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At least 1,405 records · Page 78Linked to original sources
PubMed1999

Fourth cranial nerve palsy in pediatric patients with pseudotumor cerebri.

PURPOSE: To describe three children with acute fourth cranial nerve palsy secondary to pseudotumor cerebri. METHODS: We reviewed the medical records of children younger than 18 years who were diagnosed with pseudotumor cerebri between 1977 and 1997. Pseudotumor cerebri was defined by normal neuro-imaging, elevated intracranial pressure measured by lumbar puncture, and normal cerebrospinal fluid composition. RESULTS: Three children with pseudotumor cerebri presented with vertical diplopia and clinical signs of fourth cranial nerve palsy including a hypertropia of the affected eye, which increased with adduction and ipsilateral head tilt. The fourth cranial nerve palsy resolved after reduction of the intracranial pressure in all three children. CONCLUSIONS: Fourth cranial nerve palsy may occur in children with pseudotumor cerebri and may be a nonspecific sign of elevated intracranial pressure.

Adolescent↗
PubMed1999

Castleman disease presenting with ophthalmic signs and symptoms.

PURPOSE: To describe a patient with multicentric Castleman disease who was initially examined with ophthalmic signs and symptoms. METHODS: Case report. A 71-year-old man was initially examined with swelling of both upper eyelids and diplopia of 2 months' duration. RESULTS: Medical evaluation and right axillary lymph node biopsy disclosed Castleman disease. Systemic corticosteroid treatment temporarily resolved signs and symptoms, but the patient died of recurrence with cytomegalovirus and Aspergillus infection 10 months after initial examination. CONCLUSIONS: Multicentric Castleman disease is a rare but distinct disorder that may present initially with ocular signs and symptoms. This disease must be included in the differential diagnosis of orbital pseudotumor and lymphoma.

Aged↗
PubMed2000

Bilateral sixth nerve palsy associated with MDMA ("ecstasy") abuse.

PURPOSE: To report the association of methylenedioxymetamphetamine (MDMA, "ecstasy") abuse and bilateral sixth nerve palsy. METHODS: Case report. RESULTS: A 17-year-old male presented with horizontal diplopia in all directions of gaze after having taken MDMA tablets at 5-day to 7-day intervals during a 2-month period. Examination showed bilateral sixth nerve palsy. Ocular motility returned to normal within 5 days without use of MDMA and with no other treatment. CONCLUSION: Methylenedioxymetamphetamine "ecstasy" abuse should be considered in the differential diagnosis in otherwise unexplained sixth nerve palsy.

Abducens Nerve Diseases↗
PubMed1998

Ocular manifestations of giant cell arteritis.

PURPOSE: To report the ocular manifestations of giant cell arteritis using the strict criterion of a positive temporal artery biopsy for diagnosis of giant cell arteritis. METHODS: In a prospective study from 1973 to 1995, we investigated 170 patients whose diagnosis of giant cell arteritis was confirmed on temporal artery biopsy. At the initial visit, all patients were questioned regarding systemic and ocular signs and symptoms of giant cell arteritis and underwent ophthalmic, erythrocyte sedimentation rate (Westergren), and C-reactive protein evaluations. Any patient with a high index of suspicion of giant cell arteritis was immediately started on systemic corticosteroid therapy and had temporal artery biopsy performed as soon as possible. RESULTS: Eighty-five (50.0%) of the 170 patients with giant cell arteritis proven by temporal artery biopsy presented with ocular involvement. Ocular symptoms in patients with ocular involvement were visual loss of varying severity in 83 (97.7%), amaurosis fugax in 26 (30.6%), diplopia in five (5.9%), and eye pain in seven (8.2%); ocular ischemic lesions consisted of arteritic anterior ischemic optic neuropathy in 69 (81.2%), central retinal artery occlusion in 12 (14.1%), cilioretinal artery occlusion in 12 (of 55 patients with satisfactory fluorescein angiography [21.8%]), posterior ischemic optic neuropathy in six (7.1%), and ocular ischemia in one (1.2%). In almost every patient with giant cell arteritis, fluorescein fundus angiography disclosed occlusive disease of the posterior ciliary arteries. CONCLUSION: Because giant cell arteritis is a potentially blinding disease and its early diagnosis is the key to preventing blindness, it is important to recognize its various ocular manifestations.

