Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
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Review Case Reports
Positive apraclonidine test 36 hours after acute onset of horner syndrome in dorsolateral pontomedullary stroke.
A 40-year-old man developed a Horner syndrome as part of a dorsolateral medullary brainstem infarction. Thirty-six hours after the onset of the stroke, topical instillation of 0.5% apraclonidine produced reversal of anisocoria. This is the first case in which apraclonidine testing has been applied to a patient with a Horner syndrome caused by a lesion in the first segment of the oculosympathetic pathway and the shortest reported interval between clinical manifestations of the lesion and apraclonidine-induced reversal of anisocoria. A review of all reported cases of apraclonidine testing in Horner syndrome suggests that this is a promising diagnostic adjunct that must be validated in larger studies.
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Letter Case Reports
Opsoclonus caused by diphenhydramine self-poisoning.
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Case Reports
Restricted diffusion in the superior ophthalmic vein and cavernous sinus in a case of cavernous sinus thrombosis.
A previously healthy 14-year-old boy developed headache, stiff neck, fever, diplopia, right proptosis, and right complete sixth and partial third cranial nerve palsies. Orbital CT showed features of pansinusitis and orbital fat stranding. An initial diagnosis of orbital cellulitis was made. ⋯ CT venography (CTV) confirmed these features and disclosed nonobstructing thrombus within the left sigmoid sinus and proximal segments of both internal jugular veins. MRI with diffusion imaging disclosed evidence of restricted diffusion within the SOV and cavernous sinuses. These diffusion imaging findings, which may be analogous to those reported with brain parenchymal hematoma, have been described sparingly in intravascular hematoma.
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Endovascular occlusion via the transvenous route is the favored treatment method for dural carotid-cavernous fistulas (CCFs). Ethylene vinyl alcohol copolymer (Onyx), recently approved for treatment of arteriovenous malformations, has advantages over conventional liquid embolic agents in its nonadhesive nature, which allows for longer injections with decreased risk of catheter retention. We report the use of Onyx in the successful transarterial embolization of a dural CCF fed by arterial branches of the internal and external carotid arteries (Barrow type D) after multiple failed attempts to access the cavernous sinus transvenously. Transarterial Onyx embolization could be a valuable option in transarterial treatment of CCFs when venous access is difficult.
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A 55-year-old man developed bilateral posterior ischemic optic neuropathy after prolonged prone position lumbar laminectomy. Brain MRI performed 19 hours after the procedure revealed markedly dilated superior ophthalmic veins, a finding that had disappeared on a comparable study performed 5 months later. This first report of dilated superior ophthalmic veins present in the immediate postoperative period but not later may be important in suggesting that an increase in orbital venous pressure during surgery contributes to the development of postoperative posterior ischemic optic neuropathy (PION).