PURPOSE: To report three cases of nonarteritic anterior ischemic optic neuropa thy (NAION) that occurred in patients with sleep apnea syndrome (SAS) while bein g treated with continuous positive airway pressure (CPAP)...PURPOSE: To report three cases of nonarteritic anterior ischemic optic neuropa thy (NAION) that occurred in patients with sleep apnea syndrome (SAS) while bein g treated with continuous positive airway pressure (CPAP). DESI- GN: A prospective, noncomparative case series. METHODS: Prospective review of 108 patients with NAION diagnosed between 2002 and 2003 to identify any patients who developed NAION while being treated for SAS with CPAP. RESULTS: One patient had bilateral sequential NAION and two patients had unilateral NAION despite tr eatment with CPAP for SAS. All the patients were being treated with CPAP for a p eriod ranging from 4 months to 6 years before the onset of NAION. CONCLUSIONS: I n this series, CPAP did not prevent the development of NAION in SAS patients. Larger observational studies are needed to study the benefit of CPAP in preven ting NAION in patients with SAS.展开更多
Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen...Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. Results: A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing (p = 0.0003). The probability of improvement was related to the time since injury (p = 0.0003) with a 50 to 60%chance of improvement for cases tested within 1 month after injury that decreased to about 20%for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. Conclusion: Spontaneous improvement of homonymous hemianopia is seen in at least 50%of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient’s ability to perform visual field testing reliably.展开更多
BACKGROUND Non-arteritic anterior ischemic optic neuropathy(NAION)is an independent disease characterized by edematous optic discs.In eyes with branch retinal vein occlusion(BRVO),the arteries and veins in the ethmoid...BACKGROUND Non-arteritic anterior ischemic optic neuropathy(NAION)is an independent disease characterized by edematous optic discs.In eyes with branch retinal vein occlusion(BRVO),the arteries and veins in the ethmoid plate of the optic disc are relatively crowded;however,a combination of the two is clinically uncommon.Herein,we reported a patient with NAION and concealed BRVO,for which the treatment and prognosis were not similar to those for NAION alone.CASE SUMMARY Herein,we report a case of NAION with concealed BRVO that did not improve with oral medication.A week later,we switched to intravenous drug administration to improve circulation,and the patient’s visual acuity and visual field recovered.Hormonal therapy was not administered throughout the study.This case suggested that:(1)Fundus fluorescein angiography(FFA)can help detect hidden BRVO along with the NAION diagnosis;(2)intravenous infusion of drugs to improve circulation has positive effects in treating such patients;and(3)NAION with concealed BRVO may not require systemic hormonal therapy,in contrast with the known treatment for simple NAION.CONCLUSION NAION may be associated with hidden BRVO,which can only be observed on FFA;intravenous therapy has proven effectiveness.展开更多
Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most kn...Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations. Methods: The authors reviewed medical records of all patients with HH seen in their service between 1989 and 2004. Demographic characteristics, characteristics of visual field defects, causes of visual field defects, neuroradiologic definition of lesion location, and associated neurologic deficits were recorded. Results: A total of 904 HH were found in 852 patients. A total of 340 HH (37.6%) were complete and 564 HH (62.4%) were incomplete. Homonymous quadrantanopia (264 HH, 29%) was the most common type of incomplete HH, followed by homonymous scotomatous defects (116 HH, 13.5%), partial HH (114 HH, 13%), and HH with macular sparing (66 HH, 7%). A total of 407 HH (45.0%) were isolated. Causes of HH included stroke (629 HH, 69.6%), trauma (123, 13.6%), tumor (102, 11.3%), brain surgery (22, 2.4%), demyelination (13, 1.4%), other rare causes (13, 1.4%), and unknown etiology (2, 0.2%). The lesions were most commonly located in the occipital lobes (45%) and the optic radiations (32.2%). Every type of HH, except for unilateral loss of temporal crescent and homonymous sectoranopia, was found in all lesion locations along the retrochiasmal visual pathways. Conclusion: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. Although the characteristics of visual field defects can be helpful in lesion location, specific visual field defects do not always indicate specific brain locations.展开更多
