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Biomedical subjects

F X Borruat

Publications and source records attributed to F X Borruat.

At least 19 recordsLinked to original sources
PubMed1999

[Visual hallucinations and illusions, symptoms frequently misdiagnosed by the practitioner].

INTRODUCTION: Visual hallucinations or illusions are not a rare symptom. However, they are often unrecognized. Unawareness of the meaning of these symptoms often mislead both the patient and his physician. PURPOSE: To define and describe the types of visual illusions and hallucinations which can be commonly encountered in neuro-ophthalmological practice. METHODS: Overview article. RESULTS: Hallucinations are a perception not based on sensory input, whereas illusions are a misinterpretation of a correct sensory input. Both phenomenon can be due to medication or drug, or to an altered mental status. Visual hallucinations can be formed (objects, people) or unformed (light, geometric figures). They can be generated either by a lesion on the antechiasmatic pathway, by a seizure phenomenon, by a migrainous phenomenon, or by a release phenomenon secondary to visual differentiation. Investigations will be directed towards a retinopathy, an optic neuropathy, a chiasmal or retrochiasmal lesion, or a bilateral antechiasmal lesion (Charles Bonnet syndrome). Visual illusions include meta-morphopsias, micro- macropsias, polyopia, palinopsia (visual perseveration), achromatopsia, Pulfrich phenomenon, or subjective vertical deviation. Illusions can be due to lesions of the retina, the optic nerve, the visual cortex (primary or associative), or the graviceptive pathways. CONCLUSIONS: As most patients do not spontaneously mention their symptoms, history taking is essential. The first step is to rule out medication or an altered mental status as the possible cause of these symptoms. Then, careful visual function examination should provide a good insight in the location of the lesion.

Diagnosis, Differential↗
PubMed1999

Transient vertical diplopia and silent sinus disorder.

A 57-year-old man had isolated transient recurrent vertical diplopia. Left hypoglobus and enophthalmos were present. Investigations revealed an otherwise asymptomatic left maxillary chronic aspecific sinusitis, with 8 mm lowering of the left orbital floor. Transient diplopia was thought to be secondary to transient fusion impairment. Orbital floor reconstruction cured the patient.

Diplopia↗
PubMed1998

Corneal penetration of diclofenac from a fixed combination of diclofenac-gentamicin eyedrops.

PURPOSE: To establish the corneal penetration of diclofenac in the presence of gentamicin in patients having cataract surgery. SETTING: Kantonsspital Augenklinik, Aarau, and Hôpital Jules Gonin, Lausanne, Switzerland. METHODS: Eligible patients having cataract surgery (39 women, 30 men) were treated with 4 drops of diclofenac 0.1%-gentamicin 0.3% (Voltamicin) instilled at 20 minute intervals. Paracentesis was performed 15, 30, or 60 minutes after the last instillation, and a sample of aqueous humor was collected for analysis of diclofenac by high-performance liquid chromatography. Blood samples of some patients were obtained before surgery for analysis. RESULTS: Mean diclofenac levels (+/- SD) in the aqueous humor 15, 30, and 60 minutes after the last instillation were 72 +/- 84, 108 +/- 87, and 201 +/- 116 ng/mL (= 682 nMol/L), respectively. Diclofenac remained below the limit of detection (5 ng/mL) in all samples of blood serum. In general, local tolerance was good; no side effects were reported. Comparison of the data with published results of topically instilled diclofenac 0.1% suggests that the concentration of diclofenac in the aqueous humor achieved with 4 instillations of the combination product is similar to that achieved with 8 instillations of diclofenac 0.1% (Voltaren Ophtha) alone. CONCLUSIONS: Drug levels of diclofenac in the aqueous humor well above IC-50 for cyclo-oxygenase were achieved with the regimen applied. No inhibitory effect by the gentamicin or vehicle was observed. Comparison of these data with published results of Voltaren Ophtha implies a 2-fold better penetration of diclofenac with the diclofenac-gentamicin combination.

