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https://www.readbyqxmd.com/read/29456899/facial-weakness-diplopia-and-fever-in-a-31-year-old-an-atypical-case-of-tuberculous-meningitis
#1
Ahmed H Qavi, Tasnim F Imran, Zachariah Hasan, Fariha Ilyas
Tuberculous meningitis (TBM) is an infection of the central nervous system (CNS) meninges that carries high morbidity and mortality. It is important to recognize, as patients may present with atypical symptoms. We describe the case of a 31-year-old man with a history of diabetes who presented with a sub-acute onset of right-sided facial weakness and right gaze difficulty with diplopia. History revealed low-grade fever, right-sided headache, fatigue and moderate weight loss for the past several weeks. The patient did not report neck stiffness, rigidity, fever, chills or cough...
December 7, 2017: Curēus
https://www.readbyqxmd.com/read/29455905/ventriculoperitoneal-shunt-treatment-in-a-pregnant-renal-transplant-recipient-with-idiopathic-intracranial-hypertension-case-report-and-review-of-the-literature
#2
Ebru Apaydın Doğan, Selen Doğan, Ethem Taner Göksu, Sibel Özkaynak, Çile Aktan, İnanç Mendilcioğlu
Idiopathic intracranial hypertension (IIH) is a relatively uncommon disorder characterised by raised intracranial pressure without an established pathogenesis. Diagnosis of IIH requires the demonstration of symptoms and signs referable only to elevated intracranial pressure; cerebrospinal fluid (CSF) opening pressure >25cm H2 O measured in the lateral decubitus position; normal CSF composition; and no evidence for an underlying structural cause demonstrated by using MRI or contrast-enhanced CT scan for typical patients and MRI and MR venography for atypical patients such as man, children and those with low body mass index...
February 6, 2018: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/29450866/rehabilitative-orbital-decompression-for-graves-orbitopathy-results-of-a-randomized-clinical-trial
#3
S Sellari-Franceschini, R Rocchi, M Marinò, A Bajraktari, B Mazzi, G Fiacchini, P Lepri, I Dallan, P Vitti, C Marcocci
PURPOSE: Orbital decompression (OD) is a consolidated procedure for the treatment of exophthalmos in Graves' orbitopathy (GO). The efficacy of the various procedures remains unclear due to the variability of the techniques used. To address this issue, we performed a randomized clinical trial to compare the efficacy of two surgical techniques. The primary endpoint was the reduction in proptosis. Secondary aims were the risk of post-operative diplopia (POD) in primary gaze and other surgical complications...
February 15, 2018: Journal of Endocrinological Investigation
https://www.readbyqxmd.com/read/29450486/differentiating-acute-and-subacute-vertical-strabismus-using-different-head-positions-during-the-upright-supine-test
#4
João Lemos, Adnan Subei, Mário Sousa, César Nunes, Luís Cunha, Christopher Glisson, Eric Eggenberger
Importance: Accurate clinical differentiation between skew deviation and fourth nerve palsy (4NP) is critical in the acute and subacute settings. Objective: To determine the sensitivity and specificity of the upright-supine test to detect vertical misalignment changes using different head positions for the diagnosis of acute or subacute skew deviation vs 4NP. Design, Setting, and Participants: This multicenter study enrolled consecutive patients from Coimbra University Hospital Centre, Coimbra, Portugal, and Michigan State University, Lansing, within 2 months of presenting with vertical diplopia and diagnosed as having skew deviation or acquired unilateral 4NP...
February 15, 2018: JAMA Ophthalmology
https://www.readbyqxmd.com/read/29450393/management-of-diplopia
#5
REVIEW
Daniela Adriana Iliescu, Cristina Mihaela Timaru, Nicolae Alexe, Elena Gosav, Algerino De Simone, Mehdi Batras, Cornel Stefan
Diplopia (seeing double) is an ophthalmologic complaint found mainly in elder patients. It can have both ocular and neurological causes. A careful history and clinical examination must detail the type of diplopia (monocular/ binocular), onset, and progression, associated and relieving factors. In case of monocular diplopia, refraction and biomicroscopic examination of the ocular media are mandatory. The cause of ocular misalignment for binocular diplopia must be determined and life-threatening conditions (such as posterior communicating artery aneurysm) must imply an immediate treatment...
