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276 Walsh & Hoyt: Results of Surgery on Ruptured AneurysmsSteven A. Newman, M.D., University of Virginia School of MedicineThe majority ofaneurysms are treated after they rupture. The prognosis for patients following surgery for a ruptured intracranial aneurysm is largely dependent on the effects ofthe SAH itself, the complications at surgery, and any associated episodes ofvasospasm (968). Multiple series emphasize a go...
277 Walsh & Hoyt: Endovascular Procedures - StentingSteven A. Newman, M.D., University of Virginia School of MedicinePercutaneously placed vascular stents may be used to treat unruptured intracranial aneurysms (25,905) (Fig. 41.45). Endovascular approaches and intraoperative angiography may benefit surgical procedures when used intraoperatively (906,907). When endovascular therapy fails, surgery is occasionally ne...
278 Walsh & Hoyt: Vitamin Deficiencies - Vitamin B12John R. Leigh, MD, Professor of Neurology, Emeritus, Case Western Reserve University; Janet C. Rucker, MD, NYU Langone HealthEtiology of Downbeat Nystagmus
279 Walsh & Hoyt: Vitamin Deficiencies - Vitamin B12Laura J. Balcer, MD, Professor, Department of Neurology, NYU LangoneAn association between MS and vitamin B12 deficiency is proposed but of unclear significance (99).
280 Walsh & Hoyt: Vitamin Deficiencies - Vitamin B12Leonard A. Levin, MD, PhD. Chair of Ophthalmology, McGill UniversityVisual-Evoked Potential Abnormalities
281 Walsh & Hoyt: Vitamin Deficiencies - Vitamin B12Leonard A. Levin, MD, PhD. Chair of Ophthalmology, McGill UniversityUnusual Causes of Optic Chiasmal Syndromes
282 Walsh & Hoyt: Special CircumstancesDeborah I. Friedman, MD, MPH, Professor, Neurology & Neurotherapeutics, University of Texas SouthwesternTwo studies found no postoperative changes in ICP following ONSD and concluded that the decrease in papilledema and the visual improvement occurred from a local decrease in optic nerve sheath pressure rather than from a generalized decrease in ICP (670,671).
283 Walsh & Hoyt: Surgical ProceduresDeborah I. Friedman, MD, MPH, Professor, Neurology & Neurotherapeutics, University of Texas SouthwesternSurgery is employed when patients initially present with severe optic neuropathy or when other forms of treatment have failed to prevent visual loss. It is not recommended for the treatment of headaches alone. Historically, subtemporal decompression was performed but it has been replaced by a shunti...
284 Walsh & Hoyt: Other AssociationsAnthony C. Arnold, MD, UCLANAION has been associated infrequently with a multitude of additional factors and disorders that may be causative, either due to optic disc structure or other features that might affect optic disc perfusionpressure. These include hyperopia, optic disc drusen, elevated intraocular pressure, cataract ...
285 Walsh & Hoyt: Vitamin Deficiencies - Vitamin AJoseph F. Rizzo III, MD, Massachusetts Eye and EarVitamin A is used in phototransduction and photopigment regeneration. Vitamin A must be replenished from the circulation, and failure to do so can result in retinopathy.
286 Walsh & Hoyt: Amyloid AngiopathyValérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of MedicineCerebral amyloid angiopathy, which is characterized by the deposition of -amyloid protein in the blood vessels of the cerebral cortex and leptomeninges, is another risk factor for intracerebral hemorrhage, particularly in elderly persons. O'Donnell et al (823) reported that the presence of the 2 a...
287 Walsh & Hoyt: Moyamoya DiseaseValérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of MedicineRevised Guidelines for the Diagnosis of Moyamoya Disease
288 Walsh & Hoyt: Vitamin Deficiencies - Vitamin ADeborah I. Friedman, MD, MPH, Professor, Neurology & Neurotherapeutics, University of Texas SouthwesternExogenous Substances Whose Exposure or Ingestion Has Been Associated with Pseudotumor Cerebri
289 Walsh & Hoyt: ToxoplasmosisWayne T. Cornblath, MD, Clinical Professor, Ophthalmology and Visual Sciences, Professor, Department of Neurology, University of MichiganToxoplasma is an obligate intracellular organism that is a member of the class of protozoa called Sporozoa. It thus is a member of the same class as Babesia and Plasmodium species (discussed earlier). There is only one species-Toxoplasma gondii-and all strains appear antigenically similar. The name ...
290 Walsh & Hoyt: NEUROPATHIC TONIC PUPILSAki Kawasaki, MD, PhD, Faculty of Biology and Medicine, University of LausanneThis type of tonic pupil, usually with bilateral involvement, represents one manifestation of a widespread, peripheral, and autonomic neuropathy that also involves the ciliary ganglion, the short ciliary nerves, or both (248). In some cases, there is evidence of both a sympathetic and a parasympathe...
