DOCSLIB.ORG

Acute Orbital Pseudotumors: Classification and CT Features

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Acute Orbital Pseudotumors: Classification and CT Features 431 Acute Orbital Pseudotumors: Classification and CT Features R. A. Nugent' Acute orbital pseudotumors are inflammatory lesions of unknown etiology that may J. Rootman2 affect part or, less often, all of the tissue within the orbit . A retrospective computed W. D. Robertson' tomographic (CT) study of 16 patients demonstrated that these lesions occur in one of J. S. Lapointe' five specific anatomic patterns: anterior, posterior, diffuse, lacrimal, or myositic. The most common location was lacrimal followed by anterior pseudotumors. Posterior, P. B. Harrison" 3 diffuse, and myositic pseudotumors were equally frequent. Localization on the basis of clinical features correlated with the CT localization. Illustrative cases of each of the five types are included. The role of CT in evaluating the therapeutic response is discussed. Orbital pseudotumors are reactive lesions of unknown etiology that clinicall y mimic neoplasms or inflammatory diseases of the orbit, particularly thyroid ophthalmopathy. Microscopically these lesions demonstrate a wide spectrum of inflammatory and pseudoneoplastic features. Lymphocytic infiltration is a fre­ quent histologic feature; consequently pseudotumors may mimic lymphomas [1). However, pseudotumors show histologic features of a reactive rather than a neoplastic process; thus, the diagnosis can be confirmed from the histology. A correlation between histologic features and response to treatment as well as prognosis has been described [2). Clinically, acute orbital pseudotumors typically have a rapid onset and fre­ quently produce proptosis, lid swelling, chemosis, pain, and limitation of ocular movement [3,4). Papilledema and optic neuropathy may also occur. The specific clinical features reflect the location of the pseudotumor [5). We tried to determine the location and character of acute orbital pseudotumors on computed tomo­ graphic (CT) scans and to assess the correlation of specifi c clinical features with Received October 28, 1980; accepted after the CT scan location. revision April 29, 1981. Presented at the annual meeting of the Western Neuroradiological Society, San Diego, CA, Octo­ Materials and Methods ber 1980. ' Department of Di agnostic Radiology, Univer­ Patients were c lassified as having acute pseudotumors by virtue of rapid clinical onset sity of British Columbia, 855 W. 12th Ave., Van­ and development (days to weeks) of any combination of chemosis, injection, lid edema, couver, British Columbia, Canada V5Z 1 M9. Ad­ pain, tenderness, papilledema, and ureitis associated with inflammatory features in the dress reprint requests to R. A. Nugent. orbit or in the globe, In addition , the patients did not have either clinical or laboratory 2Department of Ophthalmology, University of evidence of infective cellulitis, thyroid eye disease, or systemic inflammatory disorders. All British Columbia, Vancouver, British Columbia, the lacrimal pseudotumors were biopsied; the biopsies showed diffuse lymphocytic infil­ Canada V5Z 3N9. trates with destruction of the gland. 3Department of Diagnostic Radiology, St. Sixteen patients were studied. They were 6-79 years old; 10 were male and six were Paul's Hospital, Vancouver, British Columbia, Canada V6Z 1 Y6. female. Six were under age 20 years. CT was performed either on an EMI 1010 or a GE 8800 scanner. Axial scans were obtained on all patients and eight had coronal views. The This article appears in September/ October 1981 AJNR and November 1981 AJR. scans were examined retrospectively, with particular regard for location of the pseudotu­ mor. Specific involvement of the globe, optic nerve, or extraocular muscles was recorded. AJNR 2:431-436, September/ October 1981 0195- 6 108/ 8 1 / 0205-0431 $00.00 Most of the patients had at least one follow-up scan. Contrast enhancement was used in six © American Roentgen Ray Society patients. 432 NUGENT ET AL. AJNR:2, September/ October 1981 Fig . 1 .-Lacrimal pseudotumor, axial (A) and sagittal (B) views. SUPERIOR MEDIAL LATERAL A B A B c Fig . 2.