July 2017: Romanian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29449118/shot-by-a-gun-%C3%A2-missed-by-a-provider
#6
Eddie Garcia, Abdul H Zaid, Diane P Calello, Lisa McHugh, Grant Arzumanov, Najaf Asrar, Ari Sapin, Kristin G Fless
BACKGROUND: Botulism is a paralytic disease caused by the neurotoxin produced by Clostridium botulinum. The majority of cases are due to ingestion or injection drug use. Wound botulism from traumatic injury is exceedingly rare, with only one to two cases reported each year in the United States. CASE REPORT: A 27-year-old man presented to the Emergency Department with diplopia, dysphagia, and progressive weakness 10 days after sustaining a gunshot wound to his right lower leg...
February 12, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29446067/headache-linked-to-intracranial-hypertension-and-hypertrophic-pachymeningitis-as-the-initial-and-dominant-presentation-of-granulomatosis-with-polyangiitis-case-report-and-review-of-the-recent-literature
#7
Marianthi A Arnaoutoglou, Chrysostomos G Xerras, Ioannis K Kalevrosoglou, Vasileios D Rafailidis, Konstantinos P Notas, Thomas I Tegos
OBJECTIVE: The objective of this article is to report a rare case of headache as the initial symptom of granulomatosis with polyangiitis (GPA) and to review the recent literature. BACKGROUND: Granulomatosis with polyangiitis is a rare, systemic, autoimmune disease of unknown etiology. GPA has a wide spectrum of clinical symptomatology, including involvement of the nervous system, even as the initial manifestation. Symptoms of the peripheral nervous system used to dominate the clinical symptomatology...
February 15, 2018: Headache
https://www.readbyqxmd.com/read/29442536/a-new-surgical-technique-for-excision-of-orbital-cavernous-hemangioma-a-15-year-experience
#8
Abbas Bagheri, Reza Jafari, Hosein Salour, Maryam Aletaha, Shahin Yazdani, Sepehr Baghi
PURPOSE: To present a new surgical technique for excision of orbital cavernous hemangiomas (CHs). METHODS: This retrospective case series study included patients with orbital CH who were operated from 2001 to 2016 at our referral center. Epidemiologic data, symptoms, signs, and images were reviewed from patients' files with at least one year of follow-up. Surgical results and complications were documented. We used the "index finger dissection" technique without grasping the tumor for release of adhesions and its removal...
February 14, 2018: Orbit
https://www.readbyqxmd.com/read/29434137/ipsiversive-ocular-torsion-skew-deviation-and-hearing-loss-as-initial-signs-of-anterior-inferior-cerebellar-artery-infarction
#9
Tameto Naoi, Mitsuya Morita, Tadataka Kawakami, Shigeru Fujimoto
A 67-year-old man with hypertension and type 2 diabetes mellitus was admitted to our hospital because of left hearing loss and vertical diplopia. A neurological examination showed ocular torsion, skew deviation, and sensorineural hearing loss in the left ear. Brainstem and cerebellar neurological signs were not observed. Left middle cerebellar peduncle infarction was evident on magnetic resonance imaging. He was treated with antiplatelet, however, the infarct progressed after this administration. Ocular tilt reaction (OTR) involves the triad of ocular torsion, skew deviation, and head tilt...
February 9, 2018: Internal Medicine
https://www.readbyqxmd.com/read/29426788/approach-to-a-patient-with-diplopia-in-the-emergency-department
#10
Edward Margolin, Cindy T Y Lam
BACKGROUND: Diplopia can be the result of benign or life-threatening etiologies. It is imperative for the emergency physician to be proficient at assessing diplopia and recognize when urgent referral or neuroimaging is required. OBJECTIVE: The first part of this review highlights a simple framework to arrive at the appropriate disposition of diplopic patients presenting to the emergency department (ED). The second part of this review provides more detail and further management strategies...
