Sample records for exophthalmos

  1. Exophthalmos in Cushing's syndrome. (United States)

    Kelly, W


    Exophthalmos was noted in 4 of the 12 patients reported by Harvey Cushing in 1932. Although exophthalmos has often been included in clinical descriptions, no previous study has reported actual measurements in patients with active and treated Cushing's syndrome, and in control patients. The aim of this study was to obtain these measurements. Thirty-one patients with active Cushing's syndrome (19 iatrogenic), 15 with treated Cushing's syndrome, 18 with Graves' ophthalmopathy, 59 control patients, and 3 patients with active Cushing's syndrome plus a family or personal history of thyroid disease. A consecutive series of patients with active and treated Cushing's syndrome were assessed. They were compared with patients with Graves' ophthalmopathy, and with control patients. Exophthalmos was assessed by the author using a Hertel meter. Urinary free cortisol was measured on patients with Cushing's syndrome, and serum thyroxine was estimated for them, and for the patients with Graves' ophthalmopathy. Exophthalmos exceeding 16 mm (> 2 SD above normal mean) was found in 45% of active Cushing's syndrome, 21% of iatrogenic Cushing's syndrome, 20% of treated Cushing's syndrome, 2% of normal controls, and 77% of patients with Graves' ophthalmopathy. No patient with Cushing's syndrome had significant symptoms due to exophthalmos. Patients with active Cushing's syndrome have statistically significant exophthalmos. This rarely causes symptoms, and diminishes when cortisol concentrations become normal. Cushing's syndrome and autoimmune thyroid disease may coexist in patients with exophthalmos.

  2. Exophthalmos associated to orbital zygomatic mucocele and ...

    African Journals Online (AJOL)

    A case of exophthalmos due to zygomatic mucocele in a puppy with ipsilateral segmental maxillary atrophy is reported. A 7-month-old, mixed breed, male dog suffered the sudden-onset of unilateral painful exophthalmos and a gradual swelling of the right temporal region. A compressing, right retrobulbar mass was ...

  3. Bilateral exophthalmos in a Holstein cow with lymphosarcoma


    Malatestinic, Andrea


    A 4-year-old Holstein cow presented with severe bilateral exophthalmos. A complete blood cell count revealed late stage lymphoma; the agar gel immunodiffusion test for enzootic bovine leukosis was positive. The cow was euthanized 1 wk after presentation. Necropsy revealed generalized lymphadenopathy and tumors in most organs. Final diagnosis was lymphosarcoma.

  4. Malignant bilateral exophthalmos and secondary glaucoma in iatrogenic Cushing's syndrome. (United States)

    Boschi, A; Detry, M; Duprez, T; Rolland, F; Plas, B; De Plaen, J; Eloy, P


    The authors describe a case of iatrogenic Cushing's syndrome in which an emergency orbital decompression was performed. This procedure was necessary because major ocular hypertension and severe bilateral exophthalmos had caused a decrease in visual function and recurrent painful episodes of eyeball luxation.

  5. Calvarial hyperostosis presenting as unilateral exophthalmos in a female English Springer Spaniel. (United States)

    Mathes, Rachel L; Holmes, Shannon P; Coleman, Kevin D; Radlinsky, Mary A G; Moore, Phillip A


    A 4-month-old intact female English Springer Spaniel presented to the University of Georgia Veterinary Teaching Hospital for evaluation of unilateral, progressive exophthalmos oculus sinister (OS) of 2 weeks' duration. Complete ophthalmic examination revealed moderate OS exophthalmos and lateral globe deviation. No other abnormalities were noted on physical or ophthalmic examination, ocular ultrasound, complete bloodwork, or thoracic radiography. Skull computed tomography (CT) revealed a large, focal, smoothly irregular, cavitated, expansile bony lesion involving the left caudal maxillary and left frontal bones. Biopsies, obtained through a frontal sinusotomy approach to preserve the left globe integrity, demonstrated normal reactive trabecular bone with locally extensive fibrosis. Calvarial hyperostosis was diagnosed based upon appearance on imaging, lesion unilaterality, absence of mandibular involvement, and histopathology. Six months after initial presentation, skull CT was repeated and marked reduction in the degree of frontal bone thickening was demonstrated with complete resolution of cavitations. There was marked clinical improvement with mild, nonpainful exophthalmos, and lateral globe deviation OS on ophthalmic examination. Eleven months after initial presentation, there was complete resolution of the frontal bone lesion with mild thickening of the left calvarial bones on repeat skull CT. There was no exophthalmos or globe deviation present on clinical ophthalmic examination. The proliferative osteopathic lesion was self-resolving with resolution of the exophthalmos and has not recurred to date. To the authors' knowledge, this is the first report of calvarial hyperostosis in a previously unreported breed presenting as unilateral exophthalmos. © 2011 American College of Veterinary Ophthalmologists.

  6. Regression of Ophthalmopathic Exophthalmos in Graves' Disease After Total Thyroidectomy: a Prospective Study of a Surgical Series. (United States)

    Bhargav, P R K; Sabaretnam, M; Kumar, S Chandra; Zwalitha, S; Devi, N Vimala


    Autoimmune ophthalmopathy is one of the salient clinical features associated with Graves' disease. Exophthalmos is one of the commonest manifestations of Graves' associated ophthalmopathy. It is reported to regress after thyroidectomy favourably compared to radioiodine or antithyroid drug therapy. In this context, we present our experience based on a surgical series of Graves' disease. This is a prospective study of 15 patients of Graves' disease associated with ophthalmopathic exophthalmos. Preoperative and monthly postoperative evaluation of exophthalmos was done with Hertel's exophthalmometer, apart from documenting lid, extra-ocular muscle and orbital involvement. The minimum follow-up of the cohort was 12 months. The female to male ratio was 12:3 and the mean age of the subjects was 33.4 years (18-55). Exophthalmos was bilateral in 13 and unilateral in 2 patients. All the 15 patients underwent total thyroidectomy without any major morbidity. Exophthalmos regressed in 12 patients at a mean follow-up of 15.6 ± 6.4 months (14-38) and was static in 3. None of the cases had worsened ophthalmopathy at the final follow-up. Mean regression of exophthalmos was 2.1 mm (1-5). The regression was statistically significant at P value = 0.035. Surgery has a positive impact on the regression of ophthalmopathic exophthalmos associated with Graves' disease.

  7. The philosopher Socrates had exophthalmos (a term coined by Plato) and probably Graves' disease. (United States)

    Papapetrou, Peter D


    According to a previously published theory, Socrates was afflicted with temporal lobe epilepsy since his childhood. Plato, Xenophon, and Aristoxenus described Socrates as having exophthalmos, probably diplopia, and some symptoms compatible with hyperthyroidism. Using these data, we theorize that Socrates had Graves' disease. In order to determine a cause of his temporal lobe epilepsy, we speculate that the philosopher also had autoimmune thyroiditis and Hashimoto encephalopathy during his childhood and his epilepsy may have been a sequel to this hypothesized encephalopathy.

  8. [Unilateral exophthalmos as the debut of a non-secretory multiple myeloma]. (United States)

    Castro-Rebollo, M; Cañones-Zafra, R; Vleming-Pinilla, E N; Drake-Rodríguez-Casanova, P; Pérez-Rico, C


    A 56 year-old male presented blurred vision and diplopia for 2 months, left unilateral exophthalmos, restricted ocular motility and papilledema. The imaging proofs showed osteolytic lesions in the left sphenoid bone, fourth rib and fourth dorsal vertebral body with associated masses of soft tissues. Biopsy was performed and the diagnosis of plasma cell neoplasm was established. The diagnosis of non-secretory multiple myeloma was made by analytical criteria and bone marrow biopsy. Local radiotherapy and polychemotherapy was prescribed. The ophthalmologist can play an important role in the diagnosis of systemic neoplasms that require the intervention of a multidisciplinary team.

  9. Exophthalmos associated to orbital zygomatic mucocele and complex maxillary malformation in a puppy

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    Alessandro Cirla


    Full Text Available A case of exophthalmos due to zygomatic mucocele in a puppy with ipsilateral segmental maxillary atrophy is reported. A 7-month-old, mixed breed, male dog suffered the sudden-onset of unilateral painful exophthalmos and a gradual swelling of the right temporal region. A compressing, right retrobulbar mass was observed by ultrasound. Computed tomography revealed a large multiloculated cyst-like lesion of the right zygomatic gland projecting into the orbital space, thus displacing the eyeball. The ipsilateral molar part of the maxillary bone was underdeveloped, besides showing crowded, abnormal, multiple, unerupted maxillary molar teeth in the caudal maxillary region. Modified lateral orbitotomy and a selective caudal maxillary bone access were performed. The cyst-like lesion was removed and the zygomatic gland and the wall was collected for histology, which confirmed the mucocele. Clinical and imaging examinations six months after surgery showed neither recurrence of the mucocele nor ocular abnormalities. A possible common pathogenic mechanism involving these two conditions could be hypothesized.

  10. Exophthalmos associated to orbital zygomatic mucocele and complex maxillary malformation in a puppy. (United States)

    Cirla, Alessandro; Rondena, Marco; Bertolini, Giovanna; Barsotti, Giovanni


    A case of exophthalmos due to zygomatic mucocele in a puppy with ipsilateral segmental maxillary atrophy is reported. A 7-month-old, mixed breed, male dog suffered the sudden-onset of unilateral painful exophthalmos and a gradual swelling of the right temporal region. A compressing, right retrobulbar mass was observed by ultrasound. Computed tomography revealed a large multiloculated cyst-like lesion of the right zygomatic gland projecting into the orbital space, thus displacing the eyeball. The ipsilateral molar part of the maxillary bone was underdeveloped, besides showing crowded, abnormal, multiple, unerupted maxillary molar teeth in the caudal maxillary region. Modified lateral orbitotomy and a selective caudal maxillary bone access were performed. The cyst-like lesion was removed and the zygomatic gland and the wall was collected for histology, which confirmed the mucocele. Clinical and imaging examinations six months after surgery showed neither recurrence of the mucocele nor ocular abnormalities. A possible common pathogenic mechanism involving these two conditions could be hypothesized.

  11. Cytoenzymology and 3H-thymidine uptake of retro-ocular connective tissue cultures in experimental endocrino-exophthalmos. (United States)

    Vaida, E; Petrescu, R; Ghinea, E; Stefaneanu, L


    The in vitro retro-ocular connective tissue cultures from guinea pigs with endocrine exophthalmos were studied before and after retro-ocular treatment with cortisol and hyaluronidase. Both cortisol and hyaluronidase inhibited the cell proliferation, the cytoenzymic activities of oxydoreductases, the 3H-thymidine uptake, the number of mitoses and the protein content of cultivated cells.

  12. Osteotomía de avance del marco orbitario para el tratamiento del exoftalmos endocrino severo Advancement osteotomy of the orbital rim for the treatment of severe endocrine exophthalmos

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    F. Almeida


    Full Text Available La orbitopatía tiroidea es una enfermedad debilitante del sistema visual caracterizada por presentar cambios en los tejidos blandos orbitarios y periorbitarios debidos a un proceso inflamatorio, o a la consecuencia del mismo, y que se relaciona con alteraciones sistémicas de la glándula tiroides. Aparte de las alteraciones estéticas que ocasiona, los pacientes pueden presentar queratitis de repetición por exposición, diplopia, dolor retrobulbar, compresión del nervio óptico e incluso ceguera. La cirugía constituye el tratamiento definitivo del exoftalmos en la orbitopatía de Graves, mejorando la proptosis y la visión, así como diminuyendo la sintomatología ocular, con una morbilidad mínima. Presentamos un caso de exoftalmos severo que fue intervenido mediante osteotomía y avance del marco orbitario superior, lateral e inferior, remoción parcial de dos paredes orbitarias y lipectomía. Los resultados estéticos y el alivio de la sintomatología ocular resultaron satisfactorios.Thyroid-associated orbitopathy is a debilitating disease of the visual system that is characterized by changes in the softtissues of the orbit and periorbita as a result of an inflammatory process, or as a consequence of this, and related to systemic disorders of the thyroid gland. Apart from the aesthetic changes that arise, patients may also present persistent keratitis due to exposure, diplopia, retrobulbar pain, compression of the optic nerve and even blindness. Surgery represents the definitive treatment for exophthalmos in Graves’ orbitopathy as improvements are shown in proptosis and vision. A decrease is also experienced in ocular symptomatology and there is minimal morbidity. We present the case of severe exophthalmos that was surgically operated on with an advancement osteotomy of the supero-, lateral- and infraorbital rim, with partial removal of two of the orbital walls with lipectomy. The aesthetic results and the relief of the ocular symptoms

  13. Análise do filme lacrimal e sua relação com a largura da fenda palpebral e a exoftalmia na oftalmopatia de Graves Tear film analysis and its relation with palpebral fissure height and exophthalmos in Graves' ophthalmopathy

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    Maria Vitoria Oliveira Moura Brasil


    Full Text Available OBJETIVO: Avaliar qualidade do filme lacrimal pelo corante rosa bengala e sua estabilidade por meio do tempo de ruptura, relacionando com a largura da fenda palpebral e a exoftalmia em pacientes com oftalmopatia de Graves. MÉTODOS: Foram estudados 54 olhos de 27 pacientes com oftalmopatia de Graves, tanto em fase inflamatória quanto em fase crônica. A avaliação consistiu de análise qualitativa do filme lacrimal pelo corante rosa bengala por meio da classificação de van Bijsterveld, análise da estabilidade do filme lacrimal pelo tempo de ruptura, medida da largura da fenda palpebral e exoftalmometria. A análise estatística foi realizada com o teste do Qui-quadrado. RESULTADOS: Entre os 27 pacientes estudados, 77,8% eram do sexo feminino e 22,2% do masculino. A idade média foi de 44,26 anos (DP 12,67. O tempo médio de doença foi de 5,85 anos (DP 4,47 e o de oftalmopatia foi de 5,81 anos (DP 5,37. Dos 54 olhos em estudo, 37% apresentaram teste positivo pela escala de graduação de van Bijsterveld, 33,3% tempo de ruptura do filme lacrimal menor que 5 segundos, 57,4% largura da fenda palpebral maior que 11 mm e 55,6% exoftalmometria maior que 19 mm. Quando relacionamos o tempo de ruptura do filme lacrimal menor que 5 segundos com a largura da fenda palpebral maior que 11 mm encontramos odds ratio igual a 11,2 (p=0,0008. As demais relações estudadas não mostraram significância estatística. CONCLUSÕES: O olho seco diagnosticado pela coloração com rosa bengala e pelo tempo de ruptura do filme lacrimal ocorre com freqüência na oftalmopatia de Graves. A largura da fenda palpebral correlaciona-se com o tempo de ruptura do filme lacrimal na oftalmopatia de Graves. Seu aumento pode levar à instabilidade do filme lacrimal.PURPOSE: To evaluate tear film quality by rose bengal staining and its stability by breakup time, relating with palpebral fissure height and exophthalmos in patients with Graves' ophthalmopathy. METHODS: We studied

  14. Exophthalmos in a young woman with no graves' disease - a case report of IgG4-related orbitopathy. (United States)

    Erdei, Annamaria; Steiber, Zita; Molnar, Csaba; Berenyi, Ervin; Nagy, Endre V


    Immunoglobulin G4-related disease (IgG4-rd) is characterized by lymphoplasmacytic infiltration and tissue fibrosis. Orbital manifestations of IgG4-rd may include unilateral or bilateral proptosis, cicatricial extraocular muscle myopathy, orbital inflammation and pain which may mimic ophthalmic Graves' disease. A 25-year-old woman has been referred to the endocrinology clinic, 4 months after delivery, with suspected Graves' orbitopathy. She has had bronchial asthma and recurrent skin rashes of unknown aetiology for the last 10 years and was treated for dacryoadenitis with steroid containing eye drops 5 years ago. During pregnancy she developed eyelid swelling. After delivery, eyelid redness and retrobulbar pain evolved. Proptosis was demonstrated by Hertel's exophthalmometry. Orbital magnetic resonance imaging showed enlarged lateral and superior rectus muscles in both orbits. Thyroid function tests were in the normal range and no thyroid stimulating hormone (TSH) receptor autoantibodies were present. The eye muscle involvement pattern raised suspicion, and the high IgG4 level with positive histology of the lacrimal gland confirmed the diagnosis of immunoglobulin G4-related orbitopathy. Rapid improvement was observed following oral methylprednisolone. IgG4-related orbitopathy may mimic Graves' orbitopathy. Euthyroid patients with no TSH receptor autoantibodies should be evaluated for immunoglobulin G4-related orbitopathy. Once IgG4-related orbitopathy is proven, other manifestations of IgG4-related disease have to be searched for; lifelong follow-up is warranted.

  15. Orbital involvement in chronic lymphocytic leukemia. (United States)

    Skinnider, L F; Romanchuk, K G


    In a 68-year-old man with chronic lymphocytic leukemia diagnosed on the basis of peripheral lymphocytosis, marked bilateral exophthalmos developed owing to massive orbital involvement by the disease. At the time there was no lymphadenopathy or evidence of organ infiltration. The response to radiotherapy was excellent. Orbital involvement is rare as an early clinical feature of chronic lymphocytic leukemia but should be considered in the differential diagnosis of bilateral exophthalmos in adults.

  16. A traumatic dural arteriovenous fistula between the inferolateral trunk of the internal carotid artery and the ophthalmic vein: A case of transvenous coil embolization via the facial vein

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    Kim, Jun Young; Hong, Chang Ki; Suh, Sang Hyun [Dept. of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Kim, Dong Ik [Dept. of of Radiology, CHA Bundang Medical Center, CHA University, Seongnam (Korea, Republic of)


    A 31-year-old man was admitted with exophthalmos. He suffered from progressive exophthalmos, bruit and conjunctival chemosis 7 days after head trauma caused by falling down. Cerebral angiography showed a dural arteriovenous fistula (DAVF) draining into the ophthalmic vein caused by tear in the inferolateral trunk, which is a rare presentation of traumatic DAVF. Selective transvenous coil embolization was performed via the facial vein without neurologic complications.

  17. Assessment of intraorbital structure volume using a numerical segmentation image technique (NSI): the fatty tissue and the eyeball. (United States)

    Majos, Agata; Grzelak, Piotr; Młynarczyk, Wojciech; Stefańczyk, Ludomir


    Measurement of the degree of exophthalmos is one of the main methods used in the assessment of pathological processes that occur in the orbital space and is widely used. However, this only provides initial information about the volume relations between the intraorbital structures. The aims of our work were as follows: to draw up a new computer application, namely the numerical segmentation image (NSI) technique, for the automatic calculation of the volume of the intraorbital structures on the basis of magnetic resonance imaging (MRI) images, to determine its usefulness in the segmentation of fatty tissue and the eyeball and to estimate their volume in relation to the degree of exophthalmos. A total of 45 patients (90 orbits) were included in the study. All the patients underwent MRI examination of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomatic line. Quantitative assessment of the eyeball and fatty tissue was made using an NSI application. The influence of fatty tissue volume on the degree of exophthalmos was determined as being statistically significant (r = 0.367, p = 0.000374) but was smaller in comparison with the relationship between total eye muscle volume and degree of exophthalmos; eyeball volume was found to have the least influence (r = 0.344, p = 0.000374). Two eyeballs of significantly smaller volume were found in the group of 90 orbits analysed. The NSI technique is a clinically useful application, providing objective data calculated individually for each orbit. A credible protocol for estimating the degree of exophthalmos on the basis of the NSI technique should include the eye muscle volume, fatty tissue volume and, in cases where eyeball pathologies coexist, the eyeball volume as well.

  18. Various ocular symptoms in carotid-cavernous fistula after radiosurgery; A case report

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    Kubota, Yoshimi; Tochikubo, Tetsuo; Mori, Tatsuhiko; Komoto, Michiji; Nishikawa, Hideto (Toho Univ., Tokyo (Japan). School of Medicine)


    This is a report of the clinical course of a 38-year-old man with dural carotid-cavernous fistula fed by an extra-carotid artery and an intra-carotid artery. Severe exophthalmos and chemosis developed after radiosurgery. These were associated with visual acuity loss and secondary glaucoma. Intraocular pressure (IOP) decreased after one week, and chemosis, exophthalmos and visual acuity were normalized after 6 weeks. The various ocular symptoms were thought to be due to abnormal venous return after radiosurgery. (author).

