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1.
J Neurosurg ; 127(2): 409-416, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27715435

RESUMO

OBJECTIVE Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%-90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas. METHODS The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas. This cohort included 32 patients (64%) with visual impairment preoperatively. Twenty-seven patients (54%) had pituitary dysfunction, including 17 (34%) with hormone-producing tumors. Patients completed the National Eye Institute Visual Functioning Questionnaire and the 36-Item Short Form Health Survey preoperatively and 6 weeks and 6 months after surgery. RESULTS Patients with preoperative visual impairment reported a significant impact of this condition on VR-QOL preoperatively, including general vision, near activities, and peripheral vision; they also noted vision-specific impacts on mental health, role difficulties, dependency, and driving. After endoscopic resection of adenomas, patients reported improvement across all these categories 6 weeks postoperatively, and this improvement was maintained by 6 months postoperatively. Patients with preoperative pituitary dysfunction, including hormone-producing tumors, perceived their general health and physical function as poorer, with some of these patients reporting improvement in perceived general health after the endoscopic surgery. All patients noted that their ability to work or perform activities of daily living was transiently reduced 6 weeks postoperatively, followed by significant improvement by 6 months after the surgery. CONCLUSIONS Both VR-QOL and patient's perceptions of their ability to do work and perform other daily activities as a result of their physical health significantly improved by 6 months after endoscopic resection of pituitary adenoma. The use of multidimensional QOL questionnaires provides a precise assessment of perceived outcomes after endoscopic surgery.


Assuntos
Adenoma/cirurgia , Autoavaliação Diagnóstica , Neuroendoscopia/métodos , Neoplasias Hipofisárias/cirurgia , Qualidade de Vida , Visão Ocular , Adenoma/complicações , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Estudos Prospectivos , Osso Esfenoide , Resultado do Tratamento , Transtornos da Visão/etiologia
2.
Mult Scler Relat Disord ; 3(2): 273-5, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25878017

RESUMO

We present a unique case of isolated bilateral simultaneous cranial nerve (CN) IV palsy in a patient with neuromyelitis optica (NMO). Although some CN IV abnormalities have been described in multiple sclerosis (MS), no case of isolated bilateral simultaneous CN IV has been reported, to our knowledge, in either NMO or MS.

3.
J Neurosurg ; 118(5): 937-46, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23521551

RESUMO

OBJECT: The authors report their results in a series of large or giant carotid ophthalmic segment aneurysms clipped using retrograde suction decompression. METHODS: A retrospective review of clinical data and treatment summaries was performed for 18 patients with large or giant carotid artery ophthalmic segment aneurysms managed operatively via retrograde suction decompression. Visual outcomes, Glasgow Outcome Scale (GOS) scores, and operative complications were determined. Postoperative angiography was assessed. RESULTS: During a 17-year period, 18 patients underwent surgery performed using retrograde suction decompression. The mean aneurysm size was 26 mm. Three patients presented with subarachnoid hemorrhage. Fourteen of 18 patients presented with visual symptoms. Eleven (79%) of these 14 patients experienced visual improvement and the remaining 3 (21%) experienced worsened vision after surgery. Of 3 patients without visual symptoms and a complete visual examination before and after surgery, 1 had visual worsening postoperatively. One aneurysm required trapping and bypass, and all others could be clipped. Postoperative angiography demonstrated complete occlusion in 9 of 17 clipped aneurysms and neck remnants in the other 8 clipped aneurysms. One (5.5%) of 18 patients experienced a stroke. Eighteen patients had a GOS score of 5 (good outcome), and 1 patient had a GOS score of 4 (moderately disabled). There were no deaths. There was no morbidity related to the second incision or decompression procedure. Prolonged improvement did occur, and even in some cases of visual worsening in 1 eye, the overall vision did improve enough to allow driving. CONCLUSIONS: Retrograde suction decompression greatly facilitates surgical clipping for large and giant aneurysms of the ophthalmic segment. Visual preservation and improvement occur in the majority of these cases and is an important outcome measure. Developing endovascular technology must show equivalence or superiority to surgery for this specific outcome.