Background/aim: Fractionated stereotactic radiotherapy (FSRT) is a new treatment for brain tumours that are close to critical structures, such as the visual apparatus. This study aims to assess the visual outcomes for...Background/aim: Fractionated stereotactic radiotherapy (FSRT) is a new treatment for brain tumours that are close to critical structures, such as the visual apparatus. This study aims to assess the visual outcomes for patients with parasellar meningioma following FSRT. Methods: A retrospective, non-comparative case series of 13 patients with parasellar meningiomas who were treated in one institution with FSRT between January 1995 and January 2001. Results: 13 patients (26 eyes) were followed for amean of 2 years. Visual acuity improved in four eyes (12.5% ), remained stable in 18 eyes (75% ), and worsened in three eyes (12.5% ). Visual field improved in 15 eyes (57% ), remained stable in six eyes (23% ), and worsened in four eyes (15% ). No adverse visual outcome occurred as a result of radiation. Conclusion: These preliminary findings suggest that FSRT is a safe and effective treatment for parasellar meningiomas.展开更多
Background: Patients with prosopagnosia from occipitotemporal lesions have impaired perception of the configuration of facial features. This may be an example of impaired “within-object”spatial coding, which others ...Background: Patients with prosopagnosia from occipitotemporal lesions have impaired perception of the configuration of facial features. This may be an example of impaired “within-object”spatial coding, which others propose to be distinct from “between-object”spatial coding. Objective: To determine whether the prosopagnosic deficit in perceiving spatial configuration was specific to within-face and not between-face spatial coding and whether the deficit was face-selective or extended to objects other than faces. Methods: Six prosopagnosic patients were tested using an oddity paradigm in which they detected which of three simultaneously seen stimuli was an altered target. In the “within-face”task, the target face had altered interocular distance or mouth position. In the “between-face”task, the target face was located farther away from the other two. In the “within-object”task, the stimulus was a two-dot pattern, and the target pattern had altered interdot distance. Results: Spatial judgments were impaired within faces for all six patients and within the two-dot pattern for five of six patients. However, all six had normal between-face spatial perception. Conclusions: Impaired perception of spatial relations in prosopagnosia is selective to the spatial structure within individual objects and spares the perception of spatial location of objects. It is not specific to faces. It reveals a process involved in analyzing object structure, consistent with the patients’deficits in recognizing facial identity, and illustrates a different type of “visuospatial”defect.展开更多
Background:Neuroinflammation is an essential event in Parkinson’s disease(PD).Identifying affordable and less invasive biomarkers to make an early diagnosis and monitor therapeutic strategies should be a priority amo...Background:Neuroinflammation is an essential event in Parkinson’s disease(PD).Identifying affordable and less invasive biomarkers to make an early diagnosis and monitor therapeutic strategies should be a priority among researchers.The study’s objective was to measure tear levels of cytokines in subjects with PD and their association with motor features and the presence of dry eye symptoms.Methods:A total of 16 subjects with PD and 16 age-and sex-matched controls were included.Movement Disorders Society-Unified Parkinson’s Disease Rating Scale(MDS-UPDRS),Hoehn and Yahr(HY)stage scale,Montreal Cognitive Assessment(MoCA),tear break-up time(TBUT),blink rate(BR),Dry Eye Questionnaire 5(DEQ-5)were examined,and pro-inflammatory cytokines[interleukin(IL)-1β,IL-6,IL-8,IL-10,IL-12p70 and tumor necrosis factor-alpha(TNF-α)]were quantified in tears using the BD Cytometric Bead Array Human Inflammatory Cytokine Kit.Results:Higher tear TNF-αwere quantified in PD compared to controls(2.94±3.95 vs.0.33±0.49 pg/mL,P=0.008).According to DEQ-5,50.0%(n=8)of PD subjects and 12.5%(n=2)controls had dry eye disease(DED).No differences were found in cytokines concentrations between PD patients with DED compared to those without DED.IL-8 was associated with the HY stage,TBUT,DEQ-5,and a better MoCA score.A higher BR correlated moderately with a lower HY stage(r=−0.645,P=0.007),and DED patients have lower BR in PD(12.14±2.54 vs.9.0±2.06 blinks/minute,P=0.031).Conclusions:PD patients have higher levels of TNF-αin tears than age-and sex-matched HC.IL-8 in tears may be both involved in the severity of the disease and in the development of DED in PD.In addition,our findings suggest that as HY stage increases,indicating a more advanced stage,BR decreases,indicating greater motor impairment.Conversely,the presence of DED is associated with higher levels of bradykinesia in PD patients,suggesting a potential relationship between DED and motor impairment severity.展开更多
