Evidence of multidomain mild cognitive impairment in idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension (IIH), a disorder of unknown etiology, may occur in all age groups, but is most common in young obese women. Goals of treatment are to preserve vision and alleviate symptoms, including intractable headache, pulsatile tinnitus, and nausea. Cognitive function is not addressed routinely during clinical evaluation of IIH patients. The aim of our study was to test whether there is cognitive impairment in IIH patients and to evaluate the nature and characteristics of cognitive functions. METHODS: Design-Prospective cross-sectional observational study; Setting-Institutional;Study population-Thirty consecutive IIH patients (3 men and 27 women), mean age at time of testing was 34.4 years; Procedures-All participants completed a cognitive test battery; Outcome measures-Impairment of non-verbal memory, executive function, visual spatial processing, attention, motor skills, problem solving, and information processing speed in IIH patients. RESULTS: Mean scores for all domain index scores were below average for age and education. The global cognitive score, attention, and visual spatial indices had the lowest scores. CONCLUSIONS: Our results indicate that patients with IIH have mild cognitive impairment. All domain measures apart from memory showed a statistically significant difference from normal individuals, indicating that there is a form of multidomain cognitive impairment in IIH. The relationship between cognitive impairment and chronically elevated intracranial pressures and its role in contributing to patient morbidity requires further study.

Orbital tumors treated using transcranial approaches: surgical technique and neuroophthalmogical results in 41 patients.

OBJECT: Orbital tumors can be divided schematically into primary lesions, originating from the orbit itself, and secondary lesions, extending to the orbit from neighboring structures. These tumors are variable in their biological nature and in their location. The authors evaluate 41 cases of benign and malignant tumors involving the orbit and discuss the surgical challenge, which involves tumor removal, preserving visual function and cosmetic reconstruction. METHODS: The authors performed a retrospective analysis of a series of all cases involving patients who underwent surgery for treatment of orbital tumors in their hospital between December 2003 and December 2006. Data were collected from the patients' files in the hospital's outpatient clinic, operative notes, and pre- and postoperative imaging studies. RESULTS: The authors identified 41 patients who met the inclusion criteria (age range 14-82 years, mean 42.2 years, standard deviation 22.4 years). The most common presenting symptoms were proptosis and/or partial ptosis (11 cases [27%]) and headache (7 cases [17%]). In 5 (12%) cases, the tumors were primary intraorbital lesions, and in 34 cases (83%) they were secondary. Two patients had metastases to the orbit. The most common lesion types were meningioma (10 cases [24%]) and osteoma (7 cases [17%]). In 24 cases a midline approach through a frontal craniotomy or a subcranial approach was used; in 13 a lateral approach was used; and in 4 a biopsy procedure was performed. Maxillectomy through a Weber-Ferguson approach or a facial degloving approach was added in 5 cases to complete tumor removal. Duration of follow-up was 1-38 months (mean 20 months). None of the patients died as a result of the procedure, and there were relatively few complications. Excluding the patients who underwent orbital exenteration, none of the patients had visual deterioration following surgery, and most had no change in their visual condition. Two patients had temporary diplopia, 1 had a cerebrospinal fluid leak, and 1 had enophthalmos following removal of an orbital osteosarcoma. CONCLUSIONS: Orbital tumors can be treated safely using transcranial approaches in many cases. Preoperative imaging can accurately define the compartments involved and the surgical approach needed for tumor removal. A multidisciplinary team of surgeons facilitates optimal tumor removal and skull base sealing as well as good cosmetic results.

Comparison of peripapillary retinal nerve fiber layer loss and visual outcome in fellow eyes following sequential bilateral non-arteritic anterior ischemic optic neuropathy.

AIM: To report on the correlation of structural damage to the axons of the optic nerve and visual outcome following bilateral non-arteritic anterior ischemic optic neuropathy. METHODS: A retrospective review of the medical records of 25 patients with bilateral sequential non-arteritic anterior ischemic optic neuropathy was performed. Outcome measures were peripapillary retinal nerve fiber layer thickness measured with the Stratus optical coherence tomography scanner, visual acuity and visual field loss. RESULTS: Median peripapillary retinal nerve fiber layer (RNFL) thickness, mean deviation (MD) of visual field, and visual acuity of initially involved NAION eyes (54.00 µm, -17.77 decibels (dB), 0.4, respectively) were comparable to the same parameters measured following development of second NAION event in the other eye (53.70 µm, p = 0.740; -16.83 dB, p = 0.692; 0.4, p = 0.942, respectively). In patients with bilateral NAION, there was a significant correlation of peripapillary RNFL thickness (r = 0.583, p = 0.002) and MD of the visual field (r = 0.457, p = 0.042) for the pairs of affected eyes, whereas a poor correlation was found in visual acuity of these eyes (r = 0.279, p = 0.176). Peripapillary RNFL thickness following NAION was positively correlated with MD of visual field (r = 0.312, p = 0.043) and negatively correlated with logMAR visual acuity (r = -0.365, p = 0.009). CONCLUSION: In patients who experience bilateral NAION, the magnitude of RNFL loss is similar in each eye. There is a greater similarity in visual field loss than in visual acuity between the two affected eyes with NAION of the same individual.

The use of spectral-domain optical coherence tomography for differentiating long-standing central retinal artery occlusion and nonarteritic anterior ischemic optic neuropathy.

BACKGROUND AND OBJECTIVE: To report on the efficacy of macular and optic nerve spectral-domain optical coherence tomography (SD-OCT) in differentiating between long-standing central retinal artery occlusion (CRAO) and nonarteritic anterior ischemic optic neuropathy (NAION). PATIENTS AND METHODS: SD-OCT scans of the macula and optic nerve in 24 patients with unilateral optic atrophy secondary to CRAO (12 patients) and NAION (12 patients) were compared both qualitatively and quantitatively for differentiating features. RESULTS: In patients with long-standing CRAO, there was a significantly greater (P < .001) thinning of the macula relative to the fellow uninvolved eye (-59.7 ± 31.8 µm) compared to patients with longstanding NAION (-19.9 ± 8.4 µm) even though both conditions caused a similar (P = .726) degree of peripapillary retinal nerve fiber layer loss (-42.4 ± 18.5 µm and -44.1 ± 12.4 µm, respectively). CONCLUSION: SD-OCT macular scans can be used as an adjunctive tool for differentiating between longstanding CRAO and NAION.

Retinal thickness in patients with mild cognitive impairment and Alzheimer's disease.

OBJECTIVES: Mild cognitive impairment (MCI) may represent a transition to early Alzheimer's disease (AD). The retinal nerve fiber layer (RNFL) is composed of axons originating in retinal ganglion cells that eventually form the optic nerves. Previous studies have shown that degenerative changes occur in optic nerve fibers and manifested as thinning of RNFL in patients with AD. The objective of this study was to assess the relationship between MCI, AD and loss of RNFL. PATIENTS AND METHODS: In this study, patients fulfilling diagnostic criteria for MCI (n=24), AD (n=30) and cognitively normal age-matched controls (n=24) have undergone neuro-ophthalmologic and optical coherence tomography (OCT) examinations to measure RNFL thickness. RESULTS: There was a significant decrease in RNFL thickness in both study groups (AD and MCI) compared to the control group, particularly in the inferior quadrants of the optic nerve head, while the superior quadrants were significantly thinner only in AD. Although AD patients may have more severe changes than MCI cases, the differences were statistically nonsignificant. Furthermore among AD patients, there was no relation to the severity of the dementia. CONCLUSIONS: Our data confirm the retinal involvement in AD, as reflected by loss of axons in the optic nerves.