-Lacrimal pseudotumor. A, Axial, unenhanced scan. Soft tissue superolateral aspect of orbit produces medial and inferior displacement of mass in anterolateral aspect of orbit obscures lateral aspect of globe and globe. C, Steroids produced clinical resolution within 1 month. Only minimal produces medial deviation of globe. B, Coronal, unenhanced scan. Mass in prominence of lacrimal gland after 3 months. Results TABLE 1: Clinical Features of Orbital Pseudotumors Acute orbital pseudotumors were seen to occur in one of CT Location five anatomic patterns on CT scan (table 1). The character­ Lacrim al Anterior Posterior Diffuse Myositi c istic clinincal and CT features and the response to therapy No. Patients 6 4 2 2 2 are described below. There were no false-negative scans. General features: The pseudotumor was bilateral in only one patient. Enhance­ Pain + ++ + +++ ++ ment was seen in all of the six patients given intravenous Proptosis +' ++ + +++ + contrast material, but it was not useful in further defining Lid swelling ++t ++ + ++ the lesion. Conjunctival injection ++t ++ ++ ++§ Decreased range of muscle Lacrimal Pseudotumors (fig. 1) motion +" ++ +++ ++ Palpable mass +++ All six patients with acute lacrimal pseudotumors typically Optic neuropathy ++ ++ ++ developed sudden onset of pain, tenderness, and injection Ocular: of the lid and conjunctiva in the area of the lacrimal gland in Choroiditis ++ ++ association with a palpable lacrimal gland and an S-shaped Papillitis ++ +++ Retinal deformity of the upper lid with pouting of the lacrimal ducts. detachment + In addition, there was minimal proptosis with a downward Note.-- = none; + = infrequent/minimal; + + = common / moderate; + + + and inward displacement of the globe. None of these pa­ mark ed / characteri sti c . tients had optic neuropathy and three demonstrated restric­ . Inferomedi a l. t Upper outer. tion of ocular movements in the direction of the swollen t Supertemporal. gland. § Over muscle inserti on. • Superolateral gaze. On CT, pseudotumors of the lacrimal gland were confined , Indirection of in vo lved muscle. AJNR: 2, September/ October 1981 ACUTE ORBITAL PSEUDOTUMORS 433 Fig. 3.-Anterior pseudotumor, axial (A) and sagittal (B) views. SUPERIOR MEDIAL LATERAL A B A B c Fig . 4. -Anterior pseudotumor. A, Axial, unenhanced scan. Wedge­ ocular muscles at plane just posterior to globe. The patient had progressive shaped area of soft tissue density immediately behind globe, extending along clinical improvement with steroid therapy. C, Unenhanced scan 9 months optic nerve. Sclera is thickened and poorly defined. B, Coronal, unenhanced after initial examination. No residual soft tissue mass. Junction of optic nerve scan. Soft tissue mass obscures normal definition of optic nerve and extra- and globe is well defined . to the superolateral aspect of the orbit, adjacent to and The two acute posterior pseudotumors both produced obscuring the lateral aspect of the globe. Characteristically, less proptosis, pain, and inflammation than either the ante­ inferomedial displacement of the globe occurred (figs. 2A rior or diffuse types but were associated with early devel­ and 2B). With steroid therapy the mass size diminshed and opment of clinical optic neuropathy. On CT, they were the lateral aspect of the globe and anterior part of the lateral confined to the apical part of the orbit, characteristically rectus muscle were then better visualized (fig. 2C). obscuring the anatomy of the extraocular muscles and optic nerve at this site. Anterior extension along the course of a Anterior Pseudotumors (fig. 3) muscle or optic nerve was seen (figs. 6A and 6B). With therapy, the extension of the lesion along the muscles and There were four anterior pseudotumors, one of which was optic nerve initially resolved with later clearing of the soft bilateral. In addition to pain, diplopia, and lid swelling, these tissue at the apex (fig. 6C). acute pseudotumors affected the globe producing uveitis in three, papillitis in two, optic neuropathy in three, and an exudative inflammatory retinal detachment in one. Diffuse Pseudo tumors (fig. 7) On CT, these lesions were intimately related to the pos­ Acute diffuse pseudotumors had clinical features very terior aspect of the globe and produced thickening of the similar to those of anterior pseudotumors but were more posterior sclera and/ or choroid, obscuring the junction of severe. Each of two patients had evidence of papillitis, the optic nerve with the globe. In addition, they extended a choroiditis, and optic neuropathy. On CT, these pseudotu­ variable distance posteriorly along the optic nerve (figs. 4A mors involved the entire orbit with a soft tissue mass ex­ and 4B). As the mass resolved with steroid therapy, the tending from the apex to the posterior margin of the globe. junction of the optic nerve and globe could again be visu­ The optic nerve and extraocular muscles were obscured to alized on CT (fig. 4C). a variable extent (figs. 8A and 8B). With resolution , the normal fat density was restored and the extraocular muscles Posterior Pseudotumors (fig. 5) and optic nerve were well defined on CT (fig . 