1
|
Maheshwari M, Ho ML, Bosemani T, Dahmoush H, Fredrick D, Guimaraes CV, Gulko E, Jaimes C, Joseph MM, Kaplan SL, Miyamoto RC, Nadel HR, Partap S, Pfeifer CM, Pruthi S. ACR Appropriateness Criteria® Orbital Imaging and Vision Loss-Child. J Am Coll Radiol 2024; 21:S219-S236. [PMID: 38823946 DOI: 10.1016/j.jacr.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Orbital disorders in children consist of varied pathologies affecting the orbits, orbital contents, visual pathway, and innervation of the extraocular or intraocular muscles. The underlying etiology of these disorders may be traumatic or nontraumatic. Presumed location of the lesion along with the additional findings, such as eye pain, swelling, exophthalmos/enophthalmos, erythema, conjunctival vascular dilatation, intraocular pressure, etc, help in determining if imaging is needed, modality of choice, and extent of coverage (orbits and/or head). Occasionally, clinical signs and symptoms may be nonspecific, and, in these cases, diagnostic imaging studies play a key role in depicting the nature and extent of the injury or disease. In this document, various clinical scenarios are discussed by which a child may present with an orbital or vision abnormality. Imaging studies that might be most appropriate (based on the best available evidence or expert consensus) in these clinical scenarios are also discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | - Mai-Lan Ho
- Panel Vice Chair, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Hisham Dahmoush
- Lucile Packard Children's Hospital at Stanford, Stanford, California
| | - Douglas Fredrick
- Oregon Health & Science University-Casey Eye Institute, Portland, Oregon; American Academy of Pediatrics
| | | | - Edwin Gulko
- Westchester Medical Center, Valhalla, New York
| | - Camilo Jaimes
- Massachusetts General Hospital, Boston, Massachusetts
| | - Madeline M Joseph
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American College of Emergency Physicians
| | - Summer L Kaplan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Committee on Emergency Radiology-GSER
| | - R Christopher Miyamoto
- Peyton Manning Children's Hospital at Ascension St. Vincent, Indianapolis, Indiana; American Academy of Otolaryngology-Head and Neck Surgery
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Commission on Nuclear Medicine and Molecular Imaging
| | - Sonia Partap
- Stanford University, Stanford, California; American Academy of Pediatrics
| | | | - Sumit Pruthi
- Specialty Chair, Vanderbilt Children's Hospital, Nashville, Tennessee
| |
Collapse
|
2
|
Rosenberg JG, Nissen K, Heegaard S, Ragunathan S, Schmiegelow K, Mathiasen R, von Holstein SL. Nystagmus in children with primary brain tumours in Denmark between 2007 and 2017. Eye (Lond) 2024; 38:766-772. [PMID: 37816936 PMCID: PMC10920855 DOI: 10.1038/s41433-023-02771-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/18/2023] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The aim of the study was to evaluate the prevalence, clinical characteristics, and diagnostic importance of nystagmus in children with brain tumours. METHODS A nation-wide retrospective review of all children diagnosed with a brain tumour between January the 1st, 2007 and December 31st, 2017, in Denmark. Data is based on information from the Danish Childhood Cancer Registry, hospital records from paediatric- and ophthalmological departments, and records from private ophthalmologists. RESULTS Nystagmus was observed in 13.7% (60/437) of children with a brain tumour. In 50/60 children (83.3%) nystagmus was an incidental finding at the clinical examination and only in 10/60 children (16,7%) were nystagmus noticed by patient/caregivers prior to the clinical examination. In 38/60 children nystagmus was observed before the brain tumour diagnosis, most often (16/38, 42%) the same day as the diagnosis was made. In 22/60 children nystagmus was found after the brain tumour diagnosis (prior to any treatment) with a median of four days (range 0-47) after the brain tumour diagnosis. Nystagmus was most commonly binocular (56/60, 93.3%) and gaze-evoked (43/60, 71.7%). The median number of additional symptoms and/or clinical findings was five (range 0-11). CONCLUSION Nystagmus is frequent in children with brain tumours and is typically accompanied by other symptoms and clinical signs. However, nystagmus is often first recognized by the ophthalmologist late in the time course. Therefore, raising awareness of the importance of looking for nystagmus in children with unspecific neurological symptoms might contribute to increased suspicion of brain tumour and thereby faster diagnosis.
