[Partial evulsion of the optic nerve].
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Adult↗
Biomedical subjects
G Kommerell
Publications and source records attributed to G Kommerell.
Duction ranges in normal probands and patients with Graves' ophthalmopathy, determined using the Goldmann perimeter.
BACKGROUND: We examined whether the Goldmann perimeter is suitable for measuring the range of monocular ductions, especially in the follow-up of patients with Graves' ophthalmopathy. METHODS: Using the Goldmann perimeter, the range of monocular ductions was determined in one eye of 100 normal probands (aged between 21 and 70 years) and of 36 patients (aged between 29 and 66 years) with a motility disturbance due to Graves' ophthalmopathy. Subjects were asked to follow target I/4e which was slowly moved by the examiner in the vertical and the horizontal meridian. The end-point of the pursuit movement observed by the examiner was taken as the duction limit. Subjects were measured twice, in half of the cases by the same, in the other half by two different examiners. RESULTS: In the 100 normal probands, the mean ranges of ductions were: elevation 37.6 degrees, depression 58.0 degrees, adduction 51.6 degrees, abduction 48.7 degrees. There was a slight age-related decline. The intraobserver and interobserver mean coefficients of variation ranged between 1.5% and 3.8%. In the 36 patients with Graves' ophthalmopathy the coefficients were between 0.7% and 2.3%. In both the normal probands and the Graves' ophthalmopathy patients, the coefficients were smaller for the total vertical and horizontal duction ranges than for adduction, abduction, elevation and depression alone. CONCLUSIONS: Measurements of the range of monocular ductions with the Goldmann perimeter are highly reproducible and appear to be suitable for follow-up studies in patients with Graves' ophthalmopathy.
Adult↗
[Voluntary control of unilateral strabismus sursoadductorius].
BACKGROUND: Strabismus with unilateral elevation in adduction is an upward deviation of the adducting eye of unknown, not necessarily paretic origin. The term "old trochlear palsy" may be erroneous since the hypertropia is not necessarily larger in downward gaze and a causative lesion can usually not be identified. We describe here a marked voluntary influence on unilateral elevation in adduction, in situations that exclude binocular fusion. PATIENTS: Two patients with an elevation in adduction of the right eye and a positive head-tilt phenomenon, a 21-year-old and a 28-year-old man, were able to vary their vertical angle of squint at will. Even under artificial conditions that exclude binocular fusion (alternate cover test, dark-red glass test) could they change their right-over-left deviation, Patient 1 between 4 and 20 degrees and Patient 2 between 0 and 15 degrees. Under natural viewing conditions both patients had binocular vision with stereopsis that decompensated only when they looked to the left. CONCLUSIONS: We assume that our two patients had a "motor memory" that stores the muscle innervation for parallel eyes, i.e. the innervation suitable for binocular vision, and that the patients made use of or neglected this memory at will. In general, our observations suggest that a variable recourse to such a motor memory explains why, in patients with unilateral elevation in adduction, the angle of squint often changes. A voluntary access to this memory may, however, be exceptional.
Adult↗
MRI of lymphomas of the orbits and the paranasal sinuses.
PURPOSE: The purpose of this study was to point out MR characteristics of non-Hodgkin lymphomas of the orbits and the paranasal sinuses and the benefit of fat-suppressed contrast-enhanced sequences. METHOD: The MR images of 16 patients with lymphoma of the orbits and the paranasal sinuses were retrospectively analyzed for signal intensity, contrast enhancement, bone destruction, and mass effect. The findings were confirmed by means of biopsy (Stage IE disease) or follow-up imaging after chemotherapy (Stage IV disease). RESULTS: MRI clearly delineated the extension of the lymphomas. On the T1-weighted images, the signal intensity of the lymphoma was hypointense compared with the gray matter of the brain in 12 cases and intermediate in 4 cases. The T2-weighted fast SE images showed a hyperintense signal in 12 cases, intermediate in 3 cases, and even hypointensity in 1 case. All lesions enhanced after intravenous Gd-DTPA administration, reliably visible in the T1-weighted fat-suppressed sequences but not visible in three cases in the T1-weighted SE sequences. Bony wall destruction was evident in cases with paranasal but never in isolated orbital lymphoma. CONCLUSION: While extension of lymphoma can be accurately described by MRI, a specific diagnosis is not achievable on the basis of signal intensities and enhancement patterns alone. Therefore, at least in cases of suspected Stages IE and IIE, biopsy proof is needed. Fat-suppressed contrast-enhanced sequences possess the highest detection rate and should therefore always be applied.
Adolescent↗
Inherited Duane's syndrome: mirror-like localization of oculomotor disturbances in monozygotic twins.
Abnormal innervation hampered the left eye in one twin, while producing the same effect in the right eye of the other twin and in that of his mother.
Adult↗