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Biomedical subjects

D M Jacobson

Publications and source records attributed to D M Jacobson.

At least 37 records · Page 2Linked to original sources
PubMed1998

Pupil involvement in patients with diabetes-associated oculomotor nerve palsy.

OBJECTIVE: To derive a reliable estimate of the frequency of pupil involvement in patients with diabetes-associated oculomotor nerve palsy. PATIENTS AND METHODS: In this prospective study, standardized enrollment criteria were employed to identify 26 consecutive patients with diabetes-associated oculomotor nerve palsy who were evaluated in a referral-based, outpatient neuro-ophthalmology practice. A pupil ruler accurate to within 0.5 mm was used to measure pupil diameters using a standardized procedure. The degree of anisocoria, if present, was recorded at each office visit until the ophthalmoplegia had resolved. Descriptive statistics were used to identify the frequency and characteristics of pupil involvement. RESULTS: Internal ophthalmoplegia occurred in 10 (38%) of 26 patients. The size of the anisocoria was 1 mm or less in most patients. None of the patients had a fully dilated unreactive pupil. CONCLUSIONS: Pupil involvement in patients with diabetes-associated oculomotor nerve palsy occurs more often than has been previously recognized, although the degree of anisocoria in any 1 patient is usually only 1 mm or less. Some characteristics of the internal ophthalmoplegia may help to distinguish diabetic ophthalmoplegia from injury of the oculomotor nerve caused by aneurysmal compression.

Aged↗
PubMed1998

Relative afferent pupillary defects in patients with Leber hereditary optic neuropathy and unilateral visual loss.

PURPOSE: It has been suggested that the pupillary light reaction is relatively preserved in the affected eyes of patients with Leber hereditary optic neuropathy (LHON). To test the hypothesis that visual-pupillomotor dissociation exists in LHON, we performed a retrospective study to evaluate the magnitude of the relative afferent pupillary defect (RAPD) in patients who had experienced monocular visual loss. We also compared the size of the measured RAPD with the size of the RAPD that would be expected on the basis of documented visual field loss. METHODS: We identified a cohort of patients with LHON and monocular visual loss, whose pupillary reactions had been quantified using neutral density filters. From a review of the case records, we determined whether an RAPD was present, as well as the magnitude of the documented RAPDs. We also calculated the expected size of the RAPD for each patient, using previously established templates that correlated the size of the RAPD with the degree of visual field loss. RESULTS: An RAPD was identified in all 10 patients in this study. There was no significant difference between the size of the measured and predicted RAPD, nor did the size of the RAPD correlate with visual acuity or the time interval between the onset of visual loss and evaluation. CONCLUSION: The results of this study do not support the hypothesis that visual-pupillomotor dissociation is a common feature of LHON.

Adolescent↗
PubMed1998

Asymptomatic autonomic and sweat dysfunction in patients with Adie's syndrome.

A study was conducted to determine by using noninvasive tests whether autonomic dysfunction occurs in patients with Adie's syndrome. Eighteen consecutive patients with Aide's syndrome prospectively underwent a standardized battery of five noninvasive tests of autonomic function, including three that predominantly reflected parasympathetic function and two that predominantly reflected sympathetic function. Eight of these patients additionally underwent thermoregulatory sweat testing. Of the 18 patients 10 (56%) had no abnormal autonomic test results, 5 (28%) had one abnormal result, 2 (11%) had two abnormal results, and 1 (6%) had three abnormal results. None of the patients had more than three abnormal results. Tests that predominantly reflected parasympathetic function produced abnormal results more frequently than those that predominantly reflected sympathetic function. Three of eight (38%) patients who underwent thermoregulatory sweat testing showed abnormal patterns of sweating. Although abnormal autonomic and sweat functions are not uncommon in patients with Aide's syndrome, the abnormalities are mild and are generally unassociated with symptoms of dysautonomia. Such abnormalities have little clinical significance but may be important from a nosologic point of view.

Adie Syndrome↗
PubMed1998

Comparison of cholinergic supersensitivity in third nerve palsy and Adie's syndrome.