February 6, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29426441/surgical-outcomes-and-complications-of-sutured-scleral-fixated-intraocular-lenses-in-pediatric-eyes
#11
Parveen Sen, Vinay Kumar S, Pramod Bhende, Pukhraj Rishi, Ekta Rishi, Chetan Rao, Dhanashree Ratra, Pradeep Susvar, Sreelakshmi Kummamuri, Sufiyan Shaikh, Lingam Gopal
OBJECTIVE: To study the outcome and complications of sutured scleral fixated intraocular lenses (SSFIOL) in children. DESIGN: Retrospective study. SUBJECTS: A total of 279 eyes of 230 children who underwent SSFIOL at ≤18 years of age in a tertiary eye care centre in India. METHODS: Treatment-naive children having traumatic cataract or subluxated lens underwent a single-sitting lensectomy and pars plana vitrectomy (PPV), along with SSFIOL insertion...
February 2018: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
https://www.readbyqxmd.com/read/29426440/evaluation-and-surgical-outcome-of-acquired-nonaccommodative-esotropia-among-older-children
#12
Bo Li, Sapna Sharan
OBJECTIVE: To describe the presentation, clinical evaluation, work-up, surgical management, and surgical outcomes in children older than 8 years with spontaneous, comitant, acquired nonaccommodative esotropia (ANAET). DESIGN: Retrospective chart review. PARTICIPANTS: Children who underwent bilateral medial rectus recession surgery for ANAET with initial esotropia onset later than 8 years of age. METHODS: The medical records of children older than 8 years presenting with ANAET from 2009 to 2015 were retrospectively reviewed...
February 2018: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
https://www.readbyqxmd.com/read/29425983/primary-intracranial-angioleiomyomas-as-rare-nonmalignant-and-distinct-neoplastic-entities-a-series-of-8-cases-and-a-literature-review
#13
REVIEW
Cheng-Bei Li, Ming-Guo Xie, Jun-Peng Ma, Liang Wang, Shu-Yu Hao, Li-Wei Zhang, Wang Jia, Gui-Jun Jia, Jun-Ting Zhang, Da Li, Huan Li, Zhen Wu
OBJECTIVE: Primary intracranial angioleiomyoma is a rare and distinct neoplasm. Only 29 cases have been reported previously, and we aimed to investigate the clinical and radio-pathological features of these lesions. METHODS: Medical records and radiographs of 8 patients (7 male and 1 female; mean age: 48.7 years) at our institution were reviewed retrospectively. Patient follow-up and a literature review were performed. RESULTS: The most common preoperative symptom was a visual defect (n=2), followed by diplopia (n=1) and abducens paralysis (n=1)...
February 6, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29422856/refractive-lens-exchange-with-multifocal-intraocular-lens-for-treatment-of-chronic-intermittent-spasm-of-the-near-reflex
#14
Guy Sallet
We report the case of an emmetropic 32-year-old female with decreased uncorrected visual acuity and diplopia due to intermittent episodes of spasm of the near reflex. Neurologic, general, and ophthalmic examination could not find an organic cause. Attempts at spontaneous recovery, psychogenic therapy, and cycloplegic therapy were unsuccessful and the symptoms persisted for almost 5 years, leading to psychogenic distress. Final treatment with refractive lens exchange and implantation of a toric trifocal intraocular lens resolved the spasm of the near reflex, resulting in an uncorrected distance and near visual acuity of 20/20...
September 2017: Case Reports in Ophthalmology
https://www.readbyqxmd.com/read/29419638/permanent-versus-bioresorbable-implants-in-orbital-floor-blowout-fractures
#15
Sophia Seen, Stephanie Ming Young, Shao Jin Teo, Stephanie S Lang, Shantha Amrith, Thiam-Chye Lim, Gangadhara Sundar
PURPOSE: To compare the outcomes of bioresorbable and permanent implants in the reconstruction of isolated orbital floor blowout fractures. METHODS: Retrospective series of all patients who had orbital floor fracture repair in a single tertiary trauma center from January 2005 to December 2014. The authors reviewed the case notes and CT scans of patients with orbital floor fracture repair with either bioresorbable or permanent implants. Main outcome measures were enophthalmos, diplopia, and ocular motility restriction 1...
