scholarly journals Eyelid Edema: A Rare Cause of a Common Sign

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Andreia Soares ◽  
Cristina Almeida ◽  
Cristina Freitas ◽  
Marco Sales-Sanz ◽  
Sara Ribeiro
Keyword(s):  
Csf Leak ◽  
Orbital Fracture ◽  
Minor Trauma ◽  
Ophthalmological Examination ◽  
Brain Herniation ◽  
Orbital Roof ◽  
Eyelid Edema ◽  
Eyelid Swelling ◽  
Common Sign ◽  
The Right

We report a 48-year-old female patient who presented to the emergency room with right eyelid edema, with 3 days of evolution. She had suffered minor trauma to this eye one week before. She reported episodes of right eyelid swelling of spontaneous resolution since the occurrence of a traumatic brain injury 5 years ago. Ophthalmological examination showed a soft and painless eyelid edema of the right eye. Brain computed tomography showed an area of bone discontinuity of the orbital roof with brain herniation and a CSF leak into the eyelid (blepharocele). Magnetic resonance confirmed the result of TC and revealed an area of frontal encephalomalacia. Ibuprofen (800 mg/day) was prescribed, with complete resolution within 20 days. She was evaluated by Neurosurgery with no indication of surgery due to the resolution of the edema and absence of symptoms. Blepharocele is a rare entity that should be considered in the differential diagnosis of unilateral eyelid edema. It can be secondary to an orbital fracture or congenital lesion.

scholarly journals An Interesting Case Report of Frontal Sinus Keratocyst

2019 ◽  
Vol 9 (1) ◽  
pp. 100
Author(s):  
Alireza Mohebbi ◽  
Mohammad Aghajanpour
Keyword(s):  
Case Report ◽  
Surgical Resection ◽  
Frontal Sinus ◽  
Interesting Case ◽  
Ophthalmological Examination ◽  
Eyelid Edema ◽  
Complete Surgical Resection ◽  
Orbital Wall ◽  
History Of ◽  
The Right

Purpose: To report an unusual case of frontal sinus keratocyst. Case Report: A 31 year old woman presented with a history of swollen right eye and visual field impairment. The ophthalmological examination revealed right superior eyelid edema and some degrees of proptosis. CT scan with iodine injection evidenced the opacification of the right frontal sinus with superior orbital wall lysis. Complete endoscopic surgical resection of a mass containing foul smelling keratin material was performed via Draf type III. The patient became symptomatic after 6 years. Imaging studies showed neo- osteogenesis in the far lateral end of right frontal sinus. Frontal trephination was done and the remnant of keratocyst was removed and the septum interfacing the cell and the right frontal sinus was walled down entirely. Conclusion: Although frontal sinus keratocyst is benign but can spread to the surrounding structures leading to several complications. Therefore, complete surgical resection is necessary to avoid recurrence.

scholarly journals Levator palpabrae superioris myositis as an unusual cause of unilateral ptosis—case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ahmed M. Abdrabou
Keyword(s):  
Previous History ◽  
Good Prognosis ◽  
Oculomotor Nerve Palsy ◽  
Ophthalmological Examination ◽  
Bilateral Ptosis ◽  
Mri Findings ◽  
Upper Eyelid ◽  
Unilateral Disease ◽  
The Right ◽  
Mri Study

Abstract Background Ptosis can be a manifestation of a more serious situation. Hence, the analysis of the complaint and the search for etiology are crucial in such cases. Ptosis has many causes; some of them lead to unilateral ptosis while others cause bilateral ptosis. For instance, myasthenia gravis is a cause of bilateral ptosis while oculomotor nerve palsy induces unilateral disease. Proper evaluation of the patient and identification of the cause are important to achieve accurate management and good prognosis. Case presentation A 47-year-old male patient attended the ER complaining of dropping the right eye lid of 2 days’ duration. There was no associated pain or diplopia. On examination, the extraocular muscles’ (EOM) motility was intact, normal pupil and corneal reflexes, and there was swelling of the upper eyelid. Ophthalmological examination revealed normal anterior and posterior chambers as well as the vitreous and retina. The patient had a previous history of traumatic intracranial hemorrhage that was resolved without surgical intervention. He also had diabetes mellitus and hypertension. The patient was transferred to the MRI unit to perform MRI study of the brain and orbit with MRA and IV contrast administration. MRI findings confirmed the diagnosis of LPS myositis, and the patient received medical treatment and improved. Conclusion Proper radiological diagnosis leads to accurate management and achieves rapid recovery and optimal patient care.