Collapse
Affiliation(s)
- Jacqueline Gremaud Rosenberg
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Kamilla Nissen
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Kjeld Schmiegelow
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - René Mathiasen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Sarah Linea von Holstein
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Denmark.
- Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
3
|
Papageorgiou E, Lazari K, Gottlob I. The challenges faced by clinicians diagnosing and treating infantile nystagmus Part II: treatment. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1970533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eleni Papageorgiou
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Katerina Lazari
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, Larissa, Greece
| | - Irene Gottlob
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, UK
- Department of Neurology, Cooper University Hospital, Neurological Institute, Camden, New Jersey, USA
| |
Collapse
|
4
|
Papageorgiou E, Kapsalaki E, Tsironi EE. Disconjugate Nystagmus in a Child With Chiasmal Glioma. Pediatr Neurol 2020; 104:70-71. [PMID: 31917099 DOI: 10.1016/j.pediatrneurol.2019.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Eleni Papageorgiou
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece.
| | - Eftychia Kapsalaki
- Department of Radiology, University Hospital of Larissa, Larissa, Greece
| | - Evangelia E Tsironi
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
| |
Collapse
|
5
|
Ge LL, Shi CP. An infant intracranial tumor with nystagmus. Chin Med J (Engl) 2020; 133:99-100. [PMID: 31923113 PMCID: PMC7028207 DOI: 10.1097/cm9.0000000000000597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Li-Li Ge
- Department of Ophthalmology, The Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, China
| | | |
Collapse
|
6
|
Siedler DG, Beechey JC, Jessup PJ, Thani NB. Infantile Optic Pathway Glioblastoma. World Neurosurg 2019; 129:172-175. [PMID: 31158532 DOI: 10.1016/j.wneu.2019.05.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic pathway gliomas and glioblastomas remain a rare entity within the infant population. CASE DESCRIPTION We outline the case of a 6-month-old female who presented with failure to thrive, nystagmus and features of raised intracranial pressure. Subsequent magnetic resonance imaging demonstrated an infiltrating tumor radiating from the optic nerves bilaterally. She underwent emergent ventriculoperitoneal shunting and biopsy. Histology confirmed a World Health Organization grade IV glioblastoma. CONCLUSIONS The patient remained clinically and radiologically stable at 1 year. Optic pathway glioblastoma in this population is a previously undescribed entity that requires multidisciplinary input to guide ongoing therapy.
Collapse
Affiliation(s)
- Declan G Siedler
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jessica C Beechey
- Department of Anatomical Pathology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Peter J Jessup
- Department of Anatomical Pathology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Nova B Thani
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Tasmania, Australia.
| |
Collapse
|
7
|
Affiliation(s)
- Kyle A. Arnoldi
- Amblyopia and Eye Movement Disorders Center, St. Louis Children's Hospital at Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
8
|
Miraldi Utz V, Pfeifer W, Longmuir SQ, Olson RJ, Wang K, Drack AV. Presentation of TRPM1-Associated Congenital Stationary Night Blindness in Children. JAMA Ophthalmol 2018; 136. [PMID: 29522070 PMCID: PMC5876850 DOI: 10.1001/jamaophthalmol.2018.0185] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Congenital stationary night blindness (CSNB) implies a stable condition, with the major symptom being nyctalopia present at birth. Pediatric clinical presentation and the course of different genetic subtypes of CSNB have not, to our knowledge, been well described in the era of molecular genetic diagnosis. OBJECTIVE To describe the presentation and longitudinal clinical characteristics of pediatric patients with molecularly confirmed TRPM1-associated complete CSNB (cCSNB). DESIGN, SETTING, PARTICIPANTS This study was conducted at the University of Iowa from January 1, 1990, to July 1, 2015, and was a retrospective, longitudinal case series of 7 children (5 [71.4%] female) with TRPM1-associated cCSNB followed up for a mean (SD) of 11.1 (2.8) years. MAIN OUTCOMES AND MEASURES History, ophthalmologic examination findings, full-field electroretinogram (ffERG) results, full-field stimulus threshold testing results, Goldmann visual field results, optical coherence tomography results, and molecular genetic results were evaluated. Presenting symptoms and signs, the correlation of refractive error with electroretinography, and clinical evolution were analyzed. RESULTS Seven patients (5 [71.4%] female) presented early in childhood with strabismus (n = 6 [86%]), myopia (n = 5 [71%]), and/or nystagmus (n = 3 [43%]). The mean (SD) age at presentation was 8 (4) months and for receiving a diagnosis by ffERG was 7.3 years, with molecular diagnosis at 9.7 years. The mean (SD) length of follow-up was 11 (2.8) years. The best-corrected visual acuity at the most recent visit averaged 20/30 in the