Aged↗
PubMed1978

Silicone sheet and bead implants to correct the deformities of inadequately healed orbital fractures.

Following severe trauma to the middle third of the face, a common deformity requiring secondary correction is a combination of lowered orbital floor and enophthalmos often associated with diplopia and ptosis. Silicone discs are used to elevate the orbital floor and silicone beads inserted subperiosteally to correct the enophthalmos. In a series of 44 cases we have had no instance of infection or rejection although some beads had to be removed in 1 patient because of increased pressure on the eye. Close collaboration between plastic and ophthalmic surgeons is essential.

Diplopia↗
PubMed1990

Thin section computed tomography in the evaluation of naso-ethmoidal trauma.

We reviewed the computed tomography (CT) appearances, plain film radiographs and clinical findings of 17 patients who suffered fractures of the naso-ethmoidal complex. Six patients (35%) with diplopia were noted on CT to have lateral displacement of medial orbital wall fragments into the orbit (medial wall 'blow-in' fractures) leading to displacement of the globe or extra-ocular muscles. Medial displacement of ethmoid bone fragments (medial wall 'blow-out' fractures) with medial rectus entrapment was noted in a further two cases (11%) also. Multiple associated facial fractures were seen in all but one case with CT evidence of frontal bone fracture and intracranial injury in 12 (70%) patients. CT was judged to add valuable information to clinical findings and plain film radiography and was especially helpful where marked soft tissue swelling precluded detailed physical examination of the naso-orbital region. The CT features of naso-ethmoidal trauma are illustrated and discussed and the advantages of CT in the pre-operative evaluation of such injuries are emphasised.

Diplopia↗
PubMedDate not supplied

Effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves' ophthalmopathy.

PURPOSE: To evaluate the effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves' ophthalmopathy. METHODS: We selected 41 Japanese patients (age range, 21-76 years; mean = 49 years) who had active Graves' ophthalmopathy among 205 consecutive patients examined at Sapporo Medical University Hospital between 1997 and 1999. In a prospective study, we investigated the effect on the 41 patients of high-dose intravenous methylprednisolone pulse therapy (1 g/day x 3 days x 3 times) followed by 3-month oral prednisone therapy. Coronal computed tomography (CT) of the orbit, exophthalmometry and monocular fixation field measured by Goldmann perimetry were carried out before the steroid pulse therapy, and 1 and 6 months after the steroid pulse therapy. The maximum coronal section area of the rectus muscle in each eye was measured using an orbital CT image. RESULTS: Extraocular muscle hypertrophy was significantly reduced 1 and 6 months after the pulse therapy (paired t-test, P <.01), and was not significantly different between 1 and 6 months after the pulse therapy. Proptosis was not significantly reduced by the pulse therapy. Monocular fixation fields were measured in 34 patients with diplopia, and limitation of eye movements was improved in 15 patients (44%) by the pulse therapy. In the other patients, improvement of the limitation was not detectable by the test of the monocular fixation field. CONCLUSIONS: The treatment in this study is effective for extraocular muscle hypertrophy, and relapse was minimum within 6 months. However, this treatment has limited effect on limitation of eye movements and less effect on proptosis.

Administration, Oral↗
PubMedDate not supplied

Outcome of surgery for bilateral third nerve palsy.