  19. Eyeball muscles' diameters versus volume estimated by numerical image segmentation. (United States)

    Majos, A; Grzelak, P; Młynarczyk, W; Stefańczyk, L


    To determine the clinical usefulness of the numerical segmentation image technique (NSI) in estimating the volume of extraocular muscles and to compare this value to widely used measurements of single diameters of the muscles. Forty-five patients underwent magnetic resonance examinations in 1.5-T scanner. SE T1 sequences in transversal and coronal planes were provided and data were sent to a personal computer, where the degree of exophthalmos, horizontal diameter of medial rectus muscles, and vertical diameter of inferior rectus muscles were determined on the basis of two-dimensional images. The quantity estimation of all eye muscles volumes using NSI application in three-dimensional space was carried out with use of level set segmentation algorithm. A strong correlation between the total eye muscle volume and degree of exophthalmos was determined. The usefulness of measuring single diameters for estimating the muscles' enlargement was confirmed. The difference between a single muscle's volume and its width also was confirmed. Estimates of muscle volume correlate with the degree of exophthalmos more accurately than measurements of single diameters. The NSI technique is a clinically useful application, providing objective data calculated individually for each orbit. It allows an objective estimation of the pathologic processes leading to exophthalmos and may be especially helpful in monitoring discrete changes in the muscles volume during treatment.

  20. “Thyrotricksicosis” The confounders of GI symptomatology and ...

    African Journals Online (AJOL)

    He weighed 55kg, was afebrile and his eyes appeared normal with no evidence of exophthalmos, lid retraction or lid lag. The following (FBC, serum amylase and lipase, TSH, Ca,PTH, D dimer and CRP) initial blood tests performed were normal. His blood, stool and sputum investigations were normal. His electrocardiogram ...

  1. Subclinical hypothyroidism among Egyptian children with systemic ...

    African Journals Online (AJOL)


    (SLEDAI), symptoms suggestive of hypothyroidism (pubertal delay, puffy features, swelling in neck, cold intolerance, etc….) or hyperthyroidism (emotional lability, weight loss, and restless sleep, some degree of exophthalmos, etc….). Patients with overt thyroid disease were excluded. B- The laboratory work up of the study:.

  2. C syndrome in an Egyptian infant with dilated brain ventricles and ...

    African Journals Online (AJOL)

    C syndrome is an autosomal recessive disorder characterized by trigonocephaly, partial or complete obliteration of the metopic suture which is characteristic, and short limbs. In this paper we describe an Egyptian boy affected with this syndrome, with no exophthalmos and with dilated brain ventricles and heterotopia.

  3. Total autonomic blockage and primary sinus node dysfunction in a ...

    African Journals Online (AJOL)

    nMol/L with early node dysfunction in a patient about to undergo exophthalmos that was only detected on thyroidectomy. A 40-year old female patient had ophthalmological examination; clinically it was not been prepared with propanolol for ...

  4. Tarsorrhaphy as Treatment for Severe Conjunctival Oedema ...

    African Journals Online (AJOL)

    Background: Oedema of the conjunctiva which may follow trauma, severe conjunctivitis, parasitic infestation or thyrotrophic exophthalmos presents a problem to the ophthalmologist because of protracted period of regression. In the past, using only drugs, it took over a period of 3 months for cases of severe conjunctival ...

  5. Thrombose du sinus caverneux secondaire à une infection dentaire ...

    African Journals Online (AJOL)

    Case - reports : a 49 years old man presented to our department with bilateral exophthalmos and eyelidedemaand fever. The examination showed an inflammatory chemosis, and oculomotor disorders associated with decreased visualacuity and a maxillary dental attrition. CT scan hasrevealed a cavernous sinus ...

  6. Extraocular myositis in a female puppy | Adegboye | Open ...

    African Journals Online (AJOL)

    Extraocular myositis (EOM) is not commonly encountered in dogs. It is generally diagnosed based on clinical features of exophthalmos without third eyelid protrusion, pain or vision loss. The traditional treatment of choice is prednisolone. This report describes a case of a mixed-breed puppy with clinical signs consistent with ...

  7. A new lethal sclerosing bone dysplasia

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    Kingston, H.M. (Saint Mary' s Hospital, Manchester (UK). Regional Genetics Centre); Freeman, J.S. (Tameside General Hospital, Ashton-under-Lyne (UK). Dept. of Paediatrics); Hall, C.M. (Hospital for Sick Children, London (UK). Dept. of Paediatric Radiology)


    A neonate is described with a lethal sclerosing bone dysplasia associated with prenatal fractures and craniofacial abnormalities including microcephaly, exophthalmos, hypoplastic nose and mid-face, small jaw and nodular hyperplasia of the gums. Parental consanguinity suggests that an autosomal recessive mutation is the likely aetiology. (orig.).

  8. Fistule carotido-caverneuse indirecte post traumatique: diagnostic ...

    African Journals Online (AJOL)

    We report the case of a 58-year old patient who presented with exophthalmos and progressive vision loss in the left eye which had evolved over the previous year. The patient ... The insufficiency of technical equipment, endovascular status suggesting embolization forced us to make symptom management: artificial tear and ...

  9. An unusual orbital localization of wegener granulomatosis detected by 18F-FDG PET/CT. (United States)

    Bertagna, Francesco; Treglia, Giorgio; Rossini, Pierluigi; Giubbini, Raffaele


    We report a case of a 61-year-old male patient affected by Wegener granulomatosis and left exophthalmos who underwent F-FDG PET/CT during follow-up for rectal cancer. The study was negative for secondary lesions but revealed high uptake at the left orbital mass consistent with Wegener granulomatosis.

  10. Nasal encephalocele in a child with Beckwith-Wiedemann syndrome

    NARCIS (Netherlands)

    Broekman, Marike L. D.; Hoving, Eelco W.; Kho, Kuan H.; Speleman, Lucienne; Sen Han, K.; Hanlo, Patrick W.

    Beckwith-Wiedemann syndrome (BWS) is a rare congenital syndrome characterized by gigantism, macroglossia, exophthalmos, postpartum hypoglycemia, and multiple midline defects such as omphalocele. The authors describe, to the best of their knowledge, the first case of a child in whom BWS was diagnosed

  11. A. 0. AFOLABI, 0.0 AKUTF.

    African Journals Online (AJOL)

    A study in a. Chinese family associated mitral valve prolapse with this mutation'. Three of our patients in whom echocardiography was performed had normal mitral valves. Thomas et al8 described a non-autoimmune form of goitrous hyperthyroidism different from Graves' disease. The absence of exophthalmos and a rare.

  12. The large eyes of Wolfgang Amadeus Mozart. (On the occasion of the 250th Mozart anniversary year)

    NARCIS (Netherlands)

    Zegers, Richard H. C.; Saeed, Peerooz; Wiersinga, Wilmar M.


    This article discusses the eyes of Wolfgang Amadeus Mozart (1756-1791) which, based on portraits, can be said to have a certain noticeable feature--some degree of exophthalmos. In fact, even contemporary observers made particular mention of Mozart's eyes being large. Although cicatricial ectropion,

  13. Endoscopic and trans-fornix removal of a giant orbital-ethmoidal osteoma

    NARCIS (Netherlands)

    Gerbrandy, S. J. Feike; Saeed, Peerooz; Fokkens, Wytske J.


    A 39-year old female was referred with a 2 year history of slowly progressive headache, exophthalmos, diplopia and restricted eye movements with exotropia of the right eye. Orthoptic examination revealed restricted elevation and mildly restricted adduction of the right eye. CT and MRI demonstrated a

  14. Cephalic Tetanus from Penetrating Orbital Wound


    Eloïse Guyennet; Jean-Laurent Guyomard; Emilie Barnay; Franck Jegoux; Jean-François Charlin


    Tetanus is a neurologic disorder caused by tetanospasmin, a protein toxin elaborated by Clostridium tetani. Cephalic tetanus is a localized form of the disease causing trismus and dysfunction of cranial nerves. We report the case of a man who presented with facial trauma, complete ophthalmoplegia, exophthalmos, areactive mydriasis, and periorbital hematoma. An orbital CT revealed air bubbles in the right orbital apex. The patient was given a tetanus toxoid booster and antibiotherapy. After ex...

  15. Zygomatic Sialolithiasis Diagnosed with Computed Tomography in a Dog


    LEE, Namsoon; CHOI, Mihyun; KEH, Seoyeon; KIM, Taehyun; KIM, Hyunwook; YOON, Junghee


    ABSTRACT A 10-year-old castrated Shih-Tzu male dog was referred for examination of acute right exophthalmos, protrusion of the third eyelid and soft tissue swelling ventral to the globe. Ultrasonography revealed echogenic fluid around the right globe. Computed tomography (CT) showed an enlarged right zygomatic salivary gland compared with the left zygomatic gland and an amorphous cystic mass ventral to the right globe. Hyperdense material, which we suspected to be a sialolith, was identified ...

  16. Orbital lymphoma associated with Graves’ disease: A case report

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    Hajduković Zoran


    Full Text Available Introduction. The presence of bilateral exophthalmos and palpebral, periorbital edema associated with hyperthyroidism is most often considered as an initial sign of Graves’ ophthalmopathy. However, in up to 20% of cases, Graves’ ophthalmopathy might precede the occurrence of hyperthyroidism, which is very important to be considered in the differential diagnosis, especially if it is stated as unilateral. Among other less common causes of non-thyroid-related orbitopathy, orbital lymphoma represents rare conditions. We presented of a patient with Graves’ disease, initially manifested as bilateral orbitopathy and progressive unilateral exophthalmos caused by the marginal zone B-cell non-Hodgkin lymphoma of the orbit. Case report. A 64-yearold man with the 3-year history of bilateral Graves’ orbitopathy and hyperthyroidism underwent the left orbital decompression surgery due to the predominantly left, unilateral worsening of exophthalmos resistant to the previously applied glucocorticoid therapy. A year after the surgical treatment, a substantial exophthalmos of the left eye was again observed, signifying that other non-thyroid pathology could be involved. Orbital ultrasound was suggestive of primary orbital lymphoma, what was confirmed by orbital CT scan and the biopsy of the tumor tissue. Detailed examinations indicated that the marginal zone B-cell non-Hodgkin lymphoma extended to IV - B-b CS, IPI 3 (bone marrow infiltration: m+ orbit+. Upon the completion of the polychemiotherapy and the radiation treatment, a complete remission of the disease was achieved. Conclusion. Even when elements clearly indicate the presence of thyroid-related ophthalmopathy, disease deteriorating should raise a suspicion and always lead to imaging procedures to exclude malignancy.

  17. Assessment of the volume of intraorbital structures using the numerical segmentation image technique (NSI): the extraocular muscles. (United States)

    Majos, Agata; Grzelak, Piotr; Młynarczyk, Wojciech; Stefańczyk, Ludomir


    In recent years the use of computer systems has allowed numerical analysis of medical images to be introduced and has speeded up the conversion of numerical data into clinically valuable information. The creation of a software application that could almost automatically calculate the volume of anatomical structures imaged by MRI has seemed possible. The aim of our study was to determine the clinical usefulness of an numerical segmentation image technique (NSI) software application in estimating the volume of extraocular muscles. The study group was formed of 45 patients (90 orbits). All the patients underwent MRI examinations of the orbits by a 1.5 T scanner using a head coil. The degree of exophthalmos was determined clinically and radiologically in relation to the interzygomatic line. The quantitative assessment of all eye muscles was carried out using the NSI application, a new software program introduced by the authors. A close correlation between muscle volume and the degree of exophthalmos was revealed and confirmed by statistical analysis (r = 0.543, p = 3.13396E-08) in agreement with other papers. The NSI software program is an application which offers a reliable and precise estimation of eye muscle volume. It is therefore useful in the diagnosis of the pathological processes leading to exophthalmos. It has special clinical value for monitoring discrete volume changes of muscles during treatment.

  18. Spontaneous globe luxation in iatrogenic Cushing syndrome. (United States)

    Ortega-Evangelio, Leticia; Navarrete-Sanchis, Javier; Williams, Basil K; Tomas-Torrent, Juan Miguel


    We report a rare case of spontaneous eyeball luxation associated with exophthalmos due to iatrogenic Cushing syndrome (CS). The normalization of serum hormones led to the regression of the picture. A 64-year-old man presented with spontaneous globe luxation of the left eye after a 6-month history of bilateral, painless, and slowly progressive exophthalmos. The patient had been receiving weekly infusions of methylprednisone over the previous 6 months. His best-corrected visual acuity (BCVA) at presentation was 20/40 in the right eye and 20/20 in the left eye. The patient demonstrated full extraocular motility. The intraocular pressure (IOP) was elevated in the right eye (24 mHg) and normal in the left eye (18 mmHg). Exophthalmometry demonstrated bilateral proptosis with measurements of 27 mm in the right eye and 28 mm in the left eye. Computed tomography scan of the brain and orbits revealed increased orbital and cervical fat. Clinical, radiographic and serologic findings ruled out potential diagnoses including orbital metastasis, thyroid orbitopathy, carotid-cavernous fistula, and idiopathic orbital pseudotumor. Clinical suspicion of iatrogenic CS was high, and additional serologic testing confirmed the diagnosis. Exophthalmos is an uncommon sign of CS, but to our knowledge, this is the first reported case of spontaneous globe luxation secondary to CS. In our case, normalization of cortisol was sufficient to resolve the clinical symptoms and eliminated the need for surgical intervention such as orbital decompression surgery.

  19. Virtual surgery simulation in orbital wall reconstruction: integration of surgical navigation and stereolithographic models. (United States)

    Novelli, Giorgio; Tonellini, Gabriele; Mazzoleni, Fabio; Bozzetti, Alberto; Sozzi, Davide


    Correction of post traumatic orbital and zygomatic deformity is a challenge for maxillofacial surgeons. Integration of different technologies, such as software planning, surgical navigation and stereolithographic models, opens new horizons in terms of the surgeons' ability to tailor reconstruction to individual patients. The purpose of this study was to analyze surgical results, in order to verify the suitability, effectiveness and reproducibility of this new protocol. Eleven patients were included in the study. Inclusion criteria were: unilateral orbital pathology; associated diplopia and enophthalmos or exophthalmos, and zygomatic deformities. Syndromic patients were excluded. Pre-surgical planning was performed with iPlan 3.0 CMF software and we used Vector Vision II (BrainLab, Feldkirchen, Germany) for surgical navigation. We used 1:1 skull stereolithographic models for all the patients. Orbital reconstructions were performed with a titanium orbital mesh. The results refer to: correction of the deformities, exophthalmos, enophthalmos and diplopia; correspondence between reconstruction mesh positioning and preoperative planning mirroring; and the difference between the reconstructed orbital volume and the healthy orbital volume. Correspondence between the post-operative reconstruction mesh position and the presurgical virtual planning has an average margin of error of less than 1.3 mm. In terms of en- and exophthalmos corrections, we have always had an adequate clinical outcome with a significant change in the projection of the eyeball. In all cases treated, there was a complete resolution of diplopia. The calculation of orbital volume highlighted that the volume of the reconstructed orbit, in most cases, was equal to the healthy orbital volume, with a positive or negative variation of less than 1 cm(3). The proposed protocol incorporates all the latest technologies to plan the virtual reconstruction surgery in detail. The results obtained from our experience

  20. Orbital apex syndrome secondary to herpes zoster virus infection (United States)

    Merino-Iglesias, Alexia; Montero, Javier Antonio; Calabuig-Goena, Maria; Giraldo-Agudelo, Luisa Fernanda


    A male patient with herpes zoster ophthalmicus (HZO) presented with left exophthalmos, external and internal ophthalmoplegia and decreased visual acuity. A CT scan revealed myositis without significant compression of the optic nerve. Intravenous acyclovir and oral steroids were started with improvement of the symptoms and eventual complete recovery.Orbital apex syndrome is a rare complication of HZO. Multiple pathogenic mechanisms are involved, including a direct cytopathic effect of the virus as in the present case. Early diagnosis and therapy may lead to complete recovery of visual function. PMID:24614776

  1. [Differential diagnosis of Graves' orbitopathy. Case report]. (United States)

    Erdei, Annamária; Steiber, Zita; Gazdag, Annamária; Bodor, Miklós; Berta, Eszter; Szász, Róbert; Szántó, Antónia; Ujhelyi, Bernadett; Barna, Sándor; Berényi, Ervin; Nagy, V Endre


    Graves' orbitopathy is the extrathyroidal manifestation of Graves' disease, which is the most common cause of exophthalmos. As eye symptoms usually coincide with the development of thyrotoxicosis, the diagnosis of the disease is rarely difficult. The aim of the authors was to summarize the differential diagnosis of Graves' orbitopathy based on literature review and presentation of their own four problematic cases on this topic. They conclude that symptoms similar to endocrine orbitopathy are present in other disorders. Endocrinologists need to be aware of these other conditions to avoid treatment failures.

  2. Diagnosis of Retrobulbar Round Cell Neoplasia in a Macaroni Penguin ( Eudyptes chrysolophus ) Through Use of Computed Tomography. (United States)

    Woodhouse, Sarah J; Rose, Michelle; Desjardins, Danielle R; Agnew, Dalen W


    A 25-year-old female macaroni penguin (Eudyptes chrysolophus) was diagnosed with exophthalmos secondary to retrobulbar neoplasia through use of computed tomography (CT). Histopathologic examination of the mass supported a diagnosis of malignant round cell neoplasia. Immunohistochemical (IHC) labeling was applied to determine cell origin; the neoplastic cells did not label with T-cell marker CD3 or B-cell marker BLA.36 and could not be further characterized. The scleral ossicles precluded evaluation of the retrobulbar space by ultrasonography; therefore, CT scanning is recommended for examination of intraorbital structures in penguin and other avian species.

  3. Elevated Intraocular Pressure due to Arteriovenous Fistula between External Carotid Artery and Facial Vein. (United States)

    Cagatay, Halil Huseyin; Ekinci, Metin; Sendul, Selam Yekta; Uslu, Ceylan; Demir, Mehmet; Ulusay, Sıtkı Mert; Uysal, Ender; Seker, Selma


    Aqueous outflow via the conventional outflow pathway is dependent on the pressure gradient between intraocular pressure (IOP) and episcleral venous pressure (EVP). Elevated IOP resulting from increased EVP is a well-known complication of arteriovenous fistulas, which are usually between the carotid artery and the cavernous sinus. Arteriovenous malformations usually occur spontaneously, after a trauma or from iatrogenic causes, and they manifest with findings of chemosis, dilatation of the conjunctival vessels, exophthalmos, and extraocular motility limitation. In this study, we present a case of elevated IOP due to facial arteriovenous malformations following a functional neck dissection surgery that caused intraocular pressure elevation.

  4. Elevated Intraocular Pressure due to Arteriovenous Fistula between External Carotid Artery and Facial Vein

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    Halil Huseyin Cagatay


    Full Text Available Aqueous outflow via the conventional outflow pathway is dependent on the pressure gradient between intraocular pressure (IOP and episcleral venous pressure (EVP. Elevated IOP resulting from increased EVP is a well-known complication of arteriovenous fistulas, which are usually between the carotid artery and the cavernous sinus. Arteriovenous malformations usually occur spontaneously, after a trauma or from iatrogenic causes, and they manifest with findings of chemosis, dilatation of the conjunctival vessels, exophthalmos, and extraocular motility limitation. In this study, we present a case of elevated IOP due to facial arteriovenous malformations following a functional neck dissection surgery that caused intraocular pressure elevation.

  5. Burkitt's lymphoma with bilateral cavernous sinus and mediastinal involvement in a child

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    Huisman, Thierry A.G.M.; Tschirch, Frank; Schneider, Jacques F.L.; Martin-Fiori, Ernst; Willi, Ulrich V. [Department of Radiology and Magnetic Resonance Imaging, University Children' s Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich (Switzerland); Niggli, Felix [Department of Paediatrics, University Children' s Hospital Zurich, Zurich (Switzerland)


    We report a 12-year-old boy who presented with incomplete right ophthalmoplegia, exophthalmos and headache. Initial CT and MRI revealed a mass in the right cavernous sinus. During tumour work-up, CT identified additional tumour within the mediastinum. Biopsy of the mediastinal lesion identified Burkitt's lymphoma. We report on this case because radiologists and clinicians should be alerted to identify sites of primary Burkitt's lymphoma outside of the central nervous system if clinical symptoms indicate, or imaging shows, CNS lesions. Primary CNS involvement in Burkitt's lymphoma is rare. (orig.)