better-seeing eye (range, 20/20-20/60). The mean (SD) initial refraction was -2.80 (4.42) diopters (D) and the mean refraction at the most recent visit was -8.75 (3.53) D (range, -4.00 to -13.75 D), with the greatest rate of myopic shift before age 5 years. Full-field electroretinogram results were electronegative, consistent with cCSNB, without a significant change in amplitude over time. No patient or parent noted night blindness at presentation; however, subjective nyctalopia was eventually reported in 5 of 7 patients (71%). The full-field stimulus threshold testing results were moderately subnormal (-29.7 [3.8] dB; normal -59.8 [4.0] dB). Goldmann visual field results were significant for full I-4e, but constricted I-2e isopter. Eight different mutations or rare variants in TRPM1 predicted to be pathogenic were detected, with 3 novel variants. CONCLUSIONS AND RELEVANCE Children with TRPM1-associated cCSNB presented before school age with progressive myopia as well as strabismus and nystagmus (but not nyctalopia), with stable, electronegative ffERG results, mildly subnormal full-field stimulus threshold testing results, and a constricted I2e isopter on perimetry. These findings suggest that ffERG and cCSNB genetic testing should be considered for children who present with early-onset myopia, especially in the presence of strabismus and/or nystagmus, and that TRPM1-associated cCSNB is a channelopathy that may present without complaints of night blindness in childhood.
Collapse
Affiliation(s)
- Virginia Miraldi Utz
- Abrahamson Pediatric Eye Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Wanda Pfeifer
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
- University of Iowa Institute for Vision Research, Iowa City
| | - Susannah Q. Longmuir
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
- Private practice, Nashville, Tennessee
| | - Richard John Olson
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
| | - Kai Wang
- University of Iowa Institute for Vision Research, Iowa City
- Department of Biostatistics, University of Iowa, Iowa City
| | - Arlene V. Drack
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City
- University of Iowa Institute for Vision Research, Iowa City
| |
Collapse
|
9
|
Kinori M, Hodgson N, Zeid JL. Ophthalmic manifestations in neurofibromatosis type 1. Surv Ophthalmol 2017; 63:518-533. [PMID: 29080631 DOI: 10.1016/j.survophthal.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a relatively common multisystemic inherited disease and has been extensively studied by multiple disciplines. Although genetic testing and confirmation are available, NF1 remains a clinical diagnosis. Many manifestations of NF1 involve the eye and orbit, and the ophthalmologist, therefore, plays a significant role in the diagnosis and treatment of NF1 patients. Improvements in diagnostic and imaging instruments have provided new insight to study the ophthalmic manifestations of the disease. We provide a comprehensive and up-to-date overview of the ocular and orbital manifestations of NF1.
Collapse
Affiliation(s)
- Michael Kinori
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nickisa Hodgson
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Janice Lasky Zeid
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
| |
Collapse
|
10
|
|
11
|
Bowen M, Peragallo JH, Kralik SF, Poretti A, Huisman TAGM, Soares BP. Magnetic resonance imaging findings in children with spasmus nutans. J AAPOS 2017; 21:127-130. [PMID: 28284856 DOI: 10.1016/j.jaapos.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/23/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spasmus nutans (SN) is a rare pediatric ophthalmologic syndrome characterized by nystagmus, head bobbing, and abnormal head positioning. Historically, SN has been associated with underlying optic pathway gliomas (OPG); however, evidence of this association is based primarily on a small number of isolated case reports. Prior retrospective analyses have found the rate of OPG to be <2%, but these studies only intermittently used neuroimaging with computed tomography, which has limited sensitivity for detection of small lesions in the optic pathway. The purpose of this study was to investigate the association of SN with intracranial abnormalities, particularly OPG, using magnetic resonance imaging of the brain and orbits. METHODS Neuroradiology databases at three institutions spanning January 2010 to May 2016 were queried for examinations ordered for evaluation of SN; MRI examinations of the brain and/or orbits were included and evaluated for OPG and other structural abnormalities. Medical records were reviewed to confirm a diagnosis of SN, presence of other underlying neurological disease, or preexisting diagnoses. RESULTS A total of 40 patients with eligible MRI examinations were identified. None had optic nerve pathway gliomas. Two children had optic nerve hypoplasia; no other patients had optic pathway abnormalities. None had intracranial or orbital masses. MRI examinations were normal in 25 patients. CONCLUSIONS This series represents the largest collection of MRI examinations for SN in the literature to date and shows no association between OPG and SN. In children presenting with SN but no other findings suggesting OPG or neurological abnormalities, neuroimaging may not be required.
