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PubMed1975

[Equilibrium regulation and visual influence; studies using the pendular-platform-test (author's transl)].

30 healthy persons were investigated by sinus-like pendular movements around a vertical axis. The test was performed with the eyes open, closed and with artificially produced diplopia. Only at high accelerations there was a significant difference in the regulation of equilibrium. It is supposed, that the influence of the visual system on the equilibrium depends on the functional state of the vestibular system.

Adult↗
PubMed2002

[Sphenoid sinus lymphoma. Case report and review of the literature].

A 64-year-old man presented to his general practitioner with an history of headaches and recent diplopia. Neuroradiological investigation showed a sphenoid sinus mass involving the sella and the clivus. Diagnosis of non-Hodgkin lymphoma was made via a transsphenoidal approach. The patient subsequently underwent a 6-month course of chemotherapy (M COPPA protocol) followed by 50 Gy locoregional radiotherapy. At three years follow-up the patient was in complete clinical and radiological remission. This case underscores the importance of thorough radiological work-up for accurate identification of tumor masses involving the pituitary fossa and provides an opportunity to review the literature on the management of this rare entity.

Diplopia↗
PubMed2002

[Botulism in Casablanca. (11 cases)].

Botulism is a rare but severe disease. Whereas until 1980, only one case of botulism had been reported in our department, in 1999, a real botulism epidemic took place in Morocco. To our knowledge, it's the first outbreak of that kind in Morocco. We report here an epidemiologic and descriptive study of 11 patients suffering from botulism, admitted at the Infectious Diseases department and in the Medical Intensive Care Unit of Ibn Rochd University Hospital, from August, the 10th to October, the 1st, 1999. Clinical diagnosis of botulism was made, at the admission, on ocular signs (diplopia, ptosis), swallowing troubles and/or muscle weakness. There was no fever, no trouble of conscience and normal reflexes, at the early stage of the disease. The average age of patients was of 23.9 years +/- 12.07. Three patients were first admitted in the Medical Intensive Care Unit. The period before symptom appearance varied between 7 and 96 hours. Dysphagia sore throat, dry mouth and dysphonia were always found in all patients, with normal conscience. The fever was noted in 3 cases, polypnea in 3 cases leading to respiratory assistance in 2 cases. Neurologic findings were dominated by ptosis and hypotonia. The search of botulism toxin B in blood was positive in 6 cases. The electromyography showed clear signs of botulism. The evolution was favourable in 10 cases. Respiratory complications were found in 2 cases and infectious complications in 4 cases. One patient died. The period of hospitalization varied between 10 to 24 days with an average stay of 15.8 days. Eating "mortadella" has been noticed in 7 patients) and investigations permitted to identify the factory of "mortadella" as well as the toxin's type B responsible for these poisoning. It appears clearly that it is important to reinforce hygiene controls. Physicians and specialists in public health must be aware of the severity of this illness, knowing that the recovery is shortened when the treatment is administered on an early stage of the disease.

Adolescent↗
PubMed2003

[Lymphoma revealed by isolated obliquus inferior muscle involvement in exophthalmia].

Orbital lymphomas account for 4% of nontraumatic orbital disorders. We report the case of a 54-year-old patient who presented with binocular diplopia associated with right exophthalmia with an isolated obliquus inferior localization. This lymphomatous localization was unexpected, as lymphomas are described more often in the rectus superior and inferior muscles. Pathological examination found a low-grade non-Hodgkin's MALT lymphoma. This case is the basis of a review of the various diagnoses and the necessity of a biopsy prior to surgical tumor ablation that may damage an oculomotor muscle. Treatment should be medical: first-intention surgery would have abolished obliquus inferior function.

Biopsy↗
PubMed1992

[Clinical forms of acute herpetic infections of the central nervous system in adults].

The authors describe the course of herpetic encephalitis in 52 patients aged 16 to 64 years. Five types of the initial manifestations of herpetic infection of the CNS were revealed. In 44.3% of cases the disease started from the general cerebral symptomatology and consciousness disturbance; in 13.6% it started in a brain stroke-like manner followed by the development of the comatose status; in 13.6% of cases from memory disorder and unmotivated actions; in the same percentage of cases, the disease onset was marked by the dominance of dizziness, diplopia, ataxia and central hemiplegia ; in 15.9% the disease started from pains in the stomach, loin and lower limbs. Hemispheric and pseudotumorous stem encephalitides (48.1 and 13.6% respectively) were predominant; in 25% meningoencephalitides and in the remainder, encephalomyelitis running their course in the form of disseminated encephalomyelitis (5.7%), focal myelitis (5.7%) or opticomyelitis (1.9%). The data presented attest to the pleomorphism of the clinical picture of herpetic lesions of the CNS.

Acute Disease↗
PubMed1965

HUMAN BOTULISM DUE TO COMMERCIAL PRODUCTS.