  6. Orthognathic surgery in Melnick-Needles syndrome: a review of the literature and report of two siblings. (United States)

    O'Connell, J E; Bourke, B; Kearns, G J


    Melnick-Needles syndrome (MNS) is a rare congenital X-linked dominant skeletal dysplasia, characterized by exophthalmos, a prominent forehead, and mandibular hypoplasia and retrognathism. Dental features may include anodontia, hypodontia, or oligodontia. Increased collagen content, unpredictable collagen synthesis, and abnormal bony architecture have raised concerns regarding bone splitting intraoperatively and bone healing postoperatively. This report describes the cases of two sisters with MNS, who successfully underwent orthognathic surgery consisting of bilateral mandibular ramus osteotomies combined with advancement genioplasty and iliac crest bone grafting, to correct the classical MNS facial deformity of mandibular retrognathia. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Luxation of Eye ball following trauma: Novel simple treatment

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    Essam A Osman


    Full Text Available Luxation of the eye globe is a rare occasion but it carries a risk of threat to permanent vision loss especially when associated with very high intraocular pressure. Appropriate intervention should be undertaken instantly. Predisposing factors include; eyes as in shallow orbital sockets, floppy eyelid syndrome, and exophthalmos. Prompt reduction results in restoration of full anatomical and visual recovery in otherwise healthy eyes. We report a case of globe luxation following trauma by door handle in a 65-year-old female, who recovered completely after reposition of the globe using Desmarres Lid Retractors.

  8. [Analysis of anthropometry on head and eye for stipulating of children's spectacle frames]. (United States)

    Wang, Yong-jiang; Hong, Rong-zhao; Wei, Xiu-ju; Ai, Yu-de; Zhao, Yi


    To investigate the normal value of six parameters of head and eye in Chinese children, including interorbit distance (IOD), interpupillary distance (IPD), superior otobasion-ectocochion distance (obs-ec), intersuperior otobasion distance (obs-obs), exophthalmos and nasal basis angle, for stipulating the sizes of children spectacle frames. The value of these six parameters in 10 171 children ages 5 to 17 years old were measured with caliper in four cities and the results were analyzed. The IOD, IPD, obs-ec and obs-obs were increased and positively correlated with the age. The differences of these parameters among different ages were statistically significant (F = 0.97, P spectacle frames.


    Martínez-Nevado, Eva; Alonso-Alegre, Elisa González; Martínez, M Ángeles Jiménez; Rodríguez-Álvaro, Alfonso; de Merlo, Elena Martínez; García, Juncal García; Real, Isabel García


    Cryptococcosis is a worldwide and potentially fatal mycosis documented in wild and captive koalas ( Phascolarctos cinereus ) caused by Cryptococcus neoformans . Though mainly a subclinical disease, when the nasal cavity is affected, epistaxis, mucopurulent nasal discharge, dyspnea, and facial distortion may occur. This report describes a case of cryptococcosis in a koala where unilateral exophthalmos was the only evident clinical sign and magnetic resonance imaging and computed tomography findings are described. Both advanced imaging techniques should be considered as standard and complementary techniques for nasal cavity evaluation in koalas.

  10. Apert′s Syndrome

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    B K Sohi


    Full Text Available A case of Apert′s syndrome in a one year old female child is described and literature reviewed. She was the first born of a young couple. She had congenital syndactyl of toes and fingers, acro-cephalic skull, flat facies, exophthalmos, hypertelorism and greasy skin. In addition to the typical radiological features of this syndrome which the patient showed, thickened first metacarpals forked at the base were also seen. There were two phalanges for each toe. Calcification was seen intracranially. These radiological features have not been mentioned so far in the literature reviewed.

  11. Posterior cranial fossa arteriovenous fistula with presenting as caroticocavernous fistula

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    Liu, H.M.; Shih, H.C.; Huang, Y.C.; Wang, Y.H. [Dept. of Medical Imaging, National Taiwan University Hospital, Taipei (Taiwan)


    We report cases of posterior cranial fossa arteriovenous fistula (AVF) with presenting with exophthalmos, chemosis and tinnitus in 26- and 66-year-old men. The final diagnoses was vertebral artery AVF and AVF of the marginal sinus, respectively. The dominant venous drainage was the cause of the unusual presentation: both drained from the jugular bulb or marginal sinus, via the inferior petrosal and cavernous sinuses and superior ophthalmic vein. We used endovascular techniques, with coils and liquid adhesives to occlude the fistulae, with resolution of the symptoms and signs. (orig.)

  12. [A case of primary intraosseous cavernous hemangioma extending from the orbital rim to the sphenoid wing: a case report]. (United States)

    Inaka, Yasufumi; Otani, Naoki; Nishida, Sho; Kumagai, Kohsuke; Fujii, Kazuya; Ueno, Hideaki; Tomiyama, Arata; Tomura, Satoshi; Osada, Hideo; Wada, Kojiro; Mori, Kentaro


    A primary intraosseous cavernous hemangioma located at the sphenoid bone with extensive involvement of the orbital roof and the lateral wall of the orbit is very rare. A 48-year-old woman presented with progressive right exophthalmos and diplopia. CT showed a bony mass lesion in the right sphenoid bone extending to the orbital bone. MRI showed an abnormal lesion in the sphenoid bone, which was heterogeneously enhanced with gadolinium. All of the abnormal bone was surgically removed, and histological examination confirmed a cavernous angioma. We also present a brief clinical and radiological review of seven previously reported cases.

  13. PrimaryiIntraosseousm meningioma in the orbital bony wall: A case report and review of the literature review

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    Lee, Sung Jae; Ryu, Ji Hwa; Kim, Hong Dae; Lee, Kwang Hwi; Baek, Hye Jin; Kim, Ok Hwa; Yoon, Jung Hee; Kim, Ji Yeon [Dept. of Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of); Park, Young Mi; Kim, Dong Wook [Dept. of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)


    Meningiomas arising outside the intracranial compartment are known as extradural meningiomas. Extradural meningiomas are rare conditions, accounting for less than 2% of all meningiomas. Primary intraosseous meningioma is used to describe a subset of extradural meningiomas arising from bone. A 46-year-old woman presented with left exophthalmos. Computed tomography and magnetic resonance images revealed an expansile bony lesion in the orbital lateral wall of the left sphenoid bone. The patient underwent craniotomy for excision of the bony lesion. Pathologic examination revealed an intraosseous meningioma.

  14. The large eyes of Wolfgang Amadeus Mozart. (On the occasion of the 250th Mozart anniversary year). (United States)

    Zegers, Richard H C; Saeed, Peerooz; Wiersinga, Wilmar M


    This article discusses the eyes of Wolfgang Amadeus Mozart (1756-1791) which, based on portraits, can be said to have a certain noticeable feature--some degree of exophthalmos. In fact, even contemporary observers made particular mention of Mozart's eyes being large. Although cicatricial ectropion, caused by infectious disease, cannot be excluded, mild myopia, in combination with shallow orbits or combined with a genetic predilection, would be one possible explanation for Mozart's large eyes. Graves' orbitopathy, the ophthalmic manifestation of hyperthyroidism, or hypothyroidism have both been suggested to be the cause of Mozart's large eyes. However, these diseases are unlikely causes given their topical and systemic features.

  15. Unilateral Direct Carotid Cavernous Fistula Causing Bilateral Ocular Manifestation. (United States)

    Demartini, Zeferino; Liebert, Fernando; Gatto, Luana Antunes Maranha; Jung, Thiago Simiano; Rocha, Carlos; Santos, Alex Marques Borges; Koppe, Gelson Luis


    Unilateral carotid cavernous fistula presents with ipsilateral ocular findings. Bilateral presentation is only seen in bilateral fistulas, usually associated with indirect (dural) carotid cavernous fistulas. Direct carotid cavernous fistulas are an abnormal communication between the internal carotid artery and the cavernous sinus. They typically begin with a traumatic disruption in the artery wall into the cavernous sinus, presenting with a classic triad of unilateral pulsatile exophthalmos, cranial bruit and episcleral venous engorgement. We report the case of a 38-year-old male with traumatic right carotid cavernous sinus fistula and bilateral ocular presentation successfully treated by interventional neuroradiology.

  16. Carotid-Cavernous Fistula as a Complication of Facial Trauma: A Case Report (United States)

    Lazaridou, Maria; Bourlidou, Eleni; Kontos, Konstantinos; Mangoudi, Doxa


    Posttraumatic carotid-cavernous fistula is a very rare complication that can occur in patients with craniomaxillofacial trauma. Symptoms involve headache, diplopia, ptosis of the upper lid, conjunctival chemosis, pulsating exophthalmos, and ophthalmoplegia. Diagnosis can be challenging because various pathologic entities can present with similar symptoms such as superior orbital fissure syndrome, orbital apex syndrome, retrobulbar hematoma, and cavernous sinus syndrome. However, accurate and early diagnosis is of utmost importance because treatment delay may lead to blindness or permanent neurologic deficits. In this article, a case of posttraumatic carotid-cavernous fistula that was twice misdiagnosed is presented. PMID:26269734

  17. Orbital involvement by non-Hodgkin lymphoma NK T cells. (United States)

    Hervás-Ontiveros, A; España-Gregori, E; Hernández-Martínez, P; Vera-Sempere, F J; Díaz-Llopis, M


    The case is presented of 37 year-old male with a history of nasal obstruction with right rhinorrhea, headache, hearing loss and right exophthalmos of 4 months progression. The MRI revealed that the ethmoidal and maxillary sinuses contained inflammatory tissue extending into the orbital region. The biopsy confirmed a non-Hodgkin lymphoma of natural killer (NK) T cells. Non-Hodgkin's T NK lymphoma is a rare tumor in the orbital area that requires an early detection and multi-disciplinary care to ensure appropriate monitoring and treatment. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  18. Puls-therapy with metilprednisolon in Grave's orbitopathy

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    O I Vinogradskaya


    Full Text Available There are different intravenous (iv glucocorticoid (GC schedules to treat active Graves’ Orbitopathy (GO. There is one study compared the efficacy of two different pulse-therapy regimens (Sanchez-Ortiga R. et al, 2009: first regimen - traditional therapy, second – GC dose dependents on body weight. Both regimens were effective, but percentage clinical improvement with second regimen was 92% vs 100% with second regimen.Design. The present study compares the efficacy of two different intravenous methylprednisolone (ivGC dosing regimens: 1000 mg of ivGC daily for 5 days (group I, n = 20 or weekly for 5 weeks (group II, n = 16. Comparisons were made for efficacy according to СAS, exophthalmos, diplopia in 1, 4, 12, 24, 52 weeks after treatment withdrawal. Results. Both regimens had a beneficial effect on soft tissue, exophthalmos. In the first regimen peak of effectiveness occurred between 4 and 24 weeks, in the second regimen- between 4 and 12 weeks. The daily regimen led quickly to reduce the degree of diplopia than weekly dosing regimen. However, in the first group more patients were reported diplopia progression compared with the second group.Conclusion. Both schedules were equally effective and can be used in clinical practice.

  19. CT findings of orbital inflammatory diseases

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    Kim, Jang Min; Shin, Hyun Joon; Kim, Jung Hyuk; Suh, Won Hyuck [College of Medicine, Korea University, Seoul (Korea, Republic of)


    Twenty-nine patients with orbital inflammatory disease (OIDs) were retrospectively reviewed in order to analyze detailed CT findings which might aid in differentiating OIDs. This study comprised 18 pseudotumors, 5 thyroid ophthalmopathies, and 6 cases of orbital cellulitis. CT scans of the pseudotumors showed various findings such as exophthalmos, scleritis, myositis of the extraocular muscle (MOM), and bone lesion. Bone lesions of the pseudo tumors, which have been rarely reported, were present in 7 cases in our series. Bilateral exophthalmos, myositis, and retrobulbar fat deposition were readily detected by CT in thyroid ophthalmopathy, and, in addition, we found bone erosions involving the orbital apices in 2 cases. In orbital cellulitis, extraorbital soft tissue swelling and lateral displacement of the medial rectus muscle in cases with ethmoiditis were the most conspicuous features. In summary, because of the overlapping CT findings in OIDs, careful examination of CT findings regarding the mode of EOM involvement and the presence or absence of scleritis or sinusitis might help narrow down the differential diagnosis. A pseudotumor with bone lesions could be mistaken as a malignant lesion, and therefore it is necessary to correlate clinical features with CT findings for an accurate diagnosis.

  20. Management of orbital cellulitis and subperiosteal orbital abscess in pediatric patients: A ten-year review. (United States)

    Sciarretta, Vittorio; Demattè, Marco; Farneti, Paolo; Fornaciari, Martina; Corsini, Ilaria; Piccin, Ottavio; Saggese, Domenico; Fernandez, Ignacio Javier


    Pediatric periorbital cellulitis represents a common disease complicating a nasal infection. A ten-year retrospective review of fifty-seven children admitted to our institution with the diagnosis of periorbital cellulitis as a complication of sinus infections was carried out. The age varied from one month to eleven years (mean 3.9 years). Thirty-five were males (62%), while twenty-two were females (38%). Nine out of fifty-seven (15.8%) presented exophthalmos associated with eyelid erythema and edema, while the rest suffered mainly from eyelid erythema and edema. Twenty-two patients complaining of exophthalmos or not responding to medical therapy within 48 h were assessed with a computed tomography scan (38.6%). A subperiosteal orbital abscess was detected in nine cases and these patients underwent surgical drainage (15,8%). Recurrence of orbital infection occurred in three cases (5.3%). Medical management is the main treatment for both preseptal and postseptal orbital cellulitis. Nevertheless, there is no universally accepted guideline for the treatment of subperiosteal abscesses and each case should be treated accordingly. Urgent surgical drainage should be considered in cases not responding to adequate medical management, or those cases presenting visual deterioration. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. A case of exorbitism in association with Wegener′s granulomatosis with renal involvement

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    S Beji


    Full Text Available Wegener′s granulomatosis (WG is a necrotizing granulomatous vasculitis invol-ving the nose, paranasal sinuses, lungs, and kidneys. Ocular involvement can occur in about 50% of cases. There are very few reports of WG with orbital inflammation and exorbitism. We report a case of a female patient who presented with exorbitism related to orbital inflammation secondary to WG, with renal involvement. A 29-year-old woman with a previous history of recurrent pan-sinusitis presented with bilateral exophthalmos and renal failure with rapidly progressive glo-merulonephritis. Computed tomography showed extensive bilateral soft tissue in the retro-orbital area. Immunologic tests showed the presence of type-C anti-neutrophil cytoplasmic antibodies and renal biopsy revealed pauci immune crescentic glomerulonephritis. The patient was treated with corticosteroids and pulses of cyclophosphamide followed by azathioprine and trimethoprim-sulfamethoxazole. After a follow-up of 10 months, the renal outcome was favorable with improvement of renal function but there was persistence of exorbitism and loss of visual function. Our case suggests that WG should be considered in the differential diagnosis of persistent bila-teral exophthalmos. Prompt recognition of this early manifestation is important for the institution of early treatment.


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    V. G. Likhvantseva


    Full Text Available We searched for a possible target tissue in eye orbit for thyroid autoantibodies in endocrine ophthalmopathy (Graves’ disease, using correlation analysis method. We examined a group of 139 patients (278 eye orbits with thyroid-associated ophthalmopathy associated with diffuse toxic goiter. Serological parameters (antibodies to thyroid-stimulating hormone receptor; thyroglobulin, thyroid peroxidase were compared with instrumental diagnostic data (multi-layer CT, ultrasonography of eye orbit, and exophthalmometer, as well as clinical symptoms. Statistical correlation analysis enabled us to show different degrees of association between thyroid antibodies and clinical manifestations of Graves’ disease and eye orbit involvement. Especially, carriers of antibodies to TSH receptor and thyroglobulin (as compared to seronegative patients exhibited higher exophthalmos scores (19.16±0.26 mm, p < 0.001, and 19.41±0.40 mm, p < 0.05, respectively, and with total muscle index (2.42±0.05, p < 0.01, and 2.42±0.08, respectively. Meanwhile, eyelids in carriers of antibodies to TSH receptor and thyroid peroxidase proved to be more swollen (p < 0.001, p < 0.05, respectively. Carriage of antibodies to thyroglobulin was associated with synchronous involvement of two structures of the eye orbit: extraocular muscles and retrobulbar tissue, which is reflected by increase in the average ntegral exophthalmos index within the group.

  3. Arteriovenous Malformation in Temporal Lobe Presenting as Contralateral Ocular Symptoms Mimicking Carotid-Cavernous Fistula

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    Fadzillah Mohd-Tahir


    Full Text Available Aim. To report a rare case of arteriovenous malformation in temporal lobe presenting as contralateral orbital symptoms mimicking carotid-cavernous fistula. Method. Interventional case report. Results. A 31-year-old Malay gentleman presented with 2-month history of painful progressive exophthalmos of his left eye associated with recurrent headache, diplopia, and reduced vision. Ocular examination revealed congestive nonpulsating 7 mm exophthalmos of the left eye with no restriction of movements in all direction. There was diplopia in left lateral gaze. Left IOP was elevated at 29 mmHg. Left eye retinal vessels were slightly dilated and tortuous. CT scan was performed and showed right temporal arteriovenous malformation with a nidus of 3.8 cm × 2.5 cm with right middle cerebral artery as feeding artery. There was dilated left superior ophthalmic vein of 0.9 mm in diameter with enlarged left cavernous sinus. MRA and carotid angiogram confirmed right temporal arteriovenous malformation with no carotid-cavernous fistula. Most of the intracranial drainage was via left cavernous sinus. His signs and symptoms dramatically improved following successful embolisation, completely resolved after one year. Conclusion. Intracranial arteriovenous malformation is rarely presented with primary ocular presentation. Early intervention would salvage the eyes and prevent patients from more disaster morbidity or fatality commonly due to intracranial haemorrhage.

  4. Pregnancy presenting as hyperthyroidism with negative urine pregnancy test. (United States)

    Jindal, Rita; Deepak, Desh; Ghosh, Gopal Chandra; Gupta, Mamta


    A 22-year-old lactating mother presented with symptoms of uneasiness, palpitation, tachycardia and exophthalmos. She had an abdominal lump suggestive of 26 weeks uterine size but her urine pregnancy test was negative. Her thyroid profile was suggestive of hyperthyroidism. Gynaecological and ultrasonographic findings revealed a hydatidiform mole. She had a low β-human chorionic gonadotropin level that surprisingly increased after suction and evacuation. The paradoxical findings that appeared as erroneous laboratory results could be explained by the 'high-dose hook effect' after a review of literature. One week after the evacuation, the patient's thyroid profile and symptoms resolved completely without any treatment for hyperthyroidism. 2014 BMJ Publishing Group Ltd.

  5. Cephalic Tetanus from Penetrating Orbital Wound

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    Eloïse Guyennet


    Full Text Available Tetanus is a neurologic disorder caused by tetanospasmin, a protein toxin elaborated by Clostridium tetani. Cephalic tetanus is a localized form of the disease causing trismus and dysfunction of cranial nerves. We report the case of a man who presented with facial trauma, complete ophthalmoplegia, exophthalmos, areactive mydriasis, and periorbital hematoma. An orbital CT revealed air bubbles in the right orbital apex. The patient was given a tetanus toxoid booster and antibiotherapy. After extraction of a wooden foreign body, the patient developed right facial nerve palsy, disorders of swallowing, contralateral III cranial nerve palsy, and trismus. Only one case of cephalic tetanus from penetrating orbital wound has been reported in literature 20 years ago. When a patient presents with an orbital wound with ophthalmoplegia and signs of anaerobic infection, cephalic tetanus should be ruled out.

  6. Orbital actinomycotic mycetoma caused by

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    Stuart Walton


    Full Text Available Case summary An 18-month-old male neutered Ragdoll cat presented with an 8 week history of progressive unilateral right-sided mucopurulent nasal discharge and exophthalmos. Magnetic resonance imaging revealed a heterogeneous right retrobulbar mass and bilateral nasal cavity disease. Filamentous structures seen on cytology of retrobulbar and nasal biopsies were mistakenly identified as filamentous fungal hyphae. Subsequent investigations revealed that the cat had a retrobulbar actinomycotic mycetoma with invasion of the globe. The aetiological agent was identified on 16S recombinant DNA sequencing as Streptomyces cinnamoneus . After exenteration and chronic antimicrobial therapy the cat was alive and well 3 years after presentation. Relevance and novel information This is the first report of a pathogenic role of S cinnamoneus in a cat. Orbital actinomycotic mycetomas in cats can resemble mycotic granulomas.

