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Show LITERATURE ABSTRACTS 115 head nodding; (3) anomalous head position; and (4) absence of afferent pupillary defect, vertical nystagmus, optic nerve abnormality, or any systemic neurologic finding." They argue that computerized tomographic scans are not necessary in this group of patients even though recent literature encourages obtaining scans of all such patients. They unfortunately left out one important recent paper regarding this entity ("Leigh's Subacute Necrotizing Encephalomyalopathy Manifesting as Spasmus Nutans," Sedwick, Burde, and Hodges, Arch Ophthalmol 1984;102:1046-8 [!]) but their conclusions seem valid as long as their diagnostic criteria are strictly met, and to do so may require consultation with a neurologist. In the current medical-legal climate, it seems prudent to scan rather liberally and, if a scan is not deemed necessary, to document completely how the diagnostic criteria were met. Lyn A. Sedwick, M.D. Sphenoid Ridge Meningioma Masquerading as Graves' Orbitopathy. Reifler OM, Holtzman JN, Ringel OM. Arch Ophthalmol 1986;104:1591 (Nov). [No reprint information given.] A 42-year-old woman with mild unilateral proptosis and slow visual loss in the same eye was believed to have thyroid eye disease based on a noncontrasted computerized tomographic scan of the orbits showing an apparently enlarged superior rectus-levator complex. (The patient had a severe dye allergy.) Thyroid function testing showed normal results. Oral corticosteroids and orbital decompression resulted in no improvement of vision, but a subsequent tomographic scan drew attention to changes in the sphenoid ridge consistent with meningioma. This was proven histopathologically and treated with radiation therapy without change in the vision. One suspects that other signs of thyroid ophthalmopathy -lid retraction, lid lag, periocular edema- were not present, as they are not mentioned. This case report is interesting because of the initial computerized tomographic scan, which is striking for what looks like superior muscle enlargement and extremely subtle adjacent bony changes suggestive of meningioma. Lyn A. Sedwick, M.D. Blepharoptosis Associated With Giant Papillary Conjunctivitis. Luxenberg MN. Arch Ophthalmol 1986;104:1706 (Nov). [No reprint information given.] The pictures in this photo essay are worth all the words of the article. A 9-year-old girl with a prosthetic eye had haq. total ptosis for one year. When her giant papillary conjunctivitis was treated with cromolyn, the ptosis resolved. Lyn A. Sedwick, M.D. Oscillopsia Associated With Eyelid Myokymia. Krohel GB, Rosenberg PN. Am J Ophthalmol 1986;102:662-3 (Nov). [Inquiries to Dr. P. Rosenberg, Albany Medical College, Department of Ophthalmology, New Scotland Ave., Albany, NY 12208.] This letter concerns oscillopsia induced by eyelid myokymia or fasciculations. In two patients, both ophthalmologists, oscillopsia was relieved when the offending eyelid was pulled away from the eye. The authors suggested reassurance and lowering stress or caffeine ingestion to alleviate the eyelid movement, and recommended no neurodiagnostic workup for this benign condition. Lyn A. Sedwick, M.D. Maculopathy Associated With Combination Chemotherapy and Osmotic Opening of the BloodBrain Barrier", Millay RH, Klein ML, Shults WT, Dahlborg SA, Neuwelt EA. Am J Ophthalmol 1986;102:626-32 (Nov). [Reprint requests to Dr. M. Klein, Department of Ophthalmology, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97201.] Eleven patients treated for cranial malignancy (glioblastoma, lymphoma, and metastatic) with methotrexate intraarterially and cyclophosphamide intravenously following hyperosmotic "opening" of the blood-brain barrier by mannitol were studied. Infusions carried out via an internal carotid artery were expected to dose the ipsilateral eye via the ophthalmic artery. Most of these patients were examined before and after infusion, but the total group were "randomly selected" JClin Neuro-aphthalmol, Vol. 7, No.2, 1987 |