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At least 1,567 records · Page 87Linked to original sources
PubMed1992

Neurological problems presenting to an ophthalmic casualty department.

All patients presenting with neurological problems to an eye hospital casualty department over one year were prospectively studied. A total of 119 patients were identified. The most frequent diagnoses were retrobulbar neuritis (34; 28.5%), sixth cranial nerve palsy (22; 18.5%), third cranial nerve palsy (15; 12.6%) and Adie's tonic pupil (11; 9%). Cranial nerve palsies were most commonly due to diabetes or hypertension (16; 43.2%). Only one intracranial aneurysm was found. Symptoms included blurred vision (52; 43.7%), binocular diplopia (51; 42.8%), and eye pain (27; 22.7%). Fifty patients (42.0%) were referred by a general medical practitioner. Twenty-two (18.5%) were admitted to hospital. Forty-nine skull X-rays were requested and all were normal. Twenty-nine chest X-rays were requested. One (3.4%) showed an abnormality (carcinoma of the bronchus). Neurological patients present to ophthalmic casualty departments because of ophthalmic symptoms. Ophthalmic casualty officers are able to make working diagnoses and to direct patients appropriately. The use of investigations in the casualty department, however, is unlikely to be productive.

Adolescent↗
PubMed2000

Temporary uniocular blindness and ophthalmoplegia associated with a mandibular block injection. A case report.

A mandibular block injection produced temporary uniocular blindness, total ophthalmoplegia, mydriasis, and ptosis of the eyelid, with diplopia developing as the sight returned. These effects lasted 25-30 minutes. The explanation offered as to the cause of the anaesthetic phenomenon is an intra-arterial injection into the maxillary artery with backflow of anaesthetic solution into the middle meningeal artery. The instantaneous blindness results from the anaesthetic agent being carried into the central artery of the retina through an anastomosis of the ophthalmic and middle meningeal arteries via the recurrent meningeal branch of the lacrimal artery. Although of short duration, the symptoms mimic a more serious carotid artery embolus occluding the ophthalmic artery. Complications of mandibular blocks have been reported in the literature, however total blindness and ophthalmoplegia are extremely rare. This case report highlights an event where individual anatomical variation of the maxillary and middle meningeal arteries has allowed anaesthetic solution to be delivered to an ectopic site.

Anesthetics, Local↗
PubMed1993

Acquired Brown's syndrome in a patient with systemic lupus erythematosus.

A 27 year old woman with systemic lupus erythematosus (SLE) developed vertical diplopia with an apparent bilateral inferior oblique muscle palsy, resulting in a limitation of elevation of the globe in adduction. It resolved with systemic steroid treatment. A transient tenosynovitis affecting the superior oblique tendons was the probable underlying pathological mechanism. This is the first described case of Brown's syndrome associated with SLE.

Adult↗
PubMed1994

Superior oblique tendon lengthening for acquired superior oblique overactions.

Two patients who presented with compensatory head postures and diplopia are described. They both had marked unilateral superior oblique overaction, in one patient due to a large, incomitant skew deviation. Each underwent a superior oblique tendon lengthening procedure using a segment of silicone 240 retinal band as an expander, in combination with a contralateral superior rectus recession. Both achieved an excellent result with an improvement of the compensatory head posture and an increase in the field of binocular single vision. This surgical procedure is proposed as an option in the management of superior oblique overaction, including certain cases of skew deviation.

Accidental Falls↗
PubMed1995

Superior oblique tendon expansion in the management of superior oblique dysfunction.

Traditional superior oblique weakening procedures may be unpredictable and lead to superior oblique underaction. The use of 240 retinal band as a spacer to lengthen the superior oblique tendon has been proposed as a more controlled approach than superior oblique tenotomy and related procedures. The use of this technique is reported in a patient with diplopia following an orbital floor blow out fracture, and in a child with Brown's superior oblique tendon sheath syndrome.

Child↗
PubMed1995

Orbital blow-out fractures: long-term visual outcome of associated ocular injuries.

Severe ocular injuries are uncommon in patients with pure orbital blow-out fractures. Over a 3-year period, 45 patients with radiologically proved blow-out fractures were reviewed by an ophthalmologist. Decrease in visual acuity was the main clinical finding accompanying significant eye injury. Although most eye injuries were transient, early ophthalmic assessment is recommended to exclude potentially serious complications such as traumatic optic neuropathy. Troublesome diplopia may delay rapid rehabilitation.

Adolescent↗
PubMed1997

Sixth cranial nerve palsy following closed head injury in a child.