February 6, 2018: Ophthalmic Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29419595/endoscopic-approach-for-excision-of-venous-malformation-of-the-orbital-apex
#16
Devin Ruiz, Elie E Rebeiz
INTRODUCTION: Venous malformation is a common tumor of the orbit, presenting with visual impairment and proptosis. These lesions can be excised via an external or transcranial approach, but recent advances in minimally invasive surgery have led to increased popularity of endoscopic approach. PATIENT: The authors report a 62-year-old female presenting with diplopia and proptosis, found to have a 1.7-cm venous malformation of the orbital apex. An endoscopic trans-nasal approach was undertaken for surgical resection...
February 6, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29414291/a-cerebral-phenotype-of-chronic-lymphocytic-inflammation-with-pontine-perivascular-enhancement-responsive-to-steroids-a-case-report-and-review-of-the-literature
#17
Sho Okune, Kazuhiro Ishii, Shogo Ouchi, Kazuki Sakakura, Masahide Matsuda, Akira Tamaoka
CLIPPERS (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory central nervous system disorder that gives rise to brainstem symptoms such as diplopia and articulatory disorders. It shows characteristic "salt-and-pepper" enhancing brainstem lesions on magnetic resonance imaging (MRI) scans. We present an unusual case of CLIPPERS, in which a 29-year-old man initially presented with a seizure. Brain MRI revealed faint open-ring enhancements in the right frontal lobe, and a brain biopsy was performed to make a definitive diagnosis...
January 26, 2018: Multiple Sclerosis and related Disorders
https://www.readbyqxmd.com/read/29413638/evidence-of-diplopia-in-children-s-headache-drawings-helps-to-differentiate-pseudotumor-cerebri-from-migraine
#18
Erica B Lee, Fredrick S Edelman, Carl E Stafstrom
OBJECTIVE: This study aimed to determine whether children's headache drawings can distinguish between pseudotumor cerebri and migraine. BACKGROUND: Headache features associated with pseudotumor cerebri (pseudotumor; idiopathic intracranial hypertension) are nonspecific and are difficult to distinguish clinically from migraines. Children's headache drawings have a high predictive value for migraine versus nonmigraine headaches. We hypothesized that drawings could help to differentiate pediatric headaches due to pseudotumor cerebri from those associated with migraines...
February 2018: Pediatric Neurology
https://www.readbyqxmd.com/read/29403596/primary-atypical-lipomatous-tumor-of-the-orbit-a-case-report
#19
Douglas P Dworak, Shyam A Patel, Rohini Chennuri, Daniel Falco
Purpose: To describe a case of primary atypical orbital lipomatous tumor (ALT). Case Report: A 35-year-old man presented with a two-month history of left eye proptosis and vertical diplopia. His visual acuity was 20/30 OD and 20/60 OS. External examination showed proptosis and downward displacement of the left eye with mild lid erythema. Extraocular movements were reduced in the left eye, with 10% and 70% motility in upgaze and abduction/adduction, respectively...
January 2018: Journal of Ophthalmic & Vision Research
https://www.readbyqxmd.com/read/29398228/transient-trochlear-nerve-palsy-following-percutaneous-angioplasty
#20
I Roberts Martínez-Aguirre, M E de Las Heras Gómez de Liaño, V Lacosta Asín, M E Zarzosa Martín, J M Alonso Maroto, E Pérez-Salvador García
CASE REPORT: A case is presented of a 63-year-old man who suffered a unilateral isolated trochlear nerve palsy with vertical diplopia following an elective radial coronary angiography and percutaneous coronary intervention, which resolved spontaneously within 2 months. DISCUSSION: Ophthalmoplegia following coronary percutaneous angioplasty is rare. Only internuclear ophthalmoplegia, III and VI cranial nerve palsy have been previously reported following percutaneous angioplasty...
February 1, 2018: Archivos de la Sociedad Española de Oftalmología
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