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At least 199 records · Page 11Linked to original sources
PubMed2007

Relative afferent pupillary defect with normal vision and vertical strabismus--implications for pupillary pathway anatomy.

BACKGROUND: A relative afferent pupillary defect (RAPD) is usually a sign of visual dysfunction. Here, an unusual case of an RAPD combined with vertical strabismus but normal vision is described. Implications for pupillary pathway anatomy are discussed. METHODS: A 12-year-old girl with chronic headache was shown to have a midbrain tumour. She presented to us with intermittent diplopia. Examination included visual acuity, visual fields, pupillary function, anterior and posterior segments, and strabismus evaluation with the tangent screen. RESULTS: There was a right-sided pathologic RAPD but no afferent visual impairment. Isocoria was present in light and darkness. There was a right-sided strabismus sursoadductorius. CONCLUSIONS: A pathologic RAPD with normal vision can be caused by tumour compression of the contralateral pretectal nucleus or its afferent or efferent fibres. As an implication for pupillary pathway anatomy, our case suggests that there is equal distribution between crossing and non-crossing intercalated neurons. An associated strabismus can show a non-paralytic pattern.

Astrocytoma↗
PubMed2006

Quantification of retinal nerve fiber layer thickness reduction associated with a relative afferent pupillary defect.

BACKGROUND: A relative afferent pupillary defect (RAPD) is known to develop only when more than 25% of retinal ganglion cells are ablated in monkeys' eyes. However, there was no prior study to estimate biometrically the degree of retinal nerve fiber layer (RNFL) thickness reduction leading to the development of RAPD in live human eyes. The purpose of this study was to examine the correlation between the amount of RNFL thickness reduction and the depth of a clinically detectable RAPD in patients with unilateral optic atrophy. METHODS: Enrolled were 20 patients with optic atrophy of various etiologies. We quantified RAPD by performing the swinging flashlight test with log-scaled neutral density filters placed over the unaffected eye. Average RNFL thickness was measured by OCT3000 with the average RNFL thickness program. Linear regression analysis was used in assessing the relationship between RAPD and the ratio of affected to unaffected average RNFL thickness. RESULTS: The mean of average RNFL thickness was 95.6+/-17.3 microm in the unaffected eyes and 50.7+/-19.3 microm in the affected eyes (P<0.001). Regression analysis between RAPD and the ratio of affected to unaffected average RNFL thickness revealed a correlation coefficient R2=0.48 (P=0.0007). The regression line intersected the y-axis at 0.77. CONCLUSIONS: RAPD was not clinically detected until at least approximately 25% of the retinal nerve fibers were lost when compared with the unaffected eyes. Substantial retinal ganglion cell damage is required for the development of RAPD.

Adolescent↗
PubMed2000

Superior oblique paresis with contralateral relative afferent pupillary defect.

BACKGROUND: The purpose of this study is to report a case of superior oblique paresis and contralateral relative afferent pupillary defect (RAPD) with normal vision in a patient with brainstem astrocytoma. METHODS: We correlated the patient's clinical findings with anatomical substrates on magnetic resonance imaging (MRI) findings. RESULTS: The patient had right-sided superior oblique paresis. There was a left-sided RAPD, although visual acuities and visual fields were normal in both eyes. T1-weighted, gadolinium-enhanced MRI demonstrated a hyperintense area in the right dorsal midbrain. CONCLUSION: It is suggested that the lesion damaged both the pretectal afferent pupillary pathway and fascicles of the trochlear nerve, causing a unique combination of neuro-ophthalmologic findings.

Adult↗
PubMed1998

Correlation of relative afferent pupillary defect and estimated retinal ganglion cell loss.