  7. Spontaneous Direct Carotid-Cavernous Fistula in an Elderly Patient

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    Sirakov Stanimir S.


    Full Text Available We describe the case of an 83-year-old woman with left-sided ophthalmoplegia. She had no family history of connective tissue disease. The computed tomography study found a dilated left cavernous sinus. The conventional cerebral panangiography confirmed the diagnosis - a direct carotid-cavernous fistula (CCF, with no evidence of ruptured aneurysm. The woman underwent endovascular treatment with coiling of the cavernous sinus in combination with application of the Onyx embolic agent in the fistula. During the first 48 hours after the embolization the local pain, exophthalmos and conjunctival injection of the left eye were significantly ameliorated. The pulsatile tinnitus on the left disappeared and the ptosis of the left eyelid partially recovered. Selective angiography is the best method for the diagnosis and classification of CCF. Currently, treatment is possible with low mortality and morbidity rates. The endovascular intervention is able to completely occlude the fistula and maintain adequate blood fl ow through the carotid artery.

  8. Epileptic Seizures Induced by a Spontaneous Carotid Cavernous Fistula

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    Güner Koyuncu Çelik


    Full Text Available A 79-year-old woman was admitted to our emergency department with complaints of fainting and loss of consciousness three times during the past month. She was diagnosed with epilepsy and started to be treated with antiepileptic drug. Physical examination showed, in the left eye, chemosis, limited eye movements in all directions, and minimal exophthalmos as unexisting symptoms on admission developed on the sixth day. Orbital magnetic resonance imaging (MRI and digital subtraction angiography (DSA imaging revealed a carotid cavernous fistula (CCF. Epileptic attacks and ophthalmic findings previously present but diagnosed during our examinations were determined to ameliorate completely after performing the coil embolization. Based on literature, we present the first case with nontraumatic CCF manifesting with epileptic seizures and intermittent eye symptoms in the present report.

  9. Respiratory Syncytial Virus Infection as a Precipitant of Thyroid Storm in a Previously Undiagnosed Case of Graves' Disease in a Prepubertal Girl

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    Charlton RWilliam


    Full Text Available Graves' disease is less common in prepubertal than pubertal children, and initial presentation with thyroid storm is rare. We report an 11-year-old prepubertal Hispanic girl who presented with a one-day history of respiratory distress, fever, and dysphagia. She had exophthalmos, a diffuse bilateral goiter and was agitated, tachycardic, and hypertensive. Nasal swab was positive for respiratory syncytial virus (RSV. She was diagnosed with thyroid storm and admitted to the pediatric intensive care unit. While infection is a known precipitant of thyroid storm and RSV is a common pediatric infection, to the best of our knowledge, this is the first reported case of RSV infection apparently precipitating thyroid storm in a prepubertal child.

  10. Thiamine deficiency in dogs due to the feeding of sulphite preserved meat. (United States)

    Singh, M; Thompson, M; Sullivan, N; Child, G


    A 6-year-old dog, a 4-year-old dog and three 7-week-old puppies were diagnosed with thiamine deficiency caused by feeding sulphite treated meat. The 6-year-old dog presented with a history of inappetence, weight loss and vomiting that rapidly progressed to signs of multifocal intracranial disease including mental dullness, paresis, seizures, spontaneous nystagmus and strabismus. Thiamine pyrophosphate effect was elevated at 58% and magnetic resonance imaging revealed bilaterally symmetrical hyperintensity of the caudate nucleus and rostral colliculi. The dog recovered with thiamine supplementation. The 4-year-old dog and three 7-week-old puppies also presented with rapidly progressive multifocal central nervous system signs including ataxia, paresis, increased muscle tone, seizures, nystagmus and exophthalmos. The 4-year-old dog made a rapid recovery with thiamine supplementation. Euthanasia and necropsy of a puppy revealed malacia of multiple brainstem nuclei and oedema of the cerebral cortex. These findings were consistent with thiamine deficiency.

  11. Unilateral Blepharoptosis From Renal Cell Carcinoma

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    Federico Greco


    Full Text Available Blepharoptosis is the drooping or inferior displacement of the upper eyelid. Blepharoptosis can be either congenital or acquired. Tumour metastasis is one of the acquired causes of blepharoptosis. The lungs, locoregional lymph nodes, bone and liver are the usual sites of metastases of renal cell carcinoma (RCC; however, unusual locations of RCC have also been reported. Herein, we describe a case of a 47-year-old man with unilateral ptosis and blurred vision due to metastatic RCC. We describe the different causes of blepharopstosis, the path that led to the diagnosis, and how RCC can metastasize to unusual anatomical regions such as the orbit. Symptoms such as exophthalmos, lid edema, diplopia, ptosis, cranial nerve paralysis or blurred vision may mime a benign disease; however, they could also be the symptoms of a systemic malignancy.

  12. Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report

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    Yueh-Hua Chung


    Full Text Available Development of hyperthyroidism following primary hypothyroidism is uncommon, and only a few documented cases have been reported. Alterations in thyroid-stimulating hormone receptor antibodies in serum are currently considered to play the main role in the pathophysiology, but the exact mechanism is still unknown. Here, we report the case of a 60-year-old man with disturbed consciousness due to hyponatremia. Thyroid function tests showed primary hypothyroidism with a high anti-microsomal antibody titer (1:6,400. The patient experienced weight loss and exophthalmos 6 years later. Serum thyroid hormone levels were increased and thyroxine treatment was discontinued, but the patient remained thyrotoxic 2 months later. 131I thyroid uptake was 40.9% at 24 hours, and bilateral thyroid lobes were not enlarged with diffuse radioactivity. Six months later, the patient was still thyrotoxic and therapy with methimazole 10 mg/day was started. He is now taking methimazole and is euthyroid.

  13. [An ophthalmological complication of cherubism]. (United States)

    Elfahsi, A; Oujilal, A; Lahlou, M; Lazrak, A; Kzadri, M


    Cherubism is a rare familial fibro-osseous lesion usually observed in children. The diagnosis is clinical and radiological. Outcome is generally favorable, but with a risk of ophthalmologic complications, especially lower eyelid retraction, proptosis, diplopia, displacement of eyeball and loss of visual acuity. Clinicians must be aware of these complications for proper detection and specific treatment. We report a case of cherubism observed in a 10-year-old boy who presented exophthalmia with reduced visual acuity on the right due to reduction of the volume of the orbital cavity and compression of the optic nerve. Partial maxillectomy was required for decompression. Cherubism can lead to various types of ophthalmologic complications. Exophthalmos and loss of visual acuity due to compression of the optic nerve are the most common. Surgery is generally not required, but can become crucial in selected patients.

  14. Modified lateral orbital wall decompression in Graves' orbitopathy using computer-assisted planning. (United States)

    Spalthoff, S; Jehn, P; Zimmerer, R; Rana, M; Gellrich, N-C; Dittmann, J


    Graves' orbitopathy, a condition seen in the autoimmune syndrome Graves' disease, affects the fatty tissue and muscles inside the orbit. Graves' orbitopathy is associated with increasing exophthalmos and sometimes leads to compressive dysthyroid optic neuropathy, resulting in progressive vision loss. Dysthyroid compressive optic neuropathy, functional problems, and cosmetic problems are the main indications for surgical decompression of the orbit, especially if conservative treatment has not led to a reduction in symptoms. Many surgical techniques are described in the literature. This article presents a modification of the lateral orbital wall osteotomy, involving the rotation and reduction of the osteotomized bone segment using preoperative planning, intraoperative computed navigation, and piezoelectric surgery. This new method combines the advantages of different techniques and appears to be a valid approach to the treatment of severe cases of Graves' orbitopathy. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Feasibility of tomotherapy for Graves' ophthalmopathy. Dosimetry comparison with conventional radiotherapy

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    Nguyen, Nam P.; Krafft, Shane P. [Arizona Univ., Tucson, AZ (United States). Dept. of Radiation Oncology; Vos, Paul [East Carolina Univ., Greenville, NC (US). Dept. of Biostatistics] (and others)


    To compare the dosimetry of tomotherapy and the conventional half-beam technique (HBT) or non-split beam technique (NSBT) for target coverage and radiation dose to the lacrimal glands and lens. A retrospective review of 7 patients with Graves' ophthalmopathy who had radiotherapy because of disease progression on high steroid dose is reported: 3 patients were treated with tomotherapy and 4 patients with HBT. Compared to HBT, tomotherapy may provide better target coverage and significant reduction of radiation dose to the lacrimal glands and a higher dose to the lens. The NSBT improved target coverage but resulted in significantly higher doses to the lens and lacrimal glands. Tomotherapy may provide better coverage of the target volume and may be more effective in reducing severe exophthalmos compared to the conventional radiotherapy technique. (orig.)

  16. Progression of unilateral moyamoya disease resulted in spontaneous occlusion of ipsilateral cavernous dural arteriovenous fistula: Case report. (United States)

    Liu, Peng; Xu, Ya; Lv, Xianli; Ge, Huijian; Lv, Ming; Li, Youxiang


    The pathogenic association between cavernous dural arteriovenous fistula (CDAVF) and moyamoya disease remains unclear. This unusual case is the first report of a progression of unilateral moyamoya disease resulting in the spontaneous occlusion of ipsilateral CDAVF. A 52-year-old woman presented with two-week spontaneous exophthalmos, chemosis and tinnitus, and cerebral angiography showed a right CDAVF coexisting with ipsilateral moyamoya disease. Transvenous approaches through the inferior petrosal sinus and facial vein were attempted but failed. However, a progression of the moyamoya disease and disappearance of the CDAVF were observed on one month follow-up angiogram in accordance with the resolution of clinical symptoms. This extremely rare coincidental presentation may have deeper pathogenic implications. This case report may give a clue to the underlying mechanism of the progression of moyamoya disease and occlusion of the CDAVF. © The Author(s) 2016.

  17. Membranoproliferative glomerulonephritis in a calf with nephrotic syndrome. (United States)

    Trang, N T; Hirai, T; Nabeta, R; Fuke, N; Yamaguchi, R


    A 2-month-old Japanese black calf was presented with a history of weight loss, exophthalmos and subcutaneous oedema of the brisket. Urinalysis and serum biochemistry showed proteinuria and hypoproteinaemia suggestive of nephrotic syndrome. Microscopically, lesions in the kidney were characterized by proliferation of mesangial cells and diffuse thickening of the glomerular basement membranes with the appearance of double contours. Immune complex deposits were confirmed by electron microscopy and immunofluorescence using reagents specific for bovine immunoglobulin G, complement factor C3 and bovine viral diarrhoea virus (BVDV). Consequently, the glomerular lesion in this case was diagnosed as membranoproliferative glomerulonephritis. BVDV type 1 was detected in serum by nested reverse transcriptase polymerase chain reaction. Viral antigen was also identified in the glomeruli by immunofluorescence. These results suggest that BVDV may have been the cause of immune complex glomerulonephritis in this calf. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Hypertrophic pachymeningitis: Current criteria for diagnosis and differentiation (Clinical case and review of literature

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    E. G. Mendelevich


    Full Text Available The paper describes a 44-year-old male patient with an about 6-year history of hypertrophic pachymeningitis. The major clinical symptoms were characterized by headache, exophthalmos, and blindness in one eye. The data for differential diagnosis of the disease are given. The current literature on the clinical manifestations of hypertrophic pachymeningitis, its differential diagnosis, and the results of magnetic resonance imaging (MRI is reviewed. Diagnostic difficulties at the stage of a clinical observation are due to the nonspecificity of neurological manifestations and the need for a comprehensive examination to detect a somatic disease. MRI can diagnose the disease-specific phenomenon of damage to the meninges, which calls for further careful differentiation. Clinicians must be familiar with alternative differential diagnosis, as a rapid specific therapeutic approach will help avoid long-term or irreversible neurological complications.

  19. Zygomatic sialolithiasis diagnosed with computed tomography in a dog. (United States)

    Lee, Namsoon; Choi, Mihyun; Keh, Seoyeon; Kim, Taehyun; Kim, Hyunwook; Yoon, Junghee


    A 10-year-old castrated Shih-Tzu male dog was referred for examination of acute right exophthalmos, protrusion of the third eyelid and soft tissue swelling ventral to the globe. Ultrasonography revealed echogenic fluid around the right globe. Computed tomography (CT) showed an enlarged right zygomatic salivary gland compared with the left zygomatic gland and an amorphous cystic mass ventral to the right globe. Hyperdense material, which we suspected to be a sialolith, was identified in the right zygomatic gland. The zygomatic gland and the cystic lesion were removed, and a zygomatic sialocele with sialolith and ductal obstruction were found by histopathological examination. CT was a useful diagnostic tool for zygomatic sialolithiasis.

  20. Clinical efficacy of orbital decompression in patients with Graves ophthalmopathy

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    Shao-Zhu Hu


    Full Text Available AIM: To evaluate the efficacy and safety of orbital decompression in the treatment of Graves ophthalmopathy.METHODS: Totally 55 patients 77 eyes with Graves eye disease were selected in our hospital from February 2011 to February 2016. All eyes underwent orbital decompression, the visual acuity, exophthalmos and complications of the patients were followed up for 6mo. RESULTS:Postoperatively 6mo, the best corrected visual acuity were 0.23±0.09, which were better than that of preoperative 0.46±0.07(PPPCONCLUSION:Orbital decompression is an effective method for the treatment of Graves ophthalmopathy, but attention should be paid to postoperative complications such as diplopia.

  1. Effect of pre-shaped titanium mesh implantation on the prognosis of patients with orbital fractures

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    Gui-Fen Li


    Full Text Available AIM: To study the effectiveness and safety of 3D printing pre-shaped titanium mesh in the repair of orbital fracture compared with the conventional titanium mesh. METHODS: The clinical data of 72 eyes of 72 patients who received surgery for orbital fracture from June 2015 to March 2016 in our department were retrospectively analyzed.All patients were divided into two groups, including pre-shaped titanium mesh implantation group(observation group, 40 cases, conventional titanium mesh implantation group(control group, 32 cases. The control group was treated by physicians according to the experience of manual bending and shaping titanium mesh implantation ipsilateral orbital pad,when the observation group by the physicians directly in the pre-shaped titanium mesh of 3D printing. The eyeball exophthalmos, eye movement and diplopia were evaluated in the next 1, 3 and 6mo after the operation, and we compared the differences between the two methods at different time points and the differences of the indexes between the two materials at the same time point. RESULTS: The cure rate of the observation group and the control group about eyeball exophthalmos values was 84% and 59%, the difference of the two groups was statistically significant(PP>0.05. The cure rate of limited ocular movement of observation group was 73%, that of control group was 66%, there was no statistical significance(P>0.05. During the follow-up period, there was no infection in the two groups, no titanium mesh shift, extrusion, deformation and rejection or other complications. CONCLUSION: Pre-shaped titanium mesh shaping orbital implantation with no need for shaping the mesh in the operation, can shorten the operation time, make accurate reconstruction of orbital wall, reduce complications and improve the curative effect.

  2. A peculiar blow-out fracture of the inferior orbital wall complicated by extensive subcutaneous emphysema: A case report and review of the literature. (United States)

    Rzymska-Grala, Iwona; Palczewski, Piotr; Błaż, Marcin; Zmorzyński, Michał; Gołębiowski, Marek; Wanyura, Hubert


    Blow-out fracture of the orbit is a common injury. However, not many cases are associated with massive subcutaneous emphysema. Even fewer cases are caused by minor trauma or are associated with barotrauma to the orbit due to sneezing, coughing, or vomiting. The authors present a case of blow-out fracture complicated by extensive subcutaneous and mediastinal emphysema that occurred without any obvious traumatic event. A 43-year-old man presented to the Emergency Department with a painful right-sided exophthalmos that he had noticed in the morning immediately after waking up. The patient also complained of diplopia. Physical examination revealed exophthalmos and crepitations suggestive of subcutaneous emphysema. The eye movements, especially upward gaze, were impaired. CT showed blow-out fracture of the inferior orbital wall with a herniation of the orbital soft tissues into the maxillary sinus. There was an extensive subcutaneous emphysema in the head and neck going down to the mediastinum. The patient did not remember any significant trauma to the head that could explain the above mentioned findings. At surgery, an inferior orbital wall fracture with a bony defect of 3×2 centimeter was found and repaired. Blow-out fractures of the orbit are usually a result of a direct trauma caused by an object with a diameter exceeding the bony margins of the orbit. In 50% of cases, they are complicated by orbital emphysema and in 4% of cases by herniation of orbital soft tissues into paranasal sinuses. The occurrence of orbital emphysema without trauma is unusual. In some cases it seems to be related to barotrauma due to a rapid increase in pressure in the upper airways during sneezing, coughing, or vomiting, which very rarely leads to orbital wall fracture. Computed tomography is the most accurate method in detecting and assessing the extent of orbital wall fractures.

  3. Orbital decompression surgery and horse chestnut seed extract improved superior orbital vein blood flow in patients with thyroid-associated ophthalmopathy

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    Yu-Jie Wu


    Full Text Available AIM: To evaluate the efficacy and safety of orbital decomposition (OD surgery in combination with horse chestnut seed extract (HCSE, as compared to OD alone, in patients with thyroid-associated ophthalmopathy (TAO. METHODS: Sixty-two orbits from 62 TAO patients were randomly assigned to OD or OD+HCSE at 1:1 ratio (31 received OD alone, 31 received OD+HCSE. Forty-two orbits from 21 healthy subjects were used as controls. Complete ophthalmic examination and color Doppler flow imaging (CDFI were performed before surgery and 3mo post-surgery on all 62 orbits from the TAO patients. CDFI were also performed on the 42 control orbits. The effect of OD+HCSE and OD alone on TAO orbits was compared on several endpoints, including superior ophthalmic vein blood flow (SOVBF parameters, subjective assessment, soft tissue involvement, lid retraction, diplopia, eye movement restriction, degree of exophthalmos, and intraocular pressure. The control orbits were used as reference for the SOVBF parameters. RESULTS: OD surgery with or without HCSE improved SOVBF, symptoms and soft tissue involvement, decreased degree of exophthalmos and intraocular pressure in orbits of TAO patients. The OD+HCSE combination led to significantly better improvement of SOVBF than OD alone. The differences between the reductions of SOVBF in the two groups are 1.26 cm/s in max-volecity and 0.52 cm/s in min-volecity (P<0.0001. CONCLUSION: SOVBF is significantly reduced in the orbits affected with TAO, indicating that congestion may be an important factor contributing to TAO pathogenesis. OD surgery improves the SOVBF, and combination of HCSE medication and OD surgery further improved venous return than OD surgery alone.

