Bilateral Orbital Inflammation as a Manifestation of Paraneoplastic Syndrome

Paraneoplastic neurologic syndromes (PNS) constitute a rare group of disorders whose optimal treatment is yet to be established. We report a patient with bilateral orbital inflammation associated with PNS, who responded well to surgical resection of the primary tumor. An 83-year-old woman was referred to our department for treatment of a progressive reduction in visual acuity and palpebral swelling in both eyes for the past 2 months. She was scheduled to undergo thoracic surgery for lung cancer. The best-corrected visual acuity (BCVA) in the right and left eye had worsened from 0.3 to 0.5 one month before she was referred to our department to 0.03 and 0.07, respectively. A slit-lamp examination revealed edema in both eyelids. Goldmann perimetry revealed several paracentral scotomas with constriction of the peripheral visual fields of both eyes, along with central absolute scotomas in V-4e isopter in the right eye. Magnetic resonance imaging revealed swelling of the bilateral extraocular muscles, which compressed the bilateral optic nerves at the orbital apex. Seven days after the resection of the lung cancer, the BCVA improved to 0.07 and 0.15 in the right and left eyes, respectively, without concomitant immunotherapy. Intravenous methylprednisolone (500 mg/day) was administered for 3 days to treat the residual orbital inflammation. Fourteen days after surgery, the BCVA further improved to 0.4 and 0.5 in the right and left eyes, respectively. Swelling of the bilateral extraocular muscles and the visual field abnormalities improved dramatically. Early diagnosis is crucial for the management of PNS

Utility of Distal Forearm DXA as a Screening Tool for Primary Osteoporotic Fragility Fractures of the Distal Radius A Case-Control Study

Background: Osteoporotic fragility fractures frequently occur at the distal part of the radius. This suggests that initial osteoporosis evaluation at this site may inform screening and treatment to prevent additional fractures. The purpose of this study was to investigate the utility of distal forearm dual x-ray absorptiometry (DXA) as a screening tool to assess the risk of fragility fractures at the distal part of the radius. Methods: This retrospective, case-control study included postmenopausal women who had sustained a distal radial fracture (fracture group, n = 110) and postmenopausal women with no history of fracture (control group, n = 95). DXA measurements at the spine, hip, and distal part of the forearm (ultra-distal, mid-distal, and one-third distal sections) were compared between the groups on the basis of bone mineral density (BMD), T-score, and the proportion of patients with a T-score of £–2.5 standard deviations (SD). We also investigated the regional differences on the basis of T-score among the skeletal sites. Furthermore, the reliability of distal forearm DXA measurements was validated by assessing the statistical correlation (r) with volumetric BMD by computed tomography (CT). Results: Compared with the control group, the fracture group showed significantly lower BMD and T-scores and higher proportions of patients with a T-score of £–2.5 SD at the ultra-distal, mid-distal, and one-third distal forearm; however, the spine and hip measurements did not differ significantly between the 2 groups. With respect to regional differences, in the fracture group, T-scores were significantly lower and the proportions of patients with a T-score of £–2.5 SD were significantly higher for the 3 distal forearm sites compared with the spine and hip. DXA measurements at all 3 of the distal forearm regions exhibited high correlation with volumetric BMD by CT (r = 0.83 to 0.92). Conclusions: Some postmenopausal women were found to exhibit bone loss preferentially at the distal part of the radius, which may render them vulnerable to fragility fractures. Forearm DXA for the assessment of local bone loss may demonstrate benefit in screening for those at risk for distal radial fractures and facilitate the early identification of patients who require intervention for osteoporosis. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.Miyamura S., Kuriyama K., Ebina K., et al. Utility of Distal Forearm DXA as a Screening Tool for Primary Osteoporotic Fragility Fractures of the Distal Radius A Case-Control Study. JBJS Open Access 5, E0036 (2020); https://doi.org/10.2106/JBJS.OA.19.00036

Hemianopic Defects in Patients with Glaucoma

A step across the vertical midline is an early sign of a hemianopic defect that suggests lesions of the visual pathways at or anywhere posterior to the chiasm. It is mandatory for a physician who finds a vertical step to rule out a neurological etiology before anything else

Orbital Pseudotumor as an Initial Manifestation of Multicentric Castleman's Disease

Castleman's Disease (CD) is a rare lymph proliferative disorder that develops in the lymph node tissue primarily affecting the thorax, retroperitoneum and/or neck. It is considered a reactive disorder caused by an unidentified antigenic stimulusor faulty immuno regulation. Neither lymphocytes nor lymph nodes are present in normal orbital soft tissue, so that any lymphoidmass within the orbit is extremely abnormal

Acute Visual Loss Caused by an Onodi Cell Mucocele

An Onodi cell is the most posterior ethmoidal cell that pneumatises laterally and superiorly to the sphenoid and is intimately proximal to the optic nerve. The optic nerve often runs so close to the small cavity of the Onodi cell that bulging of the optic canal into the wall may be observed. The incidence of Onodi cells is 7 to 14%. However, an isolated mucocele of an Onodi cell causing compressive optic neuropathy is rare and only a few patients with such a condition have been reported. We report a case of acute non light perception (NLP) visual loss caused by an isolated mucocele of an Onodi cell

Spatiotemporal Profile of Cortical Responses to Visual Motion Stimuli Analyzed by MEG

To elucidate the spatiotemporal activity of a cortical network for processing motion perception, a magnetic encephalographic (MEG) study was performed in six healthy right-handed subjects

A Case of Homonymous Hemianopia without Corresponding Anomalies on MRI

We report a patient with homonymous hemianopia who presented with no evident anomalies on repeated MRI studies including FLAIR and diffusion-weighted (DW) images

Visual Evoked Magnetic Field Study of a Patient Suspected of Creutzfeld-Jakob Disease with Giant VEP

To elucidate the cortical mechanisms of giant visual evoked potential (VEP) seen in a patient suspected of Creutzfeld-Jakob disease (CJD), a magnetic encephalographic (MEG) study was performed

Neuro-Ophthalmology in Asia (Japan) (Video)

In recent years, about 20% of the attendees at NANOS meetings live and practise in parts of the world outside North America. "International" neuro-ophthalmology differs from "North American" neuro-ophthalmology in several ways. For example, the patterns and prevalence of the various diseases vary with geographic location, and there is enormous variability in local facilities for clinical service delivery and research. This symposium is designed to showcase international aspects of neuro-ophthalmology. It will focus on several different areas including the different profiles of neuro-ophthalmic disease in other parts of the world and the variable levels of service provision and education, particularly in the developing world. The symposium will provide the opportunity to foster international collaboration and increase the involvement of NANOS members at an international level. Upon completion of this course, participants should be able to: 1) Recognize differences in prevalence of neuroophthalmic diseases between different countries; 2) Describe differences in service provision in different regions of the world; and 3) Determine how to foster international neuro-ophthalmologic collaboration