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Show LlTf.[<.ATURE ABSTRACTS A Penetrating Orbitocranial Stab Wound. MacEwe n CJ, Full art 0 n G. RI' I 0]1 II t II aI 1/1 0 I 1986;70:147-9 (Feb). [Reprint rClJucsts to Dr. C. J. MacEwen, Department of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Rd., Glasgow GI20YN, Scotland. I A 28-year-old woman was stabbed with a lO-in. bread knife. On admission, the knifc was firmly embedded along the right infraorbital margin to a depth of approximately 5 in. Attempts by friends to remove it resulted in the handle breaking off. She was alert and oriented with no evidence of focal neurological signs. Perception of light was present and the pupillary reactions were normal. The globe was not penetrated. Radiological examination revealed that the knife passed along the infraorbital floor, through the ethmoid sinuses and tuberculum sellae, and the tip lay in the suprasellar cistern. A right craniotomy was performed and the knife was removed. Postoperatively and at foIlow-up, there was no evidence of either a neurological or endocrine deficit. Ophthalmological foIlow-up showed visual acuity of 20/20 in both eyes. Visual field testing revealed a small inferior nasal defect in the contralateral eye. The authors speculate that permanent damage to flow in the lateral chiasmal artery either by spasm or by clot would explain the field defect. It is remarkable that this patient escaped serious injury. She is c1inicaIly unaware of the contralateral visual field deficit. Walter M. lay, M.D. Childhood Chiasmal Gliomas: Update on the Fate of Patients in the 1969 San Francisco Study. lOll'S RK, Hoyt WF. Br I Ophthalmol 1986;70:179-82 (Mar). In a classic article published in 1969, Hoyt and Baghdassarian reviewed the clinical course of 36 optic gliomas of childhood, 29 of which involved the chiasm. (Hoyt WF, Baghdassarian SA. Optic glioma of childhood: natural history and rationale for conservative management. Br I Ophthal1l/01 1969;53:793-8.) The authors stressed that, in the natural course and despite treatment of any form, optic gliomas appeared to have a self-limited pattern of growth and morbidity, and that the prognosis for a long survival with useful vision was good. The present study included 28 of 29 patients I CI", N"u,o-ol'lIt1",lmol. Vol. 6. No.3. 1986 with chiasmal gliomas from the original study. The median period of foIlow-up was 20 years. Sixteen patients were dead, five from chiasmal gliomas and the rest from other causes. Four of the five deaths from chiasmal gliomas occurred before 1969. The mortality rate for patients with and without neurofibromatosis was essentially the same. Nine of 16 patients with neurofibromatosis were dead, two from chiasmal glioma, one from aspiration, and six from another tumor. Seven of 12 patients without neurofibromatosis were dead, three from chiasmal glioma, two from an operation on their tumor, and two from medical iIlnesses. None of the patients reported having a noticeable decrease in vision since 1969. Nine of the 12 patients still living had no radiation therapy, whereas eleven of 16 who died, including four of the five who died from their chiasmal tumors, had undergone irradiation. Commenting on the two deaths that occurred after neurosurgical procedures, the authors state their belief that both deaths were avoidable. Walter M. Jay, M.D. Giant Cell Arteritis as a Cause of Death: Report of Nine Cases. Save-Soderbergh J, MalmvaIl B, Andersson R, Bengtsson B. lAMA 1986;255:493-6 (Jan 24/31). [Reprint requests to R. Andersson, M.D., Department of Infectious Diseases, East Hospital, S-416 85 Goteberg, Sweden.] Nine patients are described who died of giant ceIl arteritis. Two died of myocardial infarction with histopathologic evidenc~ of arteritis in coronary arteries. Two died of dissecting aneurysm of the aorta where arteritis was found in the lesions of the aorta wall. Giant ceIl arteritis causing cerebral stroke was the cause of death in five patients. In seven of nine patients, symptoms and signs of the tat~1 event started before or shortly after initiatIon ot steroid therapy. In two patients, the authors regarded the dose of steroid administered to be insufficient, because of either symptoms of giant ceIl arteritis or an elevated sedimentation rate. .The major neuro-ophthalmologic complication ot giant cell arteritis is devastating visual loss from I~chemic optic neuropathy. This report emphasizes that the patient's life is in danger, as well as his vision. Walter M. Jay, M.D. |