Collapse
Affiliation(s)
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Stephen F Kralik
- Section of Neuroradiology, Department of Radiology and Imaging Sciences, Indiana University, Indianapolis, Indiana
| | - Andrea Poretti
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thierry A G M Huisman
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruno P Soares
- Section of Pediatric Neuroradiology, Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
12
|
|
13
|
Batmanabane V, Heon E, Dai T, Muthusami P, Chen S, Reginald A, Radhakrishnan S, Shroff M. The role of MR imaging in investigating isolated pediatric nystagmus. Pediatr Radiol 2016; 46:1721-1727. [PMID: 27518079 DOI: 10.1007/s00247-016-3669-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/25/2016] [Accepted: 07/20/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of MRI in isolated pediatric nystagmus remains a gray area in clinical management. Many clinicians prefer to order an MRI to rule out intracranial pathology despite the lack of clinically significant findings in most cases. OBJECTIVE To assess the yield of MR imaging in isolated pediatric nystagmus and define a management algorithm to minimize avoidable MRI referrals and streamline MRI protocols. MATERIALS AND METHODS We reviewed the charts of 148 children who underwent neuro MRI for isolated nystagmus between January 2008 and September 2014. We noted nystagmus onset and clinical characteristics and compared them with the MRI features and visual electrophysiology results. RESULTS We included 85 boys and 63 girls (total 148, average age at MRI 4.24 ± 4.19 years). Twenty-three (15.5%) children had abnormal intracranial findings on MRI including abnormal signal lesions (4.1%; n=6), Chiari I malformations (3.4%; n=5) and optic pathway glioma (2.0%; n=3). The time of onset of nystagmus was not associated with an abnormal MRI (P=0.2). Seventy children underwent visual electrophysiology testing but this test could not predict abnormality at MRI, either (P=0.12). CONCLUSION Among children with isolated nystagmus, 15.5% had abnormalities on neuroimaging. Neither clinical characteristics of nystagmus nor the visual electrophysiology results allowed prediction of intracranial pathology. We were unable to formulate a management algorithm for the optimal sequence of investigations (MRI preceding visual electrophysiology or vice versa), but we discuss the use of gadolinium contrast agent and orbital sequences in isolated pediatric nystagmus.
Collapse
Affiliation(s)
- Vaishnavi Batmanabane
- Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Elise Heon
- Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Tianyang Dai
- Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Prakash Muthusami
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shiyi Chen
- Department of Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Arun Reginald
- Department of Ophthalmology, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Shilpa Radhakrishnan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Manohar Shroff
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
14
|
Acquired nystagmus as the initial presenting sign of chiasmal glioma in young children. Eur J Paediatr Neurol 2015; 19:694-700. [PMID: 26190013 DOI: 10.1016/j.ejpn.2015.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/21/2015] [Accepted: 06/22/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND/PURPOSE The aim of the study was to investigate the incidence of nystagmus at diagnosis in children with optic pathway glioma involving the chiasm and hypothalamus. METHODS Twenty-two patients with a measurable optic pathway/hypothalamic glioma (without neurofibromatosis-1) were followed in our center from 2001 to 2013. The medical files were retrospectively reviewed for demographic and clinical findings, and the imaging scans, for tumor characteristics. RESULTS There were 9 boys and 13 girls of mean age 3.5 ± 4.4 years at diagnosis; 15 were aged <2 years. Tumor size ranged from 10 × 6 mm to 62 × 29 mm. Mean duration of follow-up was 8.3 ± 5.4 years. Nystagmus was detected at diagnosis in 10 children (45%), all <2 years old (66.6% of the younger group); no child older than 2 years presented with nystagmus. Nystagmus, once present, did not resolve and continued throughout follow-up. There were no cases of new onset of nystagmus during follow-up in the children in whom it was not detected at diagnosis. Treatment consisted of partial resection/biopsy with/without shunting (n = 13) and chemotherapy (n = 19) with (n = 2) or without adjuvant radiation. Of the 22 children, 6 had a radiographic response to treatment, 8 remained stable, and 8 (all of whom received chemotherapy) showed disease progression despite treatment. CONCLUSION In conclusion, monocular nystagmus is a more common presenting sign of optic pathway/hypothalamic glioma in children <2 years old than previously estimated. Although subtle, nystagmus has a very narrow differential diagnosis, and its presence should raise suspicions of a chiasmal tumor with prompt referral for imaging. The visual prognosis is moderate to poor.
