observation it was 80%. More than one risk factors were noted in 30% of cases. Serum Homocystein level was raised in 6 patients who had cerebral infarct. (Normal Range 3.7 – 13.9 mmol/L). In our study, out of 50 patients, one had Antithrombin – III deficiency. One patient developed metastatic brain abcess originated from congenital heart disease (TOF) Types of Stroke : In this study ; • Ischaemic stroke was present in 66% of cases. • Haemorrhagic stroke was present in 26% of cases but according to Harvard cooperative stroke registry study, the incidence was 15%. • Cortical vein thrombosis was seen in 12% of cases & all the patients observed were female in post partum period. Similar observation was made by M.E. Yeolker. According to Dalal et al study80, which included 93 cases for a period of 5 years, the incidence of Ischaemic stroke was 80.60% and Haemorrhagic stroke was 12.50% when compared with this study, the incidence of Ischaemic stroke was 66% and haemorrhagic stroke was 26% in our study. CONCLUSION : 1. The incidence of stroke in young adults is more common in the age group between 36-40 years & males are more affected (64%) than females (36%). 2. Cardioembolic stroke is the commonest cause of stroke in young adults. Smoking is the most significant risk factor for stroke in young adults mainly due to the premature atherosclerosis associated with it. 3. Even though mitral value prolapse is consided as one of the major risk factors for stroke in young adults, in our study, out of 50 young patients who had stroke only 2 had MVP. But even in those cases MVP was not the cause for stroke. 4. TIA is experienced by 10% of patients. 5. All the patients who suffered from cortical vein thrombosis are females in puerperal period. 6. Among hypercoagulopathies causing stroke, hyperhomocysteinemia is the commonest followed by antithrombin III deficiency. 7. In about 6% of cases, no cause could be attributed. 8. The predominant mode of presentation of stroke is middle cerebral territory involvement. The commonest pathological type is (ischaemic stroke (66%)). 9. In vascular disease, takayasu’s arteritis causes 4% of stroke & arteriovenous malformation causes 8% of stroke

A study on etiology of papilloedema in South Tamilnadu

INTRODUCTION: The etiological diagnosis and management of papilloedema is one of the most fascinating and perplexing problems of Neuro ophthalmology. Papilloedema is one of the most common conditions an ophthalmologist comes across in routine clinical practice. The ophthalmologist has a vital role in differentiating papilloedema from pseudo papilloedema, in confirming the diagnosis and in advising the time of surgery and in giving the prognosis as far as vision is concerned. In this study an attempt has been made to study papilloedema in all its aspects. AIM OF THE STUDY: 1. To study the different etiologies of papilloedema in a tertiary level hospital. 2. To study the progression of papilloedema during the course of disease. 3. To find out the associated systemic causes. MATERIALS AND METHODS: The study of etiologies and ophthalmoscopic findings, CT findings of papilloedema in South Tamil Nadu was carried out in the Department of Ophthalmology, Tirunelveli Medical College Hospital, Tirunelveli. Settings: Ophthalmology ward, Neuro Medicine ward, Neuro surgical ward, Medical ward, Pediatric ward. Study design: Single centre observational prospective hospital based study. Period of study: June 2007 to June 2009. Ethical approval: Obtained Tirunelveli Medical College Hospital is a tertiary care centre in South Tamil Nadu. The patient population is fairly representative sample of the disease pattern in this region. 75 patients with papilloedema in the above period who satisfied the set criteria were included. 1). Papilloedema is defined as bilateral passive noninflammatory edema of the optic disc due to raised intra cranial pressure which is almost always bilateral and without any visual deficit. 2). The patients presented with headache, nausea, vomiting, defective vision with ophthalmoscopic findings of fundus with papilloedema. 3). 75 patients, with visual acuity recording, field charting, colour vision, neurological examination, CT brain were included. Exclusion criteria: 1). Inflammatory optic disc edema. 2). Unilateral papilloedema were excluded. 3). Pseudo papilloedema were excluded. After obtaining consent from either patient or relatives, all patient in the study group were evaluated by complete medical history, full ophthalmoscopic examination, fundus examination and CT scan and MR imaging of brain in indicated cases. Clinical history: Clinical history was recorded from either the patient or his/her relatives. Special emphasis was given to the presenting complaint, mode of onset, duration, associated features, activity of the patient at the time of onset and the pattern of presentation. Presence or absence of risk factors for papilloedema were also noted. Past H/o HT, steroid intake, oral contraceptive pills, trauma, tumor, treatment were carefully sought. Ophthalmic evaluation: Visual acuity, tension, colour vision, field, fundus examination with direct ophthalmoscope, indirect ophthalmoscope and +90 D lens were noted. A detailed neurological examination was done in each patient which included examination of higher functions, cranial nerves, sensory system, motor reflex and cerebellum. Investigations like blood Hb%, TC, DC, blood sugar, CT brain, MRI brain were done in all patients. CONCLUSION: 1. Papilloedema is most common in the 3rd decade of life and rare after 50 years of age. There is a female preponderance. 2. Headache is the commonest symptom and vomiting is rare according to my study. 3. Poor vision at presentation and late detection of papilloedema are factors responsible for poor visual outcome. 4. Symptoms of vomiting and diplopia are infrequent but important indicators of papilloedema. 5. Enlarged blind spot is the commonest field defect. 6. Idiopathic intra cranial hypertension was the commonest etiology for papilloedema in my study. 7. Infra tentorial tumours are the commonest intra cranial space occupying lesions causing papilloedema. 8. All patients visiting the ophthalmology department must have a fundus examination to detect papilloedema especially those presenting with headache. 9. Behcet syndrome and iron deficiency anaemia have to be born in mind as rare but proven causes of papilloedema. RECOMMENDATION & PREVENTIVE PROSPECTS: 1. All the patients with headache should be evaluated ophthalmoscopically to look for papilloedema. 2. Early diagnosis and prompt treatment may relieve symptoms. 3. In chronic cases papilloedema resolves into optic atrophy and visual loss is the outcome. So early treatment is necessary to retain vision

Vascular Malformations of the Central Nervous System

Vascular malformations of the central nervous system are important pathologies that could present with abrupt onset hemorrhage resulting in devastating neurological deficits. Current knowledge of their biology and natural history is increasing. Diagnostic modalities help clinicians to better evaluate the individual cases, and to decide the best treatment options. Treatment alternatives are various and all treatment options should be evaluated before choosing the final therapeutic modality. The purpose of this book is to review the current knowledge about vascular malformations of the central nervous system and to evaluate the treatment alternatives