A five year old female had an isolated abducens nerve palsy following closed head injury. There was no associated skull fracture, haematoma, or other cranial nerve injury. The significance, frequency, and differential diagnosis of traumatic sixth cranial nerve injury is discussed, particularly in paediatric patients. Management is symptomatic; occlusion with an eye pad may be used if diplopia is significant. In young children alternate day occlusion of each eye will help prevent amblyopia. Most cases improve within three months and many resolve by six months. Residual palsy at six months is likely to be permanent and surgical treatment may be needed.

Abducens Nerve Injury↗
PubMed2004

Clinically evidenced unilateral dissociation of saccades and pursuit eye movements.

A patient affected by an ischaemic lesion of the right medial thalamic nucleus presented with a uniocular dissociation of upward vertical saccades and pursuit movement, with absent upward vertical saccades in the left eye. Clinical observations were confirmed by magnetic field scleral search coils analysis. During the vertical eye movement the patient denied any diplopia, thus suggesting a transient visual suppression in the left eye.

Antibodies, Antiphospholipid↗
PubMed1980

Paroxysmal symptoms as the first manifestations of multiple sclerosis.

Paroxysmal symptoms are described in 14 patients with undoubted or suspected multiple sclerosis (MS). In seven of the patients the paroxysms were the first symptom of the disease, although only one has developed definite MS so far. The clinical features have been compared with 153 patients previously reported in the literature which has been reviewed, with special reference to 36 in whom paroxysmal symptoms were the initial manifestations of MS. Attention has been focused on paroxysmal symptoms of brain stem and spinal cord origin of the following types: paroxysmal dysarthria and ataxia, diplopia, tonic seizures, paroxysmal akinesia, paroxysmal sensory disturbances and pains. Examples of each type have been reported as the first symptoms of MS with remissions ranging from less than one to 21 years before other manifestations of MS have developed.

Adult↗
PubMed1987

Transient uniocular visual loss on deviation of the eye in association with intraorbital tumours.

Five patients with unilateral orbital tumours are described in whom transient loss of vision occurred on deviation of the affected eye from the primary position. Other presenting features were diplopia, proptosis, poor visual acuity, visual field defects, pupillary abnormalities, fundal changes and altered colour vision. Abnormalities on fluorescein angiography suggest that the visual loss is due to transient ischaemia. Temporary uniocular loss of vision on eye movement may be an early sign of an intra-orbital mass.

Adult↗
PubMed2001

Infundibulohypophysitis in a man presenting with diabetes insipidus and cavernous sinus involvement.

Infundibulohypophysitis is an unusual inflammatory condition that affects the infundibulum, the pituitary stalk, and the neurohypophysis and may be part of a range that includes lymphocytic hypophysitis. Lymphocytic hypophysitis occurs mainly in women and most often presents in the later stages of pregnancy. Infundibulohypophysitis usually presents with diabetes insipidus and the cause remains unclear. The case of a 46 year old man with a 12 week history of polyuria and polydipsia is reported. Cranial diabetes insipidus was diagnosed on the basis of a water deprivation test. Initial cranial and pituitary imaging studies were normal. He subsequently developed symptoms of panhypopituitism over a period of 6-9 months and then, more acutely, developed diplopia secondary to a fourth nerve palsy. Further brain imaging studies disclosed an enhancing pituitary stalk and a left cavernous sinus lesion. An initial trial of immunosuppressive treatment did not help symptoms significantly. The diagnosis of infundibulohypophysitis was made on histological evidence. The patient was treated with prednisolone and methotrexate. At 9 months he is well, without symptoms, and the radiological abnormalities have resolved.

Anti-Inflammatory Agents↗
PubMed1990

Concomitant euthyroid Graves' ophthalmopathy and isolated ocular myasthenia gravis.

A 44 year old diabetic woman presented with diplopia and bilateral ptosis and mild exophthalmos. The patient was clinically euthyroid, the baseline thyroid function tests were normal, but the thyroid stimulating hormone response to thyrotrophin releasing hormone was flat. Computed tomographic scan and magnetic resonance imaging of the orbits showed left medial and inferior rectus muscle thickening, more prominent on the left side, consistent with Graves' disease. The tensilon stimulation test resulted in resolution of the ptosis and partial improvement of the ophthalmoplegia. The single fibre electromyography was consistent with a defect in neuromuscular transmission. However, forced duction test was normal and anti-acetylcholine receptor antibodies were undetectable. Significant improvement of the extraocular muscle function and resolution of the right ptosis had resulted from anticholinesterase therapy. These findings and the clinical response to therapy were consistent with concomitant euthyroid Graves' ophthalmopathy and ocular myasthenia gravis. Coexistent isolated ocular myasthenia gravis and Graves' ophthalmopathy is rare and should be considered in patients with findings of ocular myasthenia and extraocular muscle dysfunction.

