The authors describe a case in which 0.5 cc of 5% fluorescein diluted in 10 cc of cerebrospinal fluid (CSF) was injected at the L4-5 level for evaluation of nasal CSF leakage. Within minutes, tone increased in lower extremities accompanied by knee and ankle clonus and subjective numbness up to the waist. Non-preserved saline irrigation of the lumbar CSF was administered until it became clear, and the patient's head was elevated to retard the developing symptomatology. Although a transient temperature elevation was observed with negative CSF cultures, all signs and symptoms cleared within 48 hours. In a survey of the members of the Americal Association of Neurological Surgeons regarding frequency of use and complications stemming from intrathecal fluorescein, the response rate was 58.3% (1111) of the 1907 members, of which 6.8% (76) had used intrathecal fluorescein, and among those, 25% (19 of the 76) had observed complications involving lower extremity weakness, numbness, generalized seizure activity, opisthotonos, and cranial nerve deficit. No complications were permanent. The authors recommend caution if intrathecal fluorescein must be used. Means should be available to clear the CSF of the agent and elevate the head if complications arise.

No abstract

The not-uncommon spinal abnormalities associated with Marfan's syndrome rarely undergird clinical problems, and neurological features accompanying such bone abnormalities are rare. In such unusual circumstances it is a widened vertebral canal that attracts attention: the substrate of such widening is dural ectasia with bone erosion, presumably due to hydraulic forces operating via the cerebrospinal fluid (CSF). When neural symptoms or findings do occur they may be related to stretching and traction mechanisms. This study of a symptomatic patient defined with reasonable clarity the abnormal anatomy, and some neurological symptom relief was achieved by attempting to alter the CSF dynamics. The relevant literature has been sampled to elucidate the condition.

Sympathetic ophthalmia can be seen following pars plana vitrectomy in patients without penetrating injuries or a history of trauma. Indeed, it may be seen after successful vitrectomy for retinal detachment. Diverse clinical presentations are possible, and persistent or atypical uveitis following vitrectomy should alert the surgeon to the development of sympathetic ophthalmia.

Amphotericin B, 5-flucytosine (5-FC), and ketoconazole levels were estimated in vitreous and aqueous samples taken from four patients undergoing therapeutic vitrectomy for fungal endophthalmitis. The levels of amphotericin B in the vitreous of three patients were low (.04 - .17 microgram/ml). However, 5-FC was present in a concentration of 22.2 micrograms/ml in one patient. In another case the aqueous level of ketoconazole was 0.35 microgram/ml. The vitreous in the same patient contained 0.71 microgram/ml of the drug.