Two cases of botulism occurred in Montreal following the ingestion of commercially canned liver paste. A toxigenic, proteolytic strain of Clostridium botulinum type B was isolated from the paste in which type B toxin was also demonstrated by animal protection tests. One patient died undiagnosed about 45 hours after eating several liver-paste sandwiches. The second developed diplopia, dysphagia, speech difficulty and weakness 18 hours after ingestion of three bites of a sandwich. All symptoms progressed until admission to hospital where he was treated with 160,000 units of divalent botulinum AB antitoxin over a 72-hour period. Recovery was complete. The need for readily available supplies of both diagnostic and therapeutic botulinum antitoxin to meet such an emergency is stressed.

Adolescent↗
PubMed2003

[What do you actually see? Visual impairments and their simulation for well-seeing subjects].

Most physicians know little about how persons with limited vision perceive something. Sometimes, simple technical aids can make it possible to get an idea as to what a visual disorder means to the person involved. Examples of this are the wearing of glasses of varying positive power and light transmittance, or the study of case histories, paintings and photographic simulations. Among the latter are a woman who painted what she 'saw' with her removed eye, an anophthalmic man who painted from memory, and the painting of a protanopic artist who chose colours by reading the labels on the paint tubes. Thus one may gain insight in disturbances such as phantom images, diminished visual acuity and visual field loss, metamorphopsia, diplopia, dazzling, and visual agnosia. And also in disturbed image fusion, in depth and stereoscopic vision, dark adaptation and colour vision, as well as diminishing visual functions at high age. This article contains colour illustrations that simulate the disturbances.

Aging↗
PubMed1992

Levator-sparing nuclear oculomotor palsy. Clinical and magnetic resonance imaging findings.

Two patients with diplopia presented with unilateral oculomotor palsy, defective elevation of the contralateral eye, and sparing of the levator palpebrae muscle. In each case, magnetic resonance imaging disclosed an infarction of the oculomotor nuclear complex in the mesencephalon. This clinical neuroradiological correlation is consistent with Warwick's scheme pertaining to the neuroanatomy of the oculomotor nuclear complex and demonstrates the utility of MRI in diagnosing ocular motility disorders of brainstem origin.

Aged↗
PubMed2004

Unusual manifestation of subacute sclerosing panencephalitis: case with intracranial high-pressure symptoms.

Subacute sclerosing panencephalitis can show variations in clinical course, and some ophthalmologic abnormalities can be seen as cortical blindness and optic atrophy. A 4-year-old girl was referred to our hospital with a complaint of diplopia, vomiting, and ataxia. On physical examination, she was found to have stage IV papilledema with retinal hemorrhage. She was diagnosed as having idiopathic intracranial high pressure until magnetic resonance imaging demonstrated T2-weighted hyperintense lesions. After observation of head drop attacks and detection of elevated antimeasles antibodies in cerebrospinal fluid, the diagnosis of subacute sclerosing panencephalitis was established, and isoprinosine and carbamazepine were started for treatment. However, because carbamazepine failed to control the head drop attacks, topiramate was also included, and the attacks were kept under control with topiramate. The case presented in this article is a good example of subacute sclerosing panencephalitis in which, at early stages, some of the signs and symptoms can lead to an erroneous diagnosis. In addition, we have demonstrated that topiramate might be a good choice for treatment for the persistent myoclonus seen in this type of patient.

Anticonvulsants↗
PubMed2004

Myasthenia gravis in childhood.

INTRODUCTION: Pathologic alterations in neuromuscular transmission, known as Myasthenia Gravis (MG), comprise combinations (forms) of pre- and post-synaptic changes whose age at onset and clinical manifestations are dissimilar. Some forms have autoimmune features, while others have a defect due to functional or structural plaque alternations. The purpose of this work is to describe the clinical forms of MG seen in childhood, to facilitate proper diagnosis and treatment. MATERIAL AND METHODS: Retrospective data from 87 patients studied at the Ricardo Gutierrez Children's Hospital from 1990 to 2002 are presented. They were evaluated by clinical, pharmacological, electrophysiological, laboratory and radiological exams. RESULTS: Three distinct groups of patients were found: Group 1, Transient Neonatal Myasthenia Gravis (TNMG) represented 6.8% 9 (n=6) of the total number of patients. None of these six patients had ocular involvement. Group 2, Congenital Myasthenia (CMG) represented 17.2% of cases 9 (n=15). These patients had an onset of symptoms from 1 to 12 months of age. Eight cases were sporadic and the remainder familial. The most frequent symptom in this group was bilateral blepharoptosis in 13 patients. Group 3, Juvenile Myasthenia (JMG) comprised 76% of the patients (n=66). The onset of symptoms in this group ranged from 13 months to 14 years (mean 3.6 years). Thirty-nine of these children presented purely with ocular symptoms. CONCLUSIONS: Children with myasthenia gravis may present to the ophthalmologist first, with symptoms such as unilateral or bilateral blepharoptosis, diplopia, strabismus or ophthalmoplegia. Therefore, it is essential that the ophthalmologist be aware of the varied features of this disorder in children in order to diagnosis it correctly and make appropriate treatment referrals.

Adult↗
PubMed2004

Inferior oblique overaction/contracture following retrobulbar anesthesia for cataract extraction with a positive Bielschowsky Head Tilt test to the contralateral shoulder. A report of one case.

BACKGROUND AND PURPOSE