Pediatric Orbital Roof Fractures: A Ratio of Orbital Dimensions Correlated to Prevalence of Fracture

2020 ◽  
Author(s):  
Stephen C. Dryden ◽  
Andrew G. Meador ◽  
Andrew B. Johnston ◽  
Adrianna E. Eder ◽  
James C. Fleming ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Pediatric Population ◽  
Relative Length ◽  
Orbital Floor ◽  
Orbital Fracture ◽  
Orbital Roof ◽  
Fracture Patterns ◽  
Gender And Age ◽  
The Mean ◽  
Orbital Roof Fractures

Abstract Objective Orbital roof fractures are more likely to occur in younger children, specifically younger than 7 years. Cranium to face ratio decreases with age; however, there is no definition for measurement of the neurocranium or face. We propose using the length of the orbital roof as a measurement of the neurocranium and length of the orbital floor as a tool to estimate midface size. The purpose of this study is to test this measurement as a correlation rate of orbital roof fractures within the pediatric population. Design This is a retrospective study. Setting This study was done at the LeBonheur Children's Hospital. Participants Sixty-six patients with orbital roof fractures were identified and stratified by gender and age, specifically younger than 7 years and 7 years or older. Main Outcome Measures The main outcome measures were orbital roof length, floor length, and ratio thereof. Results Mean orbital roof length was 43.4 ± 3.06 and 45.1 ± 3.94 mm for patients <7 and ≥7 years, respectively (p = 0.02). Mean orbital floor length was 41.3 ± 2.99 and 47.7 ± 4.19 for patients <7 and ≥7 years, respectively (p < 0.00001). The mean roof to floor ratio (RTFR) for patients <7 years was 1.051 ± 0.039 and for patients ≥ 7 years was 0.947 ± 0.031 (p < 0.00001). Conclusion As children age, the relative length of the orbital roof decreases when compared with the orbital floor. The RTFR was more than 1.0 in children younger than 7 years. These differences were statistically significant when compared with children 7 years and older. This measurement shift follows the differences noted in orbital fracture patterns during childhood.

Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report

2021 ◽  
Vol 3 (3) ◽  
Author(s):  
Marcos Vilca ◽  
◽  
Carlos Palacios ◽  
Sofía Rosas ◽  
Ermitaño Bautista ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Pressure ◽  
Skull Base ◽  
Rare Complication ◽  
Cerebrospinal Fluid Leak ◽  
Standing Position ◽  
Csf Leak ◽  
Skull Base Fracture ◽  
Timely Diagnosis ◽  
The Right

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

Non-central serous chorioretinopathy in a patient with systemic lupus erythematosus and hydroxychloroquine retinopathy

2021 ◽  
Vol 14 (1) ◽  
pp. e237243
Author(s):  
Diogo Hipolito-Fernandes ◽  
Maria Elisa Luís ◽  
Rita Flores ◽  
Rita Anjos
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Central Serous Chorioretinopathy ◽  
Vision Loss ◽  
Subretinal Fluid ◽  
Ophthalmological Examination ◽  
Systemic Lupus ◽  
Diagnostic Challenge ◽  
Hydroxychloroquine Retinopathy ◽  
The Right

