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Herpes zoster ophthalmicus (HZO) is a manifestation of the reactivation of the varicella zoster virus, characterised by vesicular rash along the ophthalmic division of the trigeminal nerve. A rare but significant complication of HZO is orbital myositis, marked by painful swelling of extraocular muscles and periorbital tissues. We present the case of a 72-year-old woman initially presenting with ophthalmological symptoms, notably conjunctival congestion and superficial punctate keratitis, preceding the typical vesicular rash of herpes zoster. The subsequent development of diplopia led to the detection of lateral rectus palsy. Neuroimaging revealed orbital myositis, with the patient showing marked improvement following treatment with oral steroids. This case emphasize the importance of recognizing orbital myositis as a complication of HZO. [ABSTRACT FROM AUTHOR]

To study the rare and unusual causes of monocular elevation deficit. Five patients presenting to us with diplopia and elevation deficit were thoroughly examined and were found to have monocular elevation deficit due to rare causes. All five were found to have different underlying etiologies – iatrogenic, sphenoid wing meningioma, cysticercosis, sarcoidosis and mid brain infarct, and were managed appropriately. Monocular Elevation Deficit can occur due to a variety of causes. Having a high index of suspicion for the more serious etiologies is of utmost importance. Thorough clinical examination and imaging help clinch the diagnosis. [ABSTRACT FROM AUTHOR]

Background and purpose: The etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of isolated oculomotor nerve palsy by recruiting patients from all departments in a referral‐based university hospital. Methods: The medical records of 672 patients who had a confirmed diagnosis of isolated oculomotor nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020 were reviewed. A proportion of the etiology of isolated oculomotor nerve palsy was also compared with that of patients pooled from the previous studies that were searched on PubMed in May 2022. Results: The most common etiology was microvascular (n = 168, 26.5%), followed by vascular anomalies (n = 110, 17.4%), neoplastic (n = 86, 13.6%), inflammatory (n = 79, 12.5%), idiopathic (n = 60, 9.5%) and traumatic (n = 53, 8.4%). Neurologists were mainly involved in the management of microvascular and inflammatory oculomotor nerve palsies whilst ophthalmologists mainly participated in the care of idiopathic, neoplastic and traumatic palsies. Neurosurgeons mostly took care of oculomotor nerve palsy due to vascular anomalies. Conclusions: The proportion of etiologies of isolated oculomotor nerve palsy may differ according to the specialties involved in the management. The results of previous studies on the etiological distribution of isolated oculomotor nerve palsy should be interpreted with this consideration. [ABSTRACT FROM AUTHOR]

The sitting position is often utilized for mid-brain cavernoma excision due to its several surgical advantages. Intraoperative neuromonitoring aids dynamic functional assessment of neural structures in real-time. In this case report, we discuss the anesthetic management of a patient scheduled for midbrain cavernoma excision in a sitting position. Evoked potential monitoring was performed as the tumor was in proximity to cortico-spinal tracts. We used a combination of inhalational and intravenous anesthetics for the maintenance of anesthesia. Intraoperatively significant events included two episodes of venous air embolism, and loss of motor evoked potentials during the resection of the tumor. These complications were promptly recognized and managed. In the early postoperative period, the patient had motor power 3/5 in flexors of the right upper limb, which improved to normal by Day 5. Thus, good communication among anesthesiologists, neurologists, and surgeons helped identify altered evoked potential signals early, aiding the modification of dissection accordingly. [ABSTRACT FROM AUTHOR]

Sinonasal system malignancies are rare, constituting only 1% of all malignancies and less than 5% of head and neck malignancies. The common form of plasma cell dyscrasias is called multiple myeloma (MM), and the localized forms are called solitary bone plasmacytoma and extramedullary plasmacytoma (EMP). EMP constitutes 3-4% of malignant plasma cell dyscrasias and 1% of all head and neck tumors. 90% of EMP cases occur in the head and neck region, because the nasal and paranasal sinus regions are rich in plasma cells at around 75%. This study aims to present two different cases of plasma cell tumors presenting in the paranasal region. Based on the imaging studies, the first case is seen to have been diagnosed as MM due to bone marrow involvement and to have received systemic chemotherapy treatment, whereas the second case is seen to have undergone endoscopic total excision of the lesion due to the absence of systemic involvement. In the first case, MM was considered to have gone into remission in the sixth month after chemotherapy; however, the patient died one year after diagnosis. In the second case, no recurrence was detected during the fifth year postoperative follow-up. As a result, patients who show sinonasal symptoms should be examined in detail. [ABSTRACT FROM AUTHOR]