PURPOSE: To review the outcome of surgery for bilateral third nerve palsy. METHODS: The series comprised 16 cases. The eye deviation in the primary position averaged -27.0 degrees horizontally. Surgery was aimed at bringing both eyes into alignment in the primary position by recession-resection of horizontal muscles. Transposition of the superior oblique was performed for complete third nerve palsy. Surgery was initially performed on the nonfixating eye. The fellow eye underwent further surgery for residual disorders. RESULTS: Within 6 months after surgery, the eye deviation in the primary position averaged -0.7 degrees horizontally. After longer follow-up, the eye deviation averaged -4.7 degrees horizontally. Postoperatively, diplopia in the primary position was absent in 11 and remained in 5 cases. CONCLUSION: Surgery for bilateral third nerve paresis or palsy achieved lasting cosmetic or functional improvements in the majority of cases.

Adult↗
PubMedDate not supplied

Reversible Horner's syndrome and dysthyroid ocular myopathy associated with Hashimoto's disease.

BACKGROUND: Although it has been frequently stated that thyroid disease induces Horner's syndrome, there have been few reports describing the anatomical relation of goiter to the cervical preganglionic sympathetic nerve fibers in acquired Horner's syndrome, which is identified by the eye-drop test for adrenergic sensitivity. CASE: A 40-year-old woman with Hashimoto's disease presented with vertical diplopia, and blepharoptosis and miosis on the left side. OBSERVATIONS: Computed tomography scan showed hypertrophy of the right inferior rectus muscle, which resulted from a dysthyroid process, causing the limitation of upward movement of the right eye. The eye-drop test for adrenergic sensitivity revealed that only the left pupil dilated significantly after administration of 5% tyramine, and the Mueller's muscle on the left side did not respond. These results suggest that Horner's syndrome was due to a preganglionic sympathetic lesion. Magnetic resonance imaging (MRI) of the neck showed chronic inflammatory lesions in both lobes of the thyroid gland identified by a high-intensity signal. CONCLUSION: The reconstruction technique of MRI demonstrated that the swollen left lobe of the thyroid gland was compressing the pathway of the cervical preganglionic sympathetic nerve fibers.

Adult↗
PubMed2006

[Kahler's disease presenting with a solitary cranial vault plasmacytoma].

INTRODUCTION: Solitary plasmocytoma is rarely located in the cranial vault. Usually observed, in elderly patients, occurrence during adolescence is extremely rare. We report the case of a 16-year-old patient presenting a cranial vault solitary plasmocytoma which revealed Kahler disease. CASE REPORT: A 16-year-old patient consulted for a frontal tumefaction becoming painful with diplopia. The cranio-encephalic radiography and the MRI showed a tumoral process involving cranial vault; biopsy revealed a solitary plasmocytoma. Search for multiple myeloma was negative. Six months later, a disease of Kahler was declared. CONCLUSION: Clinical and biological follow-up of cranial plasmocytoma is necessary, because progression to multiple myeloma is possible as in our observation. Imaging and particularly MRI are needed to specify the axial seat of the tumoral process and its relationship with the nervous and vascular structures.

Adolescent↗
PubMedDate not supplied

Really painful double vision.

A 67-year-old woman with a history of chronic headache and recent removal of two squamous cell lesions from her forehead presented with left facial pain and diplopia. A diagnosis of Tolosa-Hunt syndrome was made based on clinical presentation and imaging studies. When the patient did not respond to steroids, further studies were done, including biopsy, which revealed perineural spread of squamous cell carcinoma.

Aged↗
PubMedDate not supplied

Ahhh, that's a strange eye movement.

A 57-year-old woman presents with sudden onset of horizontal diplopia following surgical repair of a ruptured posterior fossa aneurysm. Neuro-ophthalmic examination revealed a left gaze palsy, right abducens palsy, bilateral facial nerve palsy, reverse ocular bobbing and oculopalatal myoclonus. These findings can be localized to the anterior pons caused by damage to the midline perforator vessels resulting in anterior pontine pathology. A video demonstration of the oculopalatal myoclonus and other types of vertical nystagmus is provided. The etiology and characteristics of these forms of nystagmus is discussed.

Abducens Nerve Diseases↗
PubMedDate not supplied

Double trouble.