  4. Explore the Possibility of Early Clinical Diagnosis of Endocrine Ophthalmopathy Based on Eye Symptoms of Hyperthyroidism

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    V. G. Likhvantseva


    Full Text Available Purpose: to study the possibility of early clinical diagnosis of endocrine ophthalmopathy based on ocular symptoms of hyperthyroidism. Patients and methods: we analyzed the prevalence of ocular symptoms of hyperthyroidism in 139 patients (278 orbits with newly diagnosed endocrine ophthalmopathy (group 1, developed on the background of diffuse toxic goiter. The comparison group consisted of 80 patients (160 orbits with newly diagnosed diffuse toxic goiter with no radiographic evidence of endocrine ophthalmopathy (group 2. All patients were examined by an ophthalmologist and endocrinologist. We analyzed the prevalence of ocular symptoms of hyperthyroidism (symptom Dalrymple’, Mobius’, Zenger’, and combinations thereof, often encountered in diffuse toxic goiter, flowing with endocrine ophthalmopathy, and/or lack thereof - in the group of “thyrotoxic exophthalmos”. We took into account the frequency distribution of these clinical signs, and their combinations. We analyzed the clinical sensitivity and specificity of diagnosis based on the three most common symptoms, and their combinations, associated both with thyrotoxicosis and with endocrine ophthalmopathy. Results: Dalrymple’ symptom, is more common in thyrotoxic exophthalmos than with endocrine ophthalmopathy (compared to 100.0% versus 61.9 %, p<0,001. This suggests that Dalrymple’ symptom leads to over diagnosis aspect endocrine ophthalmopathy. It is obvious that it can be used to recognize and thyrotoxic exophthalmos hyperthyroidism, but you cann’t credibly claim based on orbit about the presence of the disease. In this aspect, the greatest practical interest to provide a comparative assessment of the frequency of detection of symptoms of Mobius’ and Zenger’ and their combinations in a population of endocrine ophthalmopathy and in the group of thyrotoxic exophthalmos. Significantly more symptoms Zenger’ and Mobius’ developed with endocrine ophthalmopathy (66,2% and 81

  5. Clinical Observation on Hyperthyroidism

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    Lee, Kyu Bo; Kang, Bann; Song, Suk Ho; Park, Hi Myung; Whnag, Kee Suk [Kyungpook National University School of Medicine, Deagu (Korea, Republic of)


    A clinical analysis was made on 161 cases of hyperthyroidism seen at the Radioisotope Laboratory of Kyungpook National University Hospital. This series consisted of 144 cases of diffuse goiter and 17 cases of nodular goiter. 1) Hyperthyroidism was most prevalent in the 4th decade and male to female ratio was 1 : 4.6. 2) Cardinal symptoms in the order of frequency were weakness, easy fatigability, palpitation, weight loss, nervousness, perspiration, heat intolerance, increased appetite, insomnia and dysmenorrhoea. 3) Major physical findings in the order of frequency were goiter, fine tremor, tachycardia, wide pulse pressure, emaciation, warm moist skin, exophthalmos, systolic hypertension and atrial fibrillation. 4) The complications were ophthalmopathy (34.2%), thyrotoxic heart disease (5.6%), thyroid crisis (1 case), pretibial myxedema (1 case) and thyrotoxic myopathy (1 case). 5) Mean values of the six hour and twenty-four hour {sup 131}I uptakes by the thyroid glands were 67.5% and 71.6%, respectively, in diffuse goiter and 64.5% and 65.0%, respectively, in nodular goiter. 6) Mean values of twenty-four PB{sup 131}I conversion ratio were 76.3% in diffuse goiter and 70.2% in nodular goiter and those of the basal metabolic rate was +51% in the former and +41% in the latter. Mean serum cholesterol level was 152 mg% in diffuse goiter and that in nodular goiter was 175 mg%. 7) Among the 134 cases treated with {sup 131}I, 66 cases (49.3%) were successfully controlled with single dose and in the majority of the cases the initial therapeutic dose required was 4.1-4.0 mC in diffuse goiter and 5.1-6.0 mC in nodular goiter. 8) With {sup 131}I treatment the symptoms improved in the following order: heat intolerance, emaciation, nervousness, insomnia, easy fatigability, weakness, fine tremor, goiter, perspiration, exertional dyspnea and palpitation. And in a few cases improvement of even exophthalmos was seen. 9) Following {sup 131}I treatment myxedema occurred in 4 cases (3

  6. Prevalence, risk factors, and clinical features of thyroid-associated ophthalmopathy in multiethnic Malaysian patients with Graves' disease. (United States)

    Lim, Shueh Lin; Lim, Andrew Keat Eu; Mumtaz, Malik; Hussein, Elias; Wan Bebakar, Wan Mohamad; Khir, Amir S


    The prevalence of thyroid-associated ophthalmopathy (TAO) has been reported to be lower in several Asian populations than in Caucasians. The risk factors for TAO that have been demonstrated in Caucasians have not been studied in Asian populations. The aim of this study, therefore, was to determine the prevalence, risk factors, and clinical features of TAO in a cohort of multiethnic Malaysian patients with Graves' disease (GD). This was a cross-sectional study of 167 consecutive patients with GD who attended two endocrine clinics from October 2003 to September 2004. The patients were classified as Malay, Chinese, and Indian based on their ethnic characteristics as detailed in the national identity card. The patients were examined by a single individual for the presence and characteristics of TAO. Thyroid function tests were performed, and smoking history and the extent of smoking history were recorded. The prevalence rate of TAO using the American Academy of Ophthalmology diagnostic criteria was 34.7%. This increased to 46.7% if lower lid retraction was added as an alternate criterion. The observed prevalence rate was higher than expected in the Chinese patient population based on a comparison with the Malay and Indian patients, but this was not statistically significant. Smokers with GD were at 2.75 times greater risk of TAO than nonsmokers (p = 0.019). Male gender was shown to confer higher risk of TAO on univariate analysis (p = 0.003), but not on multivariate analysis. The percentage of males who smoked in the study group was relatively high (79%). The most common presentation of TAO was exophthalmos, followed by lid retraction. TAO has relatively high prevalence rate (34.7%) in three populations of Asian patients with GD. This is similar to that reported for Caucasian patients with GD. As in Caucasian patients, smoking increases the risk of TAO. In the Asian populations we studied, exophthalmos was the most common eye sign. However, lower lid retraction was

  7. The Role of the Immune Response in the Pathogenesis of Thyroid Eye Disease: A Reassessment.

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    James T Rosenbaum

    Full Text Available Although thyroid eye disease is a common complication of Graves' disease, the pathogenesis of the orbital disease is poorly understood. Most authorities implicate the immune response as an important causal factor. We sought to clarify pathogenesis by using gene expression microarray.An international consortium of ocular pathologists and orbital surgeons contributed formalin fixed orbital biopsies. RNA was extracted from orbital tissue from 20 healthy controls, 25 patients with thyroid eye disease (TED, 25 patients with nonspecific orbital inflammation (NSOI, 7 patients with sarcoidosis and 6 patients with granulomatosis with polyangiitis (GPA. Tissue was divided into a discovery set and a validation set. Gene expression was quantified using Affymetrix U133 Plus 2.0 microarrays which include 54,000 probe sets.Principal component analysis showed that gene expression from tissue from patients with TED more closely resembled gene expression from healthy control tissue in comparison to gene expression characteristic of sarcoidosis, NSOI, or granulomatosis with polyangiitis. Unsupervised cluster dendrograms further indicated the similarity between TED and healthy controls. Heat maps based on gene expression for cytokines, chemokines, or their receptors showed that these inflammatory markers were associated with NSOI, sarcoidosis, or GPA much more frequently than with TED.This is the first study to compare gene expression in TED to gene expression associated with other causes of exophthalmos. The juxtaposition shows that inflammatory markers are far less characteristic of TED relative to other orbital inflammatory diseases.

  8. New disease records for hatchery-reared sturgeon. II. Phaeohyphomycosis due to Veronaea botryosa. (United States)

    Steckler, Natalie K; Yanong, Roy P E; Pouder, Deborah B; Nyaoke, Akinyi; Sutton, Deanna A; Lindner, Jonathan R; Wickes, Brian L; Frasca, Salvatore; Wolf, Jeffrey C; Waltzek, Thomas B


    A series of fungal cases in hatchery-reared juvenile and young adult Siberian sturgeon Acipenser baerii and white sturgeon A. transmontanus occurred at production facilities in Florida and California, USA, respectively. Affected fish exhibited abnormal orientation and/or buoyancy, emaciation, coelomic distension, exophthalmos, cutaneous erythema, and ulcerative skin and eye lesions. Necropsies revealed haemorrhage throughout the coelom, serosanguinous coelomic effusion and organomegaly with nodular or cystic lesions in multiple organs. Fungal hyphae were observed in 27 fish (24 A. baerii and 3 A. transmontanus) via microscopic examination of tissue wet mounts and on slides prepared from colonies grown on culture media. Histopathological examination of these infected tissues revealed extensive infiltration by melanised fungal hyphae that were recovered in culture. Phenotypic characteristics and sequencing of the fungal isolates with the use of the internal transcribed spacer region and 28S rRNA gene confirmed the aetiological agent as Veronaea botryosa. To our knowledge, this is the first documentation of V. botryosa infection in fish, although melanised fungi of the closely related genus Exophiala are well-known pathogens of freshwater and marine fishes.

  9. Histiocytic Sarcoma and Bilateral Facial Vein Thrombosis in a Siberian Hamster (Phodopus sungorus). (United States)

    Coble, Dondrae J; Shoemaker, Margaret; Harrington, Bonnie; Dardenne, Adrienne D; Bolon, Brad


    A 21-mo-old, male Siberian hamster (Phodopus sungorus) presented with left-sided facial swelling, proptosis of the left eye, and blepharospasm of the right eye. The hamster had been used only for breeding. Because of the poor prognosis, the hamster was euthanized without additional diagnostic assays or treatments. Routine gross pathologic evaluation demonstrated exophthalmos and presumptive hyphema of the left eye, bilateral facial edema, freely movable nodules within the mesentery, white foci within the liver, and a large mass effacing the cranial pole of the right kidney. On histologic evaluation, the mesenteric nodules and liver foci expressed histiocytic marker CD163 and thus were diagnosed as sites of histiocytic sarcoma, whereas the kidney mass was a well-differentiated renal cell carcinoma. The facial swelling resulted from bilateral, chronic, severe, branching thrombi in many facial veins. Additional age-related histopathologic findings were observed in other organs, including diffuse glomerulopathy, nesidioblastosis (pancreatic islet neoformation), and multiple foci of severe cartilage degeneration in the axial skeleton. To our knowledge, this report provides the first description of histiocytic sarcoma in a Siberian hamster.

  10. Peculiar Distribution of Tumorous Xanthomas in an Adult Case of Erdheim-Chester Disease Complicated by Atopic Dermatitis

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    Yukako Murakami


    Full Text Available Erdheim-Chester disease is a rare non-Langerhans form of histiocytosis with multiple organ involvement. Approximately 20% of patients have xanthoma-like lesions, usually on the eyelids. We report a case of Erdheim-Chester disease in a 32-year-old male who showed peculiar xanthomatous skin lesions and also had atopic dermatitis. His skin manifestations included ring-like yellowish tumors on his periorbital regions, rope necklace-like tumors on his neck, and spindle-shaped tumors on his right preauricular region and cubital fossas. He also had exophthalmos and diabetes insipidus. Chronic eczematous lesions were present on the flexor aspect of his extremities, and his serum eosinophil numbers and immunoglobulin E levels were elevated. A histological examination of his right neck tumor showed foamy macrophages and touton-type giant cells, which were positive for CD68 and CD163 and negative for S-100 and CD1a. We suggest that the complication of atopic dermatitis may have contributed to the uncommon clinical features in this case.

  11. Erdheim Chester disease–An unusual presentation of a rare histiocytic disease in a 3-year old boy

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    Muhammad Rahil Khan


    Full Text Available Erdheim Chester disease (ECD is a rare, multisystem non-Langerhans histiocytosis seen in adults characterized by a clinical triad of bone pains, bilateral painless exophthalmos and diabetes insipidus. Only 10 pediatric ECD cases are reported. We report here the youngest child in the literature, diagnosed at three years of age. He presented with osteolytic lesions in the skull, diabetes insipidus and bilateral proptosis. He was initially misdiagnosed and treated as Langerhan cell histiocytosis(LCH. In ECD, the typical radiological findings are symmetrical osteosclerosis of long bones. Osteolytic lesions are rare and if present are usually seen in the limbs. This is the first pediatric case with osteolytic lesions solely in the skull. A repeat biopsy confirmed ECD with the presence of foamy histiocytes in fibrous background positive for CD68 andCD163 and negative for CD1a and S100, typical histopathological features of ECD. The BRAFgene mutation was also detected. The patient responded well to interferon alpha therapy, which is now considered the first line treatment in ECD.

  12. Ocular surface inflammation, and nerve growth factor level in tears in active thyroid-associated ophthalmopathy. (United States)

    Yoon, Jin Sook; Choi, Soo Hyun; Lee, Joon H; Lee, Sung Jun; Lee, Sang Yeul


    To measure tear nerve growth factor (NGF) concentrations in cases of active thyroid-associated ophthalmopathy (TAO) before and after glucocorticoid treatment, and to correlate NGF levels with disease inflammatory activity and thyroid autoantibody concentration. The study involved 20 patients with active TAO and 20 age- and gender-matched controls. Tear break-up time (BUT) was obtained, the Schirmer test was performed, and tear NGF/total protein ratio was measured in control subjects and patients with active TAO before, and 2 and 4 weeks after, steroid treatment. Tear BUT and Schirmer values significantly increased after 2 and 4 weeks of steroid treatment (p tear NGF/total protein ratio was higher in patients with active TAO than in control subjects, and the ratio significantly decreased after 2 and 4 weeks of steroid treatment (p Tear NGF/total protein ratio did not correlate with inflammatory activity score, exophthalmos value and thyroid binding inhibiting immunoglobulin (TBII) level (p > 0.05). Tear NGF may have a specific role in ocular surface inflammation, which protects against ocular surface damage in patients with active TAO. Anti-inflammatory treatment significantly reduced the level of NGF in tears, increased tear film stability and production, and decreased congestive symptoms.

  13. Endovascular Management of Vascular Injury during Transsphenoidal Surgery. (United States)

    Cinar, C; Bozkaya, H; Parildar, M; Oran, I


    Vascular injury is an unusual and serious complication of transsphenoidal surgery. We aimed to define the role of angiography and endovascular treatment in patients with vascular injuries occurring during transsphenoidal surgery. During the last ten-year period, we retrospectively evaluated nine patients with vascular injury after transsphenoidal surgery. Eight patients were symptomatic due to vascular injury, while one had only suspicion of vascular injury during surgery. Four patients presented with epistaxis, two with subarachnoid hemorrhage, one with exophthalmos, and one with hemiparesia. Emergency angiography revealed a pseudoaneurysm in four patients, contrast extravasation in two, vessel dissection in one, vessel wall irregularity in one, and arteriovenous fistula in one. All patients but one were treated successfully with parent artery occlusion, with one covered stent implantation, one stent-assisted coiling method, while one patient was managed conservatively. One patient died due to complications related to the primary insult without rebleeding. Vascular injuries suspected intra or postoperatively must be investigated rapidly after transsphenoidal surgery. Endovascular treatment with parent artery occlusion is feasible with acceptable morbidity and mortality rates in the treatment of vascular injuries occurring in transsphenoidal surgery.

  14. The Extended Subfrontal and Fronto-Orbito-Zygomatic Approach in Skull Base Meningioma Surgery: Clinical, Radiologic, and Cosmetic Outcome. (United States)

    Soleman, Jehuda; Leiggener, Christoph; Schlaeppi, Ai-Jeanine; Kienzler, Jenny; Fathi, Ali-Reza; Fandino, Javier


    To review the outcome and cosmetic results of patients undergoing extended subfrontal and fronto-orbito-zygomatic craniotomy for resection of skull base meningiomas. All surgeries were performed in cooperation with an oral and maxillofacial surgeon between 2006 and 2012. Clinical presentation, surgical techniques and complications, cosmetic, clinical, and radiologic outcomes are presented. This study included 25 consecutive patients with 26 operations. Total and subtotal tumor removal was obtained in 19 (73.1%) and 7 (26.9%) patients, respectively. Permanent postoperative complications were seen in 5 (19.2%) patients. Eight of 10 patients with preoperative visual impairment showed recovery at 6 months follow-up. Anosmia was improved in 50% and no worsening was seen in any case of hyposmia. All patients showed improved or complete correction of exophthalmos, cognitive deficits, and epilepsy. One patient (3.8%) developed a postoperative ptosis. No mortality was documented. All patients reported a favorable cosmetic satisfactory score over 6 (8.67 ± 1.6). Tumor recurrence rate was 7.7% (n = 2). The extended subfrontal and fronto-orbito-zygomatic approach, used for resection of meningiomas located in the orbita and the skull base can provide better visibility of the tumor. In addition, these approaches lead to highly satisfying cosmetic and clinical results.

  15. Orbital Compartment Syndrome After Frontotemporal Craniotomy: Case Report and Review of Literature. (United States)

    Pahl, Felix H; de Oliveira, Matheus F; Dal Col Lúcio, José E; Souza E Castro, Emerson F


    Orbital compartment syndrome (OCS) is a rare condition characterized by increased intraorbital pressure and hypoperfusion of critical neural structures. It is usually associated with external ophthalmoplegia. We report a case of postoperative OCS following a frontotemporal craniotomy and review pertinent literature. A 3-year-old female patient presented with a 3-year history of refractory epilepsy and diagnosis of right frontobasal cortical dysplasia. She underwent an elective frontotemporal craniotomy to allow resection of dysplastic cortex. The intraoperative period was uneventful. Postoperatively, following removal of operating fields, we noticed proptosis and right periorbital swelling. A diagnosis of orbital compartment syndrome was made. At the pediatric intensive care unit, the patient underwent an emergency right lateral canthotomy with wide inferior and superior cantholysis. Nowadays she is in the fourth month of postoperative follow-up. There is still slight and almost indistinguishable exophthalmos, but her extrinsic eye movement ranges and reaction to light are normal. OCS is a rare ophthalmologic emergency characterized by an acute rise in orbital pressure and may result in complete irreversible blindness if not rapidly treated. The frontotemporal or "pterional" craniotomy exposure requires a myocutaneous flap to be retracted anteriorly and inferiorly near the orbit. There may be orbital compression due to this flap leading to potential harmful complications. Attention to factors such as direct ocular pressure from skin flaps, congestion from head positioning, and adequate intraoperative eye protection may reduce the risk or allow faster management. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Light and Electron Microscopic Study of the Retina in a Patient with Congenital Glaucoma. (United States)

    Maeda-Yajima, M; Mizota, A; Kimura, T


    Purpose: The morphological observation of the human retinal changes caused by severely elevated intraocular pressure (IOP) in congenital glaucoma.Method: Light and electron microscopy.Subjects: One eye of a 15-year-old boy diagnosed as having congenital glaucoma was obtained after he had suffered from severe visual disturbance and ocular pain because of extensive elevated IOP, corneal leucoma, and exophthalmos.Results: Ganglion cells and nerve fibers in the inner layer were lost and replaced by Müller cell processes. The cellular elements in the outer layer were regularly arranged, but these cytoplasmic organelles were not very well developed. Most of the cellular elements of the whole retina contained many dense bodies. The retinal capillaries in the nerve fiber layer were lost or severly damaged, but some of these in the inner plexiform layer were intact. In the retinal arteries and veins marked thickening of the adventitial tissues was observed. These tissues consisted of remarkably increased and irregularly arranged collagen fibers, and a few elastic fibers scattered in some parts.Conclusion: It appeared that the pathological changes in the inner layer of the retina were caused by ischemia. The retinal vascular abnormality was thought to be the result of protective reaction against the severly elevated IOP.

  17. Rare human diseases: 9p deletion syndrome

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    Galagan V.O.


    Full Text Available Objective of the study was to review the anamnesis, pheno - and genotype in patients with rare chromosome disorders such as 9p deletion syndrome. Genetic methods of investigation (clinical and genealogical, cytogenetic, FISH- method, paraclinical and instrumental methods of examination were used. Karyotyping was performed by the G-method of differential staining of chromosomes. Only three cases of pathology were diagnosed in the Medical Genetics Center over the last 10 years. By anamnesis data nobody in the probands’ families had bad habits, was exposed to occupational hazards, took part in the elimination of the Chernobyl accident or lived in contaminated areas. Clinical signs of diseases have not been identified in probands’ parents. All probands had trigonocephaly, bilateral epicanthal folds, ocular hypertelorism, downslanting palpebral fissures, long philtrum, flat face and nasal bridge, low set ears with malformed auricles. Two patients of three ones had exophthalmos, contracture of the second and third fingers, abnormal external genitalia. In all three cases there was monosomy of chromosome 9 of critical segment p 24. Normal karyotypes were seen in all parents, so there were three cases of new mutations of 9p deletion syndrome. Retardation of physical, psycho-spech, mental development in proband with or without congenital anomalies requires medical genetic counseling in a specialized institution. Cases of reproductive loss in anamnesis require cytogenetic investigation of fetal membranes and amniotic fluid.

  18. Orbital Cystic Schwannoma Originating from the Frontal Nerve

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    Yasuhiko Hayashi


    Full Text Available Schwannomas of the orbit are very rare benign neoplasms. Intraorbital cystic schwannomas originating from the frontal nerve are even rarer, with only 1 case reported to date. This is most likely due to the fact that, in most cases, the origin of the orbital schwannoma cannot be identified intraoperatively. The nerve origin is usually speculated from histological examination of the specimen and the postoperative neurological deficits of the patient. Here, we present the case of a 65-year-old woman with a one-month history of exophthalmos, whose orbital cystic lesion was completely removed by microsurgical transcranial operation. Intraoperatively, the continuity between the tumor and frontal nerve was seen macroscopically, leading us to confirm the frontal nerve as an origin of the tumor, which was consistent with the postoperative neurological findings. The diagnosis of the tumor was established as schwannoma from the histological examination. As a differential diagnosis of the orbital cystic lesions, the possibility of schwannomas should be kept in mind.