BACKGROUND: The relative afferent papillary defect (RAPD) is an important parameter for quantifying the loss of neuronal function in asymmetric optic nerve disease. We wanted to assess its correlation with retinal ganglion cell loss, estimated from visual field defects, using a recently described method. METHODS: In 36 patients with unilateral optic nerve disease, the RAPD was measured using an automated, computerized infrared pupillometer. The percentage of ganglion cell loss was estimated with clear templates. RESULTS: We found a highly significant correlation between the RAPD and estimated ganglion cell loss. The correlation was higher for Humphrey visual fields than for Goldmann visual fields measured with the 14e and 12e stimulus. CONCLUSION: The RAPD correlates well with estimated retinal ganglion cell loss in optic nerve disease. Humphrey visual fields seem to reflect the ganglion cell loss better than Goldmann visual fields. The spatial distribution of pupillomotor retinal ganglion cells seems to be proportional to the distribution of light-sensitive ganglion cells projecting to the lateral geniculate nucleus.

Cell Count↗
PubMed2006

A binocular pupil model for simulation of relative afferent pupil defects and the swinging flashlight test.

Many important intracranial neural pathways are involved in the control of the two muscles of the human pupil and the observation and analysis of pupil responses to light or other stimuli is of great interest in many clinical procedures. The binocular pupil model presented in this document has a topology encompassing much of the complexity of the pupil system neurophysiology. The dynamic parameters of the model were matched against pupil experiments under multiple conditions. It is employed here to simulate responses to the swinging flashlight test, a procedure which is routinely practiced in ophthalmology to diagnose different degrees of relative afferent pupil defects often a consequence of severe optic nerve diseases or retinal dysfunctions. Other, not light-dependent, pupil stimuli are briefly discussed.

Computer Simulation↗
PubMed2004

Early recognition of basal cell naevus syndrome.

UNLABELLED: The basal cell naevus syndrome is an autosomal dominant syndrome characterised by major manifestations such as basal cell carcinomas, jaw cysts, palmar or plantar pits, and intracranial calcifications. Early recognition is important in order to reduce morbidity due to cutaneous and cerebral malignancy and oromaxillofacial deformation and destruction, although diagnosis in infancy is rare. We describe three unrelated children with basal cell naevus syndrome who appeared to be the first patient in each family. CONCLUSION: Our observations lead us to recommend looking for other manifestations of this disease in patients who present with cardiac fibroma, cleft lip/palate, polydactyly or macrocephaly. Bifid, fused or splayed ribs should be considered a major criterion of great help in establishing a diagnosis, particularly in young children.

Basal Cell Nevus Syndrome↗
PubMed2001

Pupillary abnormality on admission and brain bulging during surgery as unfavourable predictors in patients treated with hypothermia: a retrospective review of 81 patients with severe head injury.

BACKGROUND: To determine factors predicting outcome of patients with severe head injury, the authors retrospectively analyzed 81 patients, 3 to 70 years of age, who were treated by hypothermia. METHOD: The initial Glasgow Coma Scale scores of the 81 patients ranged from 3 to 8. Outcome in each case was determined at six months after injury and was retrospectively analyzed with respect to patient characteristics, initial clinical status, laboratory data, computed tomographic findings, data from monitoring, intra-operative findings, and treatment methods. The significance of clinical and neuroradiological factors for predicting unfavorable outcome was analyzed by univariate logistic regression. Stepwise multiple logistic regression analysis was then used to identify independent predictors of outcome. FINDINGS: Favorable outcome was observed in 27 of 81 patients treated by hypothermia. Independent factors predicting unfavorable outcome included pupillary abnormality on admission and brain bulging during surgery. INTERPRETATION: Therapeutic effectiveness of hypothermia was thus limited in patients who presented with these grave symptoms.

Adolescent↗
PubMedDate not supplied

Retinal nerve fiber layer thickness in optic tract syndrome.

