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A case is presented of neurilemmoma of the left oculomotor nerve occurring in a 64-year-old hypertensive woman. The incipient tumour produced ptosis, limited inwards rotation of the eyeball, and persistent pupillary dilatation on the left side. The mechanism of this process is discussed, having regard to the interruption of the fibres innervating these structures by the tumour, and considering the mode of occurrence of the ocular and pupillary impairments. The patient also had generalized athero-sclerosis and fusiform aneurysm of the terminal part of the left internal carotid artery. The symptoms of headache, seizure, coma, and temporary right hemiparesis were considered as manifestations of hypertensive encephalopathy unrelated to the tumour.
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PMID:Neurilemmoma of the oculomotor nerve. 112 61

Raeder's paratrigeminal syndrome is a disorder manifested by unilateral ptosis, miosis, intact facial sweating, and severe pain in the distribution of the ophthalmic division of the fifth nerve. It is a clinical pattern where, usually, a middle-aged male gets a severe throbbing supraorbital headache accompanied by ptosis and miosis. The headache is intermittently present for several weeks or months. Facial sweating may or may not be affected. This report describes a female with Raeder's syndrome who had unilateral facial anhibrosis.
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PMID:Raeder's syndrome. 118 Apr 65

Since Fincher reported a case with arteriovenous fistula between the external carotid artery and dural sinus, many type of cases have been reported. On the other hand, so called the external carotid avernous fistula has been recognized less 20 cases in literature. We have observed three additional cases of dural arteriovenous shunts in the region of the cavernous sinus. Case 1. A 52 year old woman had suffered from left side sever headache. There was weakness of the left extraocular muscles and left ptosis. A bruit was heard over the left orbit. She was treated for hypertension since 38 year old. And she has no history of recent trauma. Selective internal and external carotid angiographies showed the bilateral external carotid cavernous sinus fistula. No operative treatment was performed in this case and the symptomes disappeared with decrease of blood pressure. Case 2. A 50 year old man came to this clinic with chief complaints of right ptosis, diplopia and headache. He was treated for diabetes mellitus and hypertension for six month...
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PMID:[Three cases of spontaneous bilateral external carotid-cavernous sinus fistula (dural arteriovenous shunts in the region of the cavernous sinus) (author's transl)]. 123 13

Since Sir Gilbert Blane's report of a case in the year 1800, bilateral aneurysms of the internal carotid artery within the cavernous sinus of nontraumatic origin are extremely rare. In reviewing literatures, only 22 cases have been described, including the present case (Table 1). We are reporting our own case in which carotid angiograms revealed the presence of bilateral giant aneurysms with a carotid-cavernous fistula on one side, and discussed briefly with reference to its clinical features, radiological observations and treatment. (case report) M.R, a woman aged 78, was admitted on May 15, 1973, with a complaint of sudden onset of right supra- and periorbital headache and a loud bruit about 2 months previously. She became aware of ptosis of the right eyelid and prominence of the right eyeball. The carotid arteriogram showed bilateral giant aneurysms in the region of the cavernous sinus (Fig 2, Fig. 3). A carotid cavernous fistula due to the ruptured giant aneurysm was seen on the right and poor filling of the right anterior and middle cerebral artery was also observed (Fig. 2). An attempt was made to close the fistula by using propelling method (polyurethane foam emboli after Ohta's technique) with great success (Fig. 4). No special treatment was done to the left giant aneurysm. She is now in good condition 7 months after discharge.
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PMID:[Bilateral giant carotid aneurysm in the cavernous sinus with a carotid-cavernous fistula on one side, case report (author's transl)]. 123 76

We have designed a screening system to diagnose unruptured aneurysms, including the use of digital subtraction angiography (DSA). We surveyed 115 patients who had undergone clipping procedures after subarachnoid hemorrhage (SAH) and questioned them with regard to the subjective symptoms. Sixty-eight of 92 patients who returned the questionnaire reported, prior to rupture, headache, eye pain, and neck pain most frequently, and also impairment of extraocular movements, ptosis, visual field defects, and motor and sensory disturbances. Nineteen (47.5%) of 40 patients who had complete pain relief after surgery complained of headache from 1 week to 1 month before SAH. In addition, nine patients (22.5%) complained of headache for several years, and were also pain-free after surgery. For the indication of DSA, we employed an expert system based on fuzzy set theory. Seven groups of parameters are: Group 1, a basic questionnaire concerning age, sex, and past and family histories; Group 2, 15 warning signs selected on the basis of retrospective study; and Groups 3-7, detailed questions concerning each sign. Scoring weights assigned to each condition based on the results of the retrospective study, and threshold values were determined by several neurosurgeons. The certainty factors for intermediate hypotheses were calculated from these weights and threshold values and summed up, from which the conclusion was obtained. Twelve new cases of unruptured cerebral aneurysm were diagnosed using this screening system. This system may improve the ability to diagnose cerebral aneurysms before rupture.
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PMID:New screening system for unruptured cerebral aneurysms--combination of an expert system and DSA examination. 170 35

