Anisocoria--not always cause for alarm

Anisocoria after Posterior Spine Surgery: A Rare but Disastrous Complication - A Case Report and Literature Review

Introduction:

Ocular complications after spine surgery in prone position are very rare and are described centrally in elective surgeries with long duration. The most well-known ocular complications are vision loss and acute angle-closure glaucoma. To the best of our knowledge, anisocoria after prone spinal surgery has never been reported previously in literature.

Case Report:

We present a very rare case of a transient harmless anisocoria in a 23-year-old otherwise healthy female patient, who underwent in the traditionally prone position lumbosacral spinal fractures stabilization and calcaneal fracture reduction and external fixation. We describe step by step the diagnosis algorithm and we discuss detaily the differential diagnosis of the unilaterally fixed and dilated pupil. Careful stepwise medical history and examination are mandatory to establish correct diagnosis and avoid unnecessary, expensive, and potentially hazardous or invasive diagnostic testing.

Conclusion:

The wrong position during prone spine surgery can cause iris sphincter muscle tears and transient or permanent dilation of the affected pupil. Fixed dilated pupil is a permanent abnormality of the iris, causing irregular cosmetic appearance, especially in young females, and requires further conservative or surgical intervention. Positioning of the patient and duration of surgery should be taken into consideration both by spine surgeons and anesthesiologists.

The Limb beyond Salvage: A Case Report on Two Cases of Fibroblastic Variants of Osteosarcoma

Introduction:

Management outcome of osteosarcoma as a primary bone malignancy is challenged in Ghana by many factors. We presented two male patients; aged 18 and 14 years, respectively, who were referred to the Tamale Teaching Hospital with advanced right knee tumors. Both patients had above knee amputation as part of treatment. The tumors were confirmed histologically as fibroblastic variants of osteosarcoma. The patients died within the immediate post-operative period without the initiation of the appropriate chemotherapy.

Conclusion:

Unacceptable delay diagnosis and management of cancers worsened survival of patients. Education of patients, health workers and others along the patient management chain on the need early reporting and accurate diagnosis and management are recommended.

A cohort study on acute ocular motility disorders in pediatric emergency department

Background

Acute ocular motility disorders (OMDs) in children admitted to Emergency Department (ED) represents a not so rare condition with a wide spectrum of different etiologies. The emergency physician must be skilled in rapidly identifying patients with potentially life threatening (LT) forms, requiring further diagnostic procedures. The aim of the study was to assess characteristics of children with acute Ocular Motility Disorders (OMDs), and to identify “red flags” for recognition of underlying life-threatening (LT) conditions.

Methods

A retrospective cohort study evaluated children (2 months-17 years) admitted to a tertiary Emergency Department in 2009–2014. A subgroup analysis was performed comparing children with and without LT conditions.

Results

Of 192 visits for OMDs, the isolated strabismus occurred most frequently (55.6%), followed by pupil disorders (31.8%), ptosis (5.2%) and combined OMDs (11.5%). The majority of acute OMDs involved no underlying LT conditions (n = 136) and most of them were infants or toddlers (50%). In a multivariable analysis, LT conditions included especially children over 6 years of age, increasing the odds ratio by 2% for each months of age (p = 0.009). LT etiologies were 16 times more likely in combined OMDs (p = 0.018), were over 13 times more likely to report associated extra-ocular signs/symptoms (p = 0.017) and over 50 times more likely to report co-morbidity (p = 0.017).

Conclusion

OMDs are not an uncommon presentation at ED. Although most of them involve non-LT conditions, the ED physician should consider potential “red flags” for appropriate management of children such as age > 6 years, combined OMDs, extra-ocular symptoms and co-morbidity.