Pain in anterior ischemic optic neuropathy.

PURPOSE: The diagnoses of both anterior ischemic optic neuropathy (AION) and optic neuritis are clinical ones with significant overlap of symptoms and signs. This study investigates the presence and character of pain at the onset of AION, in order to evaluate this symptom as a differentiating diagnostic feature between optic neuritis and AION. METHODS: Forty-one consecutive patients over 45 years of age with a clinical syndrome consistent with AION were questioned about the presence and character of associated pain. RESULTS: Pain was reported by 12% (5 of 41) of the patients with AION. This is contrasted with data compiled on 448 patients in the optic neuritis treatment trial, of whom 92.2% complained of pain. CONCLUSION: While there is overlap in the incidence and character of pain in AION and optic neuritis, its presence/absence remains a useful differentiating feature.

Clinical manifestations of lesions of the suprasellar and parasellar regions: a neuro-ophthalmologic perspective.

Radiologists, neurologists, and ophthalmologists must develop common ground in describing the clinical manifestations of and terminology used in lesions of the basilar cisterns and parasellar region. This article attempts to bridge that communications gap using lesions of the orbital apex, cavernous sinus, sella turcica, and parasellar regions as examples.

Personality and keratoconus.

We studied personality traits of patients with keratoconus in a controlled prospective study using the Minnesota Multiphasic Personality Inventory (MMPI). Whereas four of 16 (25%) control patients with herpes simplex keratitis had scores indicative of psychological abnormality, 15 of 28 (54%) keratoconus patients had scores indicative of abnormality (P less than .05). Keratoconus patients who had undergone penetrating keratoplasty had a lower rate of abnormal scores (3 of 9; 33%) than unoperated keratoconus patients (12 of 19; 63%) (P less than .05). Patients who considered themselves moderate or severely limited by their eye condition were more likely to have abnormal scores (7 of 8; 87%) than patients who thought they were mildly affected (8 of 20; 40%) (P less than .05).

Stapes prosthesis: evaluation with CT.

We used computed tomography (CT) to evaluate 44 patients who had undergone stapedectomy with insertion of a prosthesis. Several patients had poor surgical results, including recurrent conductive hearing loss, vertigo, and sensorineural hearing loss. Conductive hearing loss occurring immediately after the procedure was most often caused by anatomic limitations or surgical technique. Causes of delayed or recurrent conductive hearing loss included reparative granuloma formation, incus necrosis (at the attachment of the wire), prosthesis subluxation (most often posterior), and regrowth of otosclerosis, which occasionally is further complicated by incus dislocation. We found that CT is often diagnostic when these complications occur. Immediate sensorineural hearing loss or vertigo can be self-limited if caused by serous labyrinthitis. When delayed, these symptoms may be due to perilymph fistula. If caused by the latter, CT may not yield abnormal findings unless subluxation of the prosthesis into the vestibule has occurred.

Fenestral and cochlear otosclerosis: computed tomographic evaluation.

Computed tomography has replaced conventional multidirectional tomography in the imaging of patients with the presumed diagnosis of otosclerosis. In addition to obliterative disease, which was easily diagnosed with multidirectional tomography, anterior and posterior foci of varying sizes can now also be visualized preoperatively. Active cochlear otosclerosis (otospongiosis) is diagnosed in the presence of foci of demineralization in the otic capsule. Diagnosis of these entities has been of great interest to our referring otologic surgeons.

Computerized tomographic evaluation of the middle ear and mastoid for posttraumatic hearing loss.

High resolution computerized tomography has been proven valuable in all aspects of temporal bone study. The importance of the procedure in evaluation of traumatic lesions, particularly of the middle ear, has been underemphasized. Damage to the middle ear may occur with blunt trauma, penetrating injury, or barotrauma. Conductive hearing loss and/or CSF otorrhea may result. Detailed evaluation of the ossicles is the hallmark of properly performed computerized tomographic evaluation.