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Query: UMLS:C0029089 (ophthalmoplegia)
 3,338 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of an orbital metastasis from a bronchogenic neoplasm is described. The initial clinical presentation was of unilateral facial pain and paraesthesia shortly followed by increasing left-sided external ophthalmoplegia and proptosis and the development of a slight swelling of the left temporal fossa. The diagnosis was established by a biopsy of the temporal mass. The patient died two months after the diagnosis was established. The significance of facial pain and paraesthesia and the literature pertaining to orbital cellulitis and orbital metastases is discussed.
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PMID:Bronchogenic carcinoma metastasizing to the orbit. A case report. 21 88

A retrospective study of CT and MR examinations in 14 patients with benign and malignant tumors originating in the masticator space is presented. At presentation, 12 patients revealed tumor extension to adjacent regions and spaces. Perineural tumor spread along trigeminal nerve branches to the cavernous sinus and orbits was combined with facial pain, and/or numbness, ophthalmoplegia, and exophthalmus. Detailed analysis of tumor growth and spread, enhancement and signal features at CT and MR imaging indicated the tumor histology was, with a few exceptions, nonspecific. More extensive growth and bone destruction was noted only among malignant tumors. MR imaging was found superior to CT in delineating tumor extension due to better soft tissue contrast resolution and multiplanar imaging. Posttreatment examinations were available in 11 patients and showed long-standing regional edema of the adjacent temporal lobe and masticator muscles in 4 out of 5 patients without clinical evidence of tumor. In 6 patients, CT and MR features were found almost unchanged with only small size differences after various forms of treatment.
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PMID:CT and MR imaging of primary tumors of the masticator space. 144 72

The authors present an extremely rare case of aspergillosis of the central nervous system (CNS) causing subarachnoid hemorrhage (SAH). A 78-year-old female developed facial pain, progressive deterioration in left visual acuity, and left total ophthalmoplegia. Computed tomography demonstrated a heterogeneously enhanced mass extending from the sphenoid sinus to the left cavernous sinus and left orbit, and angiography showed luminal narrowing and irregularity of the left internal carotid artery at its siphon. Biopsy of the left orbital and sphenoid sinus mass resulted in the diagnosis of Aspergillus granuloma. Despite combined administration of amphotericin-B and 5-FC, she became comatose from brainstem infarction and finally, suddenly died. Postmortem examination revealed massive SAH due to a ruptured mycotic aneurysm of the basilar artery. Aspergillosis of the CNS is a growing problem with the wider use of immunosuppressants and antibiotics. To the authors' knowledge, however, only 13 cases of CNS aspergillosis causing SAH have been reported. The prognosis is absolutely bad, with all patients dying from rupture of major intracranial arteries such as the internal carotid artery and basilar artery. Early diagnosis and vigorous chemotherapy are important.
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PMID:Aspergillosis of the central nervous system causing subarachnoid hemorrhage from mycotic aneurysm of the basilar artery--case report. 170 41

A 64-year-old woman, with history of hypertension and arteriosclerosis, developed left painful ophthalmoplegia in July, 1988. Neurological examination proved abnormality of the third cranial nerve innervation, otherwise normal. No systemic illness was present. With corticosteroid therapy, the symptoms regressed and completely disappeared in 3 months. In January, 1990, right painful ophthalmoplegia appeared. Neurological examination revealed involvement of right sixth nerve and first branch of the right fifth nerve. With corticosteroid therapy, the symptoms completely regressed in several weeks. In April, 1990, she developed severe pain in the right side of the face. The facial pain disappeared rapidly with corticosteroid therapy, but reappeared following quit of steroid. She complained of severe pain of the right face, the territory of first and second branch of the right fifth nerve, but neurological examination was negative. With corticosteroid therapy, the pain disappeared remaining with mild tingling sensation on the right face, but during the tapering of corticosteroid in August, a severe peripheral type right facial palsy developed. Corticosteroid therapy resumed and the facial palsy regressed almost completely in ten days. Our case suggests that THS might be a variant of so-called recurrent cranial neuropathy.
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PMID:[A case of recurrent cranial neuropathy presenting as recurrent Tolosa-Hunt syndrome]. 180 72

We review our recent experience with occlusion of the cervical internal carotid artery (ICA) in 15 patients with symptomatic aneurysms of the cavernous segment. All the patients were women and ranged in age from 38 to 74 years. Ten patients sought treatment initially for ophthalmoplegia, 9 for retro-orbital pain, 8 for facial paresthesia, and 3 for loss of vision. Two patients had symptoms of transient ocular or brain ischemia. The diameter of the aneurysm was greater than 3 cm in 10 patients. Ten patients underwent gradual occlusion of the ICA by Selverstone clamp under anticoagulation and monitoring of neurological status. One patient underwent ligation of a severely stenotic ICA under general anesthesia and electroencephalographic monitoring. Four patients underwent trapping of the aneurysm (after attempts at direct obliteration) under electroencephalographic and cerebral blood flow monitoring. Two patients with incompetent circle of Willis collaterals underwent prophylactic superficial temporal artery to middle cerebral artery bypass surgery prior to ICA occlusion. There was no postoperative clinical change in 9 patients. Ophthalmoplegia improved in 2 patients, and facial pain improved in 3. Three patients developed new extraocular muscle palsies within hours of ICA occlusion; these resolved in all patients by 1 week postoperatively. No change in aneurysm size was documented by serial postoperative computed tomographic or magnetic resonance imaging scans. After a follow-up of 5 to 6 years (range, 6 months-9 years), 11 patients have remained neurologically stable. Two patients experienced delayed transient worsening of visual or facial symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Internal carotid artery occlusion for cavernous segment aneurysm. 277 Oct 11

