Martin P. Kolsky

Positional vertigo and the cerebellar vermis

A patient with lower and posterior vermis hematoma presented with truncal ataxia; paroxysmal, positional, downbeating nystagmus; and saccade dysmetria. Drainage of the hematoma resulted in complete resolution of all signs and symptoms.

Anterior ischemic optic neuropathy in Churg-Strauss syndrome.

A patient with a history of chronic rhinitis, sinusitis, and bronchial asthma developed a unilateral anterior ischemic optic neuropathy and a mild sensory motor neuropathy as the initial manifestation of systemic vasculitis. We made a probable diagnosis of Churg-Strauss syndrome. Fluorescein angiography showed delayed choroidal perfusion in both eyes. Marked eosinophilia, increased sedimentation rate, and elevated perinuclear anti-neutrophil cytoplasmic antibody and anti-myeloperoxidase antibody titers were the main laboratory abnormalities that supported this diagnosis. Therapy with high-dose methylprednisolone and cyclophosphamide may have preserved vision in the better seeing eye, improved its choroidal circulation, and reversed the laboratory abnormalities except for a mild persistent eosinophilia. The neuropathy is gradually improving.

Temporal Arteritis in Blacks

Excerpt Temporal arteritis is considered rare in blacks. In 1977, Healy and Wilske (1) noted that whites had a strong predilection for giant cell arteritis and polymyalgia rheumatica and that no ca...

Bilateral Orbital Involvement in Fatal Giant Cell Polymyositis

The case of a young woman with giant cell polymyositis is described. She had bilateral, severe, midly painful proptosis and ophthalmoplegia. Extensive pharyngeal, laryngeal, and cardiac muscle involvement occurred 18 months later coincident with fatal cardiac arrhythmia. At autopsy, extensive muscle necrosis and giant cells were noted in extraocular, pharyngeal, laryngeal, and cardiac muscle with only minimal involvement of other striated muscles.

Metastatic Prostate Cancer to the Optic Canal

PURPOSE Optic neuropathies represent a common cause of blindness among patients with cancer. The authors present the clinical and imaging findings and discuss the management of optic nerve involvement from metastatic prostate cancer to the optic canal. METHODS Five patients with advanced metastatic prostate cancer had visual loss. Neuro-ophthalmologic examination and pre- and post-gadolinium orbital and brain magnetic resonance imaging (MRI) were performed. Compressive optic neuropathy secondary to extensive optic canal involvement was demonstrated in all of the patients. Neuropathologic examination was accomplished in two cases. A combination of steroid and focal radiation therapy was used for treatment in four patients. RESULTS Imaging and neuropathologic findings demonstrated a compressive optic neuropathy secondary to both epidural metastases and to deformity and hypertrophy of the optic canal due to metastatic cancer. Treatment was of benefit in three cases. CONCLUSION Acute and subacute unilateral or bilateral optic neuropathy in patients with prostate cancer may be the result of optic canal metastases. Magnetic resonance imaging shows a characteristic pattern of bone hypertrophy and deformity with optic nerve compression. Early combination steroid and radiation therapy may induce long-lasting improvement.

Computed tomography in patients with homonymous visual field defects—A. Clinico-radiologic correlation

Abstract CT Scans were obtained in 39 patients with homonymous visual field defects and analyzed in conjunction with the results of neurologic and neuro-ophthalmologic examination. Nineteen patients had infarcts involving the optic radiations or the occipital lobes. The CT scan findings correlated with the age, size and location of the infarct. Large hemispheric infarcts were associated with dense homonymous hemianopsias. Six patients in this series had primary or metastasic neoplasm, CT again demonstrated a close correlation between the location of the lesions and the resulting field defects. Six patients had arterio-venous malformations of the occipital lobe. In three of them, CT scans identified an occipital lobe hematoma and separated these patients from those with cerebral infarction.

Unilateral Optic Neuritis Caused by Histoplasma capsulatum in a Patient With the Acquired Immunodeficiency Syndrome

PURPOSE To evaluate the potential of Histoplasma capsulatum to cause optic neuritis in the setting of the acquired immunodeficiency syndrome (AIDS). METHODS We examined a 35-year-old man with a history of AIDS and disseminated histoplasmosis who developed a unilateral progressive optic neuritis of enigmatic origin. An optic nerve sheath biopsy was performed to provide a tissue diagnosis. RESULTS Histoplasma capsulatum was identified in both the optic nerve sheath and fungal culture. CONCLUSION Histoplasma capsulatum should be considered in the differential diagnosis of optic neuritis in patients with AIDS, even in the absence of chorioretinal findings.

Cortical blindness and occipital lobe seizures induced by cis-platinum

Three patients developed occipital lobe seizures as a manifestation of diaminodichloro platinum (DDP) toxicity. They were characterized in two patients by cortical blindness, ictal nystagmus and a confusional state. The third patient had visual hallucinations followed by grand mal seizures. All the abnormalities in these patients responded to anticonvulsant therapy.