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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two patients developed proptosis and a slowly enlarging mass with increasing discomfort in the orbital socket 17 and 25 years following enucleation. Preoperative CT scans revealed a single cystic structure within the orbits of each case with distinct soft tissue tumors adjacent to the cysts. The cystic structures and the adjacent solid masses were removed en bloc necessitating reconstruction of the orbits with a dermal fat pad (case 1) and a mucous membrane graft (case 2). Postoperatively the patients were free of complaints. Microscopically, the cystic structures were identified as conjunctival inclusion cysts while the soft tissue masses were traumatic neuromas with irregular tangles and whorls composed of proliferated axons, Schwann cells and connective tissue. Only seven amputation neuromas of the orbit have been reported. Pain related to the neuroma is rarely encountered and is probably caused by mechanical irritation of the amputation neuroma, by retracting scar tissue, or compression from an adjacent cystic mass as in one of our cases.
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PMID:Amputation neuroma of the orbit. Report of two cases and review of the literature. 651 10

The Tolosa-Hunt syndrome is characterized by recurrent unilateral painful ophthalmoplegia which responds to systemic steroid therapy dramatically. The etiology appears to be a non-specific inflammation in the cavernous sinus and the superior orbital fissure. Two interesting cases similar to this syndrome are described. One is a 54-year-old man with moderate left exophthalmos who had no complaint of retro-orbital pain. CT scan demonstrated the left orbital tumor, and the orbital decompression surgery was performed. The white-yellowish tumor was found extending the orbit through the superior orbital fissure into the cavernous sinus. Histological examination revealed non-specific inflammatory granuloma. Despite the unusual clinical symptoms, the etiology of this case appeared to be identical with the Tolosa-Hunt syndrome. The other case is a 16-year-old girl who had a 2 years' history of recurrent left retro-orbital pain and the complete IIIrd nerve palsy. CT scan demonstrated a small enhancing lesion in the cavernous sinus. Corticosteroid treatment improved her IIIrd nerve palsy within 2 days, however the CT scan after the treatment revealed no change of the lesion size. Left frontotemporal craniotomy was performed and the whitish tumor in the cavernous sinus was partially removed. Histological examination revealed that the tumor was typical meningioma with whorl-formation. The anatomical structure of the cavernous sinus is so complicated that the diseases arising from this area show quite different appearances. For the differential diagnosis of these lesions, the carotid angiography and the cavernous sinus venography were said to be useful.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[2 cases simulating Tolosa-Hunt syndrome]. 662 87

Mucormycosis is the most acutely fatal fungus infection of man. The disease causes a characteristic pattern of clinical symptoms and signs, prompt recognition of which will permit immediate institution of antifungal therapy. Personal experience with 16 cases of the rhino-orbitocerebral form of mucormycosis is the basis of this report. The first of these patients was seen in 1959, and the last in 1981. All of the patients had one or more preexisting diseases, as follows: (1) diabetes mellitus, 13; (2) acute leukemia, 3; (3) terminal carcinomatosis, 1; and (4) chronic sinusitis, 1. The most common initial symptoms and signs were sinusitis, pharyngitis, nasal discharge, and orbital/periorbital pain. Proptosis and formation of a black eschar were only seldom among the initially apparent features. Hyphas were demonstrated in tissue sections in 14 of the 16 patients in whom biopsy was done. Rhizopus species were cultured in 11 of the 13 patients from whom material for culture had been obtained clinically. Five of the 16 patients survived. All of them had been treated with surgical debridement and with intravenous amphotericin B.
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PMID:Diagnosis and management of rhino-orbitocerebral mucormycosis (phycomycosis). A report of 16 personally observed cases. 664 48

Dural shunts are vascular communications in which blood flows through small meningeal branches of the carotid arteries to enter the venous circulation near the cavernous sinus. The features of 10 patients with dural shunts are described. Most of these patients were postmenopausal women with dilated episcleral vessels, unilateral elevation of intraocular pressure, and exophthalmos. Pain or discomfort was common and ptosis or limited eye movement was usually present. These findings were characteristically more mild than those associated with carotid-cavernous sinus fistulas. CT scans usually showed enlargement of the extraocular muscles and the superior ophthalmic vein. Arteriography visualized partial or complete occlusion of intracranial venous drainage posterior to the cavernous sinus in all patients. Vascular dynamics of dural shunts are reviewed, and it is suggested that many of these communications may be congenital and that the onset of clinical abnormalities may be associated with the occurrence of intracranial venous thrombosis. Most patients eventually had resolution of their clinical abnormalities without treatment, and in some cases this improvement occurred soon after carotid arteriography.
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PMID:The dural shunt syndrome. Pathophysiology and clinical course. 670 19

Forty -seven of 79 patients with sinus and paranasal tumors had clinical, radiographic or operative evidence of orbital involvement. Seventy percent of those patients with orbital extension had clinical or radiographic involvement of the orbit at the time of initial presentation. Common presenting signs and symptoms included proptosis, nasal obstruction or discharge, nasal mass, facial and/or eye pain, visual loss, facial and/or lid edema and diplopia. The most common tumor seen was squamous cell carcinoma. The maxillary sinus was the most frequent site of origin. Three patients were misdiagnosed as having sinusitis on initial evaluation. A diagnosis of sinusitis is tentative and should be reevaluated early with repeat roentgenographic studies and biopsy, especially in the presence of protracted facial and eye pain. When ordering CT scans, one must specifically request cuts of the base of the sinuses and skull as routine brain CT scans do not evaluate those regions. Two of four patients with intractable pain unrelieved by narcotics obtained pain relief with cisplatinum.
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PMID:Sinus tumors invading the orbit. 671 9