Collapse
|
15
|
Constantinescu SE, McLean RJ, Innes J, Gottlob I. Pseudo-Monocular Nystagmus Associated with Duane’s Syndrome: Report of Two Cases. Strabismus 2015; 23:132-4. [DOI: 10.3109/09273972.2015.1068347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
16
|
Abstract
A 15-month-old male presented with a one-day history of acute onset, continuous oscillating movement of his right eye. He had received his one-year immunizations four days prior and had a four-day history of a febrile viral respiratory tract infection. Pregnancy was unremarkable. He had severe iron deficiency anemia (MCV 66, Hb 65) and was developmentally delayed, as he was unable to stand independently and was non-verbal. His head circumference was 49 cm (95th percentile) and his weight was at the 25th percentile. On physical examination, continuous horizontal large amplitude pendular nystagmus of the right eye at a frequency of 3-4 Hz was observed. No nystagmus was observed in the left eye, even on funduscopic examination. The child could fixate targets in all four quadrants with both eyes independently, and could fixate and track small objects with both eyes independently suggesting no significant visual field defect or visual loss. Dilated funduscopic examination was normal, extra ocular movements were full, pupils were equal and reactive and there was no relative afferent pupillary defect. The remainder of the neurological examination was normal. There was no head bobbing or anomalous head position and no stigmata of neurofibromatosis type 1. Magnetic resonance imaging of the brain (Figure) demonstrated a 2 cm x 1.6 cm x 1.2 cm suprasellar enhancing mass involving the optic chiasm, hypothalamus, mamillary bodies and superior pituitary stalk. There was no extension into the pituitary fossa or the optic nerves and no ventricular enlargement. A biopsy of the mass was obtained and revealed histology consistent with a low-grade pilocystic astrocytoma (World Health Organization (WHO) grade 1), consistent with a diagnosis of chiasmal glioma.
Collapse
|
17
|
|
18
|
Abstract
We review current concepts of nystagmus and saccadic oscillations, applying a pathophysiological approach. We begin by discussing how nystagmus may arise when the mechanisms that normally hold gaze steady are impaired. We then describe the clinical and laboratory evaluation of patients with ocular oscillations. Next, we systematically review the features of nystagmus arising from peripheral and central vestibular disorders, nystagmus due to an abnormal gaze-holding mechanism (neural integrator), and nystagmus occurring when vision is compromised. We then discuss forms of nystagmus for which the pathogenesis is not well understood, including acquired pendular nystagmus and congenital forms of nystagmus. We then summarize the spectrum of saccadic disorders that disrupt steady gaze, from intrusions to flutter and opsoclonus. Finally, we review current treatment options for nystagmus and saccadic oscillations, including drugs, surgery, and optical methods. Examples of each type of nystagmus are provided in the form of figures.
Collapse
Affiliation(s)
- Matthew J Thurtell
- Departments of Neurology and Daroff-Dell'Osso Laboratory, Veterans Affairs Medical Center and University Hospitals, Case Western Reserve University, Cleveland, OH 44106, USA
| | | |
Collapse
|
19
|
|
20
|
|
21
|
|
22
|
Hertle RW, Tabuchi A, Dell'osso LF, Abel LA, Weismann BM. Saccadic oscillations and intrusions preceding the postnatal appearance of congenital nystagmus. Neuroophthalmology 2009. [DOI: 10.3109/01658108808996021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
23
|
|
24
|
Kiblinger GD, Wallace BS, Hines M, Siatkowski RM. Spasmus Nutans-Like Nystagmus is Often Associated With Underlying Ocular, Intracranial, or Systemic Abnormalities. J Neuroophthalmol 2007; 27:118-22. [PMID: 17548996 DOI: 10.1097/wno.0b013e318067b59f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is uncertainty as to whether spasmus nutans (SN) is an isolated idiopathic entity or whether there are underlying conditions that could cause or be associated with the nystagmus. We undertook this study to determine the frequency of ocular, intracranial, and systemic conditions in patients with nystagmus having characteristics of SN. METHODS We performed a chart review of 22 consecutive patients examined from 2000 through 2005 at the Dean McGee Eye Institute and Children' Hospital of Oklahoma with nystagmus consistent with SN. We collected information related to gender, age at presentation and age at final visit, visual acuity, refractive error, laterality of nystagmus, presence of head nodding and torticollis, pattern of strabismus, neuroimaging and electroretinography results, and other associated clinical findings. RESULTS Visual acuity was reduced in 75% of eyes at presentation and 58% of eyes at last visit. Eight patients had significant refractive error. Seven patients had strabismus. Two patients had chiasmal gliomas. Four patients had cone or rod/cone dystrophy. Only three patients had no associated ocular, intracranial, or systemic conditions. CONCLUSIONS A substantial proportion of patients presenting with SN-like nystagmus have important underlying ocular, intracranial, or systemic abnormalities that may require evaluation and management.