8C). 434 NUGENT ET AL. AJNR:2, September/ October 1981 Fig . 5.-Posterior pseudotumor, ax­ ial (A) and sagittal (B) views. SUPERIOR MEDIAL LATERAL INFERIOR A B A B c Fig . 6.-Posterior pseudotumor. A, Axial, unenhanced scan. Soft tissue partial obscuring of extraocular muscles. Lateral rec tus muscle appears mass fills apex of orbit extending along posterior aspect of lateral
Load more

Recommended publications
  • Differentiate Red Eye Disorders
    Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular
    [Show full text]
  • Eyelid and Orbital Infections
    27 Eyelid and Orbital Infections Ayub Hakim Department of Ophthalmology, Western Galilee - Nahariya Medical Center, Nahariya, Israel 1. Introduction The major infections of the ocular adnexal and orbital tissues are preseptal cellulitis and orbital cellulitis. They occur more frequently in children than in adults. In Schramm's series of 303 cases of orbital cellulitis, 68% of the patients were younger than 9 years old and only 17% were older than 15 years old. Orbital cellulitis is less common, but more serious than preseptal. Both conditions happen more commonly in the winter months when the incidence of paranasal sinus infections is increased. There are specific causes for each of these types of cellulitis, and each may be associated with serious complications, including vision loss, intracranial infection and death. Studies of orbital cellulitis and its complication report mortality in 1- 2% and vision loss in 3-11%. In contrast, mortality and vision loss are extremely rare in preseptal cellulitis. 1.1 Definitions Preseptal and orbital cellulites are the most common causes of acute orbital inflammation. Preseptal cellulitis is an infection of the soft tissue of the eyelids and periocular region that is localized anterior to the orbital septum outside the bony orbit. Orbital cellulitis ( 3.5 per 100,00 ) is an infection of the soft tissues of the orbit that is localized posterior to the orbital septum and involves the fat and muscles contained within the bony orbit. Both types are normally distinguished clinically by anatomic location. 1.2 Pathophysiology The soft tissues of the eyelids, adnexa and orbit are sterile. Infection usually originates from adjacent non-sterile sites but may also expand hematogenously from distant infected sites when septicemia occurs.
    [Show full text]
  • Treatment of Congenital Ptosis
    13 Review Article Page 1 of 13 Treatment of congenital ptosis Vladimir Kratky1,2^ 1Department of Ophthalmology, Queen’s University, Kingston, Canada; 21st Medical Faculty, Charles University, Prague, Czech Republic Correspondence to: Vladimir Kratky, BSc, MD, FRCSC, DABO. Associate Professor of Ophthalmology, Director of Ophthalmic Plastic and Orbital Surgery, Oculoplastics Fellowship Director, Queen’s University, Kingston, Canada; 1st Medical Faculty, Charles University, Prague, Czech Republic. Email: [email protected]. Abstract: Congenital ptosis is an abnormally low position of the upper eyelid, with respect to the visual axis in the primary gaze. It can be present at birth or manifest itself during the first year of life and can be bilateral or unilateral. Additionally, it may be an isolated finding or part of a constellation of signs of a specific syndrome or systemic associations. Depending on how much it interferes with the visual axis, it may be considered as a functional or a cosmetic condition. In childhood, functional ptosis can lead to deprivation amblyopia and astigmatism and needs to be treated. However, even mild ptosis with normal vision can lead to psychosocial problems and correction is also advised, albeit on a less urgent basis. Although, patching and glasses can be prescribed to treat the amblyopia, the mainstay of management is surgical. There are several types of surgical procedure available depending on the severity and etiology of the droopy eyelid. The first part of this paper will review the different categories of congenital ptosis, including more common associated syndromes. The latter part will briefly cover the different surgical approaches, with emphasis on how to choose the correct condition.