Assuntos
Aneurisma/cirurgia , Doenças das Artérias Carótidas/cirurgia , Cirurgia de Descompressão Microvascular/métodos , Artéria Oftálmica/cirurgia , Visão Ocular/fisiologia , Adulto , Idoso , Aneurisma/complicações , Angiografia , Feminino , Escala de Resultado de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Oftálmica/diagnóstico por imagem , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/etiologia , Transtornos da Visão/fisiopatologia
4.
J Neuroophthalmol ; 33(1): 66-8, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23235433

RESUMO

A 34-year-old woman presented with brainstem compression from a large third nerve schwannoma although third nerve function was intact. At surgery, preservation of the proximal third nerve was not possible. Because of preexisting amblyopia of the contralateral eye, an attempt was made to surgically reinnervate the affected third nerve. The fourth nerve was divided at its entry into the tentorium and anastomosed to the distal stump of the third nerve. Partial recovery of third function occurred over several months and is still present 6 years later. Successful long-term reinnervation of the third nerve by direct anastomosis with the fourth nerve may be useful when third repair is not possible.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Movimentos Oculares/fisiologia , Pálpebras/fisiopatologia , Neurilemoma/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Nervo Troclear/cirurgia , Adulto , Anastomose Cirúrgica , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/fisiopatologia , Descompressão Cirúrgica , Feminino , Humanos , Neurilemoma/patologia , Neurilemoma/fisiopatologia , Doenças do Nervo Oculomotor/patologia , Doenças do Nervo Oculomotor/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Resultado do Tratamento
5.
J Neurosurg ; 117(2): 218-24, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22680245

RESUMO

Compression induced by a pituitary tumor on the optic chiasm can generate visual field deficits, yet it is unknown how this compression affects the retinotopic organization of the visual cortex. It is also not known how the effect of the tumor on the retinotopic organization of the visual cortex changes after decompression. The authors used functional MRI (fMRI) to map the retinotopic organization of the visual cortex in a 68-year-old right-handed woman before and 3 months after surgery for a recurrent pituitary macroadenoma. The authors demonstrated that longitudinal changes in visual field perimetry, as assessed by the automated Humphrey visual field test, correlated with longitudinal changes in fMRI activation in a retinotopic manner. In other words, after decompression of the optic chiasm, fMRI charted the recruitment of the visual cortex in a way that matched gains in visual field perimetry. On the basis of this case, the authors propose that fMRI can chart neural plasticity of the visual cortex on an individual basis and that it can also serve as a complementary tool in decision making with respect to management of patients with chiasmal compression.


Assuntos
Adenoma/cirurgia , Descompressão Cirúrgica , Recidiva Local de Neoplasia/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Quiasma Óptico/cirurgia , Neoplasias Hipofisárias/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Retina/fisiopatologia , Córtex Visual/fisiopatologia , Campos Visuais/fisiologia , Adenoma/fisiopatologia , Idoso , Mapeamento Encefálico , Endoscopia , Feminino , Seguimentos , Humanos , Interpretação de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/fisiopatologia , Síndromes de Compressão Nervosa/fisiopatologia , Plasticidade Neuronal/fisiologia , Quiasma Óptico/fisiopatologia , Neoplasias Hipofisárias/fisiopatologia
6.
Neurosurgery ; 70(2 Suppl Operative): 343-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22072128

