The imploding antrum: An unusual case of nontraumatic painless enophthalmos.

The imploding antrum or silent sinus syndrome is a rare phenomenon that presents with spontaneous painless enophthalmos and hypoglobus. It occurs due to ipsilateral maxillary antral atelectasis secondary to asymptomatic obstructive chronic sinus mucosal disease. Ophthalmologists, otorhinolaryngologists, and radiologists must be aware of this entity. This article illustrates the typical presentation in a 17-year-old male with unilateral ptosis and a deep superior sulcus, and characteristic imaging findings of ipsilateral increased orbital volume and depression of the orbital floor, maxillary sinus opacification and atelectasis with retraction of the posterolateral and medial walls, lateralization of the uncinate process, and obstruction of the ostiomeatal unit. This is probably the first time that the syndrome is being reported in such a young person. The pathogenesis, differential diagnosis, and treatment modalities of this entity are also reviewed.

The "heart appearance" sign in bilateral pontine infarction.

BACKGROUND: Although rarely seen, bilateral anteromedial infarction of the pons demonstrates the characteristic "heart appearance" sign on magnetic resonance imaging (MRI). This sign has hitherto been described in only 2 patients before this article. This typical pattern can be attributed to atherosclerotic or thrombotic involvement of bilateral paramedian and short circumferential pontine arteries supplying the anteromedial pons. METHODS AND RESULTS: A 60-year-old man, a known patient of primary hypertension and diabetes mellitus, presented with a posterior circulation stroke. Urgent computerized tomography and MRI revealed a "heart-shaped" area of acute infarction in the anteromedian mid-pons. A few scattered infarcts were also noted in the posterior and inferior part of the right cerebellar hemisphere. The basilar artery appeared normal with preserved flow void on MRI, and there were no signs of hemorrhage. These findings were consistent with acute nonhemorrhagic infarcts involving bilateral paramedian and short circumferential pontine arteries and the right posterior inferior cerebellar artery. A repeat MRI performed after a week disclosed hemorrhagic transformation and enhancement of the pontine infarction. The basilar artery appeared normal on magnetic resonance angiography. CONCLUSIONS: Recognizing the "heart appearance" sign in a stroke-like episode may be helpful in differentiating bilateral anteromedial pontine infarction from other pathologic processes involving the pons.

The trail making test in India.

The trail making test (TMT) is a short and convenient estimate of cognitive functions, principally attention and working memory. Like most neuropsychological tests, it is derived from and primarily applicable to English-speaking individuals. Norms for other ethnic minorities may differ significantly. The application of majority or mixed norms to specific ethnic subcultures may introduce systematic bias. To examine the impact of an English test on primarily nonEnglish-speaking individuals, outpatients attending the dermatology department of a large Indian hospital (n = 120) were asked to complete the English version of the TMT. The time taken to complete the TRAILS was unexpectedly long, although all the subjects scored within normal limits on the modified mini mental status examination and a test for general knowledge. Possible reasons for the delayed completion times are discussed below.