Subretinal fluid accumulation in a patient with systemic lupus erythematosus (SLE) may represent a diagnostic challenge. We present a case of a 43-year-old man with baseline diagnosis of SLE and hydroxychloroquine-associated maculopathy who reported progressive vision loss on the right eye, associated with corticosteroids use for an arthritic crisis. Ophthalmological examination did not reveal any acute finding. On optical coherence tomography, subretinal fluid in the perifoveal area was visible on the right eye, with corresponding enlargement of the visual field defect. An increased choroidal thickness was also visible. Fluorescein angiography revealed, on the right eye, two pinpoint areas of leakage and indocyanine green angiography signs of choroidal vascular hyperpermeability. Considering a diagnosis of a non-central central serous chorioretinopathy, corticosteroids use was interrupted, with resolution of the subretinal fluid. This case illustrates the relevance of a multimodal imaging approach to guide the diagnosis of patient with an SLE with subretinal fluid.

scholarly journals Ambliopia anisometropia

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Laya Rares
Keyword(s):  
Ophthalmological Examination ◽  
Blurred Vision ◽  
Anisometropic Amblyopia ◽  
Main Complaint ◽  
Maddox Rod ◽  
The Right ◽  
Test Cover ◽  
Myopic Astigmatism ◽  
Distance Fixation ◽  
Cover Test

Abstract: Anisometropic amblyopia is blurred vision due to refractive anomaly without any anatomical disorders of the eyes. It is frequently found among children in their growth and development periods. The prognosis depends on the ambylopia severity, management, patient’s obedience to the management, and age. We report a case of anisometropic amblyopia in a 8-year-old boy with his main complaint was blurred vision of both eyes. The ophthalmological examination showed the visual acuity of both eyes 6/40, PH 6/9. Several tests that showed normal results were as follows: eyeball movements to all directions; pupil responses to light; Hischberg test; cover test dan cover uncover test at near and far distance fixation; alternate cover test; and worth four dots and Maddox rod tests. Cyclopegical refraction with streak retinoscopy at 50 cm distance resulted in right eye S-4.00 C-3.00 x1800 6/9 and left eye S-1.25 C-3.25 x1800 6/7.5; autorefraction of right eye S-4.50 C-3.25 x70 and of left eye S-1.25 C-4.25 x1710. Anterior and posterior segments of both eyes were normal. Conclusion: In this case, the diagnosis was confirmed as anisometropic amblyopia and compound myopic astigmatism of the right and left eyes. The prognosis was dubia ad bonam. The patient was treated with maximal correction glasses and observed for the first four weeks, and then would be evaluated continuously untill the vision was normal. Keywords: amblyopia anisometropia, vision, refraction anomalyAbstrak: Ambliopia anisometropia merupakan gangguan penglihatan akibat kelainan refraksi tanpa disertai adanya kelainan anatomik pada mata yang sering terjadi pada masa perkembangan anak. Prognosis sangat tergantung pada derajat ambliopia, penanganan, kepatuhan pasien terhadap penanganan, dan usia pasien. Kami melaporkan kasus ambliopia anisometropia pada seorang anak berusia 8 tahun, dengan keluhan utama penglihatan kedua mata kabur. Dari pemeriksaan oftalmologik didapatkan visus ODS 6/40, PH 6/9. Beberapa pemeriksaan yang dilakukan memperlihatkan hasil normal, yaitu: pergerakan bola mata ke segala arah; respon pupil terhadap cahaya; Hischberg test; cover test dan cover uncover test pada fiksasi jarak dekat dan jauh; alternate cover test; serta worth four dots test dan Maddox rod test. Pemeriksaan refraksi sikloplegik dengan streak retinoscopy pada jarak 50 cm didapatkan mata kanan S-4,00 C-3,00 x1800 6/9 dan mata kiri S-1,25 C-3,25 x1800 6/7,5 dan pemeriksaan autorefraksi mata kanan S-4,50 C-3,25 x70 dan mata kiri S-1,25 C-4,25 x1710. Pemeriksaan segmen anterior dan posterior mata kanan dan kiri dalam batas normal. Simpulan: Diagnosis pada kasus ini ialah ambliopia anisometropia ODS dan astigmatisma miopikus kompositus ODS, dengan prognosis dubia ad bonam. Terapi yang diberikan ialah kacamata koreksi maksimal dan diobservasi selama 4 minggu pertama, dan akan dievaluasi terus sampai ketajaman penglihatan normaL. Kata kunci: ambliopia anisometropia, ketajaman penglihatan, kelainan refraksi

scholarly journals Bilateral temporal bone fractures: a case report

2017 ◽  
Vol 4 (1) ◽  
pp. 271
Author(s):  
Kiran Natarajan ◽  
Koka Madhav ◽  
A. V. Saraswathi ◽  
Mohan Kameswaran
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Facial Nerve ◽  
Temporal Bone ◽  
Facial Paralysis ◽  
Bone Fractures ◽  
Clinical Manifestations ◽  
Csf Leak ◽  
The Right ◽  
Temporal Bones

