Reversible Visual Loss in Pseudotumor Cerebri

Gutgold-Glen, Harry; Kattah, Jorge C.; Chavis, Richard M.

doi:10.1001/archopht.1984.01040030321028

Cited by 14 publications

(2 citation statements)

References 17 publications

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“…It was this realization that called into question the epithet, "benign," encouraging a change in terminology, a more aggressive approach to treatment, and a substantially greater involvement of the neuroophthalmologist. Studies of particular importance in this development were those of Corbett, et al, 17 in 1982, Gutgold-Glen, et al, 36 in 1984, and Wall and George 87 in 1991. Whereas ophthalmological attention had earlier focused primarily on the severity of papilledema and loss of visual acuity, it was now directed more at visual field defects being detected by the newer methods of evaluation.…”

Section: The Neuroophthalmological Period-visual Loss and The Return mentioning

confidence: 98%

The historical development of the pseudotumor concept

Johnston¹

2001

FOC

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The author outlines the history of the development of the pseudotumor concept, first specifically formulated by Nonne in 1904 but implicit in earlier descriptions. A scheme of periodization is applied, identifying otological, neurosurgical, neurological, and neuroophthalmological periods; he relates theoretical and practical developments in the understanding of the condition to the concerns of the dominant speciality involved in diagnosis and management. Key studies from each period are discussed in relation to the issues of mechanism, origin, nomenclature, diagnosis, and treatment. During the otological period, approaches to the condition were heavily influenced by its common association with middle ear infection, often with venous sinus involvement, and this led to the idea of disturbed cerebrospinal fluid dynamics as the cause. The advent of neuroradiological systems ushered in the neurosurgical period in which the significant but unfinished debate began: which intracranial compartment is primarily implicated in the intracranial hypertension? By the time of the neurological period cerebral edema was implicated as the cause, and this coincided with the availability of appropriate treatment methods and steroidal and diuretic agents. Toward the end of this period additional major advances in investigative methods again brought the issue of mechanism into contention, although a resolution was not to follow. The neuroophthalmological period is characterized by an increased awareness of the significance of visual loss and a return to one of the original methods of treatment. Finally, the possible significance of impaired cranial venous outflow, a thread running through all periods, is considered.

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Section: The Neuroophthalmological Period-visual Loss and The Return mentioning

confidence: 98%

The historical development of the pseudotumor concept

Johnston¹

2001

FOC

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“…Auch bei unserer ersten Patientin kam es zu einer deutlichen Ruckbildung der Symptomatik am kontralateralen Auge, sowie zu einer Normalisierung des Hirndruckes nach Optikusscheidenfenestration eines Auges. Senkungen des erhohten Liquordrucks durch die Fenestration wurden zwar, wie bereits erwahnt, beschrieben [2,11,19], sind jedoch selten [2,17]. Der Verlauf bei unserer ersten Patientin ist konkordant mit der Annahme einer orbitalen Liquorfistel durch den Eingriff.…”

Section: Patienten and Methodenunclassified

Optikusscheidenfenestration via transkonjunktival mediale Orbitotomie

Schmidbauer¹,

Lindemuth

Ruprecht

2000

Spektrum Augeheilkd

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Zusammenfassung. Hintergrund: Stauungspapillen infolge erhohten intrakraniellen Drucks bei Pseudotumor cerebri konnen zu einer irreversiblen Sehnervenschadigung fiihren. Die operative Eroffnung der Optikusscheide wurde erstmals 1872 von de Wecker durchgefuhrt and seitdem von zahlreichen Autoren weiterentwickelt. Patienten and Methode: An sechs Augen von vier Patienten mit akuter oder progredienter funktioneller Beeintrachtigung bei Stauungspapille bei Pseudotumor cerebri wurden Optikusscheidenfenestrationen via transkonjunktival medialem Zugang durchgefuhrt, nachdem andere MaBnahmen, wie wiederholte Lumbalpunktionen and die systemische Applikation von Acetazolamid ohne Effekt blieben. Bei drei Patienten bestand die Indikation aufgrund eines deutlichen Visusverlustes, bei einem Patienten aufgrund progredienter, subjektiv sehr storender Obskurationen. Ergebnisse: Ab dem zweiten postoperativen Tag fand sich eine deutliche Ruckbildung der Papillenprominenz. Die Augen mit reduziertem Visus zeigten einen deutlichen Visusanstieg. Bei dem vierten Patient bildeten sich die Obskurationen vollstandig zuruck. Schlussfolgerung: Die Optikusscheidenfenestration fiber transkonjunktival medialem Zugang stellt eine effektive and relativ komplikationsarme Methode zur Prevention eines progredienten Visus-and Gesichtsfeldverlustes bei erhohtem intrakraniellem Druck dar. Schlusselworter: Pseudotumor cerebri, Optikusscheidenfenestration, mediale Orbitotomie, Stauungspapille, Liquordruck.Optic nerve sheath decompression via medial orbitotomy Summary. Background: Pseudotumor cerebri is characterized by raised intracranial pressure that is not secondary to a space occupying lesion, accompanied by a normal ventricular system and normal composition of cerebrospinal fluid. Permanent visual loss due to papilledema has been reported in 11% to 24% of patients. Optic nerve sheath decompression was first described by de Wecker in 1872.Patients: Optic nerve sheath fenestration was performed in six eyes of four patients with acute or progredient visual disturbances due to papilledema following pseudotumor cerebri. Three patients complained of severe loss of visual acuity, one patient complained of progredient obscurations. A transconjunctival medial approach for decompression was used while other methods as lumbar punctures and systemic administration of acetazolamide failed.Results: Beginning with the second day postoperatively papilledema reduced and visual acuity restored. In our fourth patient no obscurations occurred any more.Conclusions: Our results concordant with previous authors give evidence that optic nerve sheath decompression improves and protects visual function in patients with pseudotumor cerebri and papilledema. Performed via medial transconjunctival approach, it is a technically straight forward and effective procedure with a low rate of complications.

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Permanent Visual Impairment in Childhood Pseudotumor Cerebri

Lessell¹,

Rosman²

1986

Archives of Neurology

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Reversible Visual Loss in Pseudotumor Cerebri

Cited by 14 publications

References 17 publications

The historical development of the pseudotumor concept

The historical development of the pseudotumor concept

Optikusscheidenfenestration via transkonjunktival mediale Orbitotomie

Permanent Visual Impairment in Childhood Pseudotumor Cerebri

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