ABSTRACT
PURPOSE: To assess the prevalence, morphology and distribution of retinal hemorrhages in healthy newborns and their relationship to neonatal, maternal and obstetrical factors, and to determine their natural history. PATIENTS AND METHODS: The present study prospectively included 2,031 consecutive healthy newborns. Indirect ophthalmoscopy was performed within 24 hours after birth in all newborns. Infants with retinal hemorrhages were reexamined weekly until the hemorrhage resolved. Annual ophthalmologic follow-up was also scheduled in these children. Neonatal, maternal and obstetric parameters were analyzed in all newborns and compared between newborns with retinal hemorrhages and those without retinal hemorrhages. RESULTS: 31.8 % of newborns exhibited retinal hemorrhages. 72.6 % of hemorrhages were bilateral. They tended to be localized around the optic discs and in the posterior pole, but their distribution was variable. Retinal hemorrhages were of variable shapes. The prevalence of retinal hemorrhages was higher in newborns delivered with vacuum-assisted extraction (38 %, P<0.001), intermediate during normal vaginal delivery (32.6 %, P<0.001) and lower with cesarean section (20.8 %). Comparative analysis between elective cesarean section and emergency cesarean showed a higher incidence of retinal hemorrhages in the emergency cesarean group (P=0.006). On multivariate analysis, vacuum-assisted delivery was the only factor associated with a higher prevalence of retinal hemorrhages in newborns (P=0.045). Two thirds of hemorrhages had disappeared by one week after birth. Retinal hemorrhages had resolved in all newborns within four weeks. CONCLUSION: Birth-related retinal hemorrhages are common (1/3 of our newborns). Vacuum-assisted delivery is the main risk factor in this study. All hemorrhages resolved by one month of age. These findings may help in differential diagnosis with shaken baby syndrome.
Subject(s)
Birth Injuries/complications , Retinal Hemorrhage/epidemiology , Retinal Hemorrhage/etiology , Female , Humans , Incidence , Infant, Newborn , Male , Obstetric Labor Complications , Pregnancy , Pregnancy Complications , Prevalence , Prospective StudiesABSTRACT
Ophthalmological involvement in mantle cell lymphoma is rare. An 84-year-old man presented with bilateral proptosis. Orbital biopsy established the diagnosis of mantle cell lymphoma. The diagnosis of mantle cell lymphoma is anatomopathological and immuno-histochemical. Orbital involvement is found most often in advanced stages of the disease, but may be the presenting sign as in the case of our patient. Treatment has improved with the use of rituximab, especially in elderly patients not eligible for autologous hematopoietic stem cell transplant.
Subject(s)
Lymphoma, Mantle-Cell/diagnosis , Orbital Neoplasms/diagnosis , Aged, 80 and over , Edema/diagnosis , Edema/diagnostic imaging , Edema/etiology , Exophthalmos/diagnosis , Exophthalmos/diagnostic imaging , Exophthalmos/etiology , Eyelid Diseases/diagnosis , Eyelid Diseases/diagnostic imaging , Eyelid Diseases/etiology , Humans , Lymphoma, Mantle-Cell/complications , Lymphoma, Mantle-Cell/diagnostic imaging , Magnetic Resonance Imaging , Male , Orbital Neoplasms/complications , Orbital Neoplasms/diagnostic imaging , RadiographyABSTRACT
PURPOSE: To report clinical findings after accidental ocular instillation of Angel's trumpet (Datura suaveolens) sap. OBSERVATION: A 24-year-old man, with no particular past history, presented with sudden-onset of unilateral mydriasis. The clinical appearance, as well as the detailed history, made possible the etiologic diagnosis of ocular exposure to sap from Angel's trumpet, a plant containing natural alkaloids with parasympatholytic properties. DISCUSSION: A toxic etiology of sudden-onset anisocoria may be established by taking a detailed history and being familiar with possible causative agents. Accidental ocular instillation of sap from Angel's trumpet should be noted as a possible cause of sudden-onset mydriasis and/or systemic symptoms such as tachycardia in otherwise healthy patients.
Subject(s)
Anisocoria/chemically induced , Datura , Plant Extracts/toxicity , Acute Disease , Anisocoria/diagnosis , Humans , Instillation, Drug , Male , Plant Extracts/administration & dosage , Young AdultABSTRACT
Patients with the genetic disease xeroderma pigmentosum (XP) lack the ability to carry out a specific type of DNA repair process called nucleotide excision repair (NER). The NER pathway plays a critical role in the repair of DNA damage resulting from ultraviolet (UV) radiation. We report a case of a patient presenting a cutaneous form of XP. She presented acute paralysis of the third cranial nerve with cutaneous anesthesia. Nuclear magnetic resonance imaging revealed an intracranial tumor. She underwent surgery with incomplete tumor resection; anatomopathological study showed a schwannoma. Complementary radiosurgery was performed. The association between XP and neurological cancer is rare but not impossible. A priori, it would be assumed that the major medical outcome of hereditary deficiencies in DNA repair processes would be an increased risk of cancer. Indeed, there is an increased risk of cancer in several known DNA repair deficiencies including XP.