    [Show full text]
  • Preseptal and Orbital Cellulitis
    Journal of Microbiology and Infectious Diseases / 2014; 4 (3): 123-127 JMID doi: 10.5799/ahinjs.02.2014.03.0154 REVIEW ARTICLE Preseptal and orbital cellulitis Emine Akçay, Gamze Dereli Can, Nurullah Çağıl Yıldırım Beyazıt Univ. Medical Faculty Atatürk Training and Research Hospital Dept. of Ophthalmology, Ankara, Turkey ABSTRACT Preseptal cellulitis (PC) is defined as an inflammation of the eyelid and surrounding skin, whereas orbital cellulitis (OC) is an inflammation of the posterior septum of the eyelid affecting the orbit and its contents. Periorbital tissues may become infected as a result of trauma (including insect bites) or primary bacteremia. Orbital cellulitis generally occurs as a complication of sinusitis. The most commonly isolated organisms are Staphylococcus aureus, Streptococcus pneu- moniae, S. epidermidis, Haempphilus influenzae, Moraxella catarrhalis and S. pyogenes. The method for the diagnosis of OS and PS is computed tomography. Using effective antibiotics is a mainstay for the treatment of PC and OC. There is an agreement that surgical drainage should be performed in cases of complete ophthalmoplegia or significant visual impairment or large abscesses formation. This infections are also at a greater risk of acute visual loss, cavernous sinus thrombosis, meningitis, cerebritis, endo- phthalmitis, and brain abscess in children. Early diagnosis and appropriate treatment are crucial to control the infection. Diagnosis, treatment, management and complications of PC and OC are summarized in this manuscript. J Microbiol Infect Dis 2014; 4(3): 123-127 Key words: infection, cellulitis, orbita, preseptal, diagnosis, treatment Preseptal ve Orbital Sellülit ÖZET Preseptal selülit (PS) göz kapağı ve çevresindeki dokunun iltihabi reaksiyonu iken orbital selülit (OS) orbitayı ve onun içeriğini etkileyen septum arkası dokuların iltihabıdır.
    [Show full text]
  • Meeting Materials
    BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY EDMUND G. BROWN JR., GOVERNOR STATE BOARD OF OPTOMETRY 2450 DEL PASO ROAD, SUITE 105, SACRAMENTO, CA 95834 0 P (916) 575-7170 F (916) 575-7292 www.optometry .ca.gov OPToMi fikY Continuing Education Course Approval Checklist Title: Provider Name: ☐Completed Application Open to all Optometrists? ☐ Yes ☐No Maintain Record Agreement? ☐ Yes ☐No ☐Correct Application Fee ☐Detailed Course Summary ☐Detailed Course Outline ☐PowerPoint and/or other Presentation Materials ☐Advertising (optional) ☐CV for EACH Course Instructor ☐License Verification for Each Course Instructor Disciplinary History? ☐Yes ☐No BUSINESS, CONSUMER SERVICES, AND HOUSING AGENCY GOVERNOR EDMUND G. BROWN JR. ~~ TATE BOARD OF OPTOMETRY }I /~E{:fLi\1 ~1' DELWSO ROAD, SUITE 105, SACRAMENTO, CA 95834 op'i,otii~l~ 1~0-A~ifiF' t\,rffi-7170 F (916) 575-7292 www.optometry.ca.gov EDUCATION COU Rw1t;--ftf""~'-!-J/-i~--,--__:___::...:..::....::~-~ $50 Mandatory Fee APPLICATION ,-~Jg l Pursuant to California Code of Regulations (CCR) § 1536, the Board will app~romv~e~c~ott=nfli1~nuFTT1t;tngn'zeWl:uc~rRif'tf-:~MT~~=ilt,;;,,_J receiving the applicable fee, the requested information below and it has been determined that the course meets criteria specified in CCR § 1536(g). In addition to the information requested below, please attach a copy of the course schedule, a detailed course outline and presentation materials (e.g., PowerPoint presentation). Applications must be submitted 45 days prior to the course presentation date. Please type or print
    [Show full text]
  • Orbital Cellulitis Management Guideline – for Adults & Paeds
