Chronic daily headache with migrainous features due to papilledema-negative idiopathic intracranial hypertension.

Patients with the syndrome of chronic daily headache often report migrainous symptoms and consequently are diagnosed as having a primary headache syndrome. We report two cases of idiopathic intracranial hypertension causing chronic daily headache with migrainous features in the absence of associated papilledema.

Visual fields in neuro-ophthalmology.

1. The gathering and interpretation of visual fields is important to a thorough neuro-ophthalmic evaluation. The technique of visual field measurement is essential to the proper characterization of visual field defects and must be tailored to each patient in respect to his or her ability to perform a particular test. 2. The techniques for visual field measurement include Amsler grid, confrontation using fingers or colored objects, tangent screen, manual bowl perimeters, and automated static perimeters. 3. The ability to characterize a visual field defect and interpret its relationship to disease involves a combination of knowledge of the anatomy of the visual pathways and the use of the appropriate visual field examination strategy. Once it has been determined--by simple and expeditious confrontation visual field techniques--whether the defect is present centrally or only in the peripheral visual field, a selection of more formal visual field examination can be made.

Magnetic resonance imaging of the optic chiasm.

Magnetic resonance imaging (MRI) has become an important diagnostic modality for the evaluation of patients with chiasmal or perichiasmal disease. In this review, normal chiasmal anatomy and various pathologic conditions will be illustrated to demonstrate the advantages of MRI over computed tomography (CT). MRI is the neuroimaging method of choice in chiasmal evaluation, but sometimes it may be complemented by CT scanning.

Computerized tomographic findings in two cases of congenital fibrosis syndrome.

Two patients with congenital ptosis and extraocular muscle fibrosis are described. The first patient showed marked atrophy of the left inferior rectus muscle. The second patient showed bilateral changes in all extraocular muscles. Computed tomographic evaluation of the extraocular muscles was performed in both patients. The characteristic changes of this phenomenon were seen in both individuals and solidified the diagnosis.

Computerized tomography in the diagnosis of the congenital fibrosis syndrome.

A patient with congenital ptosis and inferior rectus fibrosis is described. Marked atrophy of the left inferior rectus muscle was demonstrated by orbital computerized tomography (CT). Computerized tomographic findings in this patient and a series of 20 patients with no ocular disease and normal motility indicate that CT is a valuable tool for the evaluation of extraocular muscle size when qualitative comparison is made between corresponding muscles in the same patient.

Giant cell arteritis associated with progressive systemic sclerosis.

The clinical and autopsy findings in a patient with both systemic sclerosis (scleroderma) and giant cell arteritis are presented. Giant cell arteritis and systemic sclerosis are autoimmune diseases affecting the elderly that may be associated with similar clinical symptoms of facial pain and arthralgias. Their coexistence is virtually unknown in the medical literature but is of great clinical importance. Systemic sclerosis is not treated with the steroid dosage necessary to prevent the morbid results of giant cell arteritis. An elevated sedimentation rate and/or an abnormal temporal artery examination in an elderly patient with systemic sclerosis should alert the clinician to the possible coexistence of giant cell arteritis.

Visual disturbances of migraine.

Migraine, a clinical syndrome of unknown etiology, is a common cause of a variety of visual disturbances. This review describes the visual alterations associated with migraine syndromes of particular interest to the ophthalmologist; acephalgic, ocular, and ophthalmoplegic. Several current theories of migraine pathophysiology are discussed. Migrainous episodes are common and must be differentiated from neurologic dysfunction due to ischemia, inflammation, seizure, and compression. The differentiating characteristics of these conditions as well as a diagnostic algorithm are presented.

Optic nerve sheath decompression. Review of 17 cases.

Seventeen patients (19 eyes) with progressive visual loss associated with retrobulbar optic nerve and/or sheath enlargement were treated by surgical nerve sheath decompression at the Bascom Palmer Eye Institute, Miami, from 1969 through 1984. A decision to intervene was based on progressive visual loss unresponsive to other modes of therapy and accompanied by retrobulbar optic nerve sheath enlargement as determined by computed tomography, contrast orbitography, or orbital echography. Follow-up ranged from three months to nine years, with an average of 17 months. Visual function improvement was noted within one month after operation in seven of 19 eyes. The other 12 eyes showed no improvement or continued to worsen. Postoperative complications were infrequent, with motility disturbances being the most common. Optic nerve sheath decompression via the medial orbital approach has a low operative morbidity and may improve visual function in patients with progressive visual loss associated with the accumulation of compressible fluids in the retro-orbital optic nerve sheaths. This relatively safe surgical approach to the retrobulbar optic nerve may also be of future use in the retrieval of optic nerve tissue and fluid for chemical and cytologic analysis.

Nerve fibre bundle visual field defects and intracranial mass lesions.

Nerve fibre bundle visual field defects are the hallmark of pathology at the optic nerve head or retina. In the present series, six eyes of four patients with large intracranial mass lesions demonstrated such field defects with visual acuity spared in three of the involved eyes. In no cases did visual function in the opposite eye offer a clue to the localization of the lesion.

Posttraumatic venous obstructive retinopathy associated with enlarged optic nerve sheath.

A case of posttraumatic unilateral enlargement of the optic nerve sheath associated with a venous obstructive retinopathy and progressive visual loss responded with marked improvement in visual function after nerve sheath decompression. Indirect (closed-head) trauma may be related to the progressive nerve sheath enlargement, venous obstructive retinopathy, and progressive visual loss. It is apparent that a venous stasis retinopathy can result from a posttraumatic optic nerve sheath lesion. Prompt recognition by echographic and/or roentgenographic investigation and subsequent decompression may be curative.