Four patients with histologically confirmed parasellar metastases are reported. The main symptoms and signs were persistent right facial pain followed by diplopia (patient 1), headache and minimal right abducens palsy (patient 2), acute, total left ophthalmoplegia (patient 3), and acute, total bilateral ophthalmoplegia (patient 4). Positive radiologic evidence was present only in patient 1: there was bony erosion of the petrous apex and computed tomography scan showed an enhanced parasellar mass. This patient underwent partial surgical removal of the tumor. Patient 3 was treated with irradiation. All patients died within 14 weeks of the onset of the initial symptoms and all were autopsied. Their primary lesions were hepatoma, stomach cancer, lung cancer, and mesenteric liposarcoma.
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PMID:Parasellar metastases: four autopsied cases. 298 Nov 20

The differential diagnosis of chronic facial pain is facilitated by a knowledge of anatomy. Nasal and dental conditions are prevalent causes of facial pain. Orbital discomfort with ophthalmoplegia or Horner's syndrome generally has a vascular etiology. The lower-half headache or atypical facial neuralgia also is vascular in origin and should be referred to as facial migraine. Previously, chronic iatrogenic trigeminal neuralgia has been erroneously included in the category of lower-half headaches. This disabling condition is due to repeated trauma to the trigeminal nerve.
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PMID:Differential diagnosis of chronic facial pain. 723 31

Magnetic resonance imaging has provided many advances in the field of neuro-ophthalmology. Refinements in magnetic resonance imaging allow excellent evaluation of the brainstem, cranial nerves, and sellar and suprasellar regions. Gadopentetic acid enhancement allows identification of subtle lesions, which may not otherwise alter morphology, as this agent may cross an abnormal blood-brain barrier. This year I have focused on imaging advances in evaluation of optic gliomas, radionecrosis of the optic nerves and chiasm, internuclear ophthalmoplegia, and facial pain and hemifacial spasm.
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PMID:Imaging advances in neuro-ophthalmology. 1014 23

Rhino-orbital-cerebral mucormycosis (ROCM) is an acute, often fatal, fungal infection caused by members of the class Zygomycetes and the order Mucorales. The genus Rhizopus accounts for most cases of ROCM. The disease is characterized by fungal hyphal invasion of blood vessels resulting in thrombosis and infarction of the nasal, paranasal sinus, orbital, and cerebral tissues. The most commonly associated condition is diabetes mellitus; other associated conditions include immunocompromised states, renal disease, deferoxamine use, and acidotic states. Common clinical findings include rhinitis, periorbital and facial swelling, facial and mucosal necrosis, ophthalmoplegia, multiple cranial nerve palsies, facial pain, and headache. Definitive diagnosis is made by demonstration of fungal hyphae in tissue specimens. The mainstay of treatment is aggressive surgical debridement of infected tissue and administration of amphotericin B. ROCM has a mortality rate of 40-50%; 70% of survivors are left with residual defects. Early diagnosis and treatment are imperative in the successful management of patients afflicted with this devastating sight- and life-threatening disease.
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PMID:Rhino-orbital-cerebral mucormycosis: a review. 1204 3

The parasellar compartments are located lateral to and on either side of the sella turcica. The cavernous sinuses are the most prominent anatomic feature of the parasella. Each sinus consists of a plexus of veins through which runs the intracavernous portion of the internal carotid artery. Ocular motor nerves three and four travel within the dural covering of the cavernous sinus to the superior orbital fissure, and cranial nerve six travels through the carotid sinus itself, giving rise to parasellar syndromes, which have distinctive clinical features. Ophthalmoplegia occurs as a result of damage to these ocular motor nerves and variable involvement of oculosympathetic nerves. Facial pain, dysesthesia, and paraesthesia are caused by damage to one or more of the divisions of the fifth cranial nerve, travelling in the dural wall of the cavernous sinus. Tumors, such as meningiomas, frequently cause parasellar syndromes, as do aneurysms of the intracavernous portion of the internal carotid artery, carotid-cavernous fistulas, and cavernous sinus thrombosis. Inflammatory conditions such as Tolosa-Hunt syndrome, ischemia to small vessels supplying the cavernous portion of the cranial nerves, and infections can cause this syndrome. Magnetic resonance imaging is the investigation of choice and therapy is specific to the cause of the parasellar syndrome, but now includes more aggressive endoscopic and microsurgical intervention, and radiosurgery.
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PMID:Parasellar syndromes. 1216 23


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