The three classic symptoms of carotid cavernous fistula (CCF) are pulsating exophthalmos, bruit and conjunctival chemosis. Here, we present a clinical case of isolated abducens nerve palsy due to a high-flow CCF in an 84-year-old woman, without the typical congestive orbito-ocular features. It was a diagnostic challenge because, for patients older than 50 years with cardiovascular risk factors, ischaemic mononeuropathy is the most frequent aetiology. This case illustrates the least common type of CCF that can be easily misdiagnosed. Physicians should consider fistula as a possible diagnosis in a patient with isolated abducens nerve palsy even without the classic triad. [ABSTRACT FROM AUTHOR]

KEY CLINICAL MESSAGE: Prompt diagnosis and treatment of GCA are crucial to preserve vision. Because of this, new-onset ptosis or diplopia in elderly patients should warrant consideration of GCA, even in the absence of classic features, systemic symptoms or elevated inflammatory markers. ABSTRACT: Giant cell arteritis (GCA) is a vision-threatening, ophthalmic emergency that classically presents with new-onset headaches, scalp tenderness, systemic symptoms, visual disturbances, and elevated inflammatory markers. We describe an atypical presentation of GCA in an 87-year-old patient with fatigable ptosis and diplopia, with subsequent anterior ischemic optic neuropathy and choroidal infarction.

Purpose: Ophthalmic manifestations of varying severity are often associated with systemic autoimmune conditions. Superior orbital fissure syndrome (SOFS) is a rare cranial neuropathy affecting nerves passing through the superior orbital fissure that causes a distinctive pattern of extraocular and pupillary findings. We report the coexistence of SOFS, relapsing polychondritis (RP) and Sjögren's syndrome (SS) in a 52-year-old female who presented with a past medical history of hypothyroidism, Raynaud's syndrome, and intermittent dry mouth and a 1-week history of worsening chemosis, proptosis, diplopia, and painful ophthalmoplegia. Methods: Following a comprehensive eye examination, the patient underwent a CT head with contrast, MRI of the orbit, lumbar puncture, and laboratory investigations. Results: CT and MRI examination revealed inflammatory standing in periorbital subcutaneous soft tissues and bilateral exophthalmos with right intraconal fat stranding surrounding the intraorbital and intracanalicular segments of the nerve, respectively. Lumbar puncture and laboratory investigations revealed an elevation in inflammatory biomarkers, a negative infectious workup, and ruled in SS when considering her history alongside a positive Schirmer test. She was started on high-dose steroids, which led to significant improvement; however, treatment revealed type 2 diabetes, necessitating a faster steroid taper, during which there was a reoccurrence of scleritis and ophthalmoplegia, leading to the initiation of rituximab infusions. After completing rituximab course, she was transitioned back to steroid therapy and was successfully tapered without event. Conclusion: This case is notable for the rare coexistence of SOFS with RP/SS overlap syndrome and highlights the management of concurrent orbital inflammatory syndrome and autoimmune diseases. [ABSTRACT FROM AUTHOR]

This case report presents the clinical findings of a female patient diagnosed with Wernicke's encephalopathy, characterized by pinpoint pupils. While pupillary changes can occur in Wernicke's encephalopathy, the presence of pinpoint pupils is exceedingly rare. In this report, we aim to document and discuss this unusual presentation, as well as speculate on the potential mechanisms underlying this atypical manifestation of the disease. [ABSTRACT FROM AUTHOR]