Collapse
|
25
|
Abstract
This review examines current approaches to the diagnosis and management of congenital forms of nystagmus. Emphasis is placed on diagnostic features that are amenable to clinical identification but those issues that can be addressed only with more detailed investigations, such as eye movement recording, are indicated. Non-surgical management, including prism spectacles, contact lenses and vision therapy, is discussed, as are surgical approaches. Because many aspects of congenital forms of nystagmus, particularly as experienced by patients with the condition in their normal lives, are poorly addressed in both the clinical and research literature, these limitations are also highlighted.
Collapse
Affiliation(s)
- Larry A Abel
- Department of Optometry and Vision Sciences, The University of Melbourne, Vic, Australia.
| |
Collapse
|
26
|
Sampangi R, Chaudhuri Z, Menon V, Saxena R. Cone-rod dystrophy and acquired dissociated vertical nystagmus. J Pediatr Ophthalmol Strabismus 2005; 42:114-6. [PMID: 15825748 DOI: 10.3928/01913913-20050301-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although usually a manifestation of vestibular or neurological disease, acquired nystagmus occasionally can be seen in ocular diseases such as ocular albinism and cone dystrophy. The present case of cone-rod dystrophy presenting with acquired dissociated vertical nystagmus probably demonstrates another unusual manifestation of cone-rod dystrophy.
Collapse
Affiliation(s)
- Raju Sampangi
- Dr. Rajendra Prasad Centre For Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | | | | | | |
Collapse
|
27
|
Moreno Villares J, Fernández Carrión F, Gallego Fernández M, Muñoz González A, Manzanares López-Manzanares J, Rodrigo Alfageme M. Síndrome diencefàlico: una causa poco común de malnutrición. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77847-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
28
|
Abstract
An eight-year-old girl presented with vision loss and optic atrophy. Neuro-imaging revealed a sellar mass, which when biopsied proved to be a chiasmatic/hypothalamic glioma. The differential diagnosis of a sellar mass in childhood is discussed, and the presentation and management of chiasmatic/hypothalamic gliomas is reviewed.
Collapse
Affiliation(s)
- G T Liu
- Division of Neuro-Ophthalmology, Department of Neurology, The Children's Hospital of Philadelphia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
29
|
Ertem D, Acar Y, Alper G, Kotiloglu E, Pehlivanoglu E. An uncommon and often overlooked cause of failure to thrive: diencephalic syndrome. J Pediatr Gastroenterol Nutr 2000; 30:453-7. [PMID: 10776962 DOI: 10.1097/00005176-200004000-00021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- D Ertem
- Division of Pediatric Gastroenterology and Nutrition, Marmara University School of Medicine, Istanbul, Turkey
| | | | | | | | | |
Collapse
|
30
|
|
31
|
Abstract
Primary tumors of the optic nerve are uncommon. The most common are optic nerve gliomas (ONGs), which account for 66% of all primary optic nerve tumors. Seventy-five percent of gliomas are diagnosed in the first decade of life, and 90% are diagnosed in the first two decades. This article discusses the anatomy and imaging of the optic pathway and the clinical manifestations of ONGs.
