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NEUROLOGY 2009;73:e8
© 2009 American Academy of Neurology
Resident and Fellow Section

Teaching Video NeuroImages: Positional exophthalmos in orbital varices

Formula

K. -D. Choi, MD, H. -S. Lee, MD, J. -W. Bae, MD, H. Y. Choi, MD and H. -J. Kim, MD

From the Departments of Neurology (K.-D.C., H.-S.L., J.-W.B.), Ophthalmology (H.Y.C.), and Radiology (H.-J.K.), Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan, Korea.

Address correspondence and reprint requests to Dr. Kwang-Dong Choi, Department of Neurology, College of Medicine, Pusan National University, 1-10 Ami-dong, Seo-gu, Pusan, 602-739, Korea kdchoi{at}medimail.co.kr

A 56-year-old woman presented with intermittent vertical diplopia and exophthalmos of the left eye, which become apparent when she was bending over. Examination disclosed mild limitation of supraduction and lid lag of the left eye. Bending over induced profound exophthalmos of the left eye (video) and aggravated vertical diplopia. The exophthalmos was confirmed by an exophthalmometer, which showed 16 mm right eye/15 mm left eye in the supine position, and 16 mm right eye/19 mm left eye in the prone position. Orbital MRI demonstrated enhancing lesions in the left retrobulbar area in the supine position (figure, A), which became prominent in the prone position (figure, B).


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  		Figure Gadolinium-enhanced axial MRI of the orbit in the supine position shows enhancing lesions in the left retrobulbar area (A), which become prominent in the prone position (B, arrowhead); accompanying exophthalmos of the left eye is also shown (B, arrow)

 

Orbital varices are congenital vascular abnormalities with the presentation of intermittent, positional exophthalmos due to the constraint of the venous return by certain head postures.1

Supplemental data at www.neurology.org

Disclosure: The authors report no disclosures.


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  1. Secil M, Soylev M, Ada E, Saatci AO. Orbital varices: imaging findings and the role of color Doppler sonography in the diagnosis. Comput Med Imaging Graph 2001;25:243–247.[Medline]




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