  19. Investigation of Anti-Myeloperoxidase Antibodies in a Dog with Bilateral Necrotizing Scleritis

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    Guillaume Cazalot


    Full Text Available Necrotizing scleritis is uncommon in dogs and presumed to be immune-mediated. Its clinical pattern and histopathology are similar to ocular lesions observed in humans suffering from granulomatosis with polyangiitis (GPA, formerly named Wegener’s granulomatosis, where the pathogenesis revolves around anti-neutrophil antibodies (e.g., anti-myeloperoxidase. These antibodies are used to diagnose and follow-up the disease in humans, but variants that only affect the eyes often test negative. Here, we present the first case of canine necrotizing scleritis where measurement of anti-myeloperoxidase antibodies was attempted. A 1.5 year-old female Scottish Terrier was presented with bilateral deep multifocal scleromalacia, severe inflammation of corneal/uveal/retrobulbar tissues, perilimbal corneal oedema and neovascularization, hypotony, and mild exophthalmos. Corticosteroids and antibiotics had been administrated (topically and orally without success. Due to painful multifocal scleral perforation with vitreal haemorrhage, the left eye underwent enucleation, so did the right eye one week later. The histopathology of the left eye revealed a neutrophilic and histiocytic scleral infiltration with extension of pyogranulomatous inflammation to the cornea, choroid, ciliary body, and orbital fat. Levels of plasma anti-myeloperoxidase antibodies were not statistically significant to those of 13 healthy dogs. Further research is warranted to investigate the presence and role of anti-neutrophil antibodies in canine necrotizing scleritis.

  20. [Endoscopic treatment of orbital cellulitis in pediatric patients: transethmoidal approach]. (United States)

    Cavaliere, M; Volino, F; Parente, G; Troisi, S; Iemma, M


    Orbital cellulitis is a septic process of the soft tissues behind the orbital septum and is the most frequent cause of the monolateral exophthalmos in pediatrics. Approximately 90% of the orbital cellulitis in pediatrics are associated to acute ethmoiditis. From the 01.01.2001 to 31.12.2010 we treated 36 patients, less than 18 years-old affected by Chandler stage II, III, or IV orbital cellulitis. The inflammation was resolved medically in 6 patients. In the 30 cases that showed no improvement in 48-72 h, an endoscopic drainage of the pus was performed by the transethmoidal route. In children, an adenoidectomy should be included, in order to eliminate eventual infections of this lymphatic organ. Endoscopic treatment has resulted in rapid resolution of disease without any complications. In addition, postoperative discomfort is minimal, with a rapid return to daily activities. Copyright © 2012 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  1. Characteristics of patients treated for orbital cellulitis: An analysis of inpatient data. (United States)

    Marchiano, Emily; Raikundalia, Milap D; Carniol, Eric T; Echanique, Kristen A; Kalyoussef, Evelyne; Baredes, Soly; Eloy, Jean Anderson


    Orbital cellulitis represents a spectrum of diseases, some of which may progress to potentially serious complications. The authors used the Nationwide Inpatient Sample (NIS) database to analyze the epidemiologic features of pediatric and adult patients admitted for the treatment of orbital cellulitis and to examine associations with surgical management. The NIS was queried for patients admitted for treatment of orbital cellulitis from 2002 to 2010. Patient demographics, length of stay, hospital charges, and concomitant diagnoses were analyzed. There were 14,149 cases of orbital cellulitis identified with 1,717 (12.1%) having undergone surgical management. Surgical patients were older (29.6 ± 23.4) and more commonly male (62.0%) (P = 0.004 and orbital cellulitis from a national perspective. Patients 10 to 19 years of age were most likely to undergo surgical management. Acute and chronic sinusitis, acute osteomyelitis, exophthalmos, diplopia, and conjunctival edema were concomitant diagnoses associated with significantly increased odds ratio of surgical intervention. 2C. Laryngoscope, 126:554-559, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  2. Safety and efficacy of technetium-99 methylene diphosphate combined with glucocorticoid for Graves ophthalmopathy

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    Ri-Qiu Chen


    Full Text Available AIM:To evaluate the clinical efficacy and safety of technetium-99 methylene diphosphate(99Tc - MDPwith glucocorticoid therapy for Graves ophthalmopathy. METHODS:A total of 96 patients with Graves ophthalmopathy were randomly divided into two groups, The control group assigned to receive methylprednisolone injection pulse therapy and oral prednisone tablets in the intermittent period. The experimental group was given the treatment of 99Tc - MDP injection based on therapy of the control group. Then the clinical efficacy and safety of the two therapies were compared. RESULTS:The clinical symptoms of the two groups were improved. The efficiency rate of the experimental group was higher than that of the control group, especially on the degree of exophthalmos, and the difference was statistically significant(PP>0.05. The experimental group did not have serious adverse reactions associated with 99Tc-MDP.CONCLUSION:There are obvious improvements in patients with Graves ophthalmopathy treated by 99Tc - MDP combined with glucocorticoid, especially in the degree of exophthalmus and with less adverse reactions, which deserves promotion.

  3. Optic neuritis as isolated manifestation of leptomeningeal carcinomatosis: a case report and systematic review of ocular manifestations of neoplastic meningitis. (United States)

    Lanfranconi, Silvia; Basilico, Paola; Trezzi, Ilaria; Borellini, Linda; Franco, Giulia; Civelli, Vittorio; Pallotti, Francesco; Bresolin, Nereo; Baron, Pierluigi


    Introduction. Leptomeningeal carcinomatosis occurs in about 5% of cancer patients. Ocular involvement is a common clinical manifestation and often the presenting clinical feature. Materials and Methods. We report the case of a 52-year old lady with optic neuritis as isolated manifestation of neoplastic meningitis and a review of ocular involvement in neoplastic meningitis. Ocular symptoms were the presenting clinical feature in 34 patients (83%) out of 41 included in our review, the unique manifestation of meningeal carcinomatosis in 3 patients (7%). Visual loss was the presenting clinical manifestation in 17 patients (50%) and was the most common ocular symptom (70%). Other ocular signs were diplopia, ptosis, papilledema, anisocoria, exophthalmos, orbital pain, scotomas, hemianopsia, and nystagmus. Associated clinical symptoms were headache, altered consciousness, meningism, limb weakness, ataxia, dizziness, seizures, and other cranial nerves involvement. All patients except five underwent CSF examination which was normal in 1 patient, pleocytosis was found in 11 patients, increased protein levels were observed in 16 patients, and decreased glucose levels were found in 8 patients. Cytology was positive in 29 patients (76%). Conclusion. Meningeal carcinomatosis should be considered in patients with ocular symptoms even in the absence of other suggestive clinical symptoms.

  4. Ticks associated with the three largest wild ruminant species in Southern Africa

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    I.G. Horak


    Full Text Available The objective of this study was to assess the host status of the three largest southern African wild ruminants, namely giraffes, Giraffa camelopardalis, African buffaloes, Syncerus caffer, and eland, Taurotragus oryx for ixodid ticks. To this end recently acquired unpublished data are added here to already published findings on the tick burdens of these animals, and the total numbers and species of ticks recorded on 12 giraffes, 18 buffaloes and 36 eland are summarized and discussed. Twenty-eight ixodid tick species were recovered. All stages of development of ten species, namely Amblyomma hebraeum, Rhipicephalus (Boophilus decoloratus, Haemaphysalis silacea, Ixodes pilosus group, Margaropus winthemi, Rhipicephalus appendiculatus, Rhipicephalus evertsi evertsi, Rhipicephalus glabroscutatum, Rhipicephalus maculates and Rhipicephalus muehlensi were collected. The adults of 13 species, of which the immature stages use small mammals as hosts, namely Haemaphysalis aciculifer, Hyalomma glabrum, Hyalomma marginatum rufipes, Hyalomma truncatum, Ixodes rubicundus, Rhipicephalus capensis, Rhipicephalus exophthalmos, Rhipicephalus follis, Rhipicephalus gertrudae, Rhipicephalus lounsburyi, Rhipicephalus lunulatus, Rhipicephalus pravus group and Rhipicephalus simus, were also collected.

  5. [Heart failure as early manifestation of neonatal hyperthyroidism. Case report]. (United States)

    Alvarado S, Jorge Luis; Fernández V, Zhirly Andrea


    Neonatal hyperthyroidism is usually a self-limited condition frequently associated with transplacental passage of thyroid stimulating antibodies secondary to maternal autoimmune disorders. To timely detect mothers with this medical antecedents decreases the risk for fetal adverse events. To report a case of neonatal hyperthyroidism associated with intrauterine growth restriction and heart failure. A 36 week-old newborn with birth weight of 1,240 g. Symptoms were tachycardia, distal coldness, exophthalmos, hepatomegaly and tremors. Echocardiogram ruled out structural heart disorders. Due to maternal symptoms suggestive of hyperthyroidism, TSH tests were performed showing 0.01 ulU/ml, free T4 7.7 ng/dl, so the diagnosis of neonatal hyperthyroidism was confirmed. It was treated with methimazole and propanol, alleviating the symptoms and decreasing the levels of free T4. To know the maternal history helps identify and manage neonatal complications of hyperthyroidism. Heart failure and other cardiopulmonary disorders are determinants of mortality during early neonatal period. High-risk newborns should receive follow up assessments.

  6. Reconstruction of orbital floor blow-out fractures with autogenous iliac crest bone: a retrospective study including maxillofacial and ophthalmology perspectives. (United States)

    O'Connell, John Edward; Hartnett, Claire; Hickey-Dwyer, Marie; Kearns, Gerard J


    This is a 10-year retrospective study of patients with an isolated unilateral orbital floor fracture reconstructed with an autogenous iliac crest bone graft. The following inclusion criteria applied: isolated orbital floor fracture without involvement of the orbital rim or other craniofacial injuries, pre-/post-operative ophthalmological/orthoptic follow-up, pre-operative CT. Variables recorded were patient age and gender, aetiology of injury, time to surgery, follow-up period, surgical morbidity, diplopia pre- and post-operatively (Hess test), eyelid position, visual acuity, and the presence of en-/or exophthalmos (Hertel exophthalmometer). Twenty patients met the inclusion criteria. The mean age was 29 years. The mean follow up period was 26 months. No patient experienced significant donor site morbidity. There were no episodes of post-operative infection or graft extrusion. Three patients had diplopia in extremes of vision post-operatively, but no interference with activities of daily living. One patient had post-operative enophthalmos. Isolated orbital blow-out fractures may be safely and predictably reconstructed using autogenous iliac crest bone. The rate of complications in the group of patients studied was low. The value of pre- and post-operative ophthalmology consultation cannot be underestimated, and should be considered the standard of care in all patients with orbitozygomatic fractures, in particular those with blow-out fractures. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  7. Radioactive iodine ablation of Grave disease; Traitement ablatif par iode

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    Taieb, D.; Tessonnier, L.; Nwatsock, F.J.; Mundler, O. [Service central de biophysique et de medecine nucleaire, centre hospitalo-universitaire de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, (France)


    The isotopic destruction by iodine of the thyroid body is an alternative to the surgery in the radical treatment of the Basedow disease, particularly for recurrent forms. Several strategies are possible in the use of iodine 131. between 2004 and 2008, 240 patients with a Basedow disease were treated in our service by an ablative activity of iodine 131 (555 MBq on average). the results are rather reproducible, that is to say a quasi constant hypothyroidism in the first three months. It appears important to underline that the ambulatory management of induced hypothyroidism is often unappropriated with too progressive introductions of LT4, leaving the patient in deep hypothyroidism during several weeks. The recurrences at short and middle term are very rare ( under 4%). A case of severe exophthalmos was observed. The other patients did not progressed with corticosteroids. The evolution of anti receptors autoantibodies of the TSH have been studying. to conclude, this kind of strategy is very efficient and reproducible, but needs an appropriate management of post therapy hypothyroidism, source of discomfort and potential morbidity. (N.C.)

  8. Brain perfusion SPECT and FDG PET findings in a patient with ballism associated with hyperthyroidism

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    Bae, Sang Kyun; Kim, Sang Jin [Pusan Paik Hospital, Pusan (Korea, Republic of)


    Ballism is a very rare presentation in association with hyperthyroidism. We describe a 22-year-old lady with episodes of recurrent ballism and hyperthyroidism. A 22-year-old lady was admitted to Neurology department because of sudden development of vigorous involuntary movement and dysarthria. She was diagnosed as hyperthyroidism at the age 12 and treated irregularly. She arrived at the emergency room because of sudden onset of involuntary movement. Computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) of brain was normal. Serum levels of thyroid hormone were increased (Free T4 3.15 ng/dl; normal range 0.93-1.71 ng/dl), whereas thyroid-stimulating hormone (TSH) was undetectable. The thyroid gland was diffusely enlarged and exophthalmos was found. She had been given antithyroid medication from local clinic but medicated irregularly. Technetium thyroid scan reveals diffusely enlarged thyroid with increased radioactivity. Radioiodine uptake in 24 hours was 71 %. Brain perfusion SPECT using Tc-99m ECD reveals asymmetrical perfusion pattern in basal ganglia. Brain PET using F-18 FDG reveals increased metabolism at both caudate nucleus and putamen. She was treated with radioiodine and involuntary movement was improved. There is only few report on ballism associated with hyperthyroidism and no report on functional brain imaging. Brain perfusion SPECT and FDG PET may give useful information about functional status of brain in patients with ballism associated with hyperthyroidism in case of normal anatomical finding on CT/MRI.

  9. Pfeiffer syndrome

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    Fryns Jean-Pierre


    Full Text Available Abstract Pfeiffer syndrome is a rare autosomal dominantly inherited disorder that associates craniosynostosis, broad and deviated thumbs and big toes, and partial syndactyly on hands and feet. Hydrocephaly may be found occasionally, along with severe ocular proptosis, ankylosed elbows, abnormal viscera, and slow development. Based on the severity of the phenotype, Pfeiffer syndrome is divided into three clinical subtypes. Type 1 "classic" Pfeiffer syndrome involves individuals with mild manifestations including brachycephaly, midface hypoplasia and finger and toe abnormalities; it is associated with normal intelligence and generally good outcome. Type 2 consists of cloverleaf skull, extreme proptosis, finger and toe abnormalities, elbow ankylosis or synostosis, developmental delay and neurological complications. Type 3 is similar to type 2 but without a cloverleaf skull. Clinical overlap between the three types may occur. Pfeiffer syndrome affects about 1 in 100,000 individuals. The disorder can be caused by mutations in the fibroblast growth factor receptor genes FGFR-1 or FGFR-2. Pfeiffer syndrome can be diagnosed prenatally by sonography showing craniosynostosis, hypertelorism with proptosis, and broad thumb, or molecularly if it concerns a recurrence and the causative mutation was found. Molecular genetic testing is important to confirm the diagnosis. Management includes multiple-staged surgery of craniosynostosis. Midfacial surgery is performed to reduce the exophthalmos and the midfacial hypoplasia.

  10. Computed tomography of tumors of paranasal sinuses and face

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    Lee, Sun Wha [Kyung Hee University College of Medicine, Seoul (Korea, Republic of)


    The computed tomography can image both bone and soft tissue structures of paranasal sinuses and face and so CT has added an important new dimension to radiological evaluation of disease of paranasal sinuses and face. CT is more accurate method of staging of tumors and essential for therapeutic planning. The author studied 25 cases of proven tumors of paranasal sinuses and face during the period from October 1977 to August 1980 in Kyung Hee University Hospital. The results were as follows: 1. Among 14 females and 11 male, their age range was from 14 years to 65 year. 2. The distribution of tumors were mucocele, squamous cell carcinoma, metastatic carcinoma, meningioma, angiofibroma, Masson's hemangiosarcoma, fibrous dysplasia, neurogenic sarcoma, Schwannoma, hemangioma, epidermoid, transitional cell carcinoma and unknown. 3. Determination of location and extent of mucocele was easily done by CT. Thus in all cases of ethmoid mucocele, chief complaint of exophthalmos could be easily explained by identification of its extension into peripheral fat space of orbit. 4. It is our belief that CT was useful method to determine staging of tumors of paranasal sinuses and was essential in choosing appropriate treatment modality. 5. The contrast enhancement is generally not helpful in pathologic diagnosis of tumors but intracranial extension of tumors are clearly defined by contrast enhancement.

  11. Orbital schwannomatosis in the absence of neurofibromatosis. (United States)

    Koktekir, Bengu Ekinci; Kim, H Jane; Geske, Mike; Bloomer, Michelle; Vagefi, Reza; Kersten, Robert C


    The aim of this study was to describe 3 cases of primary orbital schwannomatosis without associated systemic neurofibromatosis. This is a retrospective interventional study of 3 patients who presented with multiple, distinct masses in the orbit (n = 3) as well as in the hemiface (n = 1). The clinical presentation, imaging features, surgical procedures, and outcomes were defined. Two women and a man presented with of exophthalmos and diplopia. Pain was the most prominent complaint in 2 patients. None of the patients had associated systemic neurofibromatosis by history or examination. Radiologic evaluation with computed tomography or magnetic resonance imaging of orbit revealed multiple well-demarcated intraconal and extraconal masses. Masses were excised, and histopathology confirmed all masses to be schwannomas. Postoperative follow-up was uneventful with alleviation of primary complaints in all patients. Multiple orbital schwannomas (primary orbital schwannomatosis) may be observed in patients without systemic association of neurofibromatosis. Management includes surgical excision of the tumors to achieve relief from their mass effects.

  12. Clinical analysis of transcranial orbitotomy approach on cranio-orbital tumors. (United States)

    Jian, Tianming; Sun, Fengyuan; Tang, Dongrun; Wang, Song; Wu, Tong; Zhao, Liang


    The aims of this study were to investigate 21 cases of transcranial orbitotomy for cranio-orbital tumors and evaluate the clinical value of the surgical approach. A retrospective study was done on 21 patients with cranio-orbital tumors. According to the tumors' location, shape, boundary, and invasion on the images, coronal scalp flap approach, subfrontal approach, or pterion approach for transcranial orbitotomy was performed. The surgical route was coronal scalp flap approach in 7 cases (including 3 cases combined with lateral orbitotomy), subfrontal approach in 6 cases, or pterion approach in 8 cases (including 1 case combined with evisceration of orbit). Tumors were en bloc resection in 4 cases, block resection or curettage in 13 cases, and incomplete resection in 4 cases. Postoperatively, the mean reduction in exophthalmos was 4 mm; maximum reduction was 11 mm. Ocular movement restriction was made better in 10 of 14 patients, whereas there was no change in 4 of 14 patients. Ophthalmoplegia occurred in 2 cases, complete ptosis occurred in 3 cases, and mydriasis occurred in 3 cases. No vision loss or cerebrospinal fluid leak was observed. Fourteen patients were followed up, including 2 patients with metastatic carcinoma who died dead because of systemic metastasis; 2 patients had a recurrence (schwannoglioma and meningioma). No recurrence was found in the other 10 patients. Cranio-orbital tumors can be removed effectively through transcranial orbitotomy, whereas operative approach is convenient to the surgical procedure and can offer better exposure. Being familiar with the tumors' location, adhesion, and invasion, coupled with the skilled surgical techniques, would improve the results and reduce serious complications.