Osteogenic sarcoma of the Craniofacial region are uncommon.They have been mainly reported in the mandible and the maxilla, Primary osteosarcoma arising from ethmoid sinus is an extremely rare condition. We report a case of 34 year old male, presented with gradually increasing swelling over the right medial canthus with history of double vision for one year. Clinically we thought it was a mucous retention cyst in the ethmoid area. After doing Contrast enhanced CT, we proceeded with transnasal endoscopic removal of the cyst. Histopathological examination of the specimen surprisingly turned out to be a low grade Osteogenic sarcoma. Patient was treated with adjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Cholesterol Granuloma is a rare lesion which occurs at locations like ear, peritoneum, lungs, breast etc. and formed due to interaction of Cholesterol and living tissue. But Cholesterol Granuloma occurring in the orbit is a very rare entity and so we authors present a case of Cholesterol Granuloma of the orbit. [ABSTRACT FROM AUTHOR]

Introduction: Propylhexedrine is an over-the-counter nasal decongestant used recreationally for amphetamine-like effects. Prior reports have associated intravenous misuse with brainstem dysfunction and diplopia. This is a case of propylhexedrine ingestion resulting in neurological impairment with associated MRI findings. Case Report: A 21-year-old man presented with neurologic symptoms after ingesting propylhexedrine extracted from a 250 mg nasal inhaler into a lemon juice solution following recommendations from an online forum. He also followed recommendations to simultaneously ingest 1 g L-arginine to theoretically mitigate the risk of vasoconstriction. He developed flushing and euphoria before falling asleep. He awoke 12 h later with dizziness, intractable vomiting, diplopia, ataxia, dysmetria, and spontaneous horizontal nystagmus. Magnetic resonance imaging (MRI) revealed T2 enhancement concerning for vasogenic edema of the right posterior limbs of the internal capsule extending into the midbrain, cerebellar peduncles, and cerebellar white matter. Workup for primary vascular or autoimmune etiologies was unrevealing. Expanded drug testing was positive for mitragynine and THC. Blood analyzed via liquid chromatography quadrupole time-of-flight mass spectrometry was positive for propylhexedrine. On hospital day 6, the patient was discharged to physical rehabilitation with unresolved dysmetria and ataxia. Discussion: Recreational oral misuse of propylhexedrine may be associated with neurologic injury. MRI findings in this case demonstrated vasogenic edema suggesting vasospasm as a possible etiology. Serum testing confirmed the presence of propylhexedrine. Although testing was also positive for mitragynine and THC, these have not been associated with similar neurologic deficits or MRI findings. [ABSTRACT FROM AUTHOR]

Parkinson’s disease (PD) is a common degenerative disorder characterized by decreased dopamine levels from damage to the substantia nigra causing classic motor deficits. Several ocular deficits have been recognized in association with PD such as oculomotor disturbances and diplopia, glaucoma and visual field loss, dry eye disease, color and contrast impairment, visual hallucinations, and visuospatial and visuoperceptual impairments. These disorders remain underreported, underrecognized, and poorly understood. Patients with PD are largely dependent on visual cues for compensating the motor deficits. Hence, early recognition and timely management of the above ocular disorders can lead to greater patient safety, independence, and a better quality of life.

Background: Juvenile myasthenia gravis (MG) is a rare autoimmune neuromuscular disorder and has a varied presentation in childhood making it a diagnostic challenge. Clinical Description: An 8-year-old girl presented to the pediatric emergency with multiple episodes of falling, drooling of saliva, dysphagia, and bilateral ptosis. Within a few hours of admission, she had acute deterioration, developed respiratory failure, and was put on ventilatory support. Management and Outcome: A myasthenic crisis was suspected and a neostigmine challenge test was done. She was managed in the emergency with atropine, neostigmine, intravenous immunoglobulin, and supportive care. Subsequently, she achieved complete remission with steroids, physostigmine, and oral mycophenolate mofetil over the next 6 weeks. Conclusion: Juvenile MG may rarely be the cause of generalized muscular weakness. A strong suspicion of myasthenic crisis must be kept in case of sudden deterioration involving bulbar and respiratory muscles, in a patient with neurologic weakness. Early intervention in this rare condition can be lifesaving.