A 10-year-old schoolboy was referred to the Ophthalmic Unit of Ahmadu Bello University Teaching Hospital because of sudden loss of sight following 5 days of severe frontal headache. The child had bilateral ptosis with internal and external ophthalmoplegia and fixed and dilated pupils. There was no papilloedema. Eight days later, a jaw tumour and a rapidly enlarging abdominal tumour appeared. A fine needle aspiration biopsy of the jaw tumour confirmed Burkitt's lymphoma. Combination chemotherapy with cyclophosphamide, vincristine and methotrexate (COM) led to a rapid resolution of the jaw and abdominal tumour but the child never regained his sight. Cerebrospinal fluid examination was not helpful in reaching a diagnosis.
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PMID:Burkitt's lymphoma presenting with blindness: a case report. 170 53

A 23-year-old woman presented with episodic, strictly unilateral, left-sided headaches of excruciating severity. Pain was referred to the eye, lasted from seconds to a minute and was accompanied by homolateral ptosis, redness of the eye, increased lacrimation and nasal discharge. The attacks of pain repeated up to seven times over 24 hours and clustered around ovulation for seven days a month. After she became pregnant, the attacks increased in frequency and appeared every five to ten minutes during night and day. Different medical treatments including indomethacin, were without effect. Two months later pregnancy was interrupted and the pain immediately subsided. After carotid angiography the pain reappeared for two months, but it finally disappeared and she has been free of pain without treatment for the last nine months. This syndrome can be related to episodic paroxysmal hemicrania.
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PMID:[Neuralgiform paroxysmal migraine]. 179 7

We treated three cases of inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus. Case 1 was that of a 36-year-old male with diplopia and right ptosis. Case 2 was that of a 40-year-old male with frontal headache. Case 3 was that of a 70-year-old female with left impaired vision and frontal headache. In the first case, MRI demonstrated a mass lesion extending from the right half of the sphenoid sinus to the cavernous sinus and retropharyngeal space. In the second case the granuloma extended from the right cavernous sinus to the right retroorbital space. In the last case, MRI demonstrated diffuse Gd-DTPA enhancement of the left cavernous sinus and the left half of the sphenoid sinus. In all cases an operation was performed using the sublabial rhinoseptal approach, and the tumor in the sphenoid sinus was removed. Histological examination revealed an inflammatory granuloma in all 3 cases. In the first case the clinical symptoms improved following administration of glucocorticoids. In the second case the mass in the cavernous sinus decreased in size postoperatively. In the last case, the clinical symptoms gradually improved with administration of antibiotics after surgery. Granuloma of the cavernous sinus is difficult to diagnose, but when a similar pathological lesion coexists in the sphenoid sinus, a definitive diagnosis can be easily made via the sublabial rhinoseptal approach.
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PMID:[Inflammatory granulomas extending from the sphenoid sinus to the cavernous sinus: report of three cases]. 185 56

Despite there being a wide range of different epistaxis balloons their mode of action is unknown. Manufacturers' drawings depict balloons neatly filling the nasal cavity or precisely occluding the anterior and posterior nasal apertures. In view of the complexity of nasal internal anatomy these explanations seem unlikely. A better understanding of the configuration of these devices within the human nasal cavity may explain their mode of action and complications. This study aimed to delineate radiographically the configuration of 3 commonly used balloons within the noses of 4 human cadavers and to observe the effects of alterations in inflation volumes. The results showed that devices designed to fill the nasal cavity do not achieve this aim. Balloons do not conform to the contours of the nasal cavity but expand along pathways of least resistance and prolapse into the nasopharynx. The findings may explain the occurrence of complications such as headache and Eustachian tube obstruction. Accurate nasal tamponade is unlikely to be their true mode of action. These devices probably work by a combination of factors rather than as a result of specific design features. The possibility of rational design modifications is discussed.
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PMID:Intranasal balloon catheters: how do they work? 193 56

The mortality rate for posterior communicating artery (PCA) aneurysm with oculomotor nerve palsy is 33 per 100. The incidence of oculomotor palsy with PCA aneurysm varies from 34% to 56%. The classic presentation of a PCA aneurysm involving the oculomotor nerve is sudden onset of severe unilateral frontal headache, ptosis, a dilated and fixed pupil, and limitations of adduction, depression, and elevation of the eye. Carotid arteriography is diagnostic. This case is presented because of the high probability of being seen first by a primary care physician. Delay in clinical recognition and treatment can have dire consequences for the patient.
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PMID:Oculomotor nerve palsy from posterior communicating artery aneurysm. 194 May 64


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