    ORBITAL CELLULITIS MANAGEMENT GUIDELINE – FOR ADULTS & PAEDS Authors: Stephen Ball, Arthur Okonkwo, Steven Powell, Sean Carrie Orbital cellulitis management guideline – For Adults & Paeds Is it limited to Preseptal Cellulitis? i.e. Eyelid only & eye not involved Oral Co-amoxiclav (clindamycin if penicillin allergic) Consider treating as an outpatient with review in eye casualty in 24-48 hours No Indication for admission – any of: Clinical suspicion of post-septal cellulitis Baseline Investigations Pyrexia FBC, CRP, lactate (& blood culture if Immunocompromised pyrexia) Had 36-48 hours of oral antibiotics Endonasal swab <12 months old unable to assess eye due to swelling Yes Medical management Discharge ADULTS – iv Tazocin (allergy; Iv clindamycin & iv ciprofloxacin) Discharge once swelling PAEDS – iv co-amoxiclav (allergy; iv cefuroxime & has resolved and metronidazole if mild allergy - other allergy discuss with micro) pyrexia settled with IMMUNOCOMPROMISED - discuss all with microbiology/ID oral antibiotics; Consider nasal Otrivine & nasal steroids -co-amoxiclav 4 hourly eye & neuro-observations -clindamycin if Urgent Ophthalmology assessment & daily review penicillin allergic Urgent Otolaryngology assessment & daily review Yes Indication for imaging CNS involvement NO - Discuss Unable to examine eye/open eyelids with Eye signs – any of: proptosis, restriction/pain microbiology/ID on eye movement, chemosis, RAPD, reduced visual acuity/colour vision/visual field, optic nerve swelling No Failure to improve or continued pyrexia after 36-48 hours IV antibiotics Improvement in 36-48 hours Contrast enhanced CT Orbit, Sinuses and Brain Continue medical management, rescan if failure to improve after 36-48 Orbital Collection No Orbital Collection Outpatient Treatment hours Admission Surgical management Medical Management Approach depends on local skill set o Evacuation of orbital pus Imaging o Drainage of paranasal sinus pus Discuss any intracranial complication with both neurosurgery & Microbiology Surgical Management .
    [Show full text]
  • National Eye Institute Visual Function Questionnaire (NEI- VFQ25) in Subjects with IIH and Normal Controls
    Title: Correlation of Visual Function and National Eye Institute Visual Function Questionnaire (NEI- VFQ25) in subjects with IIH and normal controls. Melanie Truong, DO OD Introduction and Purpose Aims of the study: 1. To assess contrast sensitivity acuity and rapid eye movements (saccades) as a measure of visual function in Idiopathic Intracranial Hypertension (IIH) patients compared to normal patients using the King-Devick Variable Contrast Acuity Chart and the K-D rapid eye movement. 2. To assess subjects quality of visual function using the National Eye Institute Visual Function Questionnaire (NEI-VFQ25) questionnaire and Supplement as a comparison between IIH subjects and normal controls. 3. To study the correlation between visual function and quality of visual function questionnaire in subjects with IIH compared to normal controls. Contrast sensitivity is a measure of afferent visual system. Contrast sensitivity deficit with preservation of normal Snellen acuity has also been reported in glaucoma, compressive disorders of the anterior visual pathways, retinal diseases, and with cerebral lesions.1 This test is significantly more sensitive than Snellen acuity .1 It is also superior for serial testing in patients as there was significant improvement in contrast scores and papilledema grade but no significant change in Snellen acuity.1 Visual manifestation of IIH can also include parafoveal deficits. This can lead to deficits in spatial frequency contrast sensitivity.1 Contrast sensitivity is abnormal initially and improved with regression of papilledema.2 Since decisions on therapy in IIH are based on the presence and change in visual function, assessing visual acuities is not the most accurate measure of visual status in IIH.