OBJECTIVE: To determine whether the degree of cholinergic supersensitivity of the pupil differs in patients with preganglionic injury of the oculomotor nerve (third nerve palsy) compared with patients with postganglionic injury (Adie's pupil). METHODS: In this retrospective study, the authors first identified 11 patients with oculomotor nerve palsy and 11 patients with unilateral Adie's pupil who demonstrated supersensitive pupillary responses using dilute pilocarpine. The same methods for testing supersensitivity of the iris sphincter, and for defining its presence, had been used in both groups of patients. Pupil diameters of the affected and unaffected fellow eye were measured directly from self-developing photographs obtained before and 30 minutes after pilocarpine 0.1% was applied to both eyes. The amount of absolute constriction of the affected pupil, as well as the net constriction of the affected pupil (i.e., the amount of pilocarpine-induced constriction of the unaffected pupil subtracted from the amount of pilocarpine-induced constriction of the affected pupil), was compared between the two groups of patients using the Mann-Whitney test. RESULTS: No significant differences were identified in any of the comparisons. CONCLUSIONS: The degree of cholinergic supersensitivity of the iris sphincter appears to be similar regardless of whether the site of injury along the parasympathetic pathway of the oculomotor nerve is preganglionic or postganglionic.

Adie Syndrome↗
PubMed1998

Proptosis with acute oculomotor and abducens nerve palsies.

OBJECTIVE: To determine whether orbital axial proptosis occurs in the affected eye of patients with acute oculomotor or abducens nerve palsy. MATERIALS AND METHODS: In this prospective, cross-sectional survey, the Hertel instrument was used to measure the amount of axial protrusion in 26 consecutive patients with complete or severe acute oculomotor nerve palsy and 27 consecutive patients with complete or severe acute abducens nerve palsy. The Mann-Whitney test was used to compare the amount of relative proptosis of the affected eye in the patient groups with that of 40 control subjects. The absolute amount of the interocular difference in axial protrusion of the normal eyes was used to determine control values. The proportion of patients and control subjects with relative proptosis greater than 1 mm was compared using Fisher's exact test. RESULTS: There was no significant difference in the degree of relative proptosis of the affected eye of patients with oculomotor nerve palsy or abducens nerve palsy as compared with the control eyes. Likewise, there was no significant difference in the proportion of patients with relative proptosis greater than 1 mm in either the oculomotor nerve palsy group or the abducens nerve palsy group as compared with the control group. CONCLUSIONS: Acute oculomotor or abducens nerve palsy does not produce any significant amount of orbital axial proptosis in the affected eye, at least as measured clinically using the Hertel instrument. Acute neurogenic ophthalmoplegia rarely causes relative proptosis greater than 1 mm.

Abducens Nerve↗
PubMed1997

The localizing value of a quadrantanopia.

BACKGROUND: A lesion affecting the optic radiations may produce a quadrantanopia based on the topographical arrangement of the geniculocalcarine tract. OBJECTIVE: To determine the localizing associations of a quadrantic visual field defect. DESIGN: Retrospective study of case records of 41 patients with inferior quadrantanopia and 30 patients with superior quadrantanopia caused by disorders affecting the posterior visual pathway. The responsible lesion was identified with neuroimaging techniques. SETTING: Neuro-ophthalmology referral practice in a large multispecialty clinic that provides primary, secondary, and tertiary medical care. RESULTS: Cerebrovascular disorders accounted for most lesions. The location (and frequency) of lesions causing inferior quadrantanopia was occipital lobe (76%), parietal lobe (22%), and temporal lobe (2%). Other localizing signs were associated with 6%, 89%, and 0% of lesions located in the occipital, parietal, and temporal lobes, respectively. The location (and frequency) of lesions causing superior quadrantanopias was occipital lobe (83%), parietal lobe (3%), and temporal lobe (13%). Other localizing signs were associated with 4%, 100%, and 0% of lesions located in the occipital, parietal, and temporal lobes, respectively. CONCLUSIONS: A patient with a neurologically isolated quadrantanopia is likely to have a lesion in the occipital lobe, although, in the case of a superior quadrantanopia, the possibility of a temporal lobe lesion can not be excluded using clinical criteria only. Quadrantanopias caused by lesions of the parietal lobe usually are associated with other localizing signs.