Aged↗
PubMed1998

[Skew deviation].

BACKGROUND: Skew deviation is a vertical ocular misalignment of prenuclear origin. Although well described in the literature, it is still probably underdiagnosed. Natural history of skew deviation is not well described in the literature. PURPOSE: To describe the clinical presentations, etiologies and follow-up of skew deviation. METHODS: Retrospective study of 29 patients diagnosed with skew deviation between 1993 and 1996. RESULTS: The commonest cause was cerebrovascular accident (12/29) and the commonest localisation was mesencephalic (9/29). Other causes included surgery (7/29), tumor (4/29), trauma (3/29), degeneration (3/29), inflammatory (2/29), increased intracranial pressure (1/29). Other localisations included cerebellum (5/29), ponto-mesencephalic (3/29), and medulla (2/29). Vertical diplopia was always accompanied by other neuro-ophthalmologic abnormalities. 69.2% (18/26) patients were totally asymptomatic after 7.5 months. 30.8% (8/26) were still symptomatic (diplopia). One patient required surgery, three patients were relieved with prisms, one patient needed monocular occlusion. One patient died during follow-up and precise data were lacking in two symptomatic patients. CONCLUSION: Skew deviation is not so rare, 10% of the cases referred to us for diplopia in 3 years. The diagnosis of skew deviation should be entertained when vertical diplopia cannot be explained by pathology of extraocular muscles, peripheral or central cranial nerve III or IV palsies, myasthenia, or orbital pathology. Prognosis for recovery in patients with skew deviation is good. 70% will recover, after a median time of 7.5 months. Surgery should be postponed at least for 12 months.

Adolescent↗
PubMed1998

[Unilateral accommodation spasm: a diagnostic pitfall!].

BACKGROUND: Accommodation-convergence spasm (spasm of the near reflex) is usually bilateral, resulting in increased myopia, convergence, and miosis. Unilateral spasm of accommodation has rarely been reported. PATIENTS: We investigated three females (age range 10-19 years) referred for investigations of retrobulbar optic neuritis (2 cases) and decompensated esophoria (1 case). RESULTS: They all presented unilateral spasm of accommodation with visual loss due to increased myopia (-3.5 to -11.75 diopters). Apart from that, results of neuro-ophthalmological examination were normal. CONCLUSIONS: Unilateral accommodation spasm is rare and can mimic retrobulbar optic neuritis and convergent strabismus. The three components of the accommodation-convergence spasm may not always be present simultaneously. Recognizing such an entity is important to prevent the patient from useless, costful and potentially harmful investigations.

Accommodation, Ocular↗
PubMed1998

[Photopsia: an often unrecognized symptom and sensitivity of electroretinography].

BACKGROUND: Photopsias are unformed luminous spontaneous visual hallucinations, often described as flickering or wiggling lights, sometimes like a glare. Phosphenes are more intense and of shorter duration whereas migraine fortifications have a specific time course and succession of events. Recognition of this symptom is often poor, hence patients are wrongly investigated. PURPOSE: To describe the clinical presentation and electroretinographic characteristics of patients with photopsias. METHODS: 4 patients were worked-up with clinical, psychophysical, angiographic and electroretinographic examinations. RESULTS: Despite normal fundus and angiographic examinations, full-field electroretinogram was diagnostic in all cases. Retinal dysfunction involved either inner or outer retina. Paraneoplastic, and probable autoimmune/inflammatory retinopathies were found in our cases. CONCLUSION: Photopsias are often secondary to sick retinal cells. In the presence of photopsias, investigations should be directed towards the retina and electroretinography is the gold standard. Recognition of the symptom should prevent useless and potentially harmful investigations for the patient.

Diagnosis, Differential↗
PubMed1998

[Silent sinus syndrome: an unusual cause of vertical diplopia].