Collapse
Affiliation(s)
- M D Hollander
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | | | | | | | |
Collapse
|
32
|
Affiliation(s)
- J L Mims
- University of Texas Health Science Center at San Antonio, USA
| |
Collapse
|
33
|
Spasmus nutans: Neue Erkenntnisse und Differentialdiagnose. SPEKTRUM DER AUGENHEILKUNDE 1996. [DOI: 10.1007/bf03164107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
34
|
Arnoldi KA, Tychsen L. Prevalence of intracranial lesions in children initially diagnosed with disconjugate nystagmus (spasmus nutans). J Pediatr Ophthalmol Strabismus 1995; 32:296-301. [PMID: 8531033 DOI: 10.3928/0191-3913-19950901-07] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A small number of children who develop disconjugate nystagmus, torticollis, and head titubation (spasmus nutans) have been found to have optic chiasm or third ventricle gliomas. However, the prevalence of glioma or other developmental abnormalities in this disorder is unknown because no large series of spasmus nutans cases has previously been reported. A reviewer of the records of 67 consecutive children initially diagnosed with spasmus nutans and followed for an average of 3.3 years at the St Louis Children's Hospital revealed the following: 61% had a history of prematurity, developmental delay, or other systemic abnormality; strabismus, most commonly infantile esotropia, developed in 55%; 43% had neuroimaging studies; and 0% had evidence of a glioma or showed signs of tumor on follow-up examinations. From this consecutive patient series, we estimate the prevalence of tumor in spasmus nutans to be less than 1.4%. Without other evidence of an intracranial mass lesion, neuroimaging of infants initially diagnosed with spasmus nutans may not be immediately warranted.
Collapse
Affiliation(s)
- K A Arnoldi
- Amblyopia and Eye Movement Disorders Center, St Louis Children's Hospital, Washington University School of Medicine, MO 63110, USA
| | | |
Collapse
|
35
|
Wittebol-Post D, Amelink GJ, Nieuwenhuizen OV. A child with a peculiar nystagmus. Neuroophthalmology 1994. [DOI: 10.3109/01658109409024050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
36
|
Affiliation(s)
- H E Willshaw
- Department of Paediatric Ophthalmology, Children's Hospital, Birmingham
| |
Collapse
|
37
|
Gottlob I, Zubcov A, Catalano RA, Reinecke RD, Koller HP, Calhoun JH, Manley DR. Signs distinguishing spasmus nutans (with and without central nervous system lesions) from infantile nystagmus. Ophthalmology 1990; 97:1166-75. [PMID: 2234849 DOI: 10.1016/s0161-6420(90)32440-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Clinical findings as well as eye and head movement recordings were analyzed from 23 patients with spasmus nutans without central nervous system (CNS) changes, 10 patients with spasmus nutans-like disease (head nodding, intermittent nystagmus associated with intracranial anomalies or visual pathway disorders), and 25 patients with infantile nystagmus. Ten diagnostic signs were established to differentiate between the patient groups. Although they were helpful in separating patients with infantile nystagmus from those with spasmus nutans, no difference was found between the patients with spasmus nutans with and without CNS lesions. This study indicates that eye and head movement recordings do not allow differentiation between benign spasmus nutans and spasmus nutans-like disease. The differentiation must be made on the basis of neuroimaging.
Collapse
Affiliation(s)
- I Gottlob
- Foerderer Eye Movement Center For Children, Wills Eye Hospital, Philadelphia, PA 19107
| | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
At age 3 1/2 years a child developed what appeared to be classic spasmus nutans. Thorough discussions as to the propriety of neuroimaging studies in such patients are presented. With this late age of onset, the presence of a compressive lesion was suspected and neuroimaging demonstrated a sellar-suprasellar mass lesion.
