Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0029089 (ophthalmoplegia)
 3,338 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The incidence of unilateral blindness and ophthalmoplegia after aneurysm surgery is very rare, but if it occurs, it is mainly caused by intra-operative nerve injury. We experienced 6 cases of unilateral blindness immediately after surgery for 3 recent years. These patients were classified into Hunt-Hess grade I to II except for one patient with III. All patients complained of visual loss with varying degree of lid oedema and ophthalmoplegia ipsilateral to the site of surgery. Angiographic examination of these patients revealed that the aneurysm was located at the internal carotid artery bifurcation in one case and the middle cerebral artery bifurcation in five cases. All of them were relatively far from the optic nerve. The aneurysm was clipped easily with minimal brain retraction via standard pterional craniotomy since the brain was slack in all cases. In all cases, injuring the optic nerve during surgery was remote. All patients showed evidence of retinal ischaemia on fundoscopy with or without fluorescein angiography. The pathophysiology of this ischaemic event is unknown. In our patients, we could exclude possible aetiological factors such as abnormal systemic and ocular conditions, causing ischaemia in intra-orbital structures, increased intracranial pressure, intra-operative hypotension, carotid atherosclerosis, and ocular vasospasm etc. Accordingly we speculate that the complications seen in our cases were most likely related to intra-orbital ischaemia initiated by a collapse of the arterial and venous channels in the orbit and/or to direct or indirect contusion on the intra-orbital structures. These situations could be produced by inadvertent pressure placed on the eyeball with a bulky retracted frontal skin flap. Visual acuity in these patients ranged from no light perception to the ability to see objects and detect colour. Their conditions were irreversible. The degree of visual recovery seems to be dependent on the duration and severity of retinal ischaemia by orbital compression. Unfortunately there is no satisfactory treatment. We recommend the use of an eye shield to protect ipsilateral eyeball just before aneurysm surgery.
 ...
PMID:Sudden unilateral blindness after intracranial aneurysm surgery. 914 88

The objective of this article is to review clinical outcomes in patients presenting with pituitary apoplexy and compare the results of conservative and surgical management. It took the form of a retrospective review of 30 patients (23M, 7F; age range: 17-86 years) with pituitary apoplexy diagnosed between 1988 and 2004. Presenting features included headache in 27 patients, 'collapse' in three and vomiting in 14. Complete blindness occurred in four patients, monocular blindness in two, decreased visual acuity in 12, visual field loss in 10 and ophthalmoplegia in 15. Only five had no initial visual deficit. CT was the initial mode of imaging in 22 patients: three such scans were initially reported as 'normal' and a further 10 as pituitary tumour only, with no haemorrhage. Ten patients proceeded to early pituitary surgery and 20 were managed conservatively. There was one death 24 days after admission in a patient with multiple co-morbidities. Of the six patients with blindness, three (two conservatively treated) regained partial vision. Of the remaining 19 patients with visual deficits, 10 (two surgically treated) recovered fully and eight (four surgically treated) partly so. At latest follow-up the following pituitary hormone deficiencies were identified: ACTH 19; TSH 20; testosterone 18; ADH (diabetes insipidus) eight. Later recurrence of a pituitary adenoma was observed in seven cases (including six of the 10 surgically treated patients). There was no evidence that those patients managed surgically had a better outcome. Early neurosurgical intervention may not be required in most patients presenting with pituitary apoplexy.
 ...
PMID:Pituitary apoplexy: retrospective review of 30 patients--is surgical intervention always necessary? 1743 89

This study describes a patient with post-partum collapse secondary to pituitary apoplexy with bilateral carotid artery occlusion. A 29-year-old female, post delivery of a healthy child, presented with a Glasgow Coma Scale score of 3, fixed dilated pupils, complete ophthalmoplegia, and bilateral compression of the internal carotid arteries. These symptoms were due to a giant pituitary macroadenoma. She underwent a craniotomy and subsequently survived with minor cognitive deficits and functional vision. Bilateral carotid occlusion caused by pituitary apoplexy is rare, yet survival with only minor deficits is possible.
 ...
PMID:Post-partum pituitary apoplexy with bilateral third nerve palsy and bilateral carotid occlusion. 2059 74

The clinical presentation of beriberi can be quite varied. In the extreme form, profound cardiovascular involvement leads to circulatory collapse and death. This case report is of a 72 year-old male who was admitted to the Neurology inpatient ward with progressive bilateral lower extremity weakness and parasthesia. He subsequently developed pulmonary edema and high output cardiac failure requiring intubation and blood pressure support. With the constellation of peripheral neuropathy, encephalopathy, ophthalmoplegia, unexplained heart failure, and lactic acidosis, thiamine deficiency was suspected. He was empirically initiated on thiamine replacement therapy and his thiamine level pre-therapy was found to be 23 nmol/L (Normal: 80-150 nmol/L), consistent with the diagnosis of beriberi. Cardiovascular magnetic resonance (CMR) showed severe left ventricular systolic dysfunction, markedly increased myocardial T2, and minimal late gadolinium enhancement (LGE). After 5 days of daily 100 mg IV thiamine and supportive care, the hypotension resolved and the patient was extubated and was released from the hospital 3 weeks later. Our case shows via CMR profound myocardial edema associated with wet beriberi.
 ...
PMID:Cardiovascular magnetic resonance in wet beriberi. 2183 1