A 34-year-old black male presented with marked unilateral proptosis and pain in the left eye. Visual acuities were OD 6/7.5 (20/25) and OS 6/120 (20/400). His left eye was exophthalmic , had a Marcus Gunn pupil, and exposure keratitis. Sectorial pallor and a decreased Kestenbaum count were evident on the left optic nerve head. A tentative diagnosis of orbital meningioma was made and later confirmed. Optometric management of the patient, including appropriate screening tests and referrals, are discussed.
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PMID:An optometric purview of intraorbital meningioma. 673 74

The postoperative maxillary cyst develops in the maxillary sinus between the ages of 30 and 40 in persons who received sinus surgery 10 to 20 years earlier. Etiology of the cystic lesion appears to be derived from the infected sinus mucosa left after a sinus operation. Chief complaints of postoperative maxillary cysts are swelling or pain in the buccal region, discomfort of the maxilla or maxillary teeth and exophthalmos. Characteristic panoramic radiographic findings of the postoperative maxillary cyst are a monolocular cystic radiolucency with a well-defined margin and surrounding sclerotic bone in the floor of the maxillary sinus.
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PMID:Postoperative maxillary cyst. 678 77

Although thyrotoxicosis and orbital complications of acute ethmoid or frontal sinusitis are among the most common causes of unilateral exophthalmos, inflammatory pseudotumor is frequently accompanied by progressive acute unilateral proptosis. Because the associated chemosis, scleral erythema, and ophthalmoplegia constitute a spectrum of clinical findings present in numerous inflammatory orbital disorders and systemic diseases, the diagnosis of inflammatory pseudotumor is one of exclusion, often requiring orbital biopsy. Four patients without evidence of sinusitis, endocrinopathy, collagen vascular disease, or Wegener's granulomatosis are described. The diagnosis of orbital pseudotumor was disclosed by computed axial tomography, thus avoiding orbitotomy. The finding of scleral and choroidal thickening with enhancement following intravenous contrast injection represents a select group of patients with orbital pseudotumor and differentiates them from patients with endocrine exophthalmopathy or neoplasms. This noninvasive technique is extremely valuable because early diagnosis is critical for successful treatment. All four patients responded dramatically to high-dose corticosteroid therapy. In the absence of significant clinical response, however, Wegener's granulomatosis, lymphoma, and rhabdomyosarcoma, especially in younger patients, must be carefully excluded. Orbital exploration or decompression or both are used when proptosis, headache, or orbital pain does not resolve promptly, visual acuity deteriorates, or the diagnosis remains unknown.
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PMID:Computerized axial tomography in inflammatory pseudotumor of the orbit. 682 19

We report two patients who underwent orbital exploration yielding the diagnosis of sclerosing orbital pseudotumor. The presenting symptoms were exophthalmos, visual loss, abnormal ocular mobility, and ocular pain. Computed tomographic (CT) scans showed masses in the orbital apex. Steroids were ineffective. Orbital pseudotumor is a heterogeneous diagnostic category of lymphoid infiltrations of the orbit with a wide spectrum of pathological conditions and intraorbital locations. The clinical presentation typically includes the sudden onset of pain, diplopia, lid edema, and exophthalmos. Visual loss is uncommon. Most cases resolve spontaneously or respond to steroid treatment. Although fibrosis may be a prominent histological finding, the literature contains little information concerning its significance. We discuss the evidence for considering the sclerosing pseudotumors to be a significant variant with unique clinical behavior. Although features suggestive of pseudotumor were present in our case, the presence of visual loss and an apical mass shown on the CT scan led to the presumptive diagnosis of tumor and exploratory operation. Neurosurgeons should be aware of this entity as a cause of visual loss and orbital mass. Proper suspicion may in some cases permit transorbital biopsy and avoid craniotomy, inasmuch as operation is of no therapeutic benefit in this disease.
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PMID:Sclerosing orbital pseudotumor. 685 74

Of 12 consecutive patients (nine women and three men ranging in age from 18 to 70 years) with orbital myositis, four had histories of ocular or systemic autoimmune disease. Five patients treated within two weeks of developing acute orbital pain and extraocular muscle dysfunction were classified as having acute myositis. They responded to corticosteroids within 72 hours although three had single recurrences during six- to 16-month follow-up periods. No patients were heterotropic or proptotic at the final examination. Seven patients with less severe or atypical symptoms who had delays of two or more months between onset and treatment were classified as having subacute myositis. All had recurrences with five having two or more. Three required supplemental radiation therapy during seven- to 20-month follow-up periods. At the final examinations, six patients had motility defects and one had proptosis, indicating that delays in treatment may lead to recurrences, extraocular muscle dysfunction, and proptosis.
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PMID:Acute and subacute orbital myositis. 688 Dec 44


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