Introduction: Recent International reports on ocular health shared that diplopia and dry eye are the prevalent ocular disorders caused by overuse of smartphone in young adults. Studies on smartphone usage in young adult’s reports that the smartphone use begins at the age group ranges from 12-18 years old, were the minimum duration of smartphone use per day is 4-6 hours. The association between smartphone use and prevalence of ocular manifestations has recommended the need of health education programs on smartphone use and its ocular impacts. Increasing use of smart devices also can cause acute acquired comitant esotropia in adolescents. Aim: To investigate the influence of smartphone reading on the ocular surface and to compare the influences of smartphone use on ocular symptoms, status of tear film stability and volume assessment. Materials and Methods: This is a prospective randomized controlled study on volunteers who continued reading for 2 hours on different smartphone screens. A total of 100 volunteers above 18 years of age without any ocular diseases had participated in the study. A structured questionnaire was used to collect the details in the present cadaveric case, found that the IMA divided into two terminal branches. The ascending branch emanated the left colic and sigmodal artery whereas the descending branch continued as superior rectal artery. This was similar to type 2 pattern of Yada’s classification. The expert knowledge of normal and variant Anatomy of abdominal aorta is of utmost importance to the interventional Radiologists, laparoscopic Surgeons, and Surgical Oncologist in succeeding surgery with minimal complications. Keywords: Abdominal aorta, Colon, Yada's classification.of smartphone usage and the visual acuity, tear film stability and volume assessment test and Intraocular pressure (IOP) was taken as some of the parameters in the study. Results: The continuous use to smartphone causes various problems, headaches, eye dryness, earache, fatigue, and musculoskeletal manifestations. The visual acuity, tear film stability and tear volume and IOP of both right and left eye was analysed and found to be statistically significant among the control and SPVS group. The ocular manifestations are noted and correlated with the duration of usage. The precautions were recommended further from the results of the study. Conclusion: The prevalence of eye diseases is high in most of the age groups and it is important to educate about the adverse effect of smartphone usage in all categories. The study also suggests about the screen time limitation and usage of smartphones for young adults.

Purpose: To report a rare case of orbital dermoid cyst, involving the inferior rectus muscle, in a 26-year-old female presenting with proptosis and blurred vision in her right eye. Observations: The unique features of this case are discussed, including the location and contents of the cyst, the surgical approach, and the postoperative outcome. Conclusion and importance: The importance of considering dermoid cysts in the differential diagnosis of an orbital mass involving extraocular muscles and the need for a thorough evaluation to diagnose and manage these rare lesions.

Objective: Rare disease Background: Langerhans cell histiocytosis (LCH) is a rare and uncontrolled proliferation of dendritic cells of myeloid origin. The incidence of LHC was estimated at 5 cases per million children ages 0-15 years old. The most common places for this tumor are the jaw, vertebra, pelvis, and the extremities. The disease with multisystem involvement can present a mortality rate of 20% and one-third of children have multisystem involvement. We present a case with unusual bone involvement of the anterior cranial base with a challenging diagnosis and a complex surgical approach. Case Report: We report the case of a 6-year-old boy who manifested the disease with daily holocranial headache, worse in the frontal region and refractory to analgesia for 10 days, strabismus homonymous, diplopia, and right palpebral ptosis. The tumor affected the sphenoid sinus, internal carotid artery, and sella turcica, and made contact with the pituitary gland. A joint surgery with Otorhinolaryngology and Neurosurgery was performed by nasal endoscopic access to the skull base by means of the right medial turbinectomy (for the access) and right sphenoid opening, septectomy and opening of the left sphenoid to work with 4 hands and, after resection of lesion, inside the sphenoid. Conclusions: This patient had rare bone involvement from LCH and atypical clinical presentation next to the important and delicate structures of the anterior skull base, but had a satisfactory outcome. [ABSTRACT FROM AUTHOR]