  13. Case of pycnodysostosis. Observation of skull by CT scan

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    Anegawa, Shigetaka; Bekki, Yoshiaki; Furukawa, Yasuhiro; Yokota, Seishi; Torigoe, Ryuichiro


    A 13-year-old boy was presented to the Department of Neurosurgery, Saiseikai Fukuoka General Hospital for further examinations concerning abnormal findings in the skull radiogram taken when he struck his head. His physical features showed some characteristics the same as those of pycnodysostosis as follows - proportionate dwarfism, prominent forehead, short spoon-shaped fingers, bilateral exophthalmos. A skull radiogram revealed widely open cranial sutures with no healing of the fracture and craniotomy which was performed for an acute epidural hematoma 6 years ago. Furthermore, the mandible was hypoplastic with a virtural loss of mandibular angle. CT of the soft tissues showed somewhat dilated cortical sulci and ventricles without any structural abnormalities in the brain. CT of bone algorythum revealed specific characteristics of this disease. The paranasal sinuses were quite hypoplastic. Especially in the maxillary sinuses, frontal sinussus and mastoid air cells, none of developments of sinuses were noted, even though the middle and internal ear seemed to be normal. Moreover, the ethomoid and sphenoid sinuses were noted, although their developments were poor. The appearance of skull base was normal, including the inlets and outlets of cranial nerves or vessels and synchondroses. However, the density of the skull base, especially in the diploe, was higher than normal in Hansfield number. Furthermore, detailed measurements of skull base demonstrated that the skull base itself was also dwarfish. In our study, the development of sinuses in bones with intramembranous ossification are worse than that with endochondral ossification. Furthermore, sutures or synchondroses in the skull base were well-developed than those of the convex. So, it is considered that pycnodysostosis must be the neighboring entity of diseases such as achondroplastic dwarfism or cleidocranial dysplasia. (J.P.N.).

  14. Clinical and radiological manifestations of paraneoplastic syndrome of bronchogenic carcinoma

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    Goldner Branislav


    Full Text Available The objective of this study was to present some clinical and radiological manifestations of PNS in relation to bronchogenic carcinoma (BC and to evaluate the usefulness of imaging findings in the diagnosis of asymptomatic BC. In the study group of 204 patients (146 male and 58 female with proven bronchogenic carcinoma, PNS was present in 18 (8.62% patients. The patients with PNS were divided into two groups. The first one consisted of 13 (72.2% patients with symptoms related to primary tumours while the second one consisted of 5 (27.7% patients with symptoms, at initial appearance, indicative of disorders of other organs and systems. The predominant disorder was Lambert-Eaton Syndrome, associated with small-cell carcinoma. Endocrine manifestations included: inappropriate antidiuretic hormone production syndrome (small-cell carcinoma, a gonadotropin effect with gynaecomastia and testicular atrophy (planocellular carcinoma, small-cell carcinoma, a case of Cushing Syndrome (small-cell carcinoma, and hyper-calcaemia, due to the production of the parathyroid hormone-related peptide, which was associated with planocellular carcinoma. A rare case of bilateral exophthalmos was found as PNS at adenocarcinoma. Digital clubbing and hypertrophic osteoarthropathy (HO were associated with planocellular and adenocarcinoma, while clubbing was much more common than HO, especially among women. The differences between the two groups were related to the time of PNS appearance. In the first group, PNS occurred late on in the illness, while in the second group, PNS preceded the diagnosis of BC. Alternatively, the disappearance of a clinical or a radiological manifestation of PNS after surgery or chemotherapy may be an indicator of an improvement in health or PNS may be the first sign of illness recurrence. Radiological manifestations of PNS in asymptomatic patients may serve as a useful screen for identifying primary BC. In symptomatic patients, it may be an

  15. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients

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    Kirsch, M. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Universitaetsklinikum Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Henkes, H.; Liebig, T.; Weber, W.; Golik, S.; Kuehne, D. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Esser, J. [Universitaetsklinikum Essen, Zentrum fuer Augenheilkunde, Essen (Germany)


    Introduction: The purpose of this study was to evaluate the single-centre experience with transvenous coil treatment of dural carotid-cavernous sinus fistulas. Methods: Between November 1991 and December 2005, a total of 141 patients (112 female) with dural carotid-cavernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included chemosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the patients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients complete filling of the cavernous sinus and the adjacent segment of the superior and inferior ophthalmic vein with detachable coils. Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cortical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arteriovenous shunt, no recurrence was observed. The transvenous coil occlusion of the superior and inferior ophthalmic veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid-cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved. (orig.)

  16. Towards optimized anesthesia protocols for stereotactic surgery in rats: Analgesic, stress and general health effects of injectable anesthetics. A comparison of a recommended complete reversal anesthesia with traditional chloral hydrate monoanesthesia. (United States)

    Hüske, Christin; Sander, Svenja Esther; Hamann, Melanie; Kershaw, Olivia; Richter, Franziska; Richter, Angelika


    Although injectable anesthetics are still widely used in laboratory rodents, scientific data concerning pain and distress during and after stereotactic surgery are rare. However, optimal anesthesia protocols have a high impact on the quality of the derived data. We therefore investigated the suitability of recommended injectable anesthesia with a traditionally used monoanesthesia for stereotactic surgery in view of optimization and refinement in rats. The influence of the recommended complete reversal anesthesia (MMF; 0.15mg/kg medetomidine, 2mg/kg midazolam, 0.005mg/kg fentanyl; i.m.) with or without reversal and of chloral hydrate (430mg/kg, 3.6%, i.p.) on various physiological, biochemical and behavioral parameters (before, during, after surgery) was analyzed. Isoflurane was also included in stress parameter analysis. In all groups, depth of anesthesia was sufficient for stereotactic surgery with no animal losses. MMF caused transient exophthalmos, myositis at the injection site and increased early postoperative pain scores. Reversal induced agitation, restlessness and hypothermia. Even the low concentrated chloral hydrate led to peritonitis and multifocal liver necrosis, corresponding to increased stress hormone levels and loss in body weight. Increased stress response was also exerted by isoflurane anesthesia. Pronounced systemic toxicity of chloral hydrate strongly questions its further use in rodent anesthesia. In view of undesired effects of MMF and isoflurane, thorough consideration of anesthesia protocols for particular research projects is indispensable. Reversal should be restricted to emergency situations. Our data support further refinement of the current protocols and the importance of sham operated controls. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Fractional anisotropy and diffusivity changes in thyroid-associated orbitopathy

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    Han, Ji Sung; Seo, Hyung Suk; Lee, Young Hen [Korea University Ansan Hospital, Department of Radiology, Ansan, Gyeonggido (Korea, Republic of); Lee, Hwa [Korea University Ansan Hospital, Department of Ophthalmology, Ansan (Korea, Republic of); Suh, Sang-il [Korea University Guro Hospital, Department of Radiology, Seoul (Korea, Republic of); Jeong, Eun-Kee; Sapkota, Nabraj [University of Utah, Utah Center for Advanced Imaging Research, Salt Lake City, UT (United States); Kim, Ki Joon [Nanoori Hospital, Department of Neurosurgery, Seoul (Korea, Republic of)


    To investigate the extraocular muscle (EOM) changes in thyroid-associated orbitopathy (TAO) on DTI and the correlations between DTI parameters and clinical features. Twenty TAO patients and 20 age- and sex-matched controls provided informed consent and were enrolled. Ten-directional DTI was acquired in orbit. Fractional anisotropy (FA), mean, axial, and radial diffusivities were obtained at medial and lateral EOMs in both orbits. EOM thickness was measured in patients using axial CT images. FA and diffusivities were compared between patients and controls. The relationships between DTI values and muscle thickness and exophthalmos were evaluated. DTI values compared between patients in active and inactive phases by clinical activity score of TAO. DTI values were also compared between acute and chronic stages by the duration of disease. In medial EOM, FA was significantly lower in patients (p < 0.001) and negatively correlated with muscle thickness (r = -0.604, p < 0.001). Radial diffusivity was significantly higher in patients (p = 0.010) and correlated with muscle thickness (r = 0.349, p = 0.027). In lateral EOM, DTI values did not differ between patients and controls. In the acute stage, the diffusivities of the medial rectus EOM were increased compared with the chronic stage. DTI values of the medial and lateral rectus EOM did not differ significantly between active and inactive phases. DTI can be used to diagnose TAO with FA and radial diffusivity change in EOM. Diffusivities can be used to differentiate acute and chronic stage of TAO. However, DTI values showed limitation in reflecting TAO activity according to the CAS. (orig.)

  18. A 30-month prospective study on the treatment of retinoblastoma in the Gabriel Toure Teaching Hospital, Bamako, Mali. (United States)

    Boubacar, Togo; Fatou, Sylla; Fousseyni, Traoré; Mariam, Sylla; Fatoumata, Dicko-Traoré; Toumani, Sidibé; Abdoul-Aziz, Diakité; Marouf, Keïta Mamadou


    Retinoblastoma is one of the most common malignant tumours among children in Africa. However, very few studies on this disease have been published, especially studies from French-speaking countries in Africa. Prospective study over a period of 30 months from 1 January 2005 to 30 June 2007 on all cases of retinoblastoma diagnosed and treated in the Paediatric Oncology Unit of the Gabriel Touré Hospital in Bamako, Mali. Treatment was two courses of pre-operative chemotherapy (cyclophosphamide, adriamycine and vincristine), enucleation for many patients, and then two courses of adjuvant chemotherapy with the same drugs. During the study period, 55 cases of retinoblastoma were treated, which represents 33.1% of all the solid tumours, coming second in frequency after lymphomas (39.7%). The mean age of the patients was 4.2 years. Boys were the most affected, with a sex ratio of 2:1. Forty-nine mothers (89.1%) and 46 fathers (83.6%) had no formal education. Thirty-seven children (67.3%) were from rural areas. Unilateral cases were predominant (49 cases (89.1%)). Ten cases (10.9%) were bilateral. Exophthalmos was the leading symptom (30 cases (54.5%)). The survival rate at 30 months was 56% with 18% lost at follow-up. Mortality as a result of retinoblastoma remains high in our region because diagnosis is always late and it is difficult to follow-up the patients. Education of healthcare workers and raising awareness in the general population would improve the survival rate of retinoblastoma patients in Africa.

  19. Graves' disease in children: long-term outcomes of medical therapy. (United States)

    Rabon, Shona; Burton, Amy M; White, Perrin C


    Management options are limited for the treatment of Graves' disease, and there is controversy regarding optimal treatment. We describe the demographic and biochemical characteristics of children with Graves' disease and the outcomes of its management. This is a retrospective study reviewing medical records from 2001 to 2011 at a tertiary-care paediatric hospital. Diagnostic criteria included elevated free T4 and total T3, suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies or clinical signs suggestive of Graves' disease, for example exophthalmos. Patients were treated with antithyroid drugs (ATD), radioactive iodine, or thyroidectomy. The main outcome measures were remission after medical therapy for at least 6 months and subsequent relapse. A total of 291 children met diagnostic criteria. A total of 62 were male (21%); 117 (40%) were Hispanic, 90 (31%) Caucasian, and 59 (20%) African American. Mean age (±standard deviation) at diagnosis was 12·3 ± 3·8 (range 3-18·5) years. At diagnosis, 268 patients were started on an antithyroid drug and 23 underwent thyroid ablation or thyroidectomy. Fifty-seven (21%) children achieved remission and 16 (28%) of these patients relapsed, almost all within 16 months. Gender and ethnicity did not affect rates of remission or relapse. Of 251 patients treated with methimazole, 53 (21%) had an adverse reaction, including rash, arthralgias, elevated transaminases, or neutropenia. Most children with Graves' disease treated with ATD do not experience remission, but most remissions do not end in relapse. Adverse reactions to methimazole are common but generally mild. © 2016 John Wiley & Sons Ltd.

  20. [Epidemiological, clinical, therapeutic and evolutive aspects of Basedow-Graves disease in the Depatment of Internal Medicine at CHU Aristide Le Dantec, Dakar (Senegal)]. (United States)

    Diagne, Nafissatou; Faye, Atoumane; Ndao, Awa Cheikh; Djiba, Boundia; Kane, Baidy Sy; Ndongo, Souhaibou; Pouye, Abdoulaye


    Basedow-Graves disease is an autoimmune affection characterized by the association of thyrotoxicosis with variable frequency events such as goiter, ophthalmopathy and pretibial myxedema. Its diagnosis is often easy, while its management remains difficult. A simple medical treatment exposes patient to recurrence risk. In Senegal and Sub-Saharan Africa few studies have focused on Basedow-Graves disease. This study aims to describe the epidemiological, clinical, therapeutic and evolutionary aspects of Basedow-Graves disease at a Hospital in Dakar. This was a retrospective study conducted from 1 January 2010 to 31 December 2013 in the Department of Internal Medicine at the Aristide Le Dantec University Hospital. During this period, 108 patients receiving outpatient treatment for Basedow-Graves disease were included out of a total of 834 patients receiving outpatient treatment. The diagnosis was made on the basis of clinical, biological and immunological signs. One hundred and eight patients suffering from Basedow-Graves disease were included out of a total of 834 consultations. Sex ratio was 7.3 and the average age was 34.6 years. The main reasons for consultation were: palpitations and weight loss in 46.3% and 39.8% of cases respectively. Thyrotoxicosis syndrome was found in 93.5% of patients, goiter was found in 87% of patients and exophthalmos in 78.7% of patients. The main complication was cardiothyreosis found in 11.1% of patients. All patients underwent antithyroid synthetic drugs treatment. The evolution was favorable in 19,4% of cases. Disease recurrence was observed in 57% of cases and in 23.1% of patients were lost to follow-up. Basedow-Graves disease is the most common cause of hyperthyroidism, The patient's clinical picture is dominated by manifestations related to hypermetabolism. This study highlights that thyroidectomy isn't the first-line of treatment if we consider the high number of recurrences after medical treatment.

  1. Noncavernous arteriovenous shunts mimicking carotid cavernous fistulae. (United States)

    Kobkitsuksakul, Chai; Jiarakongmun, Pakorn; Chanthanaphak, Ekachat; Pongpech, Sirintara


    The classic symptoms and signs of carotid cavernous sinus fistula or cavernous sinus dural arteriovenous fistula (AVF) consist of eye redness, exophthalmos, and gaze abnormality. The angiography findings typically consist of arteriovenous shunt at cavernous sinus with ophthalmic venous drainage with or without cortical venous reflux. In rare circumstances, the shunts are localized outside the cavernous sinus, but mimic symptoms and radiography of the cavernous shunt. We would like to present the other locations of the arteriovenous shunt, which mimic the clinical presentation of carotid cavernous fistulae, and analyze venous drainages. We retrospectively examined the records of 350 patients who were given provisional diagnoses of carotid cavernous sinus fistulae or cavernous sinus dural AVF in the division of Interventional Neuroradiology, Ramathibodi Hospital, Bangkok between 2008 and 2014. Any patient with cavernous arteriovenous shunt was excluded. Of those 350 patients, 10 patients (2.85%) were identified as having noncavernous sinus AVF. The angiographic diagnoses consisted of three anterior condylar (hypoglossal) dural AVF, two traumatic middle meningeal AVF, one lesser sphenoid wing dural AVF, one vertebro-vertebral fistula (VVF), one intraorbital AVF, one direct dural artery to cortical vein dural AVF, and one transverse-sigmoid dural AVF. Six cases (60%) were found to have venous efferent obstruction. Arteriovenous shunts mimicking the cavernous AVF are rare, with a prevalence of only 2.85% in this series. The clinical presentation mainly depends on venous outflow. The venous outlet of the arteriovenous shunts is influenced by venous afferent-efferent patterns according to the venous anatomy of the central nervous system and the skull base, as well as by architectural disturbance, specifically, obstruction of the venous outflow.

  2. A comparison of different transarterial embolization techniques for direct carotid cavernous fistulas: a single center experience in 32 patients (United States)

    Lu, Xiaojian; Hussain, Mohammed; Ni, Lanchun; Huang, Qinfeng; Zhou, Fei; Gu, Zhikai; Chen, Jian; Ding, Yuchuan; Xu, Feng


    Objective Transarterial treatment of direct carotid cavernous fistulas (DCCF) via embolic materials has been well documented. This study reports, validates, and compares with existing literature our experience treating DCCFs via endovascular approaches by using detachable balloons, coils, and covered stents. Methods Between June 2006 to October 2011, 32 patients (21 male, 11 female) with 32 DCCFs (30 traumatic, 2 spontaneous cavernous ICA aneurysms) were embolized endovascularly. Followup was performed for at least 6 months. Results Among the 32 DCCFs, 21 (65.6%) were embolized using detachable balloons, eight (25.0%) with coils, one (3.1%) with balloons and coils, and two (6.3%) with covered stents. Complete DCCF obliteration was achieved in 31 (96.9%) cases. One fistula failed to respond due to premature balloon detachment. Intracranial bruit in 31 (100%) chemosis and exophthalmos in 28 (100%) cases resolved after embolization. Visual acuity and oculomotor palsy improved in 18 (90%) and 18 (69.2%) cases, respectively. There was no evidence of DCCF recurrence. Thirteen DCCFs were followed up by MRI and five by DSA. In these cases, four (4/13, 30.8%) balloon-embolized DCCFs showed pseudoaneurysms. Three patients were asymptomatic; one had minor left oculomotor palsy. Conclusions Our results correlate and reinforce literature regarding endovascular treatment of DCCFs. Application of Transarterial embolization with detachable balloons, despite extensive use has been decreasing. Coil embolization is an effective and safe alternative for treatment, especially when balloon embolization fails. Covered stent placement may be used as another alternative for selected cases. PMID:25566340

  3. Hipertiroidismo neonatal: presentación de 2 pacientes Neonatal hyperthyroidism: Report of 2 cases

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    Pedro González Fernández


    Full Text Available Se presentaron 2 pacientes con diagnóstico de hipertiroidismo neonatal: uno del sexo masculino y otro del femenino; con antecedentes de ser hijos de madres con enfermedad de Graves; una de ellas se encontraba sin tratamiento, y con síntomas de hipertiroidismo y la otra con tratamiento y tenía controlada esa afección. Se realizó el diagnóstico por los antecedentes de ser hijos de madres con enfermedad de Graves Basedow; así como por las manifestaciones clínicas: bocio, exoftalmos, pérdida de peso, irritabilidad, taquicardia e insuficiencia cardíaca en uno de los pacientes. Según los exámenes de laboratorio realizados, se obtuvieron los resultados siguientes: T4 ³ 180 nmol/L y TSH 2 patients with diagnosis of neonatal hyperthyroidism, a male and a female, are presented. Their mothers suffer from Graves’ disease, one of them has no treatment and presents symptoms of hyperthyroidism, and the other is under treatment and her disease is under control. The diagnosis was made taking into account that they are children from mothers with Graves Basedow’ disease and the following clinical manifestations: goiter, exophthalmos, weight loss, irritability, tachycardia and cardiac insufficiency in one of the patients. The results of the laboratory tests for both patients were: T4 ³ l80 nmol/L and TSH < 1 U/L. Treatment with propylthiouracilo, propanolol and phenobarbital as well as general measures and digitalis therapy in the patient requiring it were indicated. A favorable evolution was observed in these 2 patients.

  4. An 80-year experience with optic nerve glioma cases at the Armed Forces Institute of Pathology: evolution from museum to molecular evaluation suggests possibe interventions in the cellular senescence and microglial pathways (an American Ophthalmological Society thesis). (United States)

    Cameron, J Douglas; Rodriguez, Fausto J; Rushing, Elisabeth; Horkayne-Szakaly, Iren; Eberhart, Charles


    To determine whether p16, a molecular marker of cellular senescence, and CD68, a microglial marker, are detectible in optic nerve glioma tissue stored for decades, thus providing potential targets for pharmacologic intervention. Cases were retrieved from the Armed Forces Institute of Pathology Registry of Ophthalmic Pathology. Clinical information was tabulated. In specimens with sufficient tissue, a tissue microarray was constructed to conduct molecular studies. Ninety-two cases were included: gender distribution was in a ratio of one male to 1.6 females, and age range was 2 months to 50 years (average age, 10.8 years). Neurofibromatosis type 1 was identified in 10 cases (10.8%). The majority presented with decreased vision and exophthalmos. Forty-eight cases were studied by a tissue microarray construction. Glial fibrillary acidic protein, a control for immunoreactivity, was positive in 46 cases (96%). Immunoreactivity for p16 protein was seen in 36 cases (75%) and CD68-positive cells in 34 (71%). Limitations include referral bias, limited clinical information, limited amount of tissue, and extended period of tissue preservation. Optic nerve glioma is a tumor of the visual axis in young individuals, which is generally indolent but with a variable clinical course. Traditional histopathologic techniques have not been reliably predictive of clinical course. This microarray contains tumors with representative demographic, clinical, and histologic characteristics for optic nerve glioma. Immunoreactivity for p16 protein and CD68 is positive in the majority. These findings suggest a possible explanation for the variable clinical course and identify therapeutic targets in the cell senescence and microglial pathways.