A 78-year-old woman presented with vertical double vision. The Bielschowsky-Parks' three-step test suggested a left inferior rectus muscle paresis. Diagnostic testing confirmed the diagnosis of myasthenia gravis. Despite treatment with pyridostigmine bromide (mestinon) the diplopia persisted. She refused corticosteroid treatment and sought a second opinion, resulting in three unsuccessful strabismus surgeries to correct her ocular misalignment. The evaluation and management of ocular myasthenia gravis is reviewed and the appropriate timing of strabismus surgery is discussed.

Aged↗
PubMedDate not supplied

Value of parasagittal magnetic resonance images in visualizing the vascular territories of the cerebellum.

The outcomes of infarctions of the cerebellar arteries may range from self-limited neuro-ophthalmic symptoms to sudden death. Identification of the affected territory may assist in clinical management because the vascular syndromes, as well as vascular mechanisms of cerebellar infarcts, are different according to the involved cerebellar arteries. However, it is usually difficult to tell the exact vascular territories using only transaxial imagings. Magnetic resonance imaging is a good tool for obtaining parasagittal and coronal images of the cerebellum, which are better for showing the vascular territories. To illustrate this point we report a 61-year-old woman and bilateral cerebellar infarcts (right posterior inferior cerebellar artery and left superior cerebellar artery who had vertigo, vomiting, headache, intermittent vertical diplopia, and difficulty walking. The clinical value of parasagittal imaging of the cerebellum in this case is discussed.

Ataxia↗
PubMedDate not supplied

Here today ... gone tomorrow.

A 42-year-old woman presented with ptosis of the left upper lid and limitation of elevation and adduction of the left eye. Neuroimaging revealed a left cavernous sinus lesion which on biopsy proved to be a meningioma. She was symptomatically stable for three weeks until she had spontaneous elevation of her left upper lid and resolution of her diplopia over the course of one day. Spontaneous improvement of a neurologic deficit is generally considered evidence against an underlying tumor; however, it should not rule out the possibility that a tumor is present.

Adult↗
PubMedDate not supplied

Negative MRI versus real disease.

A 76-year-old diabetic woman presented with progressive binocular vertical diplopia and right eye pain. Examination revealed a pupil-involving partial right third cranial nerve palsy, with development of anisocoria over the course of several hours. MRI of the brain showed no mass lesion. MRA, even with retrospective review of the images, failed to clearly identify a 1 cm right posterior communicating artery aneurysm detected by subsequent conventional cerebral angiography. While MRA has been reported to be highly sensitive in cerebral aneurysm detection at some centers, other investigators have indicated less favorable data. Standardized protocols for data acquisition and meticulous attention to proper post-processing and image interpretation are essential if MRA is to supplant invasive arteriography. Currently, conventional (x-ray) angiography remains the gold standard for aneurysm detection, while MRA possesses excellent potential in this regard.

Aged↗
PubMedDate not supplied

The child with divergence paresis.

Divergence paralysis is a rare clinical entity that causes a comitant esotropia at distance. While this is usually benign and self-limited, there are reports of divergence paralysis associated with brain tumors, central nervous system syphilis, trauma, and multiple sclerosis. We studied a 14-year-old girl who presented with diplopia and was found to have divergence paralysis. Magnetic resonance imaging disclosed a large pontomedullary glioma.

Acute Disease↗
PubMed2000

Depth selectivity of vertical fusional mechanisms.

We measured the ability to fuse dichoptic images of a horizontal line alone or in the presence of a textured background with different vertical disparity. Nonius-line measurements of vertical vergence were also obtained. Diplopia thresholds and vertical vergence gains were much higher in response to an isolated vertically disparate line than to one with a zero vertical-disparity background. The effect of the background was maximum when it was coplanar with the target and decreased with increasing relative horizontal disparity. We conclude that vertical disparities are integrated over a restricted range of horizontal disparities to drive vertical vergence.

Adult↗