Brucellosis, a zoonotic disease caused by Brucella species, poses a significant global health concern. Among its diverse clinical manifestations, neurobrucellosis remains an infrequent yet debilitating complication. Here, we present a rare case of neurobrucellosis with unusual presentations in a 45-year-old woman. The patient's clinical course included progressive lower extremity weakness, muscle wasting, and double vision, prompting a comprehensive diagnostic evaluation. Notable findings included polyneuropathy, elevated brucella agglutination titers in both cerebrospinal fluid and blood, abnormal EMG-NCV tests, and resolving symptoms with antibiotic therapy. The clinical presentation, diagnostic challenges, and differentiation from other neurological conditions are discussed. This case underscores the importance of considering neurobrucellosis in regions where brucellosis is prevalent and highlights this rare neurological complication's distinctive clinical and radiological features. Early recognition and appropriate treatment are crucial to mitigate the significant morbidity associated with neurobrucellosis. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose is to report the results of the Boergen modification of the Harada-Ito procedure with and without simultaneous vertical muscle surgery in patients with acquired unilateral superior oblique muscle palsy. PATIENTS AND METHODS: Files of patients with acquired unilateral superior oblique muscle palsy who were treated with Boergen modification of the Harada-Ito procedure were studied retrospectively. For each patient, age at the time of surgery, the presence of diplopia, compensatory head posture, and ocular deviation before and after surgery were retrieved. Results were evaluated 6 months after surgery. RESULTS: A total of 12 patients with a mean age of 32 years at the time of surgery (range 15-45 years) were included. The underlying etiology was head trauma in eleven patients. The modified Harada-Ito procedure alone was done for three cases (Group 1), and a simultaneous combination of this procedure and vertical muscle surgery was performed in nine patients (Group 2). The average intorsional effect in the primary position was 9.2° (8° in Group 1 and 9.6° in Group 2). The average correction of hypertropia in the primary position was 8.2 prism diopters (PD) (1 PD in Group 1 and 10.6 PD in Group 2). Diplopia in the primary position and downgaze were resolved in eleven patients and ten patients, respectively. Four patients had a compensatory head tilt at their last follow-up. CONCLUSIONS: Boergen modification of the Harada-Ito procedure, alone and combined with vertical muscle surgery, successfully corrected primary position diplopia in the majority of the patients. [ABSTRACT FROM AUTHOR]

The study aimed to systematically review available literature regarding the safety of virtual reality (VR) use via head-mounted display in children under 14 years of age. The study was a systematic review including all study designs. A search was conducted in January 2023 in PubMed and EMBASE using key terms referring to 'virtual reality', 'paediatrics' and 'safety'. Following title and abstract and full-text screening, data were extracted and a narrative synthesis undertaken. Twenty-six studies met criteria for inclusion in the final review. Limited data suggest that VR may cause mild cybersickness symptoms (not severe enough to cause participants to discontinue use of VR) and that for children with existing amblyopia using VR may result in double vision, which resolves on cessation of VR exposure. Two randomised control trials did not report differences in adverse events between the intervention (VR use) and control groups. Reporting of safety data was poor; only two studies used a validated measure, and in the remaining studies, it was often unclear how adverse events were defined (if at all), how they were categorised in terms of severity and how they were recorded. Conclusion: There is limited evidence regarding any potential harms from short exposure to VR in children under 14 years under supervision. Additional research is required to understand increases in cybersickness during and after VR exposure, and the impact of repeated exposure. Adverse events need to be accurately and routinely recorded to determine any hitherto unknown safety concerns for children < 14 years using VR. What is Known: • Virtual reality (VR) is increasingly being applied in paediatrics, with benefits in terms of anxiety reduction, improved pain management associated with procedures, as an adjunct to physiotherapy and supporting treatments in autistic spectrum disorder.. • Safety guidance in relation to VR use, particularly in younger children, is limited. What is New: • A systematic review of available literature regarding the safety of VR use via head-mounted display in children under 14 years of age demonstrated limited evidence regarding any potential harms from short exposure to VR.. • Studies rarely report safety data and adverse side effects are poorly defined, measured and/or reported. • The lack of a validated measure for evaluating VR-associated symptoms in children compounds the challenging ethical issues of undertaking research into the effects of VR on younger children. [ABSTRACT FROM AUTHOR]

