The wide spectrum of radiation retinopathic manifestations from local or external beam irradiation is described in 36 eyes. The most commonly encountered ophthalmoscopic signs of retinopathy include retinal hard exudates, hemorrhages, microaneurysms, cotton-wool spots, and telangiectases. The fluorescein angiographic hallmark of radiation-induced retinopathy is retinal capillary nonperfusion, supporting the concept that vascular decompensation is the primary mechanism in the production of radiation damage to the posterior segment.
Ten patients with migraine developed persistent positive visual phenomena lasting months to years. The complaints were similar in their simplicity and involvement of the entire visual field and usually consisted of diffuse small particles such as TV static, snow, lines of ants, dots, and rain. Neurologic and ophthalmologic examinations were normal, and EEGs were normal in eight of eight patients tested. MRI was normal in all patients except one who had nonspecific biparietal white matter lesions and another with a small venous angioma. Treatment of this unusual complication of migraine was unsuccessful.
We reviewed the efficacy of CSF diversion for pseudotumor cerebri (PTC) in patients from six different institutions. Thirty-seven patients underwent a total of 73 lumboperitoneal shunts and nine ventricular shunts. Only 14 patients remained "cured" after a single surgical procedure. The average time between shunt insertion and shunt replacement was 9 months, although 64% of shunts lasted less than 6 months. Shunt failure (55%) and low-pressure headaches (21%) were the most common causes for reoperation. The vision of most patients improved (13) or stabilized (13) postoperatively. However, three who had initially improved subsequently lost vision. Six had a postoperative decrease in vision. Two patients improved in one eye but worsened postoperatively in the other. Four lost vision despite apparently adequate shunt function. Shunt failure with relapse of PTC occurred as late as 7 years after insertion. CSF diversion procedures have a significant failure rate as well as a high frequency of side effects.
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