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Biomedical subjects

J R Keane

Publications and source records attributed to J R Keane.

At least 37 records · Page 2Linked to original sources
PubMed1993

Isolated paraplegia from a remote stab wound.

A stab wound to the right flank of a 24-year-old man produced immediate paralysis of both legs but spared sensation. Recovery was slow but sufficient to allow walking with a cane. Radicular artery interruption, in combination with systemic hypotension, is presumed to have caused selective watershed infarction of the spinal cord. Strokes of the spinal cord after trauma are rare, and those at a thoracic level usually represent delayed infarctions after pediatric chest or abdominal injuries. Our patient sustained an immediate and highly selective infarction.

Adult↗
PubMed1993

Cysticercosis: unusual neuro-ophthalmologic signs.

Papilledema and pretectal signs are the usual neuro-ophthalmological manifestations of cysticercosis. The following patients with severe posterior fossa involvement exhibited uncommon signs of bilateral fourth nerve palsy, facial myokymia, upbeat nystagmus, periodic alternating nystagmus, and rhythmic oculopalatal myoclonus.

Adolescent↗
PubMed1993

Ptosis and levator paralysis caused by orbital roof fractures. Three cases with subfrontal epidural hematomas.

Blows to the forehead resulted in orbital roof fractures and subfrontal epidural hemorrhage in three patients. Neurologic eye signs were limited to ipsilateral paralysis of globe and lid elevation. In the context of an ecchymotic upper lid, these findings indicate local damage to orbital muscles rather than injury to the superior division of the third nerve. Even when such patients are alert, prompt computed tomographic (CT) scanning of the head should be undertaken to rule out an enlarging epidural hematoma.

Adult↗
PubMed1993

Intermittent third nerve palsy with cryptococcal meningitis.

In the several days before death, two AIDS patients with cryptococcal meningitis and increased intracranial pressure (ICP) experienced episodic unilateral third nerve palsies seemingly related to transient peaks in ICP. While cryptococcal neuritis may have predisposed the nerves to pressure effects, CT scans showed no evidence of tentorial herniation. These cases raise the possibility that severe elevations of ICP can precipitate third nerve paresis on rare occasions.

AIDS-Related Opportunistic Infections↗
PubMed1992

Posttraumatic cranial neuropathies.

Injury to cranial nerves is a common sequela of blunt head trauma. The olfactory, facial, and audiovestibular nerves are damaged most often, followed by the optic and ocular motor nerves. The trigeminal and lower cranial nerves are rarely involved. Chances of recovery are greatest for the facial nerve, intermediate for the ocular motor nerves, and least likely for the olfactory, optic, and audiovestibular nerves. Treatment is usually symptomatic, although steroids or surgical decompression of the optic and facial nerves can lead to dramatic results in selected patients.

Brain Concussion↗
PubMed1991

Neuro-ophthalmologic signs of AIDS: 50 patients.

In 50 hospitalized patients with acquired immunodeficiency syndrome, signs of central eye movement limitation (28 cases) were most common. Peripheral eye movement limitations (18), abnormalities of vision (18), and abnormal spontaneous eye movements (15) occurred with about equal frequency. Meningitis (17), usually due to lymphoma (8) or Cryptococcus (8), was the usual cause of peripheral nervous system involvement, while toxoplasmosis (18) was more common than lymphoma (4) or presumed viral causes (8) in producing CNS dysfunction. The midbrain and pretectal (8) were affected about as often as the pontine tegmentum (9), but rostral brainstem lesions appeared to be the result of toxoplasmosis (4) or lymphoma (3), whereas a viral etiology was the presumed cause of most caudal stem involvement.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The pretectal syndrome: 206 patients.

The pretectal syndrome occurred in 2.3% of patients personally examined over an 18-year period. The symptoms were nonspecific, but the signs (abnormal pupils in 198 patients, vertical gaze limitation in 180, disjunctive horizontal eye position in 90 and vertical in 79, lid retraction in 83, and convergence-retraction nystagmus in 71) were exquisitely localizing. The etiology, skewed by the local prevalence of cysticercosis, was hydrocephalus in 80 patients, stroke in 53, and tumor in 45. The importance of timely diagnosis was underscored by the relatively good prognosis of many patients.

Brain Diseases↗
PubMed1989

Strabismus surgery for neurological illness. The Stevens Commission 1887-1889.

In 1887, the New York Neurological Society appointed a committee of distinguished neurologists to investigate the claim of ophthalmic surgeon George Thomas Stevens that he could cure chorea and epilepsy through correction of refractive errors and strabismus. After 2 1/2 years, the supervised therapeutic trial collapsed amid mutual recriminations. The commission issued a bland statement to the effect that the treatment was not curative and was insufficiently helpful to recommend. The idea of ocular reflex causation and surgical cure of "neuroses" persisted for several more decades in the face of increasing skepticism and resistance.

History, 19th Century↗
PubMed1989

Neurologic eye signs following motorcycle accidents.

A review of 96 consecutive patients who suffered neuro-ophthalmologic injuries in motorcycle accidents revealed a wide range of findings. These findings were similar to signs associated with other forms of closed-head trauma, aside from a higher incidence of trochlear nerve palsies.

Accidents, Traffic↗
PubMed1989

Hysterical gait disorders: 60 cases.

Simulated gait abnormalities involve weakness of 1 or both legs or ataxia and trembling. The patterns rarely duplicate those of neurologic disability and are usually promptly suspected of being functional by the experienced clinician. As with other pseudoneurologic signs, normal underlying neurologic function must be demonstrated. A dramatic cure is the best diagnostic evidence, and a bias toward organic etiology is warranted by a relatively greater risk in delayed diagnosis. Dystonia and chorea are the signs most likely to be mistaken for functional conditions. While CT and MRI now provide a welcome diagnostic safety net, the variety of hysterical gaits, and probably the effectiveness of "moral" treatment, does not appear to have changed appreciably in the past century.

Adult↗
PubMed1989

Rhythmic pupillary oscillations accompanying a complete third-nerve palsy.

An automobile accident left a 26-year-old man in stupor with a complete right third-nerve palsy. Although fixed to light, the right pupil (only) exhibited continual concentric oscillations, initially at 1 Hz but slowing to 0.3 Hz during 2 weeks' observation. The pathophysiologic characteristics of this unique movement are uncertain but may involve central parasympathetic nervous system dysfunction.

Adult↗