Adolescent↗
PubMed1997

Nonarteritic anterior ischemic optic neuropathy. A case-control study of potential risk factors.

OBJECTIVE: To determine the influence of certain potential risk factors on the occurrence of nonarteritic anterior ischemic optic neuropathy. DESIGN: Case-control using 2 independent control groups, one involving a geographically defined population and the other involving patients who underwent a routine comprehensive medical evaluation. SETTING: Multispecialty clinic in a rural setting providing primary, secondary, and tertiary care for residents of central and northern Wisconsin and the Upper Peninsula of Michigan. PATIENTS: Fifty-one patients older than 45 years with first ever acute nonarteritic anterior ischemic optic neuropathy. MAIN OUTCOME MEASURES: Potential risk factors defined using standardized definitions abstracted from the medical records, including diabetes, hypertension, hypercholesterolemia, coronary artery disease, tobacco use, chronic obstructive pulmonary disease, body mass index, hematocrit, and white blood cell count. METHODS: Conditional logistic regression analyses, first using a univariate analysis and then employing a multivariate analysis using a forward selection process. RESULTS: The geographically defined case-control multivariate analysis revealed that diabetes (odds ratio = 2.7, 95% confidence interval = 1.2-6.3, P = .02) and body mass index (odds ratio = 1.07, 95% confidence interval = 1.00-1.14, P = .08) were associated with case status. The comprehensive case-control multivariate analysis revealed that only diabetes (odds ratio = 5.0, 95% confidence interval = 1.4-17.3, P = .01) was a significant risk factor. The attributable risk estimation for diabetes was 0.21 and 0.27 for the geographically defined and comprehensive controls, respectively. CONCLUSIONS: Diabetes seems to be a major risk factor for the development of nonarteritic anterior ischemic optic neuropathy. The low attributable risk estimation suggests that factors other than diabetes are important in the development of nonarteritic anterior ischemic optic neuropathy or in predisposing individuals to it.

Aged↗
PubMed1997

Optic nerve contact and compression by the carotid artery in asymptomatic patients.

PURPOSE: To estimate the frequency and clinical correlates of contact and compression of the intracranial optic nerve by the supraclinoid carotid artery in asymptomatic patients. METHODS: In a retrospective study, we identified asymptomatic patients who had undergone magnetic resonance imaging with sequences that could be used to evaluate the relation between the intracranial optic nerve and the carotid artery. These patients underwent neuroimaging evaluations for reasons unrelated to loss of vision, optic neuropathy, or carotid artery disorders. The relation between the optic nerve and carotid artery was graded in a standardized manner. The effect of a number of clinical covariates on the risk of compression was evaluated using multiple logistic regression. RESULTS: The frequencies of some of the artery-nerve relationships included contact of one or both optic nerves in 70 (70%) of 100 patients; bilateral compression in 12 (12%) of 100 patients; and unilateral compression with no arterial contact or compression on the opposite side in five (5%) of 100 patients. The estimated odds of compression were significantly increased as the diameter of the carotid artery increased. CONCLUSIONS: Among asymptomatic patients, supraclinoid carotid artery contact with the intracranial optic nerve occurs frequently. Anatomic compression, on the other hand, especially when unilateral, occurs infrequently. The risk of anatomic compression of the optic nerve is directly proportional to the diameter of the carotid artery.

Adolescent↗
PubMed1996

Progressive ophthalmoplegia with acute ischemic abducens nerve palsies.

PURPOSE: To determine the frequency of early progression of opthalmoplegia in patients with acute ischemic abducens nerve palsies. METHODS: Patients with ischemic abducens nerve palsy examined within one week from the onset of symptoms were identified using predetermined entry criteria and serially followed up using a standardized ophthalmoplegia grading scheme. RESULTS: Only two of the 35 patients initially had a complete abduction deficit. Of the 33 patients who initially had an incomplete abduction deficit, 18 (54%) showed progression of their ophthalmoplegia. CONCLUSIONS: Patients with acute incomplete ischemic abducens nerve palsies frequently demonstrate early progression of their ophthalmoplegia.

