针刺为主治疗缺血性视乳头病变临床观察

目的:观察针刺与西药治疗缺血性视乳头病变的疗效差异.方法:31例患者以针刺治疗为主,辅以穴位注射.对于发病2周之内者,局部配合球后注射.记录治疗前后视力、视野的变化.结果:治疗前后视力、视野比较,差异均有极显著性意义(P<0.001).结论:该疗法是改善缺血性视乳头病变患者视功能的有效方法.     

Optic disc drusen demonstrate a hyperechogenic artifact in B mode ultrasound

We describe a new, specific, hyperechogenic artifact spot in B-mode ultrasound (US) in patients diagnosed with optic nerve drusen (OND). This is a retrospective chart review of 34 consecutive patients with OND using B-scan US. The patients underwent full ophthalmic evaluation and neuro-ophthalmic examination. In all cases, a typical hyperechogenic spot was seen within the acoustic shadows on medium or high gain settings. The length between the US probe and the OND, and the distance between the OND and the artifact were recorded for each patient. In all cases, a typical hyperechogenic spot was seen within the acoustic shadows on medium or high gain settings. Sonograms showed a hyperechogenic focus in all eyes. The average ratio between the cornea–OND distance (25.5 mm) and the OND–hyperechogenic spot (32.1 mm) distance was 1.26. The size of the hyperechogenic spot was proportional to the size of the deposit on the disc, with the most marked attenuation of the beam seen in the largest lesions. B-scan US is a very sensitive and reliable detector of both superficial and buried OND. The described hyperechogenic artifact spot may be an additional mode to support diagnosis of OND. This finding might be helpful for making a differential diagnosis between OND and papilledema.     

Pseudotumor cerebri syndrome in children: Clinical characteristic and re-classification

AimTo describe the clinical characteristics of children with pseudotumor cerebri syndrome (PTCS) who were diagnosed according to the modified Dandy criteria and to reclassify them according to the newly proposed diagnostic criteria by Freidman.MethodologyThis retrospective study included the period from January 2016-to July 2021.Results50 patients were included; 34 males and 16 females with a male to female ratio of 2.1:1. The average age at onset of symptoms was 8 years. Obesity was noticed in 6 (12%) patients; 34 (68%) had symptoms upon presentation. The most common presenting symptom was headache (28 patients; 56%), papilledema was present in 33 (66%) patients. Most patients (37; 74%) had an initial cerebrospinal fluid (CSF) pressure ≥280 mmH₂O. At last follow-up, papilledema resolved in 11/32 (34.3%) patients, and headache resolved in 17/23 (74%) patients. 22/50 (44%) patients fulfilled the definite criteria proposed by Freidman, 11/50 (22%) fulfilled the probable, 10/50 (20%) were categorized as possible, and 7 (14%) patients were categorized as unmet.ConclusionPTCS is a chronic condition. Managing patients who do not have papilledema or who do not meet the newly proposed higher CSF pressure is challenging. Although, applying the newly proposed criteria captured most of our patients, however, around one quarter were managed based on clinical experience. This study indicates a strong need for future guidelines tailored specifically for children, taking into consideration that the cut-off point of CSF pressure might not be similar for all populations.     

Papilledema secondary to vestibular schwannoma: An atypical case without intracranial hypertension

In most cases, vestibular schwannomas with papilledema are associated with intracranial hypertension secondary to hydrocephalus (obstructive or communicating). We describe the atypical case of a 39-years-old man who presented with bilateral papilledema revealing a vestibular schwannoma, but without hydrocephalus and with normal intracranial pressure. Ophtalmologic signs were completely resolved after tumor removal. The pathophysiological mechanism generally described to explain bilateral papilledema in such cases is tumor-induced hyperproteinorachia. However, in the absence of hydrocephalus or intracranial hypertension, this case raises the question of the mechanisms involved in the visual impairment related to vestibular schwannoma.     

Outcome of idiopathic intracranial hypertension after laparoscopic sleeve gastrectomy

BackgroundIdiopathic intracranial hypertension (IIH) predominantly affects young, obese women and presents with signs and symptoms of increased intracranial pressure, such as headaches and visual impairment.ObjectiveWe aim to present our experience in the management of IIH.SettingUniversity Hospital.MethodsObese IIH patients who had a laparoscopic sleeve gastrectomy during the study period (2 years) were included. Data were retrieved from prospectively collected database. Headaches, visual alterations, and medications or interventions used to treat are discussed.ResultsThe study included 16 obese women with IIH. Mean age was 31 ± 2 years (range, 25–44 yr) and mean body mass index was 46 ± 4 kg/m² (range, 42–53 kg/m²). Main symptoms and signs were chronic headaches (14), impaired vision (15), vision loss (1), papilledema (6), and field defects in 4 patients. Symptoms were present for a mean of 5 years (4–11). History of medical treatment with carbonic anhydrase inhibitor (acetazolamide) and thecoperitoneal shunting was present in 12 and 9 patients, respectively. Mean lumbar puncture opening pressure was 41.2 ± 21- (range, 30–64) cm water. At 12 months after laparoscopic sleeve gastrectomy, body mass index and percentage excess weight loss were 27.8 ± 1 kg/m² and 75.2 ± 2%, respectively. Symptoms gradually improved with complete resolution in all but 2 patients (87.5%).ConclusionThe present work emphasizes the role of bariatric surgery in the management of obese patients with IIH. Larger, prospective, controlled studies are needed.