Decreased Vision and Junctional Scotoma from Pituicytoma

Pituicytomas are rare neoplasms of the sellar region. We report a case of vision loss and a junctional scotoma in a 43-year-old woman caused by compression of the optic chiasm by a pituitary tumor. The morphological and immunohistochemical characteristics of the tumor were consistent with the diagnosis of pituicytoma. The tumor was debulked surgically, and the patient's vision improved

Isolated presumed optic nerve gumma, a rare presentation of neurosyphilis

Purpose The incidence of syphilitic infections continues to rise and represents a major public health concern, particularly in patients co-infected with human immunodeficiency virus (HIV). The infection has a multitude of clinical presentations and is often referred to as the ‘great imitator.’ We present a rare case of an isolated presumed syphilitic optic nerve gumma and characterize it using newer imaging modalities. Observations A 36-year-old HIV-positive man, compliant with treatment, presented with a five day history of decreased vision in the left eye. On examination his visual acuity was 20/30 with mild dyschromatopsia and an inferior altitudinal field defect in the left eye. Funduscopy demonstrated small cup to disc ratios bilaterally and a swollen and hyperemic left optic disc. Following five months of stable vision, the patient's vision in the left eye declined to 20/60, associated with diffuse visual field loss and continued swelling of the left optic disc. Subsequent magnetic resonance imaging with contrast demonstrated enhancement of the left optic nerve, and his serologies were positive for syphilis. Fluorescein angiography and optical coherence tomography were used to better characterize the lesion being most consistent with a syphilitic optic nerve gumma. Conclusions and importance Gummas of the central nervous system are a rare presentation of neurosyphilis and the last reported gumma of the optic nerve was in 1990. Such lesions have not been characterized using newer imaging modalities including optical coherence tomography and fluorescein angiography, both of which may assist in the diagnosis of this rare entity. With the increased prevalence of syphilis and remarkable response to therapy, syphilitic gummas should be considered in at-risk patients presenting with an optic neuropathy

Orbital leiomyosarcoma metastasis presenting prior to diagnosis of the primary tumor.

Leiomyosarcomas, neoplasms of smooth muscle, are rarely found within the orbit. Orbital leiomyosarcoma may be primary, metastatic, or secondary to radiation. When they are metastatic, patients almost exclusively have a history of a primary leiomyosarcoma, often occurring in the spermatic cord, skin, gastrointestinal tract, or the uterus. We present the case of 48-year-old woman who presented with a metastatic orbital leiomyosarcoma, which was identified before the primary tumor

Isolated Bilateral Fourth Cranial Nerve Palsies as the Presenting Sign of Hydrocephalus

Midbrain lesions leading to bilateral fourth nerve palsies are typically accompanied by other brainstem symptomatology. Here we report a case of a 29-year-old man with hydrocephalus and significant third ventricle dilation applying pressure on the dorsal midbrain and having as only manifestation isolated, bilateral fourth cranial nerve palsies. This finding, reported now for the first time, could be attributed to a partially working ventriculoperitoneal shunt previously placed to this patient, which was able to sporadically relieve the increases of the intraventricular pressure on the midbrain that would normally lead to other manifestations

A Rod-Sparing Retinopathy in Bardet-Biedl Syndrome

Bardet-Biedl syndrome is a continuum of disorders characterized by systemic and ocular findings. Retinal abnormalities typically present as diffuse photoreceptor degeneration. Here, we report a novel case that suggests a rod-sparing variant of Bardet-Biedl syndrome

