No abstract

In this study of public hospitals in Singapore, the incidence of neuro-ophthalmic diseases was higher in Chinese and Indians compared to Malays.

Objective The degree of pneumatization of the temporal bone has implications in the pathophysiology and surgical considerations of many temporal bone disorders. This study aims to identify common pneumatization patterns in the petrous apex, mastoid, and infralabyrinthine compartments of the temporal bone. Variables associated with temporal bone pneumatization were also identified. Study Design Case series with chart review. Setting Single tertiary hospital. Subjects and Methods In total, 299 high-resolution computed tomography scans of the temporal bone performed on patients between 2013 and 2016 were reviewed. Only normal temporal bone scans in patients aged 13 years and older were included. Previously published grading systems were used to classify pneumatization patterns in the petrous apex, mastoid, and infralabyrinthine region. Results The most common pneumatization pattern in the petrous apex was group 2 (less than half of the petrous apex medial to the labyrinth is pneumatized), that in the mastoid was group 4 (hyperpneumatization), and that in the infralabyrinthine region was type B (limited pneumatization), at 54.8%, 55.4%, and 76.0% of patients, respectively. Patients with increased pneumatization of 1 temporal bone compartment tended to have increased pneumatization of the same compartment on the contralateral side and the other compartments on the ipsilateral side ( P < .05). Younger age ( P < .001) and male sex ( P = .001) were associated with increased pneumatization in the petrous apex and infralabyrinthine compartments. Conclusion The degree of temporal bone pneumatization varies among the different compartments. Age and sex have a significant association with the degree of pneumatization of the petrous apex and infralabyrinthine compartment.

images in clinical medicineT h e ne w e ngl a nd jou r na l o f m e dic i ne n engl j med 360;9 nejm.org february 26, 2009 e12 A 50-year-old woman with hypertension had an acute pontine hemorrhage, as seen on computed tomography (Panel A, arrow), which resulted in quadriplegia. Thirty months later, she reported having difficulty reading because of oscillopsia. The physical examination revealed pendular nystagmus (two cycles per second) with a predominantly vertical component and some horizontal and torsional eye movements (Video 1). She also had palatomyoclonus, seen as rhythmic, involuntary contractions of the soft palate and pharyngopalatine arch (one to two cycles per second) (Video 2). T 2 -weighted magnetic resonance imaging of the brain showed hyperintensity and enlargement of the inferior olivary nuclei, findings that were compatible with a diagnosis of hypertrophic olivary degeneration (Panel B, arrowheads). The condition, which may be caused by trauma, infection, demyelination, neoplasm, or vascular injury in the components of the dentatorubroolivary pathway, results in olivary hypertrophy rather than atrophy. Myoclonic contractions of the soft palate and nystagmus represent the effects of transsynaptic degeneration of the inferior olivary nuclei. After treatment with trihexyphenidyl, there was some improvement in the patient's visual symptoms.

Idiopathic intracranial hypertension (IIH) is uncommon in the paediatric population. Papilloedema is the hallmark sign and patients can suffer permanent vision loss as a consequence. We describe the role of optical coherence tomography (OCT) in the follow-up of two paediatric patients with newly diagnosed IIH. Patient A presented with vomiting and examination showed ophthalmoplaegia and papilloedema. She was treated with acetazolamide, furosemide and therapeutic lumbar punctures. Patient B presented with incidental papilloedema and was treated with acetazolamide and she reported intermittent headache during follow-up. Fundoscopic examinations for both patients showed persistent blurred disc margins but OCT examinations documented improvement of average retinal nerve fibre layers. OCT may be of value in monitoring for recurrence in paediatric IIH.