Vasoproliferative retinal tumors associated with peripheral chorioretinal scars in presumed congenital toxoplasmosis.

BACKGROUND: The purpose of this retrospective clinical study was to demonstrate vascularization of peripheral hyperplastic chorioretinal scars in presumed congenital toxoplasmosis by choroidal vessels and secondly to report vasoproliferative tumors of the sensory retina seen in association with such lesions. METHODS: Retrospective study of a cohort of 13 patients with peripheral hypertrophic chorioretinal scars, including fluorescein angiography (eight eyes) and indocyanine green angiography (seven eyes). Congenital toxoplasmosis was serologically confirmed in seven cases and suspected on clinical grounds in six cases. RESULTS: Sixteen eyes exhibited a peripheral complex scar with a posterior atrophic and an anterior hypertrophic part. These scars were vascularized from the choroid. In eight of these eyes an additional vasoproliferative tumor was seen within or adjacent to the scar and in one fellow eye a vasoproliferative retinal tumor was found as well. These eyes experience visual loss, resulting from vitritis and exudative/traction retinal detachment. Regression of exudation was seen in five of seven cryocoagulated or endophotocoagulated tumors. CONCLUSION: Peripheral hypertrophic scars in presumed congenital toxoplasmosis can be vascularized from the choroid. A vasoproliferative tumor of the sensory retina, secondary to presumed congenital toxoplasmosis scars, can cause vitritis and exudative/traction retinal detachment. Early coagulation of this lesion may prevent a poor outcome.

Orbital cavernous hemangioma: findings on sequential Gd-enhanced MRI.

OBJECTIVE: To describe the contrast enhancement pattern of orbital cavernous hemangioma on sequential Gd-enhanced MRI. MATERIALS AND METHODS: Six patients with an orbital mass lesion were examined with T1- and T2-weighted spin echo MRI. After intravenous administration of Gd-chelate at a dose of 0.1 mmol/kg, T1-weighted spin echo sequences were performed immediately after, after 15 to 30 min, and up to 1 h after the injection. In two patients a fat saturation prepulse was given before the Gd-enhanced study. RESULTS: In all patients the lesions were isointense to muscle on the T1-weighted sequence and hyperintense to muscle on the T2-weighted sequences. After gadolinium, all lesions showed initial central patchy enhancement. Between 20 and 60 min after the injection the lesions showed total and homogeneous filling up. CONCLUSIONS: Progressive and total homogeneous filling up of an orbital mass of Gd-enhanced MRI is a pathognomonic sign of cavernous hemangioma.

Surgical treatment of eyelid retraction by cautery.

Recession of levator aponeurosis and Muller muscle by hot cautery is a simple and reliable method in case of thyroid disease. The operation is performed under local infiltration anesthesia. The advantage is less bleeding and immediate control of the height of the eyelid.

Curative irradiation of the entire orbit in rhabdomyosarcoma: a case report.

Rhabdomyosarcoma (RMS) is a relatively frequent tumor in children. Judicious combinations have markedly improved treatment results in recent years. Orbital localizations are treated with chemotherapy and radiotherapy. It has been advocated that radiotherapy be limited to the original tumor bed. This case report illustrates the danger of shielding part of the orbit: in a clinically tumor-free region before chemotherapy, which was shielded during radiotherapy, a local recurrence was seen while the original tumor bed remained controlled. Therefore, the whole content of the orbit should be irradiated in orbital RMS.

Shortcomings and pitfalls of ocular MRI.

MRI was performed in 41 patients with ocular lesions: 27 cases of malignant melanoma, 5 of haemorrhage, 3 of choroidal metastasis, 3 of senile disciform macular degeneration, 2 retinoblastomas and 1 hamartoma. On MRI 5 small lesions (less than 2 mm thick): 1 melanoma, the 3 metastases and the hamartoma, were not seen. All the malignant melanomas visualised were hyperintense compared to the vitreous on T1-weighted images. On T2-weighted images 24 of 26 lesions were hypointense compared to the vitreous. The remaining two lesions were almost isointense, corresponding to amelanotic lesions. These MRI features did not differ significantly from those of retinoblastomas, senile disciform macular degeneration or subacute choroidal haemorrhage. Major shortcomings of MRI in lesions of the globe lie in a lack of spatial resolution and poor specificity of the findings.

Intracavernous aneurysm. Superior demonstration by magnetic resonance angiography.

A case of intracavernous aneurysm in a 56-year-old woman is reported. The superiority of MRI and MRA in the diagnosis is shown.

Magnetic resonance imaging in lesions of the eye globe.

