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ABSTRACT: A 55-year-old immunocompetent man presented with headache, nausea, progressive bilateral upper lid ptosis, and diplopia. Examination showed bilateral asymmetric upper lid ptosis with limited adduction and elevation of both eyes. Cranial magnetic resonance imaging revealed enhancing intra-axial and extra-axial midbrain lesions. Blood and cerebrospinal fluid were positive for cryptococcal antigen and cerebrospinal fluid fungal cultures grew Cryptococcus neoformans. Treatment with liposomal amphotericin B and flucytosine resulted in complete resolution of his neurological deficits and lesions on neuroimaging. Patients with cryptococcal meningitis may rarely present with bilateral cranial nerve III dysfunction.
Survey of Ophthalmology 08/2011; 57(3):284-91. · 2.35 Impact Factor
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ABSTRACT: Aneurysms are associated with tuberous sclerosis complex. We describe the first case of cavernous sinus syndrome from an intracavernous internal carotid artery aneurysm in a 9-month-old boy with tuberous sclerosis. The presence of an intracranial aneurysm should be considered in the differential diagnosis of children with tuberous sclerosis who develop cranial nerve deficits.
Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 08/2011; 15(4):389-91. · 1.07 Impact Factor
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The British journal of ophthalmology 02/2010; 94(2):265-7. · 2.92 Impact Factor
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ABSTRACT: Objective: To review the presenting signs and symptoms of patients with clival chordomas. Methods: A retrospective study of 18 patients with pathologically proven clival chordomas evaluated and treated at University of Arkansas for Medical Sciences from 1991 to 1998. Two of the 18 patients had careful neuro-ophthalmologic examination. Results: The most common symptoms at presentation included diplopia (66%) and headache (50%), while the most common neuro-ophthalmic sign was a sixth cranial nerve palsy (44%). At least one patient had resolution of his symptoms after surgery. Conclusions: Clival chordomas most commonly present with diplopia, usually from a sixth cranial nerve palsy.
07/2009; 23(2):69-73.
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ABSTRACT: Direct traumatic optic neuropathy is a rare complication of endoscopic sinus surgery and can result in irreversible damage to the optic nerve. We report a case of direct traumatic optic neuropathy after transnasal endoscopic orbital decompression for Graves's disease in a patient who experienced near-complete recovery of vision. We discuss possible mechanisms.
American journal of otolaryngology 03/2009; 31(3):193-4. · 0.77 Impact Factor
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ABSTRACT: A 70-year-old man right eye over 5 weeks. He was found clinically to have a bitemporal hemianopia and bilateral disc edema. Testing revealed optic nerve head drusen (ONHD) bilaterally causing enlarged blind spots (pseudo-bitemporal hemianopia). This case illustrates that ONHD should be listed in the differential diagnosis for bitemporal hemianopia when brain imaging is normal.
Annals of Ophthalmology 02/2009; 41(1):47-9. · 0.16 Impact Factor
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ABSTRACT: Papilledema is considered one of the cardinal ophthalmologic signs of shunt failure. However, the prevalence of papilledema in children with shunt malfunction has not been systematically investigated. The purpose of this study is to determine the sensitivity of papilledema as a sign of shunt failure in children.
A prospective evaluation was undertaken of all children (n = 29; <19 years of age) with surgically confirmed shunt malfunction who were treated at Arkansas Children's Hospital between July 2007 and April 2008. Each child had a dilated fundus examination and/or RetCam photograph while under anesthesia immediately before shunt repair. The optic disk was evaluated for the presence of papilledema and pallor. Intracranial pressure was measured during surgical shunt repair at the discretion of the neurosurgeon.
Twenty-nine patients had surgically confirmed shunt failure. Patient's age ranged from 36 days to 18 years, 8 months. Four patients (14%) had papilledema, and 1 patient had severe optic disk pallor. The remaining 24 patients had flat optic disks. Five patients had flat optic disks despite an intracranial pressure >/=300 mm H(2)O.
Papilledema is not a sensitive sign of shunt failure. Even children with severe elevations in intracranial pressure from shunt malfunction may have flat optic disks. Therefore, physicians that evaluate children with shunts should be aware that a normal optic disk does not preclude shunt malfunction.
Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 12/2008; 13(1):63-6. · 1.07 Impact Factor
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ABSTRACT: Dyskeratosis congenita, also referred to as Zinsser-Cole-Engman syndrome, is characterized by reticular skin pigmentation, dystrophic nail changes, and mucosal leukoplakia. Other findings include carious teeth, premature graying of hair, and osteoporosis. Approximately 50% of patients develop pancytopenia. Ophthalmologic manifestations include blepharitis, conjunctivitis, obliteration of the lacrimal puncta, nasolacrimal duct obstruction, ectropion, and loss of eyelashes. We report bilateral retinal hemorrhages from pancytopenia in a patient with dyskeratosis congenita.
Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 06/2008; 12(4):415-7. · 1.07 Impact Factor
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ABSTRACT: Rhombencephalosynapsis is a rare, sporadic, posterior fossa malformation characterized by agenesis of the cerebellar vermis, dorsal fusion of the cerebellar hemispheres, and fusion of the dentate nuclei and superior cerebellar peduncles. Ophthalmologic findings in patients with rhombencephalosynapsis have not been described in detail. Optic nerve and chiasmal hypoplasia were reported in two patients. Strabismus has been noted in several patients; however, specific details were not provided. We describe the association of A-pattern strabismus and superior oblique overaction with rhombencephalosynapsis.
Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 03/2008; 12(1):97-9. · 1.07 Impact Factor
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Paul H Phillips
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ABSTRACT: Binocular diplopia occurs from misalignment of the eyes. The fixation object is imaged onto the fovea of one eye and a nonfoveal region of the misaligned eye, creating diplopia. Treatment options include ocular occlusion, monovision optical correction, prism glasses, strabismus surgery, and chemodenervation. Ocular occlusion and monovision optical correction enable the patient to ignore the image from the misaligned eye. Prism glasses alter the light pathways so that the fixation object is imaged onto the fovea of both eyes, despite ocular misalignment. Strabismus surgery and chemodenervation attempt to restore ocular alignment. This article reviews the mechanisms and indications for each of these treatment options for patients with diplopia.
Seminars in Neurology 08/2007; 27(3):288-98. · 1.64 Impact Factor
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Archives of Ophthalmology 05/2003; 121(4):577-9. · 3.71 Impact Factor
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ABSTRACT: The ophthalmologist is frequently called upon to evaluate infants and children with decreased vision related to congenital
abnormalities of the optic nerve. Such evaluation necessitates a detailed understanding of the ophthalmoscopic features, associated
neuro-ophthalmic findings, current theories of pathogenesis, and appropriate ancillary studies in each condition. This chapter
examines congenital optic nerve abnormalities, discusses current controversies surrounding their pathogeneses, and reviews
associated neuroradiologic findings that may predicate the general medical management of affected patients.
01/1970: pages 204-246;
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ABSTRACT: An 8-year-old boy presented with bilateral visual loss and an increasing exotropia, and later developed deteriorating school performance. Magnetic resonance imaging of the head showed bilateral, symmetric, T2, and FLAIR white matter abnormalities in the parieto-occipital regions. Elevated serum very long chain fatty acids confirmed the diagnosis of X-linked adrenoleukodystrophy. Ophthalmologists should be aware of the diagnosis in boys with visual loss, hyperactivity, behavioral changes, and deterioration in school performance. Visual loss may be the presenting or predominant feature in X-linked adrenoleukodystrophy.
Survey of Ophthalmology 52(6):672-9. · 2.35 Impact Factor