Background:Superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery is now being widely used in moyamoya disease,and its therapeutic value in SICAO remains divergent.Methods:A systematic search was p...Background:Superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery is now being widely used in moyamoya disease,and its therapeutic value in SICAO remains divergent.Methods:A systematic search was performed in PubMed,EMBASE,and Cochrane Databases in Feb.2020 and updated in Jun.2019.We have strict inclusion and exclusion criteria.Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs.Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT.For dichotomous variable outcomes,risk ratios(RRs)and 95%confidence intervals(95%CIs)were calculated for the assessment.Results:The total patient cohort consisted of 2419 patients,of whom 1188(49.1%)patients had been grouped in STA-MCA bypass and 1231(50.9%)patients had been divided into the BMT group.Mean follow-up of included patients was 29 months.The RR of the seven studies was 1.01,and the 95%confidence interval was.89–1.15,with statistical significance,Z=.13,P=.89,sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease.Conclusions:STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke.And the risk of long-term overall stroke was mildly higher with BMT.At present,each patient should receive more precise treatment,by reasonably assessing the individual differences of each patient to reduce the recurrence rate of stroke.展开更多
一名24岁女性,在经历了短暂的意识丧失之后来到急诊,被诊断为惊恐发作并出院。2天后,因头痛加剧和视觉障碍,她被再次送回医院进行进一步的检查。第3天行头颅计算机断层扫描及静脉造影成像采集,结果均正帯。在第7天,她进行了腰椎穿刺,脑...一名24岁女性,在经历了短暂的意识丧失之后来到急诊,被诊断为惊恐发作并出院。2天后,因头痛加剧和视觉障碍,她被再次送回医院进行进一步的检查。第3天行头颅计算机断层扫描及静脉造影成像采集,结果均正帯。在第7天,她进行了腰椎穿刺,脑脊液开放压力为70 cm CSFo第8天,眼底镜检查发现视乳头水肿。最佳矫正视力下降至双眼6/24,同时面对面检查双眼周边视野缺损。她被诊断为暴发性原发颅内高压症,并转到神经科学中心,第9天在那里急诊行了腰椎腹膜分流术。术后2周,双眼视力提高到6/9。展开更多
文摘PURPOSE: To report three cases of nonarteritic anterior ischemic optic neuropa thy (NAION) that occurred in patients with sleep apnea syndrome (SAS) while bein g treated with continuous positive airway pressure (CPAP). DESI- GN: A prospective, noncomparative case series. METHODS: Prospective review of 108 patients with NAION diagnosed between 2002 and 2003 to identify any patients who developed NAION while being treated for SAS with CPAP. RESULTS: One patient had bilateral sequential NAION and two patients had unilateral NAION despite tr eatment with CPAP for SAS. All the patients were being treated with CPAP for a p eriod ranging from 4 months to 6 years before the onset of NAION. CONCLUSIONS: I n this series, CPAP did not prevent the development of NAION in SAS patients. Larger observational studies are needed to study the benefit of CPAP in preven ting NAION in patients with SAS.
文摘Objective: To describe the characteristics of spontaneous recovery of homonymous hemianopia (HH). Methods: The authors reviewed medical records of all patients with HH confirmed by formal visual field testing and seen in follow-up in their service between 1989 and 2004. Clinical characteristics, causes, neuroradiologic definition of lesion location, final outcome, and evolution of the visual field defects were recorded. The associations among final visual field defect outcome, time from injury, and clinical features were analyzed. Results: A total of 254 patients with 263 HH were included in this study. Spontaneous visual field defect recovery was observed in 101 HH (38.4%). The likelihood of spontaneous recovery decreased with increasing time from injury to initial visual field testing (p = 0.0003). The probability of improvement was related to the time since injury (p = 0.0003) with a 50 to 60%chance of improvement for cases tested within 1 month after injury that decreased to about 20%for cases tested at 6 months after surgery. No other factor was found to correlate with the final outcome of the visual field defects. Improvement after 6 months from injury was mild and usually related to improvement of the underlying disease. Conclusion: Spontaneous improvement of homonymous hemianopia is seen in at least 50%of patients first seen within 1 month of injury. In most cases, the improvement occurs within the first 3 months from injury. Spontaneous improvement after 6 months postinjury should be interpreted with caution as it is most likely related to improvement of the underlying disease or to improvement in the patient’s ability to perform visual field testing reliably.