Magnetic Resonance Imaging (MRI) findings in 22 patients with lesions of the globe were examined. There were 16 cases of malignant uveal melanoma, 2 cases of retinoblastoma, 3 cases of hemorrhagic choroidal detachment and 1 case of senile macula degeneration. MRI adequately depicted the lesions in 20 cases. In two cases MRI findings were unconclusive due to movement artifacts of the eye globe. Fourteen out of 16 uveal melanomas displayed typical T1 and T2 shortening. In the two other cases the hypointense aspect on T2-weighted images was less pronounced due to a lesser amount of melanin in the lesions as demonstrated by subsequent histology. Unlike with CT, the tumoral lesions could clearly be differentiated from subretinal exudate. The case of senile macula degeneration, two retinoblastomas and two cases of hemorrhagic choroidal detachment had the same MRI characteristics as melanomas.

Management of macular pucker.

The history of 67 patients presenting with symptoms of macular pucker has been analysed retrospectively. Thirty-seven patients had a conservative follow-up. In 30 patients a pars plana vitrectomy with peeling of the premacular membrane has been performed. The natural course of the disease has been studied in the first group. For the second group surgical indications and results are discussed.

Ophthalmological aspects of carotid cavernous sinus fistulas: a retrospective study.

The authors studied retrospectively the clinical aspects of 15 patients presenting a carotid cavernous sinus fistula. Therapeutic indications and results of treatment are discussed. All patients had prooptosis, chemosis and dilated episcleral vessels. 12 patients were treated by embolisation or surgery, treatment was successful in 8 patients. 3 patients had a conservative follow-up because their symptoms were minimal.

Angiographic diagnosis and treatment of posttraumatic carotid-cavernous fistulas.

Balloon embolization was attempted in 7 patients with posttraumatic carotid-cavernous fistulas. The procedure was successful in 4 patients and failed in 3 other. Two of these fistulas showed spontaneous regression after failed embolization. In one patient, premature detachment of the balloon led to cerebral infarction, but with total clinical recovery. One patient showed temporary palsy of the VIth cranial nerve after embolization.

Surface coil magnetic resonance imaging of the orbit at 1.5T.

MRI of the orbit at 1.5-Tesla was performed in 5 healthy volunteers and 30 patients with a variety of pathological intraocular or intraconal conditions. Major advantages of MRI over CT include higher spatial resolution, higher tissue contrast, possibility of direct multiplanar imaging, absence of bony and dental artifacts, and of ionising radiation. Specific indications of MRI in orbital pathology concern differentiation of uveal melanoma from subretinal haemorrhage, identification of lesions of the orbital apex, the orbital fissure or the optic canal, differentiation of inflammatory pseudotumour from malignant lesions, determination of the posterior extension of lesions of the optic nerve, and detection of abnormal flow in normal or hypertrophic intraorbital vessels. Limitations are due to motion artifacts on T2 weighted sequences, less accurate visualisation of calcification, poor specificity of some findings, and absence of signal from cortical bone.

Anomalous cerebral venous drainage in Aarskog syndrome.

A 17-year-old female developed a syndrome of benign intracranial hypertension after a minor craniocerebral trauma. On the vertex a congenital scalp anomaly was noticed. An underlying bone defect was revealed by skull radiographs. Cerebral angiography showed absence of the straight sinus as well as other abnormalities of the cerebral venous drainage. In addition, several dysmorphic features, especially of the face and hands were present, which were also found in the mother and the sister. These stigmata could be interpreted as a partial expression of the Aarskog (facial-digital-genital) syndrome after examination of the 9-year-old brother who presented the typical facial, digital and genital features of this X-linked recessively inherited syndrome.

Pseudotumor cerebri due to intracranial arteriovenous malformation.

The authors present a case history of a meningeal arteriovenous malformation, presenting as a pseudotumor cerebri syndrome. Subarachnoid hemorrhage did not occur and brain configuration was normal on CT-scan. The pathogenesis of papilledema in this case is discussed. Probably the cause must be sought in the massive overload of the venous return, resulting in increase of cerebral blood volume, impairment of CSF absorption and increase of CSF production. The common denominator and final pathway in intracranial hypertension, also directly responsible for papilledema, is CSF hypertension.

Primary mesodermal dysgenesis of the cornea (Peters' anomaly) in two brothers.

In this report two brothers with a severe form of Peters' anomaly, i.e., primary dysgenesis mesodermalis of the cornea, are described. The third-degree consanguinity of the parents is an additional argument for the autosomal recessive inheritance of this condition.