Adult↗
PubMed1999

Assessment of colour vision in epileptic patients exposed to single-drug therapy.

Diplopia, blurred vision and colour disturbances are well-known side effects associated with anti-epileptic drugs (AEDs). Farnsworth-Munsell 100-hue colour test (F-100) is an accepted and sensitive tool to detect changes in colour perception. To determine the impact of AEDs upon colour vision, we evaluated 37 consecutive patients with complex partial seizures exposed to monotherapy with phenytoin (PHT, carbamazepine (CBZ) or valproic acid (VPA). All had normal IQ and no congenital disturbances in colour vision or ocular diseases. Twenty normal controls were used for statistical analysis. Thirteen patients were exposed to PHT, 12 to CBZ and 12 to VPA. Visual colour perception was impaired in 30/37 (82%) of the study group. The most significant abnormality was detected in the blue-yellow axis in 10/13 patients exposed to PHT (p < 0.02) and in 8/12 treated with CBZ (p < 0.009). In 8/12 patients taking VPA, no significant abnormality was observed (p < 0.06). None of the studied patients complained of colour vision disturbances. Our findings strongly support the negative effect of AEDs upon colour vision discrimination, most likely due to changes at the retinal processing level. F-100 proved to be very useful to assess early toxicity due to AEDs.

Adolescent↗
PubMedDate not supplied

Orbital involvement in multiple myeloma: first sign of insufficient chemotherapy.

Orbital involvement in multiple myeloma is unusual. We describe the case of a 60-year-old male who presented with left proptosis, reduced visual acuity, diplopia and progressing signs of globe indentation 2 months after chemotherapy for multiple myeloma. MRI showed a well-defined tumor filling the mediobasal part of the left orbit. Incisional biopsy and reduction of tumor mass were performed using an anterior transconjunctival orbitotomy. Histopathologic findings and further systemic examination confirmed the reactivation of the multiple myeloma. Proptosis, intraocular pressure and visual acuity improved following external beam radiation therapy of the left orbit and repeated systemic chemotherapy. Orbital involvement in multiple myeloma was the only sign of insufficient chemotherapy.

Antineoplastic Agents↗
PubMed2004

Pituitary metastasis of follicular thyroid carcinoma.

OBJECTIVE: The case of a 60-year-old male patient with follicular thyroid cancer who developed a pituitary mass proved to be a metastasis from thyroid cancer. METHODS: Assessment with whole-body scan, ultrasound, computed tomography and thyroglobulin measurements. RESULTS: Despite surgery and repeated doses of radioiodine, the patient developed diplopia and ptosis of the right eyelid, along with increasing thyroglobulin levels. A pituitary mass was discovered, with no signs of pituitary deficiency. The mass was removed and found to consist of neoplastic cells immunohistochemically positive to thyroglobulin. CONCLUSIONS: Distant metastases may develop in cases of follicular thyroid carcinoma, even after repeated doses of (131)I. Metastatic follicular thyroid carcinoma to the pituitary is a rare entity.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Acute transient cerebral toxicity associated with administration of high-dose methotrexate.

OBJECTIVE: To report the first case of transient central nervous system toxicity after administration of high-dose methotrexate (HDMTX) in the Middle East. CLINICAL PRESENTATION: A 10-year-old boy was diagnosed with osteosarcoma of the proximal end of the left tibia. He underwent primary amputation and was started on adjuvant chemotherapy, which included administration of HDMTX. He developed acute cerebral toxicity after the 5th dose of HDMTX in the form of diplopia, seizures and disorientation. He recovered completely without any complication or neurological sequelae. CONCLUSION: The acute cerebral toxicity associated with HDMTX was completely reversible and without any sequelae.

Acute Disease↗
PubMed1977

Ophthalmoplegic migraine with persistent abducens nerve palsy.

A 27-year-old woman had been suffering from recurring episodes of left-sided migraine since the age of 5. When 14 years old, a diplopia on looking to the left followed each episode; its length progressed with time and eventually became permanent. On examination a left abducens palsy was found. Arteriography failed to reveal the presence of aneurysm or other vascular anomalies.

Abducens Nerve↗