Background and purpose: Diagnosis of lymphoma involving the central nervous system (CNS) is challenging. This study aimed to explore the abnormal vestibular and ocular motor findings in CNS lymphoma. Methods: A retrospective search of the medical records identified 30 patients with CNS lymphoma presenting ocular motor and vestibular abnormalities from four neurology clinics of university hospitals in South Korea (22 men, age range 14–81 years, mean 60.6 ± 15.2). The demographic and clinical features and the results of laboratory, radiological and pathological evaluation were analyzed. Results: Patients presented with diplopia (13/30, 43%), vestibular symptoms (15/30, 50%) or both (2/30, 7%). In 15 patients with diplopia, abnormal ocular motor findings included ocular motor nerve palsy (n = 10, 67%), internuclear ophthalmoplegia (n = 2, 13%), external ophthalmoplegia (n = 2, 13%) and exophoria (n = 1, 7%). The vestibular abnormalities were isolated in 14 (82%) of 17 patients with vestibular symptoms and included combined unilateral peripheral and central vestibulopathy in three from lesions involving the vestibular nuclei. CNS lymphoma involved the brainstem (53%), cerebellum (33%), leptomeninges (30%), deep gray nuclei (23%) or cranial nerves (17%). Two patients showed the "double‐panda" sign by involving the midbrain. Conclusions: This study expands the clinical and radiological spectra of CNS lymphoma. Neuro‐ophthalmological and neuro‐otological evaluation may guide the early diagnosis of CNS lymphoma. [ABSTRACT FROM AUTHOR]

A 77-year-old-man with arterial hypertension, diabetes mellitus type II presented at our clinic for a routine ophthalmological exam. He complained of intermittent double vision. The ophthalmic examination revealed paralysis of III (n. oculomotorius) and VI (n. abducens) cranial nerves with ptosis, deficit in elevation and abduction of the left eye. The patient underwent urgent MRI imaging of the brain/orbits and paranasal sinuses, and urgent neurological assessment. MRI revealed a volume-occupying process, starting from the posterior wall of the left maxillary sinus with perineural diffusion and involvement of the homolateral trigeminal nerve, intracranial spread in the medial cranial fossa and involvement of the cavernous, sphenoidal sinuses and the orbital apex on the left side. Biopsy was performed, and the histology resulted in sinonasal squamous cell carcinoma with intracranial spread. [ABSTRACT FROM AUTHOR]

A 63-year-old man with diabetes presented with unilateral ptosis and an exotropia. A diagnosis of isolated diabetic III nerve palsy was made. Subsequent neuro-ophthalmologic evaluation showed multiple cranial nerves involvement consistent with a diagnosis of orbital apex syndrome. Review of past medical history was significant for a previous nasopharyngeal carcinoma, and biopsy of the involved site was consistent with tumor recurrence. This case highlights the importance of correct medical history taking and anatomo-clinical correlation in neuro-ophthalmology. [ABSTRACT FROM AUTHOR]

Background: To track improvement in diplopia symptoms with strabismus-specific health-related quality of life (HRQOL) questionnaire across a treatment consisting of prism correction followed by vision therapy/orthoptics when prism treatment alone has not succeeded. Methods: Forty-eight participants with diplopia and a mean age of 62.45 were asked to complete an Adult Strabismus-20 (AS-20) questionnaire and a Diplopia Questionnaire (DQ) before and after prism correction. Inclusion criteria were diplopia reported on the DQ as "sometimes", "often" or "always" at reading or straight-ahead distance. The prism correction was classified as successful if the participant reported "never" or "rarely" on the DQ for reading and straight-ahead distance; and unsuccessful if the perceived diplopia worsened or remained the same. For all participants, mean initial AS-20 scores were compared with mean post-prism correction scores, taking into account AS-20 subscales (reading and general functions, and self-perception and interaction). Participants in the failed prism treatment subgroup subsequently underwent a programme of vision therapy wearing their prism correction, the results of which were again determined by participants' responses on the AS-20 questionnaire, completed before and after the vision therapy. Results: Five of the 48 participants dropped out of the study. Prism correction was classified as successful in 22 of 43 participants (51%), and unsuccessful in 21 (49%). Those participants for whom the prism correction was classified as a success showed a statistically significant improvement (p = 0.01) in both reading and general functions. In the failed treatment subgroup, no significant change in AS-20 score was recorded for any of the domains (p = 0.1). After treatment with vision therapy/orthoptics, however, 13 of the 20 participants in the unsuccessful prism correction subgroup (one of them dropped out the study) achieved binocular vision and statistically significant improvement in reading and general functions (p = 0.01). Conclusions: Although effective prism correction of diplopia is correlated with enhanced HRQOL, prism correction alone is frequently not sufficient to achieve this objective. In these cases, vision therapy/orthoptics treatment as a coadjutant to prism correction is shown to improve HRQOL. [ABSTRACT FROM AUTHOR]