Abducens Nerve↗
PubMed1996

Paraneoplastic disorders of neuro-ophthalmologic interest.

Certain paraneoplastic disorders associated with degeneration of the retina, optic nerve, brainstem, and cerebellum may cause visual loss, impairment of ocular motility, or nystagmus and other saccadic intrusions and oscillations. Most of these remote effects of cancer are probably autoimmune conditions. Many affected patients have circulating antineuronal antibodies that serve to identify the autoimmune nature of their clinical presentation and allow the treating physician to target the evaluation to certain organs likely to be harboring an occult malignancy associated with that particular remote effect. Because patients with paraneoplastic disorders affecting vision and eye movement frequently develop symptoms before their underlying cancer is diagnosed, they will typically seek the assistance of an ophthalmologist first. Recognition that their symptoms or findings reflect a paraneoplastic syndrome may allow the tumor responsible for its presentation to be diagnosed at an earlier stage, which might positively influence the patient's overall prognosis.

Autoimmunity↗
PubMed1996

Acute zonal occult outer retinopathy and central nervous system inflammation.

This case report describes a patient who developed the characteristic features of acute zonal occult outer retinopathy (AZOOR), but whose case was unusual because of macular involvement, recurrences, and association with an inflammatory CNS disorder. The patient was followed for > 7 years; clinical examinations, electroretinography, electro-oculography, cerebrospinal fluid evaluations, and magnetic resonance imaging (MRI) were used to document the recurrent AZOOR and CNS disorder. The patient first presented with entoptic symptoms and a scotoma referable to dysfunction of her peripapillary and peripheral right retina. At that time, she also had asymptomatic involvement of her peripheral left retina, cerebrospinal fluid pleocytosis, and multiple brain MRI signal abnormalities. During the next several years, she developed recurrences of AZOOR, which first affected her right macula and later involved her peripheral left retina. Visual electrophysiological studies confirmed impairment of outer retinal function. The patient developed her first neurological symptom, acute relapsing-remitting cervical myelitis, > 6 years after her visual presentation. Her clinical course, laboratory studies, and neurodiagnostic evaluations were consistent with CNS inflammation, but they were not typical of multiple sclerosis. Since AZOOR is a newly recognized disorder, its full clinical spectrum may not yet be established and could include CNS involvement.

Adult↗
PubMed1996

Idiopathic hypertrophic cranial pachymeningitis: clinical-radiological-pathological correlation of bone involvement.

We present the clinical, radiological, and pathological findings in an elderly man who developed a progressive superior orbital fissure syndrome due to idiopathic hypertrophic cranial pachymeningitis. The unique aspect of this case concerned the increased density of the sphenoid ridge and lateral orbital wall observed by using computed tomography, and the enhancement of the marrow signal seen on magnetic resonance imaging. These neuroimaging abnormalities of bone resulted from an indirect nonspecific response of the marrow to the adjacent soft tissue and dural inflammatory process.

Aged↗
PubMed1995

Early progression of ophthalmoplegia in patients with ischemic oculomotor nerve palsies.

OBJECTIVE: To describe the frequency and clinical correlates of early progression of ophthalmoplegia in patients with ischemic oculomotor nerve palsies. DESIGN: Cohort survey, case series. SETTING: Multispecialty clinic providing primary, secondary, and tertiary care in central and northern Wisconsin. PATIENTS: Sixteen patients evaluated within 1 week of the reported onset of ischemic oculomotor nerve palsy were identified and followed up prospectively using a standardized ophthalmoplegia grading scheme. All patients were followed up serially until their ophthalmoplegia resolved. MAIN OUTCOME MEASURES: Descriptive analysis of the temporal course of ophthalmoplegia and frequency of progression of deficits. Comparison between the group that had progression of ophthalmoplegia with the group that did not for age, hematocrit, cholesterol level, and adiposity; presence of diabetes, hypertension, hypercholesterolemia, and coronary artery disease; history of stroke; and tobacco use. RESULTS: Eleven (69%) of 16 patients had progression of ophthalmoplegia. The median time between reported onset and peak severity of ophthalmoplegia was 10 days. The only important difference between the progressive and nonprogressive groups was a shorter time to resolution of ophthalmoplegia for the nonprogressive group. CONCLUSIONS: Early progression of ophthalmoplegia occurs often in patients with ischemic oculomotor nerve palsies. The power to find differences between progressive and nonprogressive groups was limited by the small number of patients available for analysis.