<p>Bilateral temporal bone fractures are rare; accounting for 9% to 20% of cases of temporal bone fractures. Clinical manifestations include hearing loss, facial paralysis, CSF otorhinorrhea and dizziness. This is a case report of a patient who presented with bilateral temporal bone fractures. This is a report of a 23-yr-old male who sustained bilateral temporal bone fractures and presented 18 days later with complaints of watery discharge from left ear and nose, bilateral profound hearing loss and facial weakness on the right side. Pure tone audiometry revealed bilateral profound sensori-neural hearing loss. CT temporal bones &amp; MRI scans of brain were done to assess the extent of injuries. The patient underwent left CSF otorrhea repair, as the CSF leak was active and not responding to conservative management. One week later, the patient underwent right facial nerve decompression. The patient could not afford a cochlear implant (CI) in the right ear at the same sitting, however, implantation was advised as soon as possible because of the risk of cochlear ossification. The transcochlear approach was used to seal the CSF leak from the oval and round windows on the left side. The facial nerve was decompressed on the right side. The House-Brackmann grade improved from Grade V to grade III at last follow-up. Patients with bilateral temporal bone fractures require prompt assessment and management to decrease the risk of complications such as meningitis, permanent facial paralysis or hearing loss. </p>

scholarly journals Early Identification of Traumatic Durotomy Associated with Atlantooccipital Dislocation May Prevent Retropharyngeal Pseudomeningocele Development

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Robert S. Qiu ◽  
Mina G. Safain ◽  
Max Shutran ◽  
Alejandra M. Hernandez ◽  
Steven W. Hwang ◽  
...  
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Csf Leak ◽  
Rare Presentation ◽  
Vehicle Accident ◽  
C2 Nerve Root ◽  
Csf Diversion ◽  
The Right ◽  
Atlantooccipital Dislocation ◽  
Mri Image

Atlantooccipital dislocation can be complicated by a traumatic durotomy that may lead to the rare development of a retropharyngeal pseudomeningocele. To our knowledge this has been reported only five times previously. We present the case of a 60-year-old man involved in a motor vehicle accident who suffered an atlantooccipital dislocation and C5-C6 three-column injury. A unique MRI image of a defect in the ventral dura posterior to C2 was appreciated. He underwent occiput to T2 internal fixation and arthrodesis. During surgery, CSF egress was seen caudal to the right C2 nerve root. A DuraMatrix onlay patch reinforced with DuraSeal was placed to stop the CSF leak. A lumbar subarachnoid drain was also placed. The patient made a satisfactory recovery with residual mild weakness of his right upper extremity. In this report, we demonstrate that careful MRI review can reveal a ventral durotomy in a traumatic atlantooccipital dislocation and, if discovered, effective treatment including a lumbar subarachnoid drain for CSF diversion may prevent progression to a retropharyngeal pseudomeningocele. The literature on this rare presentation and associated durotomy is provided.

Rapidly Spreading Deep Dissecting Hematoma Occurring One Month After A Minor Trauma: A Case Report.