Copyright of Bosphorus Medical Journal / Boğaziçi Tıp Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To report a relatively new surgical treatment for near exotropia called medial rectus inferior half plication. Methods: This was a retrospective analysis of the outcomes from a single surgeon performing a plication of the inferior half of the medial rectus muscle in 17 consecutive patients with near exotropia unresponsive to medial rectus bupivacaine injection. Results: Thirteen of 17 (76%) patients were asymptomatic after surgery with no diplopia for near fixation and with either a normal or slightly reduced prism fusion range enabling them to have comfortable binocular single vision. There was one minor surgical overcorrection with distance diplopia that disappeared within 2 weeks of surgery. Of the 4 of 17 (24%) patients who required further intervention, 3 required one further surgical procedure and 1 required an injection of bupivacaine into the contralateral medial rectus muscle to obtain a satisfactory alignment and control of symptoms. No patient needed more than two total operations. Conclusions: The data show medial rectus inferior plication can produce excellent outcomes with minimal risk of overcorrection. [J Pediatr Ophthalmol Strabismus. 2024;61(3):219–222.] [ABSTRACT FROM AUTHOR]

Copyright of BMC Ophthalmology is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Inflammatory myofibroblastic tumor (IMFT) is a rare tumor of unknown etiology. It can involve any part of the body. The IMFT involving the base of skull is rare with only 36 cases reported in the literature. We report a rare case of IMFT of temporal bone with review of literature. A 42 year old male presented with complaints of headache and double vision and MRI brain showed lesion in the right petrous apex region suggestive of a neurogenic mass. He had excision of lesion and histopathology was suggestive of IMFT with IgG4 and ALK positive. He had complete clinical response but a month later he presented with right eyelid ptosis and decreased rotation of eye medially with recurrent lesion on MRI. Patient received radiation by SRT technique and then started on Ceretinib with partial response. The IMFT is rare tumor of unknown etiology and tumors of temporal bone are more aggressive. It is benign but locally invasive tumor. Treatment of IMFT is controversial. Extensive surgery with complete excision has about 80% response rates and with intracranial extension, adjuvant radiation is need. In head and neck IMFT response rates are lower (30 to 40%). Monoclonal antibodies and steroids are used in IMFT at recurrence. In advanced or metastatic ALK positive tumors, Crizotinib is used with a response rate of 50%. Radiotherapy (25 to 30 Gy) induces remission and helps to taper the steroids. Temporal bone IMFT is a rare tumor with multimodality approach and variable response to treatment. [ABSTRACT FROM AUTHOR]

Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms. [ABSTRACT FROM AUTHOR]

Background: Petroclival meningiomas are challenging tumors. Several skull base approaches have been proposed in the last decades, with variable rates of postoperative morbidity and extent of resection. Methods: We herein reported the step-by-step microsurgical resection of a large petroclival meningioma through an extended retrosigmoid approach. Detailed surgical technique has been accompanied by a 2D operative video. Conclusion: The extended retrosigmoid approach allowed for a safe gross total resection of the tumor, as confirmed by the postoperative MRI. The patient did not experience any new postoperative deficit, despite a transient diplopia, and was discharged on postoperative day 7. [ABSTRACT FROM AUTHOR]

