PubMed · 14770648
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G L TABOR. 1950. Intractable postoperative diplopia.. https://doi.org/10.1001/archopht.1950.00910020527004
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PURPOSE: To clarify in which cases of blow-out fractures ocular motility will naturally recover. DESIGN: A retrospective review of observational cases. METHODS: Involved ocular motility ranges were measured by the Hess screen test at 15 or 30 degrees in 23 nonsurgical blow-out fracture patients without muscle entrapment or strong mechanical ocular restriction and in eight surgical patients with the above. RESULTS: In nonsurgical patients, the eyes moved more than 10 or 20 degrees respectively on a 15- or 30-degree Hess screen test in the early period, whereas in the surgical patients, the eyes did not. No nonsurgical patients had serious ocular motility disturbances; however, natural ocular motility recovery in many patients took more than 4 weeks. CONCLUSIONS: When an involved eye without muscle entrapment or strong mechanical restrictions moves more than 10 or 20 degrees on each Hess chart, natural recovery can be expected.
A 59-year-old, right-handed woman had a paroxysmal polyoptic visual illusion, in which multiple copies of the object she saw spread horizontally in the left hemi-visual field. Polyopsia appeared for a few seconds. Neurological examination was normal. Magnetic resonance imaging (MRI) showed a tumor-like lesion involving the cortical and subcortical matters in the right mesial temporal regions. An interictal EEG showed frequent spikes in the right mesial temporal area and intermittent theta waves in the right fronto-temporal area. Video-EEG monitoring using the sphenoidal electrodes showed the seizure discharges originating in the right sphenoidal lead accompanying the polyoptic visual illusion. The seizure discharges were restricted within the right mesial temporal lobe. Paroxysmal visual illusion disappeared after administration of anti-epileptic drugs. EEG showed rare spikes in the right mesial temporal area. Polyopsia in this patient presumed to be associated with right mesial temporal lobe epilepsy because polyopsia and seizure activities on the ictal EEG were coupled and polyopsia ceased after administration of anti-epileptic drugs. Polyopsia is recognized as visual perseveration in space and a rare visual illusion. The lesion causing polyopsia has been reported to be mostly within posterior cerebral areas including occipital, parietal and temporal regions. This patient whose ictal polyopsia associated with mesial temporal lobe epilepsy is a very rare case because most reported cases presenting ictal polyopsia are neocortical temporal lobe epilepsy. The precise mechanism of polyopsia remains unknown. The mesial temporal lobe includes the hippocampus and parahippocampal formation that have been reported to receive information from the diverse association cortex and work as memory controllers. Ictal polyopsia may result from dysfunction of the visual association cortex or visual memory systems induced by the epileptic activities in the mesial temporal lobe. Polyopsia is a rare ictal semeiology of mesial temporal lobe epilepsy and may be one of the important ictal symptoms.
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