Role of neuroimaging in cases of primary and secondary hemifacial spasm.

Purpose: The objective of this study was to analyze the role of neuroimaging and documenting various intracranial pathologies in primary and secondary hemifacial spasm. Methods: This retrospective study included patients with HFS who had undergone neuroimaging. The demographic profile, onset, progression, neuroimaging findings, and types of HFS were documented and analyzed. Results: A total of 202 patients (male = 110, female = 92) were included. The mean age of the study population was 51.81 ± 11.76 years. The right side was involved in 104 patients, the left side was involved in 97 patients and bilateral involvement was observed in one patient. Primary HFS: secondary HFS was 9.6:1. The mean age of onset of the spasms in the primary HFS group was 49.26 ± 8.35 years and in secondary HFS was 43.13 ± 12.12 years respectively. The anterior inferior cerebellar artery was the major vessel causing neurovascular conflict in primary HFS (n = 55). Facial nerve palsy was the most common cause (n = 13) of secondary HFS followed by cerebellopontine angle (CPA) tumors. Conclusion: The hemifacial spasm occurs mostly in the fifth decade of life. Primary HFS is more prevalent than secondary HFS. Clinical distinction between them is difficult. Neuroimaging is essential to detect the conflicting vasculature in cases of primary HFS and pathologies like CPA tumor, cyst, and aneurysms in cases of secondary HFS.

Magnetic Resonance Imaging Features of Medial Canthal Tendon in Centurion Syndrome.

PURPOSE: To describe the magnetic resonance imaging (MRI) features of the medial canthal tendon (MCT) insertion in a series of patients of the Centurion syndrome. METHODS: This was a prospective study carried out over a period of 1 year. All patients clinically diagnosed with Centurion syndrome underwent MRI with surface coils. The insertion of both the limbs (anterior and posterior) of the MCT was studied radio-logically and correlated clinically. RESULTS: We recruited six patients, of whom four were males. The anterior limb of the MCT was found to insert anterior to the anterior lacrimal crest in three, normally inserted in two, and thinned out and mal-developed in one. None of the patients with normal insertion had the classical beak sign or prominent nasal bridge. CONCLUSION: The anterior limb of the MCT may not always be inserted anteriorly in cases of Centurion syndrome; it can be normal or mal-developed. Disinsertion of the MCT, which is the most common procedure done for Centurion syndrome, might not be helpful in cases where the MCT is normally inserted or mal-developed.

Bilateral optic neuropathy with central diabetes insipidus in a child.

Central nervous system germ cell tumors are rare and they occur in the first two decades of life.[1] Optic nerve germinomas can sometimes mimic optic nerve inflammation.[2] In this case report, we discuss an 11-year-old girl who presented with features of presumed bilateral optic neuritis and developed polyuria and polydipsia, subsequently she was diagnosed to have infiltrative etiology. Her clinical and radiological presentations were initially consistent with inflammatory optic neuropathy. Poor visual recovery to steroid therapy and progressive visual loss warranted the need for optic nerve biopsy which revealed germinoma.

Timing of surgery in traumatic globe dislocation.

Traumatic globe dislocation into the maxillary sinus is a rare event and usually associated with a poor visual outcome if not managed appropriately. We report a 45-year-old female patient who presented to the emergency after blunt injury to her face with a door. Initial evaluation revealed nil perception of light and an apparently anophthalmic socket. Neuroimaging revealed large floor and medial wall fracture with dislocation of the globe into the maxillary sinus. The patient underwent exploration with repositioning of the globe and fracture repair. She was also administered 1 g intravenous methylprednisolone along with tapering course of oral steroids for 3 days. Patient's final visual acuity at 18 months of follow-up improved to counting fingers at 1 m. A thorough review of the literature suggests immediate surgery might improve the final visual outcome in such cases.

Isolated cortical blindness without simultaneous neurological involvement in progressive multifocal leukoencephalopathy in a patient with human immune deficiency virus infection.

BACKGROUND: This is a case report of cortical blindness in a HIV-positive patient with progressive multifocal leukoencephalopathy (PML) without any other associated neurological dysfunction. FINDINGS: Young HIV-positive patient presented to us with sudden profound visual loss. On examination and further investigation, we have diagnosed cortical blindness without any other focal neurological deficit due to PML. CONCLUSION: Our case highlights the fact that PML needs to be suspected in patients with HIV, presenting with cortical blindness even without any other focal neurological defect.

Helical computed tomographic dacryocystography and its role in the diagnosis and management of lacrimal drainage system blocks and medial canthal masses.

AIM: To study the indications, technique and diagnostic utility of helical computed tomographic dacryocystography (CTDCG). MATERIALS AND METHODS: Retrospective analysis of 13 patients who underwent CTDCG with subsequent surgical intervention, during the period January 2003 to December 2005, was done. Axial plain computed tomography (CT) scan was performed, followed by administration of water-soluble contrast in the conjunctival cul de sac or by cannulation of the lacrimal passages. Thin-slice helical CT with two-dimensional (2D) and three-dimensional (3D) coronal and sagittal reformation was done. RESULTS: Four patients were males and 9 were females. Age range was 5 to 62 years. Seven patients presented with watering and 6 patients with a medial canthal mass. Three patients had history of trauma. CTDCG was performed by instillation technique in 10 patients and by cannulation in 3 patients. CTDCG showed mass lesion displacing the sac in 5 cases, nasolacrimal duct obstruction in 6 cases and mucocele in 2 cases. Based on the findings on CTDCG, 5 patients underwent mass excision, 7 underwent dacryocystorhinostomy and 1 patient underwent primary silicone tube intubation. CONCLUSION: Helical CTDCG is a safe and useful diagnostic tool for the lacrimal surgeon. Instillation technique is a physiological and convenient method, and cannulation is needed only in cases where adequate visualization is not achieved.

Thrombosed orbital varix -- a correlation between imaging studies and histopathology.

A thrombosed varix in the orbit is comparatively rare. Clinical examination alone is often inadequate for diagnosis. Radio-logical examination, such as a computed tomography (CT) scan of the orbit, is extremely important. Histopathological examination (HPE) after excision biopsy can confirm the diagnosis. The present authors describe a case of proptosis in the left eye of a 45-year-old man. CT-scan and HPE supported the diagnosis of a thrombosed orbital varix. This paper discusses the use of radiological investigations to supplement a clinical suspicion and make the diagnosis. This entity needs to be included in the differential diagnosis of proptosis and requires a coordinated approach for establishment of the diagnosis.