Tag Archives: Vascular

Giant Cell Arteritis

Synonyms: a.k.a. cranial arteritis a.k.a. temporal arteritis: Diagnosis: Biopsy of the temporal artery within 7 days of starting steroids: With serial sectioning Or clinical features plus raised ESR or CRP plus response to steroids Pathology: Panarteritis: Intimal thickening and proliferation, Lymphocytic infiltration of media and adventitia, giant cells, Disruption of elastic lamina Chronic phase: intimal … Continue reading Giant Cell Arteritis

Takayasu’s Disease

Synonyms: a.k.a. aortic arch syndrome a.k.a. Takayasu’s arteritis: Diagnosis: Arteriography: Irregular vessel walls, stenosis, poststenotic dilation, aneurysms, occlusion, collaterals Usually smooth stenosis of the common carotid and the subclavian arteries Other imaging: Ultrasound: thickened intima layer CT: thickened enhancing walls MRA Treatment: Control the symptoms and inflammation before surgery: Prednisolone, Correct the anatomical defects: Angioplasty … Continue reading Takayasu’s Disease

Encephalofacial Angiomatosis, Sturge-Weber disease

Diagnosis: A combination of clinical findings and imaging Clinical features: Skin: Facial nevus ‘port wine stain’ ‘nevus flammeus’, may be absent. In the distribution of trigeminal nerve Eye: Congenital glaucoma, bupthalmus, cloudy enlarged cornea Findings on Investigations: CT: Calcification of the cortex Cortical atrophy MRI: Venous hemangioma of the meninges in the occiptal region. Underlying … Continue reading Encephalofacial Angiomatosis, Sturge-Weber disease

Isolated Facial palsy, CN VII

Upper motor neuron lesion: Diagnosis: This is a clinical diagnosis. The underlying cause is determined by investigations and clinical correlation. Clinical features: Sparing of the forehead muscles Asymmetry of face at rest or on movement: smile, puffing the cheeks and on wincing The palpebral fissure may be widened on the affected side Investigations to consider: … Continue reading Isolated Facial palsy, CN VII

Acquired Oculomotor Apraxia

Synonyms: a.k.a. Roth-Bielschowsky syndrome (supranuclear palsy of gaze due to corticotectal/corticotegmental tract lesions) Diagnosis: A form of supranuclear palsy diagnosed clinically and by isolating the underlying cause Clinical features: Inability to perform horizontal saccades Vertical eye movements may be intact Oculocephalic reflexes are intact Caloric testing shows slow deviation without saccades Optokinetic nystagmus remains without … Continue reading Acquired Oculomotor Apraxia

Cavernous Sinus Syndrome

Diagnosis: This is a clinical diagnosis. Dysfunction of cranial nerves III, IV, and VI, and the superior divisions of cranial nerve V. Investigations to consider: Blood tests: FBC, U&E, fasting Glucose Vasculitic screen, ESR, CRP, ANCA, ANA, ENA SPEP, ACE Tests for infections: Borrelia serology, HIV MRI pre and post contrast: Pituitary tumors, meningioma, metastasis … Continue reading Cavernous Sinus Syndrome

Internuclear Ophthalmoplegia (INO)

Diagnosis: This is a clinical diagnosis. The underlying cause is determined by investigations Clinical features: Diplopia Classic variant, posterior INO: On lateral gaze: Failure of adduction of the contralateral eye, nystagmus of the abducting eye Medial rectus is less weak on testing each eye separately Anterior INO variant: Divergent eyes bilaterally, paralysis of both medial … Continue reading Internuclear Ophthalmoplegia (INO)

Abducens (cranial nerve VI palsy)

Diagnosis: This is a clinical diagnosis Clinical features: Horizontal diplopia In neutral gaze, normal appearance or head is slightly turned to the unaffected side (compensation for unopposed medial rectus) On movement: Affected eye fails to abduct Investigations to consider: Blood tests: ESR: giant cell arteritis TFT, glucose ANCA: Wegner’s granulomatosus HbA1c ESR CT: Out rules … Continue reading Abducens (cranial nerve VI palsy)

Trochlear Nerve Palsy (Cranial IV palsy)

Diagnosis: This is a clinical diagnosis Clinical features: Rare in isolation In neutral gaze: slight head tilted contralateral to the weak superior oblique muscle (loss of in-torsion) Test with eye adducted and moved inferiorly. This is also the position of worse diplopia If bilateral: on horizontal gaze, the abducting eye drifts downwards (inferior rectus of … Continue reading Trochlear Nerve Palsy (Cranial IV palsy)

Oculomotor Palsy (cranial nerve III palsy)

Synonyms: a.k.a. III nerve palsy Diagnosis: This is a clinical diagnosis. The underlying cause requires investigations. Clinical features: In neutral gaze: The eye is looking down & out. There is complete ptosis. On looking downwards torsional (in-torsion) nystagmus of the eye occurs (due to intact IV nerve action) Note the presence of meiosis: Normal pupil … Continue reading Oculomotor Palsy (cranial nerve III palsy)