Collapse
Affiliation(s)
- S A Newman
- Division of Ophthalmology, University of Virginia, Health Sciences Center, Charlottesville
| | | | | | | |
Collapse
|
39
|
Abstract
Nystagmus occurs in a very wide range of circumstances, each type showing characteristic clinical, pathological and electrophysiological features, and analogies between them can be identified by comparing and contrasting nystagmus of different kinds. The effect of altered visual and vestibular conditions on nystagmus, and the features of its waveform, indicate the relationship between eye movements and vision, and the influence of visual and vestibular input in stabilising steady fixation. Ultimately, the significance of nystagmus is that it indicates the state of the mechanisms underlying this stabilisation: in physiological nystagmus they are operating successfully, and in pathological nystagmus they are disturbed. More than this, investigation of nystagmus has shown that the visual system is not divided in a clear-cut way into sensory and motor poles, but that between them there exists a neural region where a 'copy' of the visual world is matched with a programme of potential eye movements, and where sensorimotor information exists indivisibly. Long feedback loops, involving occipital cortex and extraocular muscle proprioceptors, and short ones within the cerebellum and integrator, emphasise the great precision involved in eye movement control, enabling the visual cortex to make optimal use of the resolution capabilities of the fovea. Nystagmus always reflects an asymmetry in the output of the eye movement generators, and it has been shown that the inappropriate movement which is responsible for pathological nystagmus is the slow movement. This may arise because of an intrinsic defect in that part of the generator called the neural integrator, or because of 'tonic imbalance' in its input. Nystagmus occurring with identifiable acquired central nervous pathology can, to some extent, be understood mechanistically, but idiopathic congenital nystagmus poses greater difficulties. Analysis of its waveform suggests that an intrinsic fault in the integrator can explain the clinical and electrophysiological findings in CN, but the cause of the high gain instability in the integrator remains to be explained. The integrator is adaptable, or self-tuning, adjusting its output by visual feedback. Circumstantial evidence suggests that the original disorder in idiopathic CN may occur higher than the integrator, detuning it by conveying an inappropriately organised visual input. In particular if the organisation of the visual system into fields is defective, the gaze generators, whose output is orientated according to field, will have a less accurate 'copy' of the world from which to formulate their movements.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
|
40
|
Abstract
An 8-year-old girl was first seen at the age of 4 with nystagmus and hypoplastic discs. Subsequent follow-up demonstrated poor visual acuity and optic atrophy. A CT scan showed a chiasmal or perichiasmal mass. The presumptive diagnosis of an optic chiasmal glioma is being considered. The use of neuroimaging in chiasmal or perichiasmal lesions and the natural history and treatment of optic nerve and chiasmal gliomas are discussed.
Collapse
Affiliation(s)
- J W Gittinger
- Division of Ophthalmology, University of Massachusetts, Worcester
| |
Collapse
|
41
|
Abstract
A patient is described who presented with dissociated nystagmus (atypical spasmus nutans) and an underlying pulvinar-tectal lesion. Atypical spasmus nutans is discussed and clinicians are alerted to a spectrum of possible etiologies.
Collapse
Affiliation(s)
- T Z Baram
- Department of Neuro-Oncology, University of Texas System Cancer Center, M.D. Anderson Hospital and Tumor Institute, Houston 77030
| | | |
Collapse
|
42
|
Abstract
Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Abnormal head position for ocular reasons is usually assumed in order to maintain binocularity and/or to optimize visual acuity. A variety of conditions may be responsible. The sensory organ of position sense, the labyrinth, lies within the inner ear and it relates to eye movement in both a dynamic and static fashion. The Bielschowsky head tilt test is based on the functioning of the otolithic apparatus and is the primary test in evaluating abnormal head position. Treatment is usually surgical, with extent and location dependent upon on the underlying cause. While corrective surgery has usually been done on an elective basis for cosmetic purposes, there is evidence that uncorrected torticollis can cause musculoskeletal problems. This review describes the physiological bases for ocular torticollis and the diagnosis and treatment of its various underlying causes.
Collapse
|
43
|
Abstract
Of 11 young children (six girls and five boys, ranging in age from 4 to 14 months) with monocular nystagmus, six were found to have chiasmal tumors whereas only four had spasmus nutans. Differentiating features between these two groups included decreased vision and optic nerve anomalies (including four cases of optic nerve hypoplasia) in the tumor group. However, we found that no consistent clinical finding absolutely separates these groups. We therefore recommend that all infants and children with monocular nystagmus or the other features of spasmus nutans should undergo computed tomographic scanning.
Collapse
|
44
|
Abstract
Ocular involvement occurs frequently in the disorders known as neurocutaneous syndromes or phakomatoses. Recognition of characteristic eye lesions in the context of related skin and systemic abnormalities may be crucial to making the diagnosis of a neurocutaneous syndrome. Ocular disease in these conditions may be the cause of serious morbidity, leading to blindness or disfigurement, but successful treatment is often possible. All clinicians involved in the care of patients with neurocutaneous syndromes should have some familiarity with their ophthalmologic aspects. This review deals with ocular manifestations of neurofibromatosis, tuberous sclerosis, Sturge-Weber syndrome, von Hippel-Lindau disease, ataxia telangiectasia, and Bloch-Sulzberger syndrome. Clinical signs and symptoms, differential diagnosis, and natural history are considered in detail, with brief discussion of pathophysiology and management. No specialized knowledge of eye disease in general is presumed.
Collapse
|