BACKGROUND: Causes of transient vertical diplopia include myasthenia, dysthyroid orbitopathy, multiple sclerosis, decompensation of a pre-existing state. PURPOSE: To describe an unusual cause of transient diplopia, silent sinus syndrome. METHODS: Clinical, radiological and pathology findings from a 55-year-old man with acquired transient vertical diplopia are reported. RESULTS: Eight months after onset of symptoms, vertical diplopia was constant. Hypoglobus and enophthalmos were present. On CT scan, orbital floor was thinned and lowered by 8 mm. Maxillary sinus was filled with material compatible with the histological diagnosis of mucocele. Sinus surgery and orbital floor reconstruction resulted in resolution of diplopia. CONCLUSION: Sinus disorders can produce diplopia and/or visual loss, when invading the orbit. Usually, an acute orbitopathy is obvious. Our case shows that chronic sinus disorders can produce "silent" oculomotor disturbances and, at least in the beginning, transient diplopia.

Diplopia↗
PubMed1998

[Rhino-orbito-cerebral mucormycosis: clinical presentation].

BACKGROUND: Rhino-orbito-cerebral mucormycosis is an opportunistic rapidly progressive infection affecting almost exclusively diabetic or immunocompromised patients. CASE REPORTS: Three cases are reported. For one patient mucormycosis was the first manifestation of juvenile diabetes and the evolution was favorable. In the second case the infection affected a known diabetic patient and the clinical course was fatal. The third patient was immunocompromised, showed mild clinical features and a rapidly fatal evolution, the diagnosis being made only postmortem. CONCLUSION: These three cases illustrate the wide clinical spectrum of rhino-orbito-cerebral mucormycosis, its serious nature and difficult diagnosis.

Adolescent↗
PubMed1998

HLA typing in patients with multiple evanescent white dot syndrome (MEWDS).

BACKGROUND: Multiple evanescent white dot syndrome (MEWDS) is an acquired chorioretinal disorder of unknown etiology. We investigated the possibility that MEWDS might be related to a specific HLA subtyping. METHODS/RESULTS: Blood was obtained from nine patients affected by MEWDS. HLA-B51 was found in four of these nine patients with MEWDS. CONCLUSION: There was a 3.7-fold increased frequency of HLA-B51 in patients affected by MEWDS (relative risk 5.86). MEWDS might then be related to the presence of a specific HLA subtype, HLA-B51. However, due to the small sample size, our results need to be confirmed by further testing.

HLA Antigens↗
PubMed1998

Acute posterior multifocal placoid pigment epitheliopathy following mumps.

PURPOSE: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an acquired inflammatory disorder affecting the retina, retinal pigment epithelium, and choroid of healthy adults. APMPPE has been reported to occur after diverse infectious diseases, suggesting a possible immune disorder. The primary site of inflammation remains hypothetical. METHODS/RESULTS: A previously healthy 37-year-old patient developed APMPPE soon after the onset of mumps. Indocyanine green angiography (ICGA) revealed numerous hypofluorescent lesions throughout the posterior pole, outnumbering the lesions detectable either ophthalmoscopically or on fluorescein angiography. The hypofluorescent lesions visible on ICGA disappeared on follow-up studies. CONCLUSION: This case represents the first reported patient with AMPPE following mumps. Our results suggest that a multifocal choroidopathy might be the underlying cause of APMPPE.

Acute Disease↗
PubMed1998

[Ocular mitochondrial myopathies: a spectrum of clinical presentations].

PURPOSE: To determine the spectrum of clinical presentations of patients with chronic progressive external ophthalmoplegia (CPEO). METHODS: Retrospective study of 13 cases with CPEO. RESULTS: Eight patients presented an isolated CPEO, three patients had an associated retinopathy (Kearns-Sayre syndrome), one case suffered from retinopathy, deafness, diabetes mellitus and dysphagia, and one patient had an associated dysphagia. Mitochondrial DNA deletions were found in two cases. CONCLUSIONS: Our cases illustrate the wide spectrum of mitochondrial ocular myopathies. As patients present mostly with ptosis and ophthalmoplegia, ophthalmologists should be aware of these rare conditions.

Adult↗
PubMed1998

[Indocyanine green angiography in "multiple evanescent white dot syndrome" (MEWDS)].

