Kirsi Setälä

Wernicke's encephalopathy: is diffusion-weighted MRI useful?

We present the clinical and magnetic resonance imaging (MRI) findings of five patients with acute Wernickes encephalopathy. T2-weighted and fluid-attenuated inversion recovery (FLAIR) images demonstrated symmetrical hyperintense lesions within the dorsomedial thalami, periaqueductal white matter, and the tectum of the midbrain. None of the lesions enhanced with gadolinium. In addition to conventional MRI sequences, we performed diffusion-weighted imaging (DWI). In all patients, DWI showed symmetrical pathologic thalamic and midbrain signal hyperintensities more distinctly than did conventional T2-weighted or FLAIR sequences. The apparent diffusion coefficient (ADC) map images showed slight signal reductions in four patients, suggesting restricted diffusion within these regions. In one patient, the signal intensity within the affected thalami was isointense with the ipsilateral basal ganglia on ADC map images. For enhanced detection of pathology, we conclude that DWI should be included in the imaging protocols of patients suspected to suffer from Wernickes encephalopathy.

Outcome of fractionated stereotactic radiotherapy in patients with pituitary adenomas resistant to conventional treatments: a 5·25‐year follow‐up study

Objectiveu2002 To investigate the long‐term outcome of fractionated stereotactic radiotherapy (FSRT) [45u2003Gy (range 45–54) in 25 fractions] in patients with pituitary adenomas characterized by tumour progression or hormonally active disease despite surgery and/or medical therapy.

Neuroimaging supports the clinical diagnosis of methanol poisoning

Abstract. In addition to visual loss, methanol intoxication can cause brain damage that is revealed by neuroimaging. We report on a 34-year-old man whose visual acuity deteriorated dramatically during his journey round the world, shortly after an evening with excessive alcohol consumption. Two months after the start of visual disturbances he returned to Finland. At examination, poor visual acuity and glaucomatously cupped pale optic discs were detected. The history and clinical findings indicated possible methanol intoxication, which was supported by both CT and MRI. The MRI findings are discussed in the light of the MRI appearance of the pallidum nuclei among patients of different age groups.

Effects of experimental exposure to triethylamine on vision and the eye.

OBJECTIVES: To determine the effect of triethylamine (TEA) on the cornea and to evaluate the cause of blurred vision. To find the lowest observed effect concentration of exposure to TEA. METHODS: Four people were exposed to TEA for 4 hours at concentrations of 40.6, 6.5, and 3.0 mg/m3. Before and after every exposure, symptoms and ocular microscopy findings were recorded. Binocular visual acuity and contrast sensitivity at 2.5% contrast were also measured. Also, before and after the 40.6 mg/m3 exposure, corneal thickness was measured and ocular dimensions were recorded by ultrasonography, endothelial cells of the cornea were analysed, and serum and lacrimal specimens were collected for the analysis of TEA. RESULTS: After exposure to 40.6 mg/m3 TEA there was a marked oedema in the corneal epithelium and subepithelial microcysts. However, corneal thickness increased only minimally because of the epithelial oedema. The lacrimal concentrations of TEA were, on average (range) 41 (18-83) times higher than the serum TEA concentrations. The vision was blurred in all subjects and visual acuity and contrast sensitivity had decreased in three of the four subjects. After exposure to TEA at 6.5 mg/m3 two subjects experienced symptoms, and contrast sensitivity had decreased in three of the four subjects. There were no symptoms or decreases in contrast sensitivity after exposure to a TEA concentration of 3.0 mg/m3. CONCLUSIONS: TEA caused a marked oedema and microcysts in corneal epithelium but only minor increases in corneal thickness. The effects may be mediated by the lacrimal fluid owing to its high TEA concentration. Four hour exposure to a TEA concentration of 3.0 mg/m3 seemed to cause no effects, whereas exposure to 6.5 mg/m3 for the same period caused blurred vision and a decrease in contrast sensitivity.

Silicone oil in retinal detachment surgery. Results and complications.

Abstract Results and complications with the use of intraocular silicone oil in 25 eyes operated on for complicated retinal detachment are reported. Most eyes had undergone several operations for detachment before silicone injection. The follow‐up time after silicone injection was 12–48 months. In perforating injuries the outcome was quite poor, 27% received anatomic success (attached retina) compared to primary rhegmatogenous detachments with 57% success rate. Visual acuity was counting fingers 1 m or better in 56% in the whole group examined. Silicone oil was removed in 5 eyes. Of the late complications, keratopathy occurred in 3 eyes (12%), increased intraocular pressure in 4 eyes (16%), and cataract in 2 of 3 phakic eyes. Angiographic signs of iris neovascularization were obvious or suspected in 3 of 9 eyes examined.

Efficacy and safety of orbital decompression in treatment of thyroid-associated ophthalmopathy: long-term follow-up of 78 patients.

Objectiveu2002 To study the long‐term results of decompression surgery in patients with thyroid‐associated ophthalmopathy (TAO).