RESUMO

BACKGROUND AND IMPORTANCE: Dural arteriovenous fistulas (dAVFs) represent 10% to 15% of all intracranial arteriovenous malformations. Most often, embolization is accomplished with transfemoral catheter techniques. We present a case in which embolization of a cavernous sinus dAVF was made possible through transcranial cannulation of a cortical draining vein. CLINICAL PRESENTATION: An 82-year-old woman presented with diplopia, left sixth cranial nerve palsy, intraocular hypertension, and bilateral chemosis. Angiography revealed a complex cavernous dAVF with cortical venous reflux, supplied by both external carotid arteries and the left meningohypophyseal trunk. Percutaneous transvenous access failed, and only partial occlusion was achieved by transarterial embolization. A frontotemporal craniotomy was performed to access the superficial middle cerebral vein in the left sylvian fissure. Under fluoroscopic guidance, a microcatheter was advanced through this vein to the floor of the middle cranial fossa and into the dAVF, permitting coil occlusion. CONCLUSION: This transcranial vein technique may be a useful adjunct in dAVF therapy when percutaneous transarterial or transvenous approaches fail or are not possible.


Assuntos
Trombose do Corpo Cavernoso/terapia , Malformações Vasculares do Sistema Nervoso Central/terapia , Veias Cerebrais/cirurgia , Embolização Terapêutica/métodos , Idoso de 80 Anos ou mais , Cateterismo/instrumentação , Cateterismo/métodos , Trombose do Corpo Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/patologia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/patologia , Embolização Terapêutica/instrumentação , Feminino , Humanos , Radiografia , Reoperação/métodos
7.
Vision Res ; 51(8): 908-24, 2011 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-21324336

RESUMO

Patients with damage to primary visual cortex can sometimes direct actions towards 'unseen' targets located in areas of the visual field that are deemed 'blind' on the basis of static perimetry tests. Here, we show that a patient with a complete right homonymous hemianopia after a V1 lesion remains sensitive to the width of objects presented in her blind field but only when reaching out to grasp them in 'real-time'. A subsequent fMRI experiment revealed spared extra-geniculostriate pathways, which may mediate her preserved abilities. Taken together, the results support the view that visually guided movements can be mediated by pathways that do not support visual consciousness.


Assuntos
Hemianopsia/fisiopatologia , Desempenho Psicomotor/fisiologia , Córtex Visual/patologia , Percepção Visual/fisiologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Estimulação Luminosa/métodos
8.
Can J Neurol Sci ; 37(6): 837-42, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21059548

RESUMO

OBJECTIVES: To describe the tumor characteristics and visual function in conservatively managed patients with non-functioning pituitary macroadenoma (NFMA) that contacted/compressed the visual pathway. DESIGN: Retrospective case-series. SETTING: Tertiary-care academic institution. PARTICIPANTS: Six patients with diagnosis of NFMA. MAIN OUTCOME: Visual function and radiological characteristics of the optic apparatus and pituitary tumor. RESULTS: All patients had radiological evidence of optic apparatus compression but only one had visual field defect at the initial presentation. While two of the six patients developed visual field changes during followup (41±34.8 months), the patient with visual field defect at the time of diagnosis improved to normal vision. CONCLUSIONS: Select NFMAs that contact the optic apparatus, without visual dysfunction, may be managed with close ophthalmological and radiographic monitoring, depending on tumor and imaging characteristics. This may be of particular relevance in patients considered to have a high peri-operative risk, such as advanced age or significant co-morbidities.


Assuntos
Adenoma/complicações , Neoplasias Hipofisárias/complicações , Transtornos da Visão/etiologia , Campos Visuais/fisiologia , Adenoma/diagnóstico , Idoso , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Hipofisárias/diagnóstico , Estudos Retrospectivos , Transtornos da Visão/diagnóstico , Vias Visuais/fisiopatologia
9.
Can J Neurol Sci ; 37(4): 488-91, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20724257