文摘BACKGROUND Non-arteritic anterior ischemic optic neuropathy(NAION)is an independent disease characterized by edematous optic discs.In eyes with branch retinal vein occlusion(BRVO),the arteries and veins in the ethmoid plate of the optic disc are relatively crowded;however,a combination of the two is clinically uncommon.Herein,we reported a patient with NAION and concealed BRVO,for which the treatment and prognosis were not similar to those for NAION alone.CASE SUMMARY Herein,we report a case of NAION with concealed BRVO that did not improve with oral medication.A week later,we switched to intravenous drug administration to improve circulation,and the patient’s visual acuity and visual field recovered.Hormonal therapy was not administered throughout the study.This case suggested that:(1)Fundus fluorescein angiography(FFA)can help detect hidden BRVO along with the NAION diagnosis;(2)intravenous infusion of drugs to improve circulation has positive effects in treating such patients;and(3)NAION with concealed BRVO may not require systemic hormonal therapy,in contrast with the known treatment for simple NAION.CONCLUSION NAION may be associated with hidden BRVO,which can only be observed on FFA;intravenous therapy has proven effectiveness.
文摘Objective: To describe the clinical characteristics and clinical-anatomic correlations of homonymous hemianopia (HH). Background: Homonymous hemianopia impairs visual function and frequently precludes driving. Most knowledge of HH is based on relatively few cases with clinical-anatomic correlations. Methods: The authors reviewed medical records of all patients with HH seen in their service between 1989 and 2004. Demographic characteristics, characteristics of visual field defects, causes of visual field defects, neuroradiologic definition of lesion location, and associated neurologic deficits were recorded. Results: A total of 904 HH were found in 852 patients. A total of 340 HH (37.6%) were complete and 564 HH (62.4%) were incomplete. Homonymous quadrantanopia (264 HH, 29%) was the most common type of incomplete HH, followed by homonymous scotomatous defects (116 HH, 13.5%), partial HH (114 HH, 13%), and HH with macular sparing (66 HH, 7%). A total of 407 HH (45.0%) were isolated. Causes of HH included stroke (629 HH, 69.6%), trauma (123, 13.6%), tumor (102, 11.3%), brain surgery (22, 2.4%), demyelination (13, 1.4%), other rare causes (13, 1.4%), and unknown etiology (2, 0.2%). The lesions were most commonly located in the occipital lobes (45%) and the optic radiations (32.2%). Every type of HH, except for unilateral loss of temporal crescent and homonymous sectoranopia, was found in all lesion locations along the retrochiasmal visual pathways. Conclusion: Homonymous hemianopia is usually secondary to stroke, head trauma, and tumors. Although the characteristics of visual field defects can be helpful in lesion location, specific visual field defects do not always indicate specific brain locations.
文摘Background/aim: Fractionated stereotactic radiotherapy (FSRT) is a new treatment for brain tumours that are close to critical structures, such as the visual apparatus. This study aims to assess the visual outcomes for patients with parasellar meningioma following FSRT. Methods: A retrospective, non-comparative case series of 13 patients with parasellar meningiomas who were treated in one institution with FSRT between January 1995 and January 2001. Results: 13 patients (26 eyes) were followed for amean of 2 years. Visual acuity improved in four eyes (12.5% ), remained stable in 18 eyes (75% ), and worsened in three eyes (12.5% ). Visual field improved in 15 eyes (57% ), remained stable in six eyes (23% ), and worsened in four eyes (15% ). No adverse visual outcome occurred as a result of radiation. Conclusion: These preliminary findings suggest that FSRT is a safe and effective treatment for parasellar meningiomas.
文摘Background: Patients with prosopagnosia from occipitotemporal lesions have impaired perception of the configuration of facial features. This may be an example of impaired “within-object”spatial coding, which others propose to be distinct from “between-object”spatial coding. Objective: To determine whether the prosopagnosic deficit in perceiving spatial configuration was specific to within-face and not between-face spatial coding and whether the deficit was face-selective or extended to objects other than faces. Methods: Six prosopagnosic patients were tested using an oddity paradigm in which they detected which of three simultaneously seen stimuli was an altered target. In the “within-face”task, the target face had altered interocular distance or mouth position. In the “between-face”task, the target face was located farther away from the other two. In the “within-object”task, the stimulus was a two-dot pattern, and the target pattern had altered interdot distance. Results: Spatial judgments were impaired within faces for all six patients and within the two-dot pattern for five of six patients. However, all six had normal between-face spatial perception. Conclusions: Impaired perception of spatial relations in prosopagnosia is selective to the spatial structure within individual objects and spares the perception of spatial location of objects. It is not specific to faces. It reveals a process involved in analyzing object structure, consistent with the patients’deficits in recognizing facial identity, and illustrates a different type of “visuospatial”defect.