    [Show full text]
  • Central Serous Papillopathy by Optic Nerve Head Drusen
    Clinical Ophthalmology Dovepress open access to scientific and medical research Open Access Full Text Article CASE REPORT Central serous papillopathy by optic nerve head drusen Ana Marina Suelves1 Abstract: We report a 38-year-old man with a complaint of blurred vision in his right eye for the Ester Francés-Muñoz1 previous 5 days. He had bilateral optic disc drusen. Fluorescein angiography revealed multiple Roberto Gallego-Pinazo1 hyperfluorescent foci within temporal optic discs and temporal inferior arcade in late phase. Diamar Pardo-Lopez1 Optical coherence tomography showed bilateral peripapillary serous detachment as well as right Jose Luis Mullor2 macular detachment. This is the first reported case of a concurrent peripapillary and macular Jose Fernando Arevalo3 detachment in a patient with central serous papillopathy by optic disc drusen. Central serous papillopathy is an atypical form of central serous chorioretinopathy that should be considered Manuel Díaz-Llopis1,4,5 as a potential cause of acute loss of vision in patients with optic nerve head drusen. 1 Department of Ophthalmology, La Fe Keywords: central serous papillopathy, peripapillary central serous chorioretinopathy, optic University Hospital, Valencia, Spain; For personal use only. 2Instituto de Investigación Sanitaria, nerve head drusen, peripapillary subretinal fluid Fundación para la investigación, La Fe Hospital, Valencia, Spain; 3Retina and vitreous service, Clínica Introduction Oftalmológica Centro Caracas, Optic nerve head drusen (ONHD) are hyaline material calcificated
    [Show full text]
  • Orbital Imaging in Thyroid-Related Orbitopathy
    Orbital imaging in thyroid-related orbitopathy Christopher Lo, MD, Shoaib Ugradar, MD, and Daniel Rootman, MD, MS SUMMARY A broad understanding of the different imaging modalities used to assess the physiologic changes seen in Graves’ orbitopathy complement clinical examination. Subtle applications of radiographic imaging techniques allow for a better understanding of the overall physiology of the orbit, quantify progression of disease, and differentiate it from orbital diseases with overlapping features. A nuanced approach to interpreting imaging features may allow us to delineate inactive from active thyroid eye disease, and advances within this field may arm clinicians with the ability to better predict and prevent dysthyroid optic neuropathy. ( J AAPOS 2018;22:256.e1-256.e9) rbital imaging plays a central role in the diag- mean inferior rectus width, 4.8 mm; medial rectus width, nosis and management of thyroid-related orbit- 4.2 mm; superior rectus width, 4.6 mm; and lateral rectus O opathy (TRO). Diagnostically, it is used to width, 3.3 mm.8,9 These numbers can be used as a guide; compliment a careful ophthalmic examination, laboratory however, they represent population averages, each with values, and ancillary studies to confirm the presence of significant variation. Overlap in populations exist, and TRO and/or dysthyroid optic neuropathy (DON). It can both diseased and nondiseased muscles can have widths also be helpful in surgical planning and understanding close to these values. In the end, there are no strict rules. the progression of thyroid myopathy. Computed tomogra- In terms of muscle involvement, clinical myopathy is phy (CT), magnetic resonance imaging (MRI), ultrasound, thought to most often involve the inferior rectus muscle, and nuclear medicine all have applications in the field.
    [Show full text]
  • Idiopathic Intracranial Hypertension
    IDIOPATHIC INTRACRANIAL HYPERTENSION William L Hills, MD Neuro-ophthalmology Oregon Neurology Associates Affiliated Assistant Professor Ophthalmology and Neurology Casey Eye Institute, OHSU No disclosures CASE - 19 YO WOMAN WITH HEADACHES X 3 MONTHS Headaches frontal PMHx: obesity Worse lying down Meds: takes ibuprofen for headaches Wake from sleep Pulsatile tinnitus x 1 month. Vision blacks out transiently when she bends over or sits down EXAMINATION Vision: 20/20 R eye, 20/25 L eye. Neuro: PERRL, no APD, EOMI, VF full to confrontation. Dilated fundoscopic exam: 360 degree blurring of disc margins in both eyes, absent SVP. Formal visual field testing: Enlargement of the blind spot, generalized constriction both eyes. MRI brain: Lumbar puncture: Posterior flattening of Opening pressure 39 the globes cm H20 Empty sella Normal CSF studies otherwise normal Headache improved after LP IDIOPATHIC INTRACRANIAL HYPERTENSION SYNDROME: Increased intracranial pressure without ventriculomegaly or mass lesion Normal CSF composition NOMENCLATURE Idiopathic intracranial hypertension (IIH) Benign intracranial hypertension Pseudotumor cerebri Intracranial hypertension secondary to… DIAGNOSTIC CRITERIA Original criteria have been updated to reflect new imaging modalities: 1492 Friedman and Jacobsen. Neurology 2002; 59: Symptoms and signs reflect only those of - increased ICP or papilledema 1495 Documented increased ICP during LP in lateral decubitus position Normal CSF composition No evidence of mass, hydrocephalus, structural
