A rare cause of Horner's syndrome: cervicothoracic spinal root cysts.

OBJECTION: We herein report cervicothoracic spinal root cysts as a rare cause of Horner's syndrome. CASE REPORT: A 62-year-old woman was admitted to our neuro-ophthalmology clinic complaining of drooping of her right upper eyelid. The history, physical examination, and laboratory tests were normal. The extraocular movements were full. The right eyelid was ptotic and the right pupil was smaller than the left. Right Horner's syndrome was diagnosed by the neuro-ophthalmologic examination and pharmacological tests. Cervical magnetic resonance imaging showed multiple spinal nerve root cysts between C7 and T1 segments of the spinal cord. CONCLUSION: This report showed for the first time that cervicothoracic spinal root cysts could cause Horner's syndrome and should be kept in mind in performing neuroimaging studies.

Baseline demographics, clinical features, and treatment protocols of 240 patients with optic neuropathy: experiences from a neuro-ophthalmological clinic in the Aegean region of Turkey.

PURPOSE: To analyze the demographic patterns, clinical characteristics, and treatment protocols of optic neuropathies. MATERIALS AND METHODS: The hospital data of patients with optic neuropathy admitted to the Department of Neuro-ophthalmology in a tertiary referral center in Turkey between January 2010 to January 2017 were retrospectively analyzed. Demographic patterns, clinical features, treatment protocols, and the natural disease courses were assessed. RESULTS: The total number of patients with optic neuropathy seen over this period was 240, which consist of 43 with idiopathic optic neuritis (17.9%), 40 with multiple sclerosis-related optic neuritis (16.7%), 12 with chronic relapsing inflammatory optic neuritis (5.0%), 12 with atypical optic neuritis (5.0%), 11 with neuromyelitis optica spectrum disorders-related optic neuritis (4.6%), 90 with non-arteritic ischemic optic neuropathy (37.5%), 4 with arteritic ischemic optic neuropathy (1.7%), 10 with traumatic optic neuropathy (4.1%), 6 with compressive optic neuropathy (2.5%), and 12 with mitochondrial optic neuropathy [9 with toxic optic neuropathy (3.7%) and 3 with Leber's hereditary optic neuropathy (1.2%)]. There were 101 males (42%) and 139 females (58%). The mean age was 43.34 ± 15.86 years. CONCLUSION: This study reported the demographics, clinical characteristics, and treatment protocols of optic neuropathies in a neuro-ophthalmology specialty clinic at a tertiary referral center in Turkey during the past decade. The data may be useful in assessing the global status of optic neuropathies.

Sildenafil-related cerebral venous sinus thrombosis and papilledema: a case report of a rare entity.

We present a rare case of cerebral venous sinus thrombosis associated with long-term and high-dose use of sildenafil. A 29-year-old man was referred to our neuroophthalmology clinic for bilateral visual deterioration and severe headache. He had stage 2 papilledema and other clinical and neurological examinations were normal. He had used the drug for nearly 2 years, two to three times a day. All laboratory parameters including blood count cell, coagulation panels, and genetic tests including methylene-tetrahydrofolate reductase and factor V Leiden mutation were unremarkable. The brain magnetic resonance imaging result confirmed transverse cerebral venous sinus thrombosis (CVST). The opening pressure of cerebrospinal fluid (CSF) was 43 cm H2O with normal biochemistry and no cells. Clinicians must be aware of the possibility of CVST when the patient uses sildenafil.

Comparison of clinical features in patients with vestibular migraine and migraine.

Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM.

Vestibular migraine, demographic and clinical features of 415 patients: A multicenter study.

OBJECTIVE: To evaluate demographic and clinical features of vestibular migraine (VM) patients METHODS: Four hundred fifteen patients with VM were evaluated by using a structured questionnaire in addition to clinical examination. RESULTS: The mean age of headache and vertigo onset was 25 years and 39 years, respectively. In 12.3%, benign paroxysmal positional vertigo (BPPV) was detected during the interictal period. Ten percent had hearing loss on audiometry, in 8.7% it was one-sided low-frequency sensory-neural hearing loss below 2000 Hz and the history was typical for Meniere's disease (MD) in addition to VM. Tinnitus was present in 94.4%, aural fullness in 83.4%, nausea in 72.2% and vomiting in 30.5% of patients with VM/MD. The prevalence of these symptoms was higher in patients with VM/MD than in pure VM. Median attack severity determined by visual analog scale measured in centimeters from 0 to 10 was 8 for headache and 7 for vertigo for the whole group. Severe headache was significantly correlated with age of ≤ 43 years (OR: 6.831, 95% CI: [4.10-11.63]; p < 0.001) and severe vertigo was significantly correlated with age ≥ 41 years (OR: 7.073, 95% CI: [4.55-10.98]; p < 0.001). Motion sickness was revealed from past medical history in 51.8%. Family history of migraine was present in 72.5% and the age of onset of both migraine headaches (p = 0.008) and vertigo attacks (p = 0.004) was lower in these patients. CONCLUSION: Younger patients suffered more severe headache attacks whereas vertigo attack severity was higher in the elderly. BPPV and MD were commonly associated with VM and VM/MD was accompanied by aural and autonomic features more frequently than pure VM. Previous history of motion sickness was detected in more than half of the whole group. Family history of migraine was associated with younger onset of migraine headaches and vertigo attacks.

Pupil cycle time: as indicator of visual pathway dysfunction in multiple sclerosis.

To evaluate the value of pupil cycle time (PCT) as an indicator of optic nerve dysfunction in patients with multiple sclerosis (MS), 42 patients with MS and 35 control subjects were included to the study. Patients with MS with a history of ON were accepted as group 1, without a history of ON as group 2 and healthy control subjects as group 3. Groups were compared with Chi-square and one-way ANOVA tests. Correlations of PCT results with age, best corrected visual acuity, duration of MS, visual field (VF) test, visual evoked potential (VEP) latans, retinal nerve fiber layer (RNFL), and ganglion cell layer-inner plexiform layer (GCL-IPL) thicknesses were analyzed. Mean PCT was 1286.4 ± 357.8 ms in group 1, 1021.3 ± 102.3 ms in group 2, and 872.5 ± 69.4 ms in group 3 (p < 0.001). Moderate-to-significant correlations were found between PCT measurements and duration of MS, VF test, VEP latans, RNFL, and GCL-IPL thicknesses. PCT might be an alternative method to evaluate the optic nerve function in patients with MS.