291 Walsh & Hoyt: BACTERIA AND BACTERIAL DISEASES - EmpyemaPrem S Subramanian, MD, PhD, ​Professor of Ophthalmology, Neurology, and Neurosurgery, University of ColoradoMost infections caused by Klebsiella affect the respiratory tract, although the organisms also may cause urinary tract, biliary tract, and surgical wound infections. Infections of the CNS caused by Klebsiella are unusual and are usually associated withbacteremia. Nevertheless, K. pneumoniae and othe...
292 Walsh & Hoyt: Intracranial Infections-EmpyemaPrem S Subramanian, MD, PhD, ​Professor of Ophthalmology, Neurology, and Neurosurgery, University of ColoradoIntracranial abscesses and empyemas caused by H. influenzae are uncommon but occur in bothch ildren and adults (20,38,43,49,1855,1856). In many cases, they are part of a polymicrobial infection and result from spread of organisms from the inner ear or paranasal sinuses. Indeed, in one study of 17 pa...
293 Walsh & Hoyt: Wilson's DiseaseParashkev Nachev, PhD, MRCP(UK), University College London; Christopher Kennard, PhD, FRCP, FMed Sci, University of OxfordPrimary neuropathologic features of AD include neurofibrillary tangles, neuritic plaques, loss of neurons, and granulovacuolar degeneration. These changes are found in the neocortical association areas, the hippocampus, and other limbic areas. They are also present in certain subcortical nuclei that...
294 Walsh & Hoyt: HUNTINGTON'S DISEASEParashkev Nachev, PhD, MRCP(UK), University College London; Christopher Kennard, PhD, FRCP, FMed Sci, University of OxfordHuntington's disease is an autosomal-dominant disease of the CNS that becomes symptomatic in adulthood. It is characterized by an inexorably progressive movement disorder, usually chorea, and psychologic disturbances, including cognitive impairment and affective disturbances. These clinical features...
295 Walsh & Hoyt: POSTERIOR ISCHEMIC OPTIC NEUROPATHYAnthony C. Arnold, MD, UCLAPosterior ischemic optic neuropathy (PION) is a syndrome of acute visual loss with characteristics of optic neuropathy without initial disc edema and marked by the subsequent development of optic atrophy. Occasionally, a small amount of disc edema appears withinthe first week or so after acute visua...
296 Walsh & Hoyt: Perioperative ComplicationsAnthony C. Arnold, MD, UCLAION occurs in the setting of various surgical interventions, most commonly cardiopulmonary bypass (176,289-297), and lumbar spine surgery (286,298-,303). Other cases include abdominal procedures (282-284,287,288), hip incision and drainage (295), cholecystectomy (282), and parathyroidectomy (291).
297 Walsh & Hoyt: LESIONS PRODUCED BY INFECTIONBarrett J. Katz, MD, MBA, Montefiore Medical CenterA variety of lesion types may be produced by infections and inflammations. These include abscesses, aneurysms, areas of demyelination, cerebral edema, empyemas, encephalitis, granulomas, meningitis, mucoceles and pyoceles, neuritis, and vasculitis. In this section, we consider the origin, pathologic...
298 Walsh & Hoyt: Supranuclear and Internuclear Ocular Motility DisordersDavid S Zee, M.D., Professor of Neurology, Johns Hopkins University; David Newman-Toker, MD, PhD, Associate Professor, Departments of Neurology, Ophthalmology, & Otolaryngology, The Johns Hopkins University School of MedicineMany structures within the medulla are important in the control of eye movements: the vestibular nuclei, perihypoglossal nuclei, and inferior olive and its outflow pathway through the inferior cerebellar peduncle. The perihypoglossal nuclei consist of the nucleus prepositus hypoglossi (NPH), which l...
299 Walsh & Hoyt: Traumatic Optic NeuropathiesKenneth D. Steinsapir, MD, Blepharoplasty Beverly Hills; Robert A. Goldberg, MD, UCLA HealthOptic nerve injuries are classically divided into direct and indirect injuries. Direct injuries are open injuries where an external object penetrates the tissues to impact the optic nerve. Indirect optic nerve injuries occur when the force of collision is imparted into the skull and this energy is a...
300 Walsh & Hoyt: NYSTAGMUS AND RELATED OCULAR MOTILITY DISORDERSJohn R. Leigh, MD, Professor of Neurology, Emeritus, Case Western Reserve University; Janet C. Rucker, MD, NYU Langone HealthTorsional nystagmus is a less commonly recognized form of central vestibular nystagmus than downbeat or upbeat nystagmus. It is often difficult to detect except by careful observation of conjunctival vessels or by noting the direction of retinal movement on either side of the fovea
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