Dorsal midbrain syndrome or Parinaud syndrome is a supranuclear brainstem syndrome involving the vertical gaze centre.These are case series with three patients who were diagnosed with dorsal midbrain syndrome secondar...Dorsal midbrain syndrome or Parinaud syndrome is a supranuclear brainstem syndrome involving the vertical gaze centre.These are case series with three patients who were diagnosed with dorsal midbrain syndrome secondary to pineal gland tumours.The prognosis varied depending on tumour types,age of presentation and treatment received.All of them were presented with life-threatening obstructive hydrocephalus.Our first patient was successfully treated with emergency surgery followed by radiotherapy.He regained normal visual acuity and full recovery of his ocular movement.Second and third patients had undergone surgery for raised intracranial pressure.Both had an inoperable pineal gland tumour.As for our second patient,we detected a worsening of vertical gaze during his four years follow-up.However,his bilateral good visual acuity was preserved.The third patient passed away as a result of uncontrolled enlarging tumour.We also briefly reviewed the clinical presentation,diagnosis,and therapeutic approach of the three patients.One of the caveats is that urgent radiological study is crucial to differentiate the tumour type via the pathognomonic features and to delineate the tumour extension.The preferable treatment options vary among each tumour type.A multidisciplinary approach is crucial in early detection,in addition to treatment initiation and long term follow up to achieve a better outcome.展开更多
Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visua...Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.展开更多
文摘Dorsal midbrain syndrome or Parinaud syndrome is a supranuclear brainstem syndrome involving the vertical gaze centre.These are case series with three patients who were diagnosed with dorsal midbrain syndrome secondary to pineal gland tumours.The prognosis varied depending on tumour types,age of presentation and treatment received.All of them were presented with life-threatening obstructive hydrocephalus.Our first patient was successfully treated with emergency surgery followed by radiotherapy.He regained normal visual acuity and full recovery of his ocular movement.Second and third patients had undergone surgery for raised intracranial pressure.Both had an inoperable pineal gland tumour.As for our second patient,we detected a worsening of vertical gaze during his four years follow-up.However,his bilateral good visual acuity was preserved.The third patient passed away as a result of uncontrolled enlarging tumour.We also briefly reviewed the clinical presentation,diagnosis,and therapeutic approach of the three patients.One of the caveats is that urgent radiological study is crucial to differentiate the tumour type via the pathognomonic features and to delineate the tumour extension.The preferable treatment options vary among each tumour type.A multidisciplinary approach is crucial in early detection,in addition to treatment initiation and long term follow up to achieve a better outcome.
文摘Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly.