Comparison of CT and clinical findings of Terson's syndrome in 121 patients: a 1-year prospective study

OBJECTnTersons syndrome (TS) is a vitreous hemorrhage in association with subarachnoid hemorrhage (SAH). Its diagnosis is often delayed, which may result in vision loss secondary to treatable conditions. Methods to hasten early diagnosis and consequent ophthalmic referral are desirable. The aims of this study were 1) to assess the specificity and sensitivity of conventional head CT for diagnosing TS in patients with aneurysmal SAH (aSAH); and 2) to determine the incidence of TS and its association with age, sex, aSAH severity, and overall mortality.nnnMETHODSnPatients admitted to Helsinki University Central Hospital who underwent surgery or endovascular treatment for a ruptured intracranial aneurysm during 2011 were participants in this prospective study. They underwent serial dilated fundoscopic examinations during a 6-month period. Two radiologists independently reviewed ocular findings suggestive of TS on conventional CT head scans obtained in all patients as a routine diagnostic procedure. Associations between TS and relevant clinical, radiological, and demographic data were analyzed with uni- and multivariate logistic regression.nnnRESULTSnOf 121 participants, 13 (11%) presented with TS, and another 22 (18%) with intraretinal hemorrhages. For reviewing CT head scans, the overall observed agreement between the 2 raters was 96% (116 of 121 cases), with a substantial κ of 0.69 (95% CI 0.56-0.82). The sensitivity of the CT findings for TS was 42%, and the specificity was 97%. Associations of the World Federation of Neurosurgical Societies (WFNS) and Hunt and Hess grades on admission, the presence of intracerebral hemorrhage, female sex, and aneurysm length with TS were all statistically significant. Logistic regression demonstrated that sex and WFNS grade were independently associated with TS and provided the best fit to the data.nnnCONCLUSIONSnRoutinely looking for TS findings in CT head scans may prove valuable in clinical practice. Tersons syndrome is associated with female sex and poor clinical condition on admission.

Long-term visual outcome after microsurgical removal of occipital lobe cavernomas

OBJECTnCavernomas in the occipital lobe are relatively rare. Because of the proximity to the visual cortex and incoming subcortical tracts, microsurgical removal of occipital cavernomas may be associated with a risk of visual field defects. The goal of the study was to analyze long-term outcome after operative treatment of occipital cavernomas with special emphasis on visual outcome.nnnMETHODSnOf the 390 consecutive patients with cavernomas who were treated at Helsinki University Central Hospital between 1980 and 2011, 19 (5%) had occipital cavernomas. Sixteen patients (4%) were surgically treated and are included in this study. The median age was 39 years (range 3-59 years). Seven patients (56%) suffered from hemorrhage preoperatively, 5 (31%) presented with visual field deficits, 11 (69%) suffered from seizures, and 4 (25%) had multiple cavernomas. Surgery was indicated for progressive neurological deterioration. The median follow-up after surgery was 5.25 years (range 0.5-14 years).nnnRESULTSnAll patients underwent thorough neuroophthalmological assessment to determine visual outcome after surgery. Visual fields were classified as normal, mild homonymous visual field loss (not disturbing the patient, driving allowed), moderate homonymous visual field loss (disturbing the patient, driving prohibited), and severe visual field loss (total homonymous hemianopia or total homonymous quadrantanopia). At the last follow-up, 4 patients (25%) had normal visual fields, 6 (38%) had a mild visual field deficit, 1 (6%) complained of moderate visual field impairment, and 5 (31%) had severe homonymous visual field loss. Cavernomas seated deeper than 2 cm from the pial surface carried a 4.4-fold risk of postoperative visual field deficit relative to superficial ones (p = 0.034). Six (55%) of the 11 patients presenting with seizures were seizure-free postoperatively. Eleven (69%) of 16 patients had no disability during the long-term follow-up.nnnCONCLUSIONSnSurgical removal of occipital cavernomas may carry a significant risk of postoperative visual field deficit, and the risk is even higher for deeper lesions. Seizure outcome after removal of these cavernomas appeared to be worse than that after removal in other supratentorial locations. This should be taken into account during preoperative planning.

Trabeculectomy with the use of sodium hyaluronate. One year follow-up.

Abstract The effect of sodium hyaluronate (Healon) on the post‐operative course 1 week, 1 month and 1 year after trabeculectomy is reported. Forty‐six eyes of 38 patients with open‐angle glaucoma (16 simple, 16 capsular and 14 secondary glaucomas) were operated with the use of sodium hyaluronate. The study was prospective. For comparison, 46 eyes of 38 age‐, sex‐and diagnosis‐matched patients with glaucoma operated during the pre‐Healon period were selected. Patients in the study group were operated by the same surgeon and in the control group by different senior staff members. IOP decrease was essentially the same in both groups. No differences in post‐operative pressure level existed between the different types of glaucoma. Extremely shallow or flat chamber occurred more frequently in the control series: 15 versus 9. Statistical analysis could not be applied. The trend in favour of Healon is discussed. Pressure rise ≥ 30 ramHg 2–7 days after the operation was diagnosed in 8 eyes of the Healon group and 13 eyes of the control group. IOP rise was relieved by argon laser treatment of the fistula during the first week post‐operatively in 6/8 eyes of the Healon group in order to facilitate aqueous drainage. Sodium hyaluronate facilitated the technical performance and prevented collapse of anterior chamber and AC haemorrhages during the operation. Sodium hyaluronate seems to prevent excessive early filtration and hypotony. After follow‐up of one year, 7 patients in the control series and 4 in Healon series had progression of cataract. Two of the patients in the control‐group needed cataract operation during the follow‐up period. A definite conclusion in favour of Healon has to be verified.

Neuromyelitis optica and aquaporin-4 (AQP4) autoantibodies in consecutive optic neuritis patients in Southern Finland

Purpose:u2002 To analyse the frequency of neuromyelitis optica (NMO) among consecutive optic neuritis (ON) patients in Southern Finland and the feasibility of Aquaporin‐4 (AQP4) autoantibody assay in the diagnosis of NMO.