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Show I· C/ill. Nt,.lrtHlp""lfJIIIIlII. 5: 71-12. lq~5. Muslin Optic Neuropathy Til tIlt, Editl1r: I \\"l~ \'l'n' intl'fl'stl'd ttl fl'.ld thl' .lrtidl' bv Rl'pl..a l't .11. ~'ntitkd -l'ptit' Nl'UWp.lth\" fwm th~' L'sl' l,f IntrMr.llli.ll ~luslin. - whit'h .1l~P".lrl'd in thl' Sl'ph.'lllbl'r I~:\4 iSSlll' "f thl' .I"urn.ll. I h.1W ltlll'l\\'l'd .1 ~imil.lr (.lSI' ,lllii f,'r thl' bl'nl'fit of your rl'.ldt'rs. I \\'tluld IIl..l' t" Sh.lrl' it with VOli. . I t:',.lmint'd a t-~-~·l'.u-old woman 'on Julv 20. I \):\~. \\"ht' (tllllplainl'd tlf blurfl'd \'i~ion in thl' ri~ht ,'\'\' ft'r .l )-\\'\'l'l.. pt'ritld. Ht'r pa~t mt:'dit:'al hi~t,'ry W.1S rt'marl...lbl,' f,lr a It:'ft occipital artt:'rv t" middll' (Wt'br.ll .utl'ry byp.1SS in J.lIlu.lI"Y IQ81, tlllltl\\'l'd by dippin~ tlt a middlt:' cl'rl'br.ll artl'rv an,'ur\"~m. Thr,'" m'lIlths I.ltl'r. Shl' undl'rWl'nt d ri~ht ,'r,mt.ll ('f.lni'lt'lmy in .1Il attl'mpt at iSlllation l,f a ~iant ri~ht (awtid ,'phth.llmk artl'ry anl'Ur\"~ m. This \\'a~ n,lt f,'und to bl' trl'atabll' with diprin~ and was. subsl'qut:'ntly. wrappl'd with muslin. Sht:' did wdl until 2 wars latl'r whl'n \'isilm in tht:' ri~ht t:'Yt:' bt:'camti blurred. On l'Xaminatilm 'lIl July 20. 1982, ri~ht l'yl' vision was :; ;~oo and Idt t:'\'l' \'isi"n was 20/25 slowlv. Thl'rl' was a ~+ aHl'rent pupillary ddl'ct notl'd on the ri~ht. \'isual fidds showl'd an incongruous Il'ft hl1monymllus hemianopia in\'olvin~ fixation in the right fidd. \1ild tlptic atmphy was noted on thl' right. The patil'nt was admitted to the hospital and started lln high-dose intravenous Decadron. In additillll. a CT scan and arteriograms were performed which ducumented persistence uf a I-cm cawtid uphthalmic artery aneurysm un the ri~ht. Hl'r \'isual functiun continut.'d tu improve with Dl'cadrun treatmt.'nt and. at thl' timl' uf di!>char~e, March 1985 ri~ht l'yl' visiun W.l!> 20/50 and left l'yl' vision 20/ 20. VislI.ll fidds Wl'r,' .llso improwd. Sh,' W.l!> !>llIwly t.l!X'r,'d off stl'roids and did wdl until F,'brU,lrV 22. 1ClH3. whl'n visiun in thl' ri~ht "y" f.ldl'd "i"in. At that tim". visual acuity W.1S 20/200 un th,' right. Sh,' was a~ain trl'ated with ()l'c.ldwn. 4 m~ 4.i.d. and by March 8th. ri~ht "Yl.' vi!>ion had .l~ain impruwd tll 20/40 +1. Sh\.' rl'main\.'d at this 1l.'Vl'J. uff steroids. until M.1Y 26th, when shl.' complain,'d uf blurrt.'d visiun in th,' ri~ht l.'yl.' again. Visual acuity had dropped tll 20/70 un thl.' right and she was admitted to the huspital. On June 8. 1983. exploration of the chiasm was dunl' via ri~ht frontal craniotomy. The right optic nl.'rve was noted to bt:' covered by thickened arachnoid. In the area of the right carotid ophthalmic artl'ry aneurysm, dense scar tissue was found. Dense adhesions were also noted throughout the optic chiasm and optic tract areas. Consl'rvative removal of some of the scar tissue surrounding the right optic nerve was done. Stemid thl.'rapy was stopped approximately 2 weeks following the operation and when last seen in Ntlvembt:'r 1983, right eye vision had stabilized at 20/70. A telephone conversation with the patil.' nt in Septembt:'r 1984, indicated that she was subjl'Ctivelv stable. I bring this case to your attention sincl' the stl'roid resptlnsl' was marked. intracranial muslin was used. and a marked Hbmtit:' reactitln afllund thl.' nl'rves and chiasn was seen at the time of tlperation as in the rt:'port by Rt:'pka et al. RlIbt:'rt L. TlImS.lk, M.D.. Ph.D. CI,'wl'llld. Ohill 71 |