PURPOSE: Multiple evanescent white dot syndrome (MEWDS) is a benign acquired chorioretinal disorder occurring mostly in young adults. Its pathophysiology is unknown. To describe the results of indocyanine green angiography (ICGA) in MEWDS. PATIENTS AND METHODS: Four patients with MEWDS were investigated by ICGA. RESULTS: In all cases, ICGA revealed numerous choroidal hypofluorescent lesions that largely outnumbered the lesions visible with either fundoscopy or fluorescein angiography. Three cases showed a blind spot enlargement on perimetry associated with the presence of a large peripapillary hypofluorescent zone on ICGA. Three cases showed macular granularity on fundoscopy correlating with a significant subfoveal hypfluorescent lesion on ICGA. Evolution was always favorable with disappearance of the hypofluorescent choroidal lesions. CONCLUSIONS: Our results confirm that MEWDS is primarily a choroidal disorder. The blind spot enlargement and the macular granularity, frequently detected in MEWDS, result from larger peripapillary and subfoveal choroidal lesions.

Adult↗
PubMed1997

Face recognition and postero-inferior hemispheric lesions.

Two patients with severe and lasting prosopagnosia were studied for visuo-cognitive functions and anatomo-clinical correlations. Both patients were deficient in recognizing familiar faces and items of previously well known categories (plants and fish for patient 1, mountains for patient 2). Patient 2, but not patient 1, was also deficient for matching of unknown faces. Patient 1, but not patient 2, was achromatopsic. Both patients had bilateral symmetrical lesions. Patient 1 had a lesion of the inferior occipito-temporal cortex, including inferior parts of early stage visual areas. Patient 2 had a lesion of the inferior temporal and fusiform gyri anterior to the early stage visual areas. When compared in Talairach space, the lesions of both patients had minimal overlap. Thus, severe and lasting prosopagnosia was associated with two almost exclusive lesion sites in the postero-inferior part of the hemispheres. Comparison between activation studies of face processing (by others) and our lesion study uncovered several paradoxes. Lesions of regions involved in a given task in normal subjects do not produce a deficit in this task, as shown here for gender discrimination and partially for face matching. Conversely, lesions of a region not specifically involved in a given task in normal subjects can produce a deficit in the task, as shown here for face identification.

Brain Diseases↗
PubMed1997

Visual disturbances and transurethral resection of the prostate: the TURP syndrome.

A 73-year-old man with a history of a cerebral and a cardiac vascular disease and atrial flutter developed visual disturbances characterized by vision being dark in both eyes and by seeing as through a color photographic negative immediately after an uncomplicated transurethral resection of the prostate (TURP) for prostatic hyperplasia under spinal anesthesia. There was complete remission of the symptomatology after 2.5 h. A cerebrovascular workup was negative. Considering postoperative hyponatremia and hypoosmality, we discuss the possible role of glycine-induced visual disturbances as described in the TURP reaction syndrome, to our knowledge an entity almost unknown in the neurologic literature. Glycine-induced visual disturbances should therefore be considered in the differential diagnosis of bilateral transient visual loss.

Aged↗
PubMed1996

Multiple evanescent white dot syndrome after hepatitis B vaccine.

PURPOSE: Hepatitis B vaccine has become an effective means of preventing complications of hepatitis B. However, it occasionally induces serious side effects. We report a case of multiple evanescent white dot syndrome (MEWDS) that occurred following hepatitis B vaccination. METHODS: A 23-year-old woman with a one-week history of progressive loss of vision in the left eye and bilateral photopsia was referred for examination. Her symptoms appeared 24 hours after a booster intramuscular injection of hepatitis B vaccine. RESULTS: Clinical examination, fluorescein angiography, and the course of events were typical of MEWDS. CONCLUSIONS: This case demonstrates the occasional occurrence of MEWDS after hepatitis B vaccine and suggests that hepatitis B virus immunization may be a risk factor for this retinal condition.

Adult↗