RESUMO

BACKGROUND: The ability to predict conversion to multiple sclerosis (MS) accurately when assessing a patient with a clinically isolated syndrome (CIS) is of paramount importance. Magnetic resonance imaging (MRI) is the best paraclinical tool currently available; however the significance of a history of an event suggestive of demyelination prior to CIS presentation has not been evaluated. METHODS: A retrospective chart review of all optic neuritis cases presenting as CIS to a single neuro-ophthalmologist in London, Ontario between 1990 to 1998 was performed. Data were collected regarding demographics, past medical history, history of present illness, and family history. Conversion to MS was determined by the McDonald criteria after ten years of follow-up. Bayesian statistics and logistic regression were used to determine the best predictors of conversion to MS from CIS. RESULTS: One hundred and sixteen optic neuritis subjects were included in the analysis. After ten years, 42.2% had converted to MS. The best predictor of future conversion remained at least one brain lesion, disseminated in space, on MRI (sensitivity 0.90, specificity 0.75). However, if the subject additionally had a history suggestive of a demyelinating event in the past that had not been confirmed clinically, the specificity increased to 0.96. These two traits taken together had an odds ratio of 27.8 for conversion to MS in the next ten years (p<0.001). CONCLUSIONS: A history of an event suggestive of demyelination prior to presenting with optic neuritis as CIS increases the ability of the clinician to predict conversion to MS in the next ten years.


Assuntos
Esclerose Múltipla/complicações , Esclerose Múltipla/diagnóstico , Neurite Óptica/etiologia , Adulto , Teorema de Bayes , Estudos de Coortes , Doenças Desmielinizantes , Progressão da Doença , Feminino , Humanos , Modelos Logísticos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Estudos Retrospectivos
10.
Epilepsia ; 51(6): 1018-23, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20074232

RESUMO

PURPOSE: The aim of this study was to assess the incidence of mild (90 degrees from vertical) visual field defects (VFDs) in patients after anterior temporal lobectomy (ATL), and their postoperative improvement over time. METHODS: The angles of postoperative VFDs of 75 patients who underwent ATL were recorded at various time points (1, 2, 6, 12, 18, 24, and 36+ months). RESULTS: Of all 23 patients who came in for their <1 month postoperative appointment, 65% of patients had surgically induced VFDs <90 degrees , whereas 35% had VFDs >90 degrees postoperatively. Patients in the latter group were reported for suspension of their driver's license. However, 38% experienced improvement of their VFD to <90 degrees such that their driver's license could be reinstated. Of patients with any VFD, 18-30% improved on average by a magnitude of 38 degrees within the first year postoperatively. DISCUSSION: Although 35% of the VFDs that occur following temporal lobe surgery are severe, approximately 38% of these patients (especially those with starting postoperative VFDs closer to the 90 degrees angle) experience some improvement shortly after surgery. This may increase their chances of having their driver's license reinstated.


Assuntos
Lobectomia Temporal Anterior/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia , Campos Visuais/fisiologia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Lobo Temporal/fisiopatologia , Lobo Temporal/cirurgia , Fatores de Tempo , Resultado do Tratamento , Transtornos da Visão/fisiopatologia , Adulto Jovem
11.
J Neuroophthalmol ; 29(1): 21-5, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-19458571

RESUMO

A 39-year-old man who presented with unilateral proptosis and periocular pain rapidly developed reduced consciousness, facial numbness, dysarthria, and gait ataxia from a direct carotid-cavernous fistula (CCF) with drainage into posterior fossa veins. Brain MRI revealed abnormal signal throughout the brainstem, indicative of venous hypertension and edema. Closure of the fistula by detachable balloon eliminated the clinical and imaging abnormalities. This is the fifth reported case of brainstem complications of a direct CCF. It highlights potentially serious complications of this condition and their reversibility with prompt treatment.