Internações em UTI por causas obstétricas

The objective was to analyze the admission of women of childbearing age to an Obstetric Intensive Care Unit. A cross-sectional, documentary and retrospective study was carried out in an Obstetric Intensive Care Unit, located in Fortaleza/Ceará, with women of childbearing age admitted to the unit in 2016. Data were collected from 106 medical records that met the inclusion criteria during the month of April 2017, using a semi-structured form, and analyzed by means of descriptive statistics. The majority of the women were between 20 and 29 years old, common-law married, with complete secondary education, primiparous, had initiated prenatal care in the first trimester of pregnancy, and attended 4 to 6 consultations. Among the direct obstetric causes (61.1%), the most frequent were Eclampsia (34.4%), HELLP syndrome (15.1%) and Severe preeclampsia (11%). The indirect obstetric causes (38.9%) included Renal insufficiency (13.5%), Acute lung edema (11.5%) and Heart disease (9.6%). Data revealed a fragile health care for women within the pregnant-puerperal cycle.Su objetivo es analizar los ingresos de mujeres en edad fértil en una Unidad de Cuidados Intensivos Obstétrica. Estudio transversal, documental y retrospectivo, realizado en una Unidad de Cuidados Intensivos Obstétrica, ubicada en Fortaleza / Ceará, con la presencia de mujeres en edad fértil admitidas en la unidad en el año 2016. Los datos fueron recolectados de los registros que atendieron a los criterios de inclusión. Durante el mes de abril de 2017, mediante un formulario semiestructurado y analizado por medio de estadística descriptiva, siendo incluidos 106 registros. La mayoría de las mujeres tenía un grupo de edad entre 20 y 29 años, pardas, en unión estable, con enseñanza media completa, primíperas, con inicio del prenatal en el primer trimestre gestacional, con 4 a 6 consultas. Entre las causas obstétricas directas (61,1%) las principales fueron Eclampsia (34,4%), Síndrome de Hellp (15,1%) y Pre-eclampsia grave (11%) y para las causas obstétricas indirectas (38,9 (%), Se observan las siguientes: Insuficiencia renal (13,5%), Edema agudo de pulmón (11,5%) y Cardiopatía (9,6%). Los datos revelan una línea tenue en lo que concierne a la atención a la salud de las mujeres dentro del ciclo gravídico-puerperal.Objetivou-se analisar as internações de mulheres em idade fértil em uma Unidade de Terapia Intensiva Obstétrica. Estudo transversal, documental e retrospectivo, realizado em uma Unidade de Terapia Intensiva Obstétrica, localizada em Fortaleza/Ceará, com a presença de mulheres em idade fértil admitidas na unidade no ano de 2016. Os dados foram coletados dos prontuários que atenderam aos critérios de inclusão, durante o mês de abril de 2017, mediante um formulário semiestruturado e analisados por meio de estatística descritiva, sendo incluídos 106 prontuários. A maioria das mulheres tinham faixa etária entre 20 a 29 anos, pardas, em união estável, com ensino médio completo, primíperas, com início do pré-natal no 1º trimestre gestacional, com 4 a 6 consultas. Dentre as causas obstétricas diretas (61,1%) as principais foram Eclâmpsia (34,4%), Síndrome de Hellp (15,1%) e Pré-eclâmpsia grave (11%) e para as causas obstétricas indiretas (38,9%) destacam-se Insuficiência renal (13,5%), Edema agudo de pulmão (11,5%) e Cardiopatia (9,6%). Os dados revelam uma linha ténue no que concerne a atenção a saúde da mulheres dentro do ciclo gravídico-puerperal

Emerging challenges in understanding trypanosome antigenic variation

Many pathogens evade host immunity by periodically changing the proteins they express on their surface — a phenomenon termed antigenic variation. An extreme form of antigenic variation, based around switching the composition of a variant surface glycoprotein (VSG) coat, is exhibited by the African trypanosome Trypanosoma brucei, which causes human disease. The molecular details of VSG switching in T. brucei have been extensively studied over the last three decades, revealing in increasing detail the machinery and mechanisms by which VSG expression is controlled and altered. However, several key components of the models of T. brucei antigenic variation that have emerged have been challenged through recent discoveries. These discoveries include new appreciation of the importance of gene mosaics in generating huge levels of new VSG variants, the contributions of parasite development and body compartmentation in the host to the infection dynamics and, finally, potential differences in the strategies of antigenic variation and host infection used by the crucial livestock trypanosomes T. congolense and T. vivax. This review will discuss all these observations, which raise questions regarding how secure the existing models of trypanosome antigenic variation are. In addition, we will discuss the importance of continued mathematical modelling to understand the purpose of this widespread immune survival process

Current Status of Image-Guided Radiation Therapy for Patients with base of Skull Tumors

Management of tumors in the cranial base has been challenging for neuro-ophthalmologists, radiation oncologists, otolaryngologists and neurosurgeons for more than a century. Since tumors are located deep in the skull and can involve important visual and neurovascular structures, surgical treatment was associated with high morbidity and mortality.curriculum_fellow; VBskullbasetumor

Optic Chiasmal Glioma in an Adult Associated with a Good Long-Term Prognosis: A Case Report and Review of the Literature

To report a case of a glioma of the optic chiasm that presented in an adult and was associated with an excellent long-term prognosis

Comparison of AO Hardy-Rand-Rittler and Richmond Products Color Plates

AOHRR pseudoisochromatic plates are used to recognize acquired dyschromatopsia for diagnosing optic neuropathy. They contain blue-yellow and red-green discriminations, providing a simple, sensitive, selective test. The AOHRR plates have been out of print since 1957. We investigated whether RP plates are an equivalent replacement for AOHRR