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Show LITERATURE ABSTRACTS 55 Bilateral Optic Nerve Sheath Enlargement. Wojno T, Beck RW, Grosserode R. Ophthalmic Surg 1986;17:584-8 (Sept). [Reprint requests to Ted Wojno, M.D., The Emory Eye Center, Department of Ophthalmology, Emory University School of Medicine, 1327 Clifton Road, N.E., Atlanta, GA 30322.] A 43-year-old man is described who had progressive visual loss over 3 months, to the level of 20/200. Extensive work-up including spinal tap revealed only enlarged optic nerves on orbital computerized tomographic scanning. No magnetic resonance scanning was performed. Vision deteriorated further to his being able to count fingers at several feet with the right eye and at one foot with the left eye. Left orbitotomy was performed, which revealed a distended optic nerve sheath. When the sheath was incised, clear colorless fluid gushed out. A biopsy of the nerve showed normal tissue (no atrophy). Optic nerve sheath decompression on the right revealed similar findings. Postoperatively, he could count fingers at three feet with the right eye and had no light perception in the left eye. There was no improvement over time. The authors postulate that their case, without observable disc edema, is similar to other described cases of monocular disc edema with visual loss. Although interesting, this case report is somewhat troubling as one cannot be sure that visualloss was truly secondary to the suboptic nerve sheath fluid in the first place. Lyn A. Sedwick, M.D. Optic Atrophy in Familial Dysautonomia. Rizzo JF III, Lessell S, Liebman SO. Am J Ophthalmol 1986;102:463-7 (Oct). [Reprint requests to Joseph F. Rizzo III, M.D., Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114.] Three patients with familial dysautonomia were examined at various times in their lives and found to have progressive visual loss attributable to optic atrophy. One patient had inferior corneal lesions, but all three had clear visual axes. Cranial computerized tomographic and magnetic resonance scanning were each normal in one patient. The authors find an association between familial dysautonomia and optic atrophy cited only once before in the literature. They speculate that optic atrophy is evidence of central nervous system involvement in this disease and that such atrophy may not often be appreciated because of the short life span of patients with this disorder (74% mortality by age 20). Lyn A. Sedwick, M.D. Ocular Neuromyotonia. Shults WT, Hoyt WF, Behrens M, MacLean J, Saul RF, Corbett JJ. Arch Ophthalmol 1986;104:1028-34 (July). [Reprint requests to W. Thomas Shults, M.D., Oregon Lions Sight and Hearing Institute, Neurological Sciences Center, Good Samaritan Hospital, 1040 N.W. 22nd, Portland, OR 97210.] Six very interesting patients are presented who exhibit what these authors believe to be ocular neuromyotonia, i.e., "episodic involuntary discharge of ocular motor nerves producing sustained and inappropriate contraction of their respective ocular muscles." Four patients had third nerve episodes and one each had fourth and sixth nerve episodes. Four of six had previous radiation therapy for pituitary tumors and three patients improved with carbamazepine therapy. The thought-provoking discussion section likens this disorder to superior oblique myokymia and contrasts it to ocular motor paresis with cyclical spasm. This is a paper well worth reading in its entirety. Lyn A. Sedwick, M.D. Neoplastic Angioendotheliomatosis. Elner VM, Hidayat AA, Charles NC, Davitz MA, Smith ME, Burgess 0, Dawson N. Ophthalmology 1986;93: 1237-45 (Sept). [Reprint requests to Ahmed A. Hidayat, M.D., Department of Ophthalmic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.] Three patients are described with this rare disease, each of whom had vitreous and retinal ocular abnormalities. In only one patient was the diagnosis made ante mortem from a skin biopsy. This bizarre disease is nicely discussed and christened "a peculiar extranodallarge cell lymphoma" by these authors. Lyn A. Sedwick, M.D. JClill Neuro-Ol'hthlllmol. Vol. 7. No. ], ]987 |