Assuntos
Tronco Encefálico/irrigação sanguínea , Fístula Carótido-Cavernosa/complicações , Hiperemia/etiologia , Adulto , Angiografia , Fístula Carótido-Cavernosa/diagnóstico , Fístula Carótido-Cavernosa/terapia , Cateterismo , Circulação Cerebrovascular , Humanos , Hiperemia/diagnóstico , Hiperemia/terapia , Imageamento por Ressonância Magnética , Masculino , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/etiologia , Doenças Orbitárias/terapia
12.
Can J Ophthalmol ; 43(5): 591-5, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18982039

RESUMO

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a rare and progressive degenerative disease of the central nervous system (CNS), characterized pathologically by spongiform changes in various CNS tissues. It most often presents with rapidly progressing dementia and cognitive decline, along with other neurologic findings that correspond to affected areas of the CNS. We present 5 sporadic cases of CJD presenting with visual manifestations, 2 of which were consistent with the Heidenhain variant, which predominantly affects the occipital lobe. METHODS: Each of the cases demonstrated electroencephalographic changes suggestive of CJD. The neuro-ophthalmic findings included both sensory and motor manifestations, including cortical blindness, hemianopsia, dysmetria, visual hallucinations, hypometric saccades, and diplopia. RESULTS: All patients died within 5 months after the onset of signs of the disease and pathologic specimens were obtained in 4 of the cases. INTERPRETATION: Although CJD is not a commonly seen condition, its possibility should be entertained in any patient presenting with typical neurologic deterioration and complaining of visual symptoms.


Assuntos
Síndrome de Creutzfeldt-Jakob/diagnóstico , Transtornos da Visão/diagnóstico , Idoso , Cegueira Cortical/diagnóstico , Ataxia Cerebelar/diagnóstico , Diplopia/diagnóstico , Evolução Fatal , Feminino , Alucinações/diagnóstico , Hemianopsia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Movimentos Sacádicos
15.
Strabismus ; 10(2): 129-36, 2002 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12221492

RESUMO

Non-human primate models suggest that amblyopia has a neural basis in the form of a massive reduction in binocular neurons, and in some cases, a shift in ocular dominance of neural activity toward the unaffected eye. To date, the resolution of neuroimaging has been insufficient to investigate the neural basis of ocular dominance in human amblyopia. We used high spatial resolution (0.5 x 0.5 x 3 mm) functional magnetic resonance imaging (fMRI) to obtain maps of ocular dominance within the visual cortex of adult human amblyopes. fMRI maps of ocular dominance were similar in appearance to maps reported in the literature. For each of six adults with early-onset amblyopia, the number of map pixels corresponding to the unaffected eye was greater than the number corresponding to the amblyopic eye. This shift in ocular dominance was not seen for the two adults with later-onset amblyopia, suggesting that a shift in ocular dominance of neural activity occurs only if amblyopia onset is within the critical period of brain development. Our findings demonstrate how fMRI can non-invasively investigate the neural substrates underlying human amblyopia at the cortical column level.


Assuntos
Ambliopia/diagnóstico , Dominância Ocular , Córtex Visual/patologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Plasticidade Neuronal
16.
Neurocase ; 8(3): 194-204, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12119314

RESUMO

Using variants of a visually guided pointing task, in which subjects make pointing movements towards targets of varying sizes, we explored motor imagery in a patient with visual neglect. When this patient actually pointed towards targets of different sizes he showed the normal correlation between movement duration (MD) and target size, such that MD increased as target size decreased. In contrast, his imagined movements did not show the same speed-accuracy trade-off observed for actual movements. This was true regardless of the hand used or the initial direction of movement (left versus right). The patient performed normally on several tasks of visual imagery, including size estimation, perceptual discrimination and localization of cities on an imagined map. This patient's performance suggests that the networks in the right parietal lobe play an important role in the generation of internal models of motor movements regardless of the hand used to perform the task.


Assuntos
Transtornos Cognitivos/psicologia , Imaginação/fisiologia , Movimento/fisiologia , Lobo Parietal/patologia , Idoso , Retroalimentação/fisiologia , Lateralidade Funcional/fisiologia , Mãos/fisiologia , Humanos , Masculino , Desempenho Psicomotor , Acidente Vascular Cerebral/patologia , Acidente Vascular Cerebral/psicologia
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