Optic nerve compression in allergic fungal sinusitis.

OBJECTIVE: To describe the syndrome of optic nerve involvement in cases of allergic fungal sinusitis. SETTING: Academic tertiary care centre. METHODS: Analysis of prospectively accrued data for 10 consecutive cases (three bilateral, giving 13 eyes) with visual loss secondary to optic nerve compression, from a total of 70 cases of allergic fungal sinusitis undergoing surgical treatment between June 1997 and May 2007. RESULTS: The mean duration of rhinological symptoms prior to the onset of visual loss was 22 months. At presentation, visual loss ranged from a visual acuity of 6/12 to complete loss of light perception. Bilateral involvement was noted in three of the 10 cases. Urgent surgical decompression with removal of all fungal debris and decompression of the optic nerve resulted in visual recovery in seven of the 13 eyes. On univariate analysis, recovery was less likely in cases with long standing visual loss, and in cases with complete visual loss. CONCLUSION: Long standing allergic fungal sinusitis may be complicated by visual loss due to compression of the optic nerve. Urgent surgery to clear the sinuses and decompress the optic nerve is successful in reversing visual loss in cases with partial visual loss.

Acute spinal cord compression caused by disseminated Nocardia infection involving the conus medullaris.

Distinguishing between an infective and malignant process provides a diagnostic challenge for clinicians. This case highlights an example of an acute spinal cord compression that could fall into either of these two categories. The diagnosis in this case of disseminated Nocardiosis is an extremely rare cause of acute spinal cord compression and to our knowledge intrinsic conus medullaris infection from Nocardia has not previously been reported in the literature. Nocardia cyriacigeorgica is an emerging strain of Nocardia species recently identified which was previously categorised as Nocardia asteroides type VI infection. The challenge of eliciting the diagnosis and the need to have an index of suspicion of Nocardia as a possible aetiology agent is shown in the report. The case shows this is especially important in evaluation of a multi-system infection in an immunosuppressed individual. The case described highlights an interesting diagnostic case with the resultant causative organism an emerging strain of Nocardia species with no previous reported cases of conus medullaris involvement.

Detection of neuropathy due to Mycobacterium leprae using noninvasive neurosensory testing of susceptible peripheral nerves.

The prevalence of disability in patients with Hansen disease is related to peripheral nerve dysfunction. This dysfunction, which is due to chronic nerve compression, is the result of invasion of the peripheral nerve by Mycobacteria leprae. This suggests that early identification of M. leprae would be aided by detection of early stages of peripheral nerve compression. Traditional evaluation of peripheral nerve function with monofilaments, electrodiagnostic testing, or by observing motor palsy or digital ulcers unfortunately identifies only late sequelae of peripheral nerve dysfunction. The cutaneous pressure threshold required to identify 1 from 2 static-touch stimuli was obtained with the Pressure-Specified Sensory Device in upper and lower extremities of 51 patients who completed multidrug therapy for Hansen disease. Abnormal peripheral nerve function was identified in each patient and in each of the 120 bilateral nerves that were evaluated. The degree of nerve dysfunction included the range from early to late stages of nerve compression, suggesting that this method of neurosensory testing offers the possibility for early detection of peripheral nerve problems in Hansen disease.

Single tendon--two insertion versus two tendon transfers for reablement of ulnar-median palsied thumb in leprosy.

Twenty-three opponensplasties for ulnar median paralysis in 20 leprosy patients were performed by two different procedures i.e. extensor indicis proprius and flexor digitorum superficialis transfers using standard techniques. The results were evaluated using various objective and subjective, anatomical and functional parameters. Two tendon transfers appeared to be superior to single tendon two insertion transfers. It was concluded that if situation permits, two tendon transfers should be performed for combined ulnar median paralysis.

Cauda equina syndrome, diskospondylitis, and a paravertebral abscess caused by Rhodococcus equi in a foal.

A 4-month-old male Quarter Horse was referred for evaluation of urinary incontinence. Physical examination revealed clinical signs consistent with cauda equina syndrome. Radiography revealed diskospondylitis of S2 through S4. Infected bone was surgically curretted, and drainage was established for an associated paravertebral abscess. Rhodococcus equi was isolated from specimens of bone and from fluid samples obtained from the paravertebral abscess. Bethanechol was administered to stimulate urination. Erythromycin and rifampin were administered for 120 days. The foal's neurologic dysfunction resolved completely. Two years after discharge, the horse remained neurologically normal and did not have apparent effects as a result of its previous disorder.