Aged↗
PubMed1995

Benign episodic unilateral mydriasis. Clinical characteristics.

PURPOSE: To describe the clinical features of the syndrome of neurologically isolated episodic unilateral mydriasis. METHODS: Information was obtained by reviewing the case records of 24 patients evaluated by the author and collected by polling other neuro-ophthalmologists. RESULTS: Nineteen patients were women. The median age was 31 years. Fourteen patients had migraines. The median interval between onset of events and evaluation was 6 months. The median duration and frequency of events were 12 hours and two to three per month, respectively. Most patients did not identify any factor that could precipitate an occurrence. The most common associated symptoms during an episode included visual blur in 15 patients, headache in 9, and orbital pain in 5. Eleven patients were examined during an attack. Three patients who were examined had impaired near vision, four had impaired accommodative function, and six had an anisocoria that increased with added ambient light. None of these patients had a tonic pupil or cholinergic agonist-induced pharmacologic mydriasis. Five other patients examined during an attack had normal vision and unimpaired direct light reactivity of their large pupil. No neurologic disorder was identified after neurodiagnostic testing, clinical evaluation, and natural history observation. CONCLUSIONS: The syndrome of idiopathic episodic unilateral mydriasis probably comprises a heterogeneous group of conditions that result in parasympathetic insufficiency of the iris sphincter in some patients, and sympathetic hyperactivity of the iris dilator in others. Patients with episodes similar in characteristics to the ones described in this survey appear to have a benign neurologic prognosis, and do not require further neurodiagnostic studies.

Adolescent↗
PubMed1995

Transient trochlear nerve palsy following anterior temporal lobectomy for epilepsy.

Three of 22 patients (14%) who underwent anterior temporal lobectomy for treatment of medically intractable epilepsy at our institution from July 1987 through July 1993 experienced diplopia immediately after surgery. We found ipsilateral paresis of the superior oblique muscle in all three patients. Their ophthalmoplegia resolved completely within 14 weeks. We did not observe any new structural or ischemic changes on postoperative MRIs to account for their deficits. Trochlear nerve palsy--not oculomotor nerve palsy, as is reported in most reference texts--is a relatively common cause of transient diplopia following temporal lobectomy. Indirect (ie, traction) injury of the trochlear nerve is a plausible mechanism that would explain this complication.

Adult↗
PubMed1995

Acetylcholine receptor antibodies in patients with Graves' ophthalmopathy.

OBJECTIVES: To determine the frequency and clinical correlates of acetylcholine receptor (AChR) antibody seropositivity in patients with Graves' ophthalmopathy. MATERIALS AND METHODS: Fifty consecutive new patients with Graves' ophthalmopathy diagnosed in an outpatient neuro-ophthalmology practice underwent determination of AChR-binding antibodies. Clinical and biochemical thyroid variables were compared between seropositive and seronegative patients. Clinical variables included age, sex, thyroid disorder, and duration and course of illness. Biochemical variables included thyroid hormone levels and thyroid antibodies. Seropositive patients were followed clinically to identify signs of myasthenia gravis. RESULTS: Four of 50 (8%) patients had definitely elevated levels of AChR-binding antibodies. No obvious differences existed between the seropositive and seronegative groups in regards to age, sex, underlying thyroid disorder, biochemical thyroid state, presence of thyroid antibodies, or duration and course of their disease. None of the four seropositive patients developed signs of myasthenia gravis during the median follow-up period of 4.5 years. CONCLUSION: AChR-binding antibody seropositivity occurs in a small proportion of patients with Graves' ophthalmopathy but, by itself, does not necessarily identify an individual with concurrent myasthenia gravis or an individual at risk to develop myasthenia gravis.

Adult↗