BACKGROUND: Optic tract syndrome (OTS) is characterized by incongruous homonymous hemianopia and a perpendicular pattern of bilateral optic atrophy due to the optic tract lesion. However, loss of retinal nerve fiber layer thickness (RNFLT) associated with OTS has not been quantitatively assessed. CASE: A 20-year-old woman with blunt head trauma showed normal visual acuity, color vision, ocular motility, and intraocular pressure. Because of a relative afferent pupillary defect in her left eye and left-sided homonymous hemianopia, we suspected right-sided optic tract damage, although magnetic resonance imaging detected no intracranial lesion. OBSERVATIONS: Using optical coherence tomography (OCT), the RNFLT of this case was measured at 31 months after the trauma and compared with age-matched normal controls (n = 41). Nasal, temporal, superior, and inferior quadrant RNFLT was reduced by 22%, 21%, 5%, and 46% in the right eye and 76%, 64%, 25%, and 27% in the left eye, respectively. The reduction was > 3 x the standard deviation of the normal mean values in the nasal and temporal quadrants of the left eye and in the inferior quadrant of the right eye. CONCLUSIONS: OCT can determine the RNFLT reduction corresponding to the characteristic patterns of optic atrophy of OTS.

Adult↗
PubMed1952

True polycoria.

Explore the source record for details and available documents.

Humans↗
PubMed1989

Severe visual loss related to isolated peripapillary retinal and optic nerve head cytomegalovirus infection.

We examined ten patients from a consecutive series of 73 patients with either isolated cytomegalovirus papillitis or limited cytomegalovirus retinitis contiguous with the optic disk. Patients with peripheral retinitis and other areas of retinitis were excluded. All patients were treated with ganciclovir. Two distinct types of cytomegalovirus infection of the peripapillary area were identified. Type I was characterized by spread of limited retinitis to the optic disk margin, good central visual acuity, and permanent arcuate and altitudinal visual field defects that enlarged and became more complete as the retinitis progressed toward the disk. Type II appeared to be a true cytomegalovirus infection of the optic nerve characterized by primary, isolated papillitis with peripapillary retinitis, an early afferent pupillary defect, and good initial visual acuity, which rapidly deteriorated despite prompt antiviral therapy. Peripapillary cytomegalovirus retinitis appears to be an important and underreported cause of visual morbidity in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Morphologic and clinical features of retrocorneal melanin pigmentation and pigmented pupillary membranes: review of 225 cases.

Observations based on clinical and histopathologic data from 200 consecutive cases of retrocorneal pigmentation by melanin-containing cells (RCP) and 25 cases of pigmented pupillary membranes (PPM) are reported. RCP was observed to be formed by four cell types, either alone or in combinations. The characteristic morphologic appearance of each cell type is described, and the significance and the predisposing factors for the various forms of RCP are outlined. RCP from endothelial-cell pigment phagocytosis, and in cases of resulting pigmented macrophages, was found to be a rather nonspecific reaction to release of pigment granules of iris pigment epithelium after surgical trauma, inflammation, and with the pigment dispersion syndrome. RCP from iris pigment epithelium was especially associated with anterior segment trauma with iris incarceration and peripheral anterior iris synechiae. This form was the least frequent. Most frequent in this series was RCP from iris stromal melanocytes. This seemed to be stimulated by surgical or accidental trauma and by corneal inflammation. Iris melanocytization of the anterior chamber angle and posterior corneal surface appeared to be related to the formation of retrocorneal fibrous tissue, the presence of anterior synechiae, and the development of secondary open-angle glaucoma. PPM are formed mostly by a combination of the pigmented cells of the iris. The predisposing conditions for formation of PPM were the same as for RCP. However, no correlation of implicated cell types and predisposing factors was detected. With these findings the importance of iris tissue, especially iris stromal melanocytes, in these basic reactions to anterior segment trauma or corneal inflammation is discussed.

Adolescent↗
PubMedDate not supplied

Intermittent pupillary dilation in a young woman.

A 28-year-old woman presented with a history of unilateral throbbing headache associated intermittently with transient pupillary dilation. The differential diagnosis and suggested method of investigation are discussed. Therapeutic recommendations are mentioned for the treatment of common migraine.

Adult↗
PubMed1992

A rare presentation of posterior communicating artery aneurysm.

This is a report of a successfully treated case of a 55-year-old woman with posterior communicating artery aneurysm who had a partial 3rd nerve palsy with pupillary sparing, temporal lobe intracerebral hematoma and a subdural hematoma. Such an association has not been reported earlier.

Carotid Artery Diseases↗