Tubular aggregate myopathies comprise a rare group of disorders with characteristic pathological findings and heterogeneous phenotypes, including myasthenic syndrome. We describe a patient with tubular aggregate myopathy who presented with fatiguable weakness improving with pyridostigmine, respiratory involvement and possible cardiac manifestations. We highlight the utility of muscle biopsy in atypical myasthenic syndrome. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of IIH (idiopathic intracranial hypertension) in children is challenging. The pathogenesis of IIH is still largely unknown. The aim of this study to evaluate the clinico-demographic profile and short-term outcome of IIH among Bangladeshi children. Methodology: This observational cohort study was done in pediatric Neurology Department, National Institute of Neurosciences and Hospital Bangladesh from January 2018 to July 2019. Total 19 cases were enrolled who were clinically suspected and/or had normal CSF with opening pressure (OP) above 250 mmH2O. They were further categorized as "definite IIH", definite IIH without papilledema, and "probable IIH". Clinical, radiological profile and shortterm outcome were analyzed by SPSS version 22. Result: Among them most were probable IIH (74%). Episodic (57.9%), moderate, diffuse headache was the predominant symptom along with vomiting, double vision, unilateral VI nerve palsy and papilledema. Obesity was found in 21% cases. Mean CSF pressure was 21.84+7.62cm H2O and found high in definite IIH. All the cases were treated with acetazolamide and serial LP was done in 4(15.8%) cases. Definite IIH requires longer hospital stay (6.42 ± 2.87days). Recurrence was observed in 10.5% cases and visual impairment was found in 15.8% cases. Conclusion: This study found wide range of diversity between clinical feature and CSF opening pressure in Pediatric IIH and diagnostic confirmation was challenging. Initial treatment response was satisfactory with a low recurrence rate. [ABSTRACT FROM AUTHOR]

We present here a 12-year-old child who presented with complaints of blurring of vision and drooping of the left upper eyelid for the past 4 years, which started 1 month after he encountered blunt trauma to the left-sided orbital region. History, examination and pharmacological (neostigmine test) tests were suggestive of ocular myasthenia gravis, however anti-acetylcholine receptor antibodies and anti-musk antibodies were negative. Repetitive nerve stimulation tests and electromyography were also unremarkable. The patient was labelled as a case of trauma-induced double-Seronegative Ocular Myasthenia Gravis and was started on oral Pyridostigmine. The patient reported a drastic improvement in both diplopia and ptosis that he initially presented with. Ocular Myasthenia Gravis can be a diagnostic challenge as its initial presentation can vary to a great degree. Thorough history and examination remain of prime importance which can provide adequate clues to lead us to the diagnosis of ocular myasthenia gravis. Trauma should also be recognized as a triggering factor for myasthenia gravis and more attention needs to be given to understand the pathophysiology of this interesting association. [ABSTRACT FROM AUTHOR]

To clinically and radiographically evaluate patient-specific titanium meshes via a trans -antral approach for correction of enophthalmos and orbital volume in patients with recent unilateral orbital floor fracture. Seven patients with unilateral orbital floor fractures received patient-specific titanium meshes that were designed based on a mirror-image of the contralateral intact orbit. The patient-specific implants (PSIs) were inserted via a trans -antral approach without endoscopic assistance. The patients were evaluated clinically for signs of diplopia and restricted gaze as well as radiographically for enophthalmos and orbital volume correction. Diplopia was totally resolved in two of the three patients who reported diplopia in the upward gaze. Whereas enophthalmos significantly improved in all but two patients, with a mean value of 0.2229 mm postoperatively compared to 0.9914 mm preoperatively. CT scans showed excellent adaptation of the PSIs to the orbital floor with a mean reduction of the orbital volume from 29.59 cc to 27.21 cc, a mean of 0.6% smaller than the intact orbit. It can be concluded that the proposed PSI can offer good reconstruction of the orbital floor through an isolated intraoral transantral approach with minimal complications. It could of special benefit in extensive orbital floor fractures. [ABSTRACT FROM AUTHOR]

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