  5. One-Stage Treatment for Adult Patients With Crouzonoid Appearance by Orthognathic and Face Contouring Surgery. (United States)

    Kim, Byung Jun; Bae, Hahn Sol; Lee, Yoonho


    Crouzon syndrome is a rare genetic disorder with autosomal-dominant inheritance that shows a triad of hallmark characteristics: craniosynostosis, exophthalmos, and midface retrusion. General treatment protocol for patients with Crouzon syndrome has already been established, but there is no standard treatment strategy for adult patients with Crouzonoid appearance. The authors present clinical patients of 1-stage orthognathic and face contouring surgery to achieve functional and aesthetic improvement.One-stage surgery was performed in adult patients with Crouzonoid appearance without a history of facial surgery. Orthognathic 2-jaw surgery was first performed to treat class III malocclusion. Face contouring surgery was conducted next to improve the aesthetic appearance using midface augmentation with onlay rib bone graft, advancement genioplasty, augmentation rhinoplasty, and ancillary procedures such as neck lift, fat graft, or fillers.Five patients (2 men, 3 women) were enrolled in this study. The mean age at the time of surgery was 19.0 years. No specific surgery-related complications such as infection, nerve injury, or recurred malocclusion were observed during the 3.5 years of follow-up. Normal class I occlusion was reached in all patients. The frontonasal angle, nasolabial angle, and labiomental angle improved from 125.1° to 135.1° (P > 0.05), 60.9° to 86.3° (P = 0.018), and 146.3° to 125.0° (P = 0.018), respectively. The Global Aesthetic Improvement Scale score was 4.75 and 5.00 in frontal and profile views, respectively.One-stage orthognathic and face contouring surgery may be an effective surgical option with good postoperative functional and aesthetic improvement in adult patients with Crouzonoid appearance.

  6. Transpalpebral Corrugator Resection: 25-Year Experience, Refinements and Additional Indications. (United States)

    Guyuron, Bahman; Son, Ji H


    The senior author introduced the transpalpebral approach for the first time during the ASPS meeting in 1993. He has made some refinements in the technique and has developed newer indications for this procedure. These refinements, indications and the related new video are the subject of this report. The modifications in the technique are as follows: After elevation of the skin and the orbicularis muscle and dissection under the muscle, a thin layer of the depressor supercilii muscle overlying the darker and more friable corrugator supercilii muscle is removed. A fairly constant branch of the supraorbital nerve piercing this muscle medially is first identified on the surface and followed deep in the muscle using a mosquito hemostat. The muscle is then lifted, and then, the same nerve branch is identified above the periosteum. The segment of the muscle lateral to this nerve is then isolated and removed by first transecting it medially and then lateral to the nerve. A cephalic segment is isolated and removed using the coagulation power of the cautery to minimize the postoperative bleeding. The rest of the muscle is then removed in a piecemeal fashion as thoroughly as possible, including a lateral segment of the procerus muscle, the end point being visualization of the subcutaneous fat. If the intention of the surgery is to treat frontal migraine headaches, the supratrochlear and supraorbital arteries are also removed. If the nerve and vessel pass through a foramen, a foraminotomy is carried out on patients with migraine headaches. Two to three cc of fat is injected in the glabellar and corrugator sites in most patients to avoid any depression and to restore the lost glabellar volume. Beyond patients with male pattern baldness, those with a long forehead and those with overactive frown muscles but optimal eyebrow positions, this technique is now being used for those with proptosis, exophthalmos and those with eyelid ptosis who would not undergo ptosis correction to

  7. Thyrotoxic and pheochromocytoma multisystem crisis: a case report. (United States)

    Suzuki, Kodai; Miyake, Takahito; Okada, Hideshi; Yamaji, Fuminori; Kitagawa, Yuichiro; Fukuta, Tetsuya; Yasuda, Ryu; Tanaka, Yoshihito; Okamoto, Haruka; Nachi, Sho; Doi, Tomoaki; Yoshida, Takahiro; Kumada, Keisuke; Yoshida, Shozo; Ushikoshi, Hiroaki; Toyoda, Izumi; Ogura, Shinji


    Thyrotoxic crisis and pheochromocytoma multisystem crisis are rare, life-threatening, emergency endocrine diseases with various clinical manifestations. Here we report a case of a patient who simultaneously developed thyrotoxic crisis and pheochromocytoma multisystem crisis and required intensive cardiovascular management. A 60-year-old Asian man experienced nausea and vomiting, and subsequently developed dyspnea and cold sweats while farming. His serum free thyroxine, free triiodothyronine, and thyrotropin receptor antibody levels were elevated at 2.9 ng/dL, 7.2 pg/dL, and 4.7 IU/L, respectively. Serum thyrotropin levels were suppressed at less than 0.01 μIU/mL. Thyroid echography demonstrated no thyroid swelling (23 × 43 mm). A whole body computed tomography was performed for systemic evaluation. This revealed exophthalmos and a mass of size 57 × 64 mm in the anterior pararenal space. Based on these findings, we made an initial diagnosis of thyrotoxic crisis secondary to exacerbation of Grave's hyperthyroidism. Treatment was begun with an iodine agent at a dose of 36 mg/day, thiamazole at a dose of 30 mg/day, and hydrocortisone at a dose of 300 mg daily for 3 consecutive days. To control tachycardia, continuous intravenously administered propranolol and diltiazem infusions were given. At the same time, small doses of doxazosin and carvedilol were used for both alpha and beta adrenergic blockade. On hospital day 5, his blood pressure and serum catecholamine concentrations (adrenalin 42,365 pg/mL, dopamine 6409 pg/mL, noradrenalin 72,212 pg/mL) were still high despite higher beta blocker and calcium channel blocker doses. These findings contributed to the diagnosis of pheochromocytoma multisystem crisis with simultaneous thyrotoxic crisis. We increased the doses of doxazosin and carvedilol, which stabilized his hemodynamic status. On hospital day 16, metaiodobenzylguanidine scintigraphy showed high accumulation in the right adrenal gland tumor

  8. A Study on the Clinical Diagnosis of Hyperthyroidism

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    Ku, In Soo; Koh, Chang Soon; Lee, Mun Ho [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    To attain a simple and reliable method of evaluating the thyroid function the reliability of the clinical manifestation and the conventional thyroid function tests in diagnosing the hyperthyroidism was studied. The subjects included 184 patients with hyperthyroidism and 66 cases with euthyroidism, who were treated at the Thyroid Clinic, Seoul National University Hospital, from July 1971 through August 1972. The observed results were as follows: l. In the cases of hyperthyroidism, 19% of the patients were male and 81% female; in the cases of euthyroidism, 7. 6% of the patients were male and 92. 4% female. The majority of the patients were in 2nd to 4th decades of their lives. 2. There were objective signs clearly manifested in hyperthyroidism which were rare or absent in the euthyroid state. These clinical signs included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor, and warm skin. In the hyperthyroid state 91. 3% of the cases manifested two or more of the above signs, whereas in the euthyroid state no patients manifested any two of the above signs. 3. The most frequent complaints of the patients with thyroid disease were palpitation, weight low, increased appetite, heat intolerance, perspiration, hunger feeling; nervousness, exertional dyapnea, etc. There was no clear difference in the incidence of the symptoms between hyperthyroidism and euthyroidism. 4. In the diagnosis of hyperthyroidism, the reliability of thyroid function tests was as follows: T{sub 7} was 92. 4% reliable, {sup 125}IT{sub 3} resin uptake rate 91. 6% reliable, {sup 131}I thyroid uptake rate in 24 hrs. 89. 4% reliable, serum T{sub 4} level 85. 9% reliable and BMR 75. 5% reliable. Therefore the careful observation of the clinical manifestation of the disease is a simple and reliable way of making a correct diagnosis of either hyperthyroidism or euthymidism. 5. In hyperthyroidism there shows no correlationship between the results of the thyroid function test and clinical

  9. Molecular identification and histopathological study of natural Streptococcus agalactiae infection in hybrid tilapia (Oreochromis niloticus

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    Laith Abdul Razzak


    Full Text Available Aim: The main objective of this study was to emphasize on histopathological examinations and molecular identification of Streptococcus agalactiae isolated from natural infections in hybrid tilapia (Oreochromis niloticus in Temerloh Pahang, Malaysia, as well as to determine the susceptibility of the pathogen strains to various currently available antimicrobial agents. Materials and Methods: The diseased fishes were observed for variable clinical signs including fin hemorrhages, alterations in behavior associated with erratic swimming, exophthalmia, and mortality. Tissue samples from the eyes, brain, kidney, liver, and spleen were taken for bacterial isolation. Identification of S. agalactiae was screened by biochemical methods and confirmed by VITEK 2 and 16S rRNA gene sequencing. The antibiogram profiling of the isolate was tested against 18 standard antibiotics included nitrofurantoin, flumequine, florfenicol, amoxylin, doxycycline, oleandomycin, tetracycline, ampicillin, lincomycin, colistin sulfate, oxolinic acid, novobiocin, spiramycin, erythromycin, fosfomycin, neomycin, gentamycin, and polymyxin B. The histopathological analysis of eyes, brain, liver, kidney, and spleen was observed for abnormalities related to S. agalactiae infection. Results: The suspected colonies of S. agalactiae identified by biochemical methods was observed as Gram-positive chained cocci, β-hemolytic, and non-motile. The isolate was confirmed as S. agalactiae by VITEK 2 (99% similarity, reconfirmed by 16S rRNA gene sequencing (99% similarity and deposited in GenBank with accession no. KT869025. The isolate was observed to be resistance to neomycin and gentamicin. The most consistent gross findings were marked hemorrhages, erosions of caudal fin, and exophthalmos. Microscopic examination confirmed the presence of marked congestion and infiltration of inflammatory cell in the eye, brain, kidney, liver, and spleen. Eye samples showed damage of the lens capsule

  10. Patología orbitocraneana de presentación oftalmológica Orbitocranial pathology with ophthalmologic symptoms

    Directory of Open Access Journals (Sweden)

    Silvina De Luca


    ón de estudios por imágenes en la evaluación de las principales entidades neuro-oftalmológicas que se presentan con signos y síntomas oculares nos permiten arribar a un diagnóstico temprano y, como consecuencia, a la implementación del tratamiento indicado.Objectives. To report the clinical and etiological correlation of different orbitocranial lesions in patients initially presenting with ophthalmologic symptoms and to determine its contribution to the selection of the diagnostic test of choice for each individual case. Materials and Methods. We have evaluated retrospectively 36 patients with orbital and/or intracranial conditions, who presented at the ophthalmology department of our institution between july 2007 and january 2011. All patients underwent an ophthalmologic examination, computerassisted campimetry, multislice computed tomography (MSCT, magnetic resonance imaging (MRI and some had a histopathological test performed. Results. The most common initial symptom was decreased or impaired visual acuity, present in 22 patients (61%. Others symptoms were diplopia in 9 patients (25%, exophthalmos in 2 (5.5%, orbital hematoma in 2 (5.5% and leukocoria in 1 (3%. In the group of patients with visual impairments, the etiological diagnoses were diverse and included: sphenoid meningioma (n=4, Devic's disease (n=2, brainstem glioma (n=1, optic glioma in the context of type 1 neurofibromatosis (n=1, metastasis of breast carcinoma (n= 4, brain lymphoma (n=2, stroke (n=4, lymphocytic hypophysitis (n=1 and pseudotumor cerebri (n=2. In patients with diplopia diagnosis included: a quadrigeminal plate tumor, one pineal cyst with acute hydrocephalus, two posterior communicating artery aneurysms, two intracavernous internal carotid artery aneurysms (one of them giant and dissecting, one ventral supraclinoid internal carotid artery aneurysm and two fronto-ethmoidal mucoceles. We highlight the presence of two optic nerve meningiomas initially presented with exophthalmos and

  11. Chemical contaminants, health indicators, and reproductive biomarker responses in fish from the Colorado River and its tributaries (United States)

    Hinck, J.E.; Blazer, V.S.; Denslow, N.D.; Echols, K.R.; Gross, T.S.; May, T.W.; Anderson, P.J.; Coyle, J.J.; Tillitt, D.E.


    evidence of contaminant exposure as indicated by fish health indicators and reproductive biomarker results. Multiple health indicators including altered body and organ weights and high health assessment index scores may be associated with elevated Se concentrations in fish from the Colorado River at Loma, Colorado and Needles. Although grossly visible external or internal lesions were found on most fish from some sites, histopathological analysis determined many of these to be inflammatory responses associated with parasites. Edema, exophthalmos, and cataracts were noted in fish from sites with elevated Se concentrations. Intersex fish were found at seven of 14 sites and included smallmouth bass (M. dolomieu), largemouth bass (M. salmoides), catfish, and carp and may indicate exposure to endocrine disrupting compounds. A high proportion of smallmouth bass from the Yampa River at Lay (70%) was intersex but the cause of this condition is unknown. Male carp, bass, and catfish with low concentrations of vitellogenin were common in the CRB. Comparatively high vitellogenin concentrations (> 0.2??mg/mL) were measured in male bass from the Green River at Ouray NWR and the Colorado River at Imperial Dam and indicate exposure to estrogenic or anti-androgenic chemicals. Anomalous reproductive biomarkers including low GSI and gonadal abnormalities (calcifications, edema, and parasites) observed in fish downstream of Phoenix are likely related to the poor water-quality of the Gila River in this area.

  12. Biomonitoring of Environmental Status and Trends (BEST) Program: Environmental contaminants, health indicators, and reproductive biomarkers in fish from the Colorado River basin (United States)

    Hinck, Jo Ellen; Blazer, Vicki; Denslow, Nancy D.; Gross, Timothy S.; Echols, Kathy R.; Davis, Anne P.; May, Tom W.; Orazio, Carl E.; Coyle, James J.; Tillitt, Donald E.


    . Current-use or unlisted pesticides such as dacthal, endosulfan, '-HCH, and methoxychlor were also greatest in fish from Gila River. Total polychlorinated biphenyls (PCBs; >0.11 ?g/g ww) and TCDD-EQs (>5 pg/g ww) exceeded wildlife guidelines in fish from the Gila River at Phoenix, Arizona. Hepatic ethoxyresorufin O-deethylase (EROD) activity was also relatively high in carp from the Gila River at Phoenix, Arizona and in bass from the Green River at Ouray NWR, Utah. Altered biomarkers were noted in fish throughout the CDRB. Fish from some stations responded to chronic contaminant exposure as indicated by fish health and reproductive biomarker results. Multiple fish health indicators including altered body and organ weights and high health assessment index scores may be associated with elevated Se concentrations in fish from the Colorado River at Loma, Colorado and Needles, California. Although grossly visible external or internal lesions were found on most fish from some sites, histopathological analysis determined many of these to be inflammatory responses associated with parasites. Edema, exophthalmos, and cataracts were noted in fish from sites with elevated Se concentrations. Reproductive biomarkers including gonad development and maturation, vitellogenin concentrations, and steroid hormone concentrations were anomalous in fish from the Gila River at Hayden and Phoenix, Arizona. In addition, intersex fish were found at seven of 14 sites. The intersex condition was identified in smallmouth bass (M. dolomieu), largemouth bass (M. salmoides), channel catfish, and carp and may indicate exposure to endocrine disrupting compounds. Seven of ten male smallmouth bass from the Yampa River at Lay, Colorado were intersex. Male carp, bass, and channel catfish with low concentrations of vitellogenin were common in the CDRB. Comparatively high vitellogenin concentrations (>0.2 mg/mL) were measured in male fish from the Green River at Ouray NWR, Utah and the Colorado River at Im

  13. [The corneal biomechanical properties of patients with Graves' orbitopathy]. (United States)

    Zhang, Y; She, X X; Yu, X J; Chen, L F; Shen, L J


    active group is (533.52±18.88) μm, which had no statistical significant difference from the CCT of (546.25±28.84) μm in control group (t1=-1.91,P=0.059;t2=-1.52,P2=0.132). Corneal hysteresis was negatively correlated with exophthalmos, IOPg, IOPcc (Pearson=-0.279,-0.385,-0.663,Pcorneal central thickness and corneal resistance factor (Pearson=0.246,0.583,P<0.05) in TAO group. Cornea hysteresis of TAO patients decreased, combined with lower ability of cornea to recover to the primary conditions when upon pressure. CH was negatively correlated with IOPg and IOPcc.(Chin J Ophthalmol, 2016, 52: 263-267).

  14. A Clinical Study on {sup 125}IT{sub 3} Resin Uptake Rate and Serum Thyroxin(T{sub 4}) in Hyperthyroidism

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    MooN, Ern Soo; Park, Yoh Han; Cho, Chang Ho; Park, In Soo; Lee, Chong Suk; Lee, Hak Choong [National Medical Center, Seoul (Korea, Republic of)


    Hyperthyroidism may be defined as those clinical conditions which result from an increase in the circulating levels of one or both thyroid hormones. Hyperthyroidism in broad sense could be classified with toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter on the basis of the circulating thyroid hormone levels. For this study, the subject included 94 cases with hyperthyroidism were presented in 77 with toxic diffuse goiter, 8 with toxic adenomatous goiter, and 9 with toxic multinodular goiter on the levels of {sup 125}IT{sub 3} resin uptake rate and serum thyroxine (T{sub 4}). The observed results were as follows: 1) In the cases of hyperthyroidism including toxic diffuse goiter, toxic adenomatous goiter, and toxic multinodular goiter, 20.21% of the patients were male and 79.79% female. The majority of the patients were in 2nd to 4th decades of their lives. 2) There were objective signs clearly manifested in hyperthyroidism including toxic diffuse goiter and toxic adenomatous goiter which were rare in the multinodular goiter. The clinical signs in toxic diffuse and toxic adenomatous goiter included wide pulse pressure, tachycardia, systolic murmur, exophthalmos, tremor and warm skin etc. 3) The most frequent complaints of the patients with hyperthyroidism were palpitation, weight loss, increased appetite, perspiration, heat intolerance, nervousness, exertional dyspnea, and menstrual disturbance etc. There was no clear difference in the incidence of symptoms between toxic diffuse goiter and toxic adenomatous goiter, but there was clear difference between toxic multinodular goiter. 4) Considering of results of {sup 125}IT{sub 3} resin uptake rate and serum T{sub 4} level in toxic diffuse goiter, toxic adenomatous goiter and toxic multinodular goiter, {sup 125}IT{sub 3} resin uptake rate was 49.15+-9.94% (mean) and serum T{sub 4} 21.29+-7.04 ug/dl (mean) in toxic diffuse goiter. In toxic multinodular goiter, {sup 125}I T{sub 3} resin uptake

  15. Anticuerpos antitiroperoxidasa y antitransglutaminasa en familiares de primer grado de personas con diabetes tipo 1 y su relación con algunas características clínicas, bioquímicas e inmunológicas Antithyroperoxidase and antitransglutaminase antibodies in first degree relatives of type 1 diabetes persons and its relation to some clinical, biochemical and immunological features

    Directory of Open Access Journals (Sweden)

    Levi González Rivero


    antitransglutaminase (tTGAb antibodies are useful markers of autoimmune thyroid disease and celiac disease, respectively. Its presence in first-degree relatives of type 1 diabetes patients has not been described in Cuba. OBJECTIVE: to determine the TPOAb and tTGAb frequencies in first-degree relatives of type 1 diabetes patients and its relation to some clinical, biochemical and immunological features. METHODS: in a group of 285 subjects we measured TPOAb and in 262 subjects we measured tTGAb. The cases included aged between 2 and 65. Data were registered on age, sex, skin color, personal backgrounds, and a family history of obesity, type 2 diabetes, thyroid disease and celiac disease. Symptoms were look for and clinical signs of celiac disease and autoimmune thyroid disease were explored. Fasting glucose, fasting insulin, TPOAb, tTGAb and type 1 diabetes associated autoantibodies (AGAD and AIA-2 were determined as well as the insulin resistance according the HOMA-IR index. RESULTS: the frequencies of positive TPOAb and tTGAb were of 5,3 and 1,9%, respectively. The family history of thyroid disease, slight muscular tremor and exophthalmos are related to presence of TPOAb. Intestinal malabsorption, persistent diarrhea, recurrent abdominal pain and personal background of liver disease were associated with presence of tTGAb. There was an association between tTGAb and AIA-2. Insulin resistance was not associated with the presence of both antibodies. CONCLUSIONS: in first-degree relatives of type 1 diabetes patients, frequencies of TPOAb and tTGAb are low. Some backgrounds, symptoms and signs linked to celiac disease and autoimmune thyroid disease may be practical indicators previous to perform these autoantibodies.