Vikas Kanaujia

Metastatic tumor of orbit presenting as pulsatile proptosis

Pulsatile proptosis is caused by vascular lesion of orbit or by herniation of brain through bony defect in orbit. Pulsatile proptosis secondary to a metastatic tumor of orbit is very uncommon. We report a 69-year-old male who presented with pulsatile proptosis owing to metastasis of an asymptomatic renal cell carcinoma.

Metastasis to Optic Nerve Presenting as Ill-fitting Prosthesis

We report a rare case of metastatic adenocarcinoma of lung in anophthalmic socket, which presented as painful and difficult prosthetic wear long after an uneventful enucleation. Bulge in the socket indicated amputation neuroma, a rarity in itself; but further evaluation concealed a yet silent pulmonary mass. No case report so far describes metastatic mass in an anophthalmic socket and we describe first case of unknown lung malignancy presenting as ill-fitting prosthesis.

A case report of rim enhancing lesion at the orbital apex

ABSTRACT We report a case of partial third nerve palsy resulting from a cystic lesion located at the orbital apex. Imaging was suggestive of cystic schwanomma but histopathology of the lesion confirmed epidermoid cyst, which is a rare tumour of the orbit.

Inferior petrosal sinus route microcatheterization study and embolization for primary orbital varix.

Purpose Primary orbital varix is a rare lesion but difficult to treat. Our main aim was to demonstrate the varices and their central venous communication and to explore the feasibility of embolization of these lesions. Method In four patients with clinical suspicion of varix, in whom MRI showed retro-global vascular channels, microcatheter digital subtraction angiography (DSA) of the varices was performed using femoral venous access. Embolization was carried out in two patients. Results In all four patients orbital varices could be accessed with a microcatheter through inferior petrosal sinus and ophthalmic vein (superior or inferior) route. Microcatheter angiography showed opacification of varices and demonstrated their central venous communication. Two patients were treated with coil embolization. Complete resolution of symptoms was seen in one patient and partial relief in the other. Conclusion The study presents microcatheterization of orbital varices via the inferior petrosal sinus–cavernous sinus–ophthalmic vein route with injections into distal ophthalmic veins for demonstration of these variceal sacs and their central venous connection. Coiling to disconnect the venous communication should be the primary goal of embolization.

Monocular visual loss due to herniation of gyrus rectus: A case report with review of literature.

The authors present an unusual case of a polar mass in the frontal lobe of the brain, causing acute monocular visual loss in a 50-year-old woman with history of breast carcinoma treated with surgery, radiation and chemotherapy. Neuroimaging demonstrated herniation of the gyrus rectus into the suprasellar cistern resulting in compression of the anterior visual pathway.

Carotid-Cavernous Fistula: Natural history and Clinical Profile

Purpose: To evaluate the presentation, clinical course and outcome of carotid-cavernous fistula (CCF) cases with endovascular treatment in our institution during the last 10 years. Methods: It is a prospective, protocol- based study of 45 consecutive cases who had presented in our Neuro-ophthalmology department from 2005 to 2015. Detailed history and complete neuro-ophthalmic examination along with relevant investigations and treatment was done. The patients were followed up immediately after the procedure and at three monthly intervals for one year and then yearly. Results: In our study the age range is from 3 to 63 years. Of the total 45 cases 42 had direct CCF while 3 cases were of dural CCF . Orbital and neuro-ophthalmological symptoms and signs were most common clinical presentation at diagnosis. All the cases but one responded well to transfemoral balloon/coil embolization in our institute Conclusion: CCF mostly have classical presentation but few cases can cause a diagnostic dilemma and so the ophthalmologist have to be observant about the disease. Early diagnosis results into least morbidity. Timely intervention with endovascular coiling results in successful closure of the fistula .

Intraocular pressure and its correlation with midnight plasma cortisol level in Cushing's disease and other endogenous Cushing's syndrome

Purpose: The purpose of this study is to measure intraocular pressure (IOP) and evaluate the correlation between IOP and midnight plasma cortisol (MPC) level in patients with Cushings disease (CD) and other endogenous Cushings syndrome (ECS). Methods: This is a cross-sectional study from a single center including newly diagnosed patients with CD or ECS. All patients underwent detailed ophthalmological evaluation. IOP was measured by Goldmann applanation tonometry in the morning and evening on two consecutive days. MPC value was obtained for each patient. The data were compared using paired and unpaired t-test, Mann–Whitney U-test, and Spearmans rank correlation coefficient. Results: Among 32 patients, 22 were CD (68.75%) and 10 patients were other ECS (31.25%). A total of 25 patients (78.12%) in our study group had normal IOP (<22 mmHg), and seven patients (21.88%) had increased IOP (≥22 mmHg). The percentage of patients with normal IOP was found to be significantly higher compared to percentage of patients with high IOP (P = 0.001) using one-sample Chi-square test. Mean MPC value was 468.6 ± 388.3 nmol/L in patients having IOP ≥22 mmHg and 658.5 ± 584 nmol/L in those with IOP <22 mmHg from both CD and ECS groups, but the difference was not statistically significant. No correlation was found between IOP and MPC (Spearmans rank correlation rho = −0.16 [P = 0.38]). Conclusion: In CD and ECS patients, IOP elevation is an uncommon feature, and high IOP in either group does not correlate with MPC level.

Orbital Metastasis An Analysis of Nine Cases And Review of Literature

Aim: To analyze nine cases of orbital metastasis with review the literature for incidence, presentation, evaluation and discuss their multidisciplinary management. Materials and Methods: Retrospective study of nine patients between Jan 2012March 2015 Results: Out of nine consecutive patients with orbital metastasis treated in three year at the department of neurosurgery and neuro-ophthalmology, six patients (75%) were 60 years or older and two were less than 60 years at diagnosis. M: F ratio was 2:1 (M=6, F=3). These patients presented with proptosis in eight (88.8%), pain in four (44.4%), restriction of eye movement in six (66.6%) patients and vision loss in two (22.2%). All these patients presented primarily with orbital symptoms without known primary tumor. Metastatic adeno carcinoma (n=4) was most common histology followed by adenoid cystic carcinoma of salivary gland (n=2), malignant lymphoma, papillary carcinoma of thyroid and malignant osteosarcoma was present in 1 patient each.Over a mean follow-up of eighteen months, seven (77.7%) patients had orbital wall metastasis related systemic involvement and one case (11.1 %) remained free of systemic involvement after chemo. for lymphoma. Three (33.3%) patients had recurrence following surgery within six months. Conclusions: Orbital metastasis is rare and in 1/3 of patients presents as initial presentation with unknown primary. Gastro-intestinal tract, lungs, breast and kidney are most common cancers frequently metastases to orbit. Management of orbital metastasis depends on the outcome of primary disease and overall clinical condition of the patient. The prognosis of these tumors is variable depending on the tissue diagnosis.