Trichotillomania: ophthalmic presentation

Purpose: A case of trichotillomania, or compulsive hair-pulling, involving the eyelids is presented to alert ophthalmologists to this common, but frequently overlooked cause of eyelash and eyebrow alopecia.
Methods and results: Clinical records of a 33-year-old woman suffering from trichotillomania were reviewed. Compulsive hair-pulling began in childhood and had become chronic. Psychiatric intervention was unsuccessful.
Conclusions: The diagnosis of trichotillomania is made on history and slit-lamp examination findings. A skin biopsy may be necessary to exclude alopecia areata. Adults should be referred to a psychiatrist. Although childhood disease is usually benign, often reflecting a disturbed parent-child relationship, in adults hair-pulling is generally chronic and associated with psychiatric illness.     

Cerebral Tuberculoma

SUMMARY Intracranial tuberculoma has become a rarity. It remains a curable lesion that responds well to medical therapy. Although diagnosis in developed countries is often made only postoperatively, early and effective treatment can be instituted if a high index of suspicion is maintained and diagnostic criteria are looked for. A case is presented which illustrates the difficulties in reaching a diagnosis, and a review of the literature is given.     

PSYCHIATRIC AND BEHAVIOURAL MANIFESTATIONS OF NORMAL-PRESSURE HYDROCEPHALUS

SUMMARY Seven patients with psychiatric and behavioural manifestations of normal-pressure hydrocephalus are described. There is little disagreement about the classical triad of symptoms. However, it requires a high index of suspicion when a patient presents with non-specific psychiatric and behavioural symptoms. Clinicians must be alert to the possibility when positive findings point to the diagnosis of normal-pressure hydrocephalus, namely gait disturbance, incontinence, soft neurological signs, history of hypertension and no previous psychiatric history.     

Sumatriptan blocks spreading depression in isolated chick retina

Spreading depression is a neurohumoral phenomenon that has been related to the pathophysiology of migraine. The recently introduced 5HT_1D agonist anti-migraine compound sumatriptan blocks neurogenic extravasation and induces cerebral vasoconstriction, but the actual mechanism of action against migraine remains obscure. Retinal spreading depression (RSD) velocity has been measured in isolated chick retinas in the presence of 0.05-2.00:nM sumatriptan. This drug reversibly blocks RSD in a concentration-dependent manner. Since the preparation is blood-vessel free, this effect must be related to the nervous tissue.     

Recovery of Consciousness after Thiopental or Propofol: Bispectral Index and the Isolated Forearm Technique

Background: Currently, there exists no effective monitor that can predict the probability of a patient being conscious during general anesthesia. The electroencephalogram-derived bispectral index (BIS) is a promising new method to assess anesthetic adequacy. This study used the BIS to predict the probability of recovery of consciousness after a single bolus induction dose of propofol or thiopental.

Methods: Twenty unpremedicated surgical patients were anesthetized with 4 mg/kg thiopental and 20 patients with 2 mg/kg propofol. The BIS was monitored throughout the study. After induction, before administration of neuromuscular blocking agent, a tourniquet was applied to one arm and inflated above the systolic blood pressure. This allowed preservation of the ability to move the hand after neuromuscular blocking agent onset. Patients were then prompted to squeeze the investigator's hand every 30 s, until they responded to the request. At the time of response, anesthesia was reinduced and the study terminated.

Results: The BIS at loss of consciousness and recovery of a response was not statistically different between propofol and thiopental. No patient with a BIS less than 58 was conscious. In both groups, a BIS of less than 65 signified a less than 5% probability of return of consciousness within 50 s.     

Treatment of orbital capillary haemangioma with interferon

Background: Capillary haemangiomas are vascular tumours of childhood characterised by proliferative and involutional phases and affecting 1% to 2% of newborns. Recently, recombinant interferons have been used in the treatment of life and sight threatening complications of these tumours. Methods: The history, results of examination, investigations, management and outcome of two patients with sight-threatening orbital capillary haemangiomas treated with recombinant interferon alpha-2a and 2b respectively were reviewed. Results: Orbital and systemic lesions displayed good response to interferons. Side effects noted were transient pyrexia and elevated serum aminotransferase levels. Disturbed liver function test results occurred in one case and normalised with temporary cessation of therapy. Conclusions: The interferons are a useful alternative treatment of orbital capillary haemangioma in selected cases.     

Automated extraction and quantification of macular drusen from fundal photographs

The objective quantification of drusen (and other macular lesions) should have applications epidemi-ologically, in the study of the natural history of drusen, and with such instruments as the scanning laser ophthalmoscope. The automated extraction of drusen from photographs is technically difficult because of uneven macular reflectance, and the confusing pattern of darker vessels. We have developed a method using an IBM personal computer, an image digitising board and specially written software. Once the image is digitised, no further input from the operator is necessary. We present the results of manual counting versus automated counting on a small series of patients with drusen. The automated technique is highly reproducible, and will calculate the retinal area occupied by drusen. The area and numbers of drusen can be compared over time, giving an index of progression. Hard drusen are fairly well detected, but the detection of soft drusen with their lower contrast remains a problem. The technique cannot distinguish between drusen and other pale lesions (e.g., atrophic retinal changes).