2021 ◽  
Author(s):  
Rémy Hamdan ◽  
Narcisse Zwetyenga ◽  
Yvan Macheboeuf ◽  
Patrick Ray
Keyword(s):  
Skin Necrosis ◽  
Clinical Signs ◽  
International Normalized Ratio ◽  
Blood Collection ◽  
Minor Trauma ◽  
Surgical Emergency ◽  
Superficial Skin ◽  
Muscle Fascia ◽  
The Right ◽  
A Minor

Abstract Background: Deep dissecting hematoma (DDH) is a rapidly extending blood collection that splits the hypodermis from muscle fascia, constituting a medical surgical emergency. The natural history of this condition includes trauma (even minor physical injury) shortly before onset of the lesion, occurring in a patient with advanced dermatoporosis. A delay of several weeks between the appearance of a superficial haematoma following a minor trauma and its sudden decompensation into a rapidly spreading DDH has been scarcely mentioned in the medical literature. Case presentation: We report the admission of a 70-year-old woman under anticoagulation to the emergency department of our hospital for the sudden appearance of a rapidly evolving hematoma one month after a negligible trauma to the right leg. A complete skin examination revealed clinical signs (spontaneous superficial skin haematomas, lacerations, wrinkles, stellate pseudo-scars) of advanced dermatoporosis, especially on the forearms. The initial biological testing disclosed an International Normalized Ratio of 3.15. The clinical aspect of the haematoma, its rapid extension and the cutaneous signs of dermatoporosis on the forearms allowed the diagnosis of DDH. Bedside ultrasound examination was used to eliminate differential or additional diagnoses and to assess the main features of the hematoma (dimensions, existence of blood supply). Due the extent of the lesion and the risk of extended skin necrosis, surgical debridement and hematoma drainage were performed. The operative report confirmed the diagnosis of DDH. Wound healing was obtained spontaneously after three months. Conclusion: DDH is the most serious complication of dermatoporosis. Given its rapid horizontal extension and the risk of skin necrosis it induces, DDH is a medical-surgical emergency and must be diagnosed early. This observation emphasises that in patients with severe dermatoporosis, on the occasion of a Vitamin K Antagonist overdose, a limb-threatening DDH can develop suddenly, even several weeks after a minor impact.

The nasal cavity and paranasal sinuses

2013 ◽  
Author(s):  
Martin E. Atkinson
Keyword(s):  
Nasal Cavity ◽  
Nasal Septum ◽  
Goblet Cells ◽  
Septal Cartilage ◽  
Olfactory Mucosa ◽  
Nasal Cartilages ◽  
Orbital Roof ◽  
External Nose ◽  
The Right ◽  
Lateral Walls

The nasal cavity is the entrance to the respiratory tract. Its functions are to clean, warm, and humidify air as it is inhaled. Respiratory mucosa covered by pseudostratified ciliated epithelium and goblet cells, as described in Chapter 5 and illustrated in Figure 5.2B, lines the majority of the nasal cavity. The cilia and mucus trap particles, thus cleaning the air; the mucus also humidifies the air and warming is achieved through heat exchange from blood in the very vascular mucosa. The efficiency of all these processes is increased by expanding the surface of the nasal cavity by folds of bone. The nasal cavity also houses the olfactory mucosa for the special sense of olfaction although the olfactory mucosa occupies a very small proportion of the surface of the nasal cavity. The nasal cavity extends from the nostrils on the lower aspect of the external nose to the two posterior nasal apertures between the medial pterygoid plates where it is in continuation with the nasopharynx. Bear in mind that in dried or model skulls, the nasal cavity is smaller from front to back and the anterior nasal apertures seem extremely large because the cartilaginous skeleton of the external nose is lost during preparation of dried skulls. As you can see in Figure 27.1 , the nasal cavity extends vertically from the cribriform plate of the ethmoid at about the level of the orbital roof above to the palate, separating it from the oral cavity below. Figure 27.1 also shows that the nasal cavity is relatively narrow from side to side, especially in its upper part between the two orbits and widens where it sits between the right and left sides of the upper jaw below the orbits. The nasal cavity is completely divided into right and left compartments by the nasal septum . From the anterior view seen in Figure 27.1 , you can see that the surface area of lateral walls of the nasal cavity are extended by the three folds of bone, the nasal conchae. The skeleton of the external nose shown in Figure 27.2 comprises the nasal bones, the upper and lower nasal cartilages, the septal cartilage, and the cartilaginous part of the nasal septum.

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