Riri S. Manor

Uremic Optic Neuropathy

A 41-year-old male patient in end-stage renal failure presented on two occasions, over an 18-month period, with painless unilateral visual deterioration and optic disc edema. Clinical findings were compatible with a diagnosis of uremic optic neuropathy. On his initial presentation, the patient refused the onset of dialysis, resulting in a permanent visual deficit of the left eye. On his subsequent admission with a similar clinical picture, this time of the right eye, dialysis combined with corticosteroid therapy was promptly instituted. This led to a rapid improvement of the visual acuity and visual field defects of the right eye concomitant with subsidence of the edema of the optic nerve head.

Amaurosis fugax at downward gaze

A 54-year-old man with a past history of hypertension, diabetes mellitus, hypercholesterolemia and two myocardial infarctions presented with repeated attacks of amaurosis fugax in the right eye. The fact that the amaurosis occurred only on downward gaze is sufficient evidence to exclude carotid atheromatous disease and to imply an orbital etiology.

Pituitary apoplexy during carotid angiography

SummaryA case is described of pituitary apoplexy and consequent blindness during carotid angiography. The possibility of haemorrhage from the fragile pathological vessels of the tumour due to an increase in pressure in the carotid system during angiography is discussed.

Retinal Red-Free Light Photographs in Two Congenital Conditions: A Case of Optic Hypoplasia and a Case of Congenital Hemianopia

Two patients with congenital anomalies involving the optic pathways are described. The first case presented a unilateral hypoplastic optic nerve as well as an ipsilateral inferior conus and an elevated disc. The second case showed the features of homonymous hemianopia with sparing of the macula and decreased visual acuity on the side of the affected cerebral hemisphere. Red-free photographs were obtained in both cases. The importance of this old-new investigative tool in completing a neuro-ophthalmological study is stressed.

Reading-evoked Visual Dimming

PURPOSE To carry out a neuroradiologic investigation in a monocular 49-year-old patient who during the past five years described symptoms of dimming of central vision in his left eye, which was provoked only by reading. METHODS Computed tomography and magnetic resonance imaging were performed. RESULTS An orbital apex intraconal tumor situated laterally to and above the optic nerve was found. CONCLUSIONS Reading-evoked visual dimming can be a variant of gaze-evoked amaurosis. The optic nerve displaced laterally and superiorly, and stretched by the act of reading, may be compressed between the tumor above and the contracted inferior rectus muscle inferiorly.

Presumed post-myelography migraine-like phenomena

Severe attacks of migraine-like headache appeared in two patients at the age of 30 years and in one patient at the age of 49 years without any history of migraine in their family. A permanent homonymous field defect was left in two of them.The common denominator of these three patients was the presence of pantopaque drops in the basal cisterns following myelography. This condition suggested the possibility of the development of an allergic/toxic reaction in certain patients after contrast myelography leading to a chronic inflammatory arachnoideal process.

Narrow-Band (540-nm) Green-Light Stereoscopic Photography of the Surface Details of the Peripapillary Retina

We used narrow-band (540-nm) green-light stereoscopic fundus photography to study the surface details of the peripapillary retina in 14 patients. Each photograph was divided into four areas; the papillomacular bundle, the upper arcuate bundle, the lower arcuate bundle, and the nasal sectorial fibers. We scored each area on a scale of 0 (normal) to 3 (total loss of nerve fiber layer), and compared these scores to those obtained by testing the corresponding visual fields. The scores were the same in 88 of 111 comparisons; the retinal scores were higher in 17 comparisons and the visual field scores were higher in six comparisons. This photographic technique makes the nerve fiber layer easier to see and evaluate and the detection of defects becomes less difficult.

Treatment of Idiopathic Orbital Inflammatory Disease with Cyclosporine-A: A Case Presentation

We present a case of idiopathic orbital inflammatory disease that was responded favorably to low-dose cyclosporine-A.

Diencephalic Syndrome Due to a Suprasellar Epidermoid Cyst

A 5-year-old child with the unusual association of late-onset diencephalic cachexia and pituitary insufficiency is described. At operation a suprasellar epidermoid cyst was found and excised. This curable tumor should be added in the differential diagnosis of diencephalic syndrome.

Entopic Phenomena in Pregeniculate and Postgeniculate Hemianopsia with Splitting of Macula by Perimetry

With splitting of macula by perimetry, the entopic phenomena (the perception of ones own foveal xanthophilic pigment and macular vessel leukocytes) were utilized to study the character of macular sparing or splitting in patients with pregeniculate or postgeniculate hemianopsia. In the pregeniculate group, 11 of 14 eyes perceived the Haidinger brushes figure as a half circle corresponding to the perimetric macular splitting, whereas flying corpuscles were not perceived at all or were less numerous on the hemianoptic side than on the normal field side. In contrast, six of seven patients with postgeniculate lesions perceived the Haidinger brushes figure as a complete circle, four of six perceived fewer flying corpuscles on the hemianoptic side than on the normal field side, and two patients reported perceiving an equal number in all quadrants. This study indicated that in pregeniculate hemianopsia there is usually a true splitting of the macula, whereas in postgeniculate hemianopsia, there is some macular sparing even when perimetry shows macular splitting.