    [Show full text]
  • Amaurosis Fugax (Transient Monocular Or Binocular Vision Loss)
    Amaurosis fugax (transient monocular or binocular vision loss) Syndee Givre, MD, PhD Gregory P Van Stavern, MD The next version of UpToDate (15.3) will be released in October 2007. INTRODUCTION AND DEFINITIONS — Amaurosis fugax (from the Greek "amaurosis," meaning dark, and the Latin "fugax," meaning fleeting) refers to a transient loss of vision in one or both eyes. Varied use of common terminology may cause some confusion when reading the literature. Some suggest that "amaurosis fugax" implies a vascular cause for the visual loss, but the term continues to be used when describing visual loss from any origin and involving one or both eyes. The term "transient monocular blindness" is also often used but is not ideal, since most patients do not experience complete loss of vision with the episode. "Transient monocular visual loss" (TMVL) and "transient binocular visual loss" (TBVL) are preferred to describe abrupt and temporary loss of vision in one or both eyes, since they carry no connotation regarding etiology. Transient visual loss, either monocular or binocular, reflects a heterogeneous group of disorders, some relatively benign and others with grave neurologic or ophthalmologic implications. The task of the clinician is to use the history and examination to localize the problem to a region in the visual pathways, identify potential etiologies, and, when indicated, perform a focused battery of laboratory tests to confirm or exclude certain causes. Therapeutic interventions and prognostic implications are specific to the underlying cause. This topic discusses transient visual loss. Other ocular and cerebral ischemic syndromes are discussed separately. APPROACH TO TRANSIENT VISUAL LOSS — By definition, patients with transient visual loss almost always present after the episode has resolved; hence, the neurologic and ophthalmologic examination is usually normal.
    [Show full text]
  • Anatomy of the Periorbital Region Review Article Anatomia Da Região Periorbital
    RevSurgicalV5N3Inglês_RevistaSurgical&CosmeticDermatol 21/01/14 17:54 Página 245 245 Anatomy of the periorbital region Review article Anatomia da região periorbital Authors: Eliandre Costa Palermo1 ABSTRACT A careful study of the anatomy of the orbit is very important for dermatologists, even for those who do not perform major surgical procedures. This is due to the high complexity of the structures involved in the dermatological procedures performed in this region. A 1 Dermatologist Physician, Lato sensu post- detailed knowledge of facial anatomy is what differentiates a qualified professional— graduate diploma in Dermatologic Surgery from the Faculdade de Medician whether in performing minimally invasive procedures (such as botulinum toxin and der- do ABC - Santo André (SP), Brazil mal fillings) or in conducting excisions of skin lesions—thereby avoiding complications and ensuring the best results, both aesthetically and correctively. The present review article focuses on the anatomy of the orbit and palpebral region and on the important structures related to the execution of dermatological procedures. Keywords: eyelids; anatomy; skin. RESU MO Um estudo cuidadoso da anatomia da órbita é muito importante para os dermatologistas, mesmo para os que não realizam grandes procedimentos cirúrgicos, devido à elevada complexidade de estruturas envolvidas nos procedimentos dermatológicos realizados nesta região. O conhecimento detalhado da anatomia facial é o que diferencia o profissional qualificado, seja na realização de procedimentos mini- mamente invasivos, como toxina botulínica e preenchimentos, seja nas exéreses de lesões dermatoló- Correspondence: Dr. Eliandre Costa Palermo gicas, evitando complicações e assegurando os melhores resultados, tanto estéticos quanto corretivos. Av. São Gualter, 615 Trataremos neste artigo da revisão da anatomia da região órbito-palpebral e das estruturas importan- Cep: 05455 000 Alto de Pinheiros—São tes correlacionadas à realização dos procedimentos dermatológicos.
    [Show full text]