基金supported by Hospital Fundacion Nuestra Senora de la Luz,Private Assistance Institution.
文摘Background:Neuroinflammation is an essential event in Parkinson’s disease(PD).Identifying affordable and less invasive biomarkers to make an early diagnosis and monitor therapeutic strategies should be a priority among researchers.The study’s objective was to measure tear levels of cytokines in subjects with PD and their association with motor features and the presence of dry eye symptoms.Methods:A total of 16 subjects with PD and 16 age-and sex-matched controls were included.Movement Disorders Society-Unified Parkinson’s Disease Rating Scale(MDS-UPDRS),Hoehn and Yahr(HY)stage scale,Montreal Cognitive Assessment(MoCA),tear break-up time(TBUT),blink rate(BR),Dry Eye Questionnaire 5(DEQ-5)were examined,and pro-inflammatory cytokines[interleukin(IL)-1β,IL-6,IL-8,IL-10,IL-12p70 and tumor necrosis factor-alpha(TNF-α)]were quantified in tears using the BD Cytometric Bead Array Human Inflammatory Cytokine Kit.Results:Higher tear TNF-αwere quantified in PD compared to controls(2.94±3.95 vs.0.33±0.49 pg/mL,P=0.008).According to DEQ-5,50.0%(n=8)of PD subjects and 12.5%(n=2)controls had dry eye disease(DED).No differences were found in cytokines concentrations between PD patients with DED compared to those without DED.IL-8 was associated with the HY stage,TBUT,DEQ-5,and a better MoCA score.A higher BR correlated moderately with a lower HY stage(r=−0.645,P=0.007),and DED patients have lower BR in PD(12.14±2.54 vs.9.0±2.06 blinks/minute,P=0.031).Conclusions:PD patients have higher levels of TNF-αin tears than age-and sex-matched HC.IL-8 in tears may be both involved in the severity of the disease and in the development of DED in PD.In addition,our findings suggest that as HY stage increases,indicating a more advanced stage,BR decreases,indicating greater motor impairment.Conversely,the presence of DED is associated with higher levels of bradykinesia in PD patients,suggesting a potential relationship between DED and motor impairment severity.
文摘Background:Superficial temporal artery(STA)-middle cerebral artery(MCA)bypass surgery is now being widely used in moyamoya disease,and its therapeutic value in SICAO remains divergent.Methods:A systematic search was performed in PubMed,EMBASE,and Cochrane Databases in Feb.2020 and updated in Jun.2019.We have strict inclusion and exclusion criteria.Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs.Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT.For dichotomous variable outcomes,risk ratios(RRs)and 95%confidence intervals(95%CIs)were calculated for the assessment.Results:The total patient cohort consisted of 2419 patients,of whom 1188(49.1%)patients had been grouped in STA-MCA bypass and 1231(50.9%)patients had been divided into the BMT group.Mean follow-up of included patients was 29 months.The RR of the seven studies was 1.01,and the 95%confidence interval was.89–1.15,with statistical significance,Z=.13,P=.89,sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease.Conclusions:STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke.And the risk of long-term overall stroke was mildly higher with BMT.At present,each patient should receive more precise treatment,by reasonably assessing the individual differences of each patient to reduce the recurrence rate of stroke.
文摘一名24岁女性,在经历了短暂的意识丧失之后来到急诊,被诊断为惊恐发作并出院。2天后,因头痛加剧和视觉障碍,她被再次送回医院进行进一步的检查。第3天行头颅计算机断层扫描及静脉造影成像采集,结果均正帯。在第7天,她进行了腰椎穿刺,脑脊液开放压力为70 cm CSFo第8天,眼底镜检查发现视乳头水肿。最佳矫正视力下降至双眼6/24,同时面对面检查双眼周边视野缺损。她被诊断为暴发性原发颅内高压症,并转到神经科学中心,第9天在那里急诊行了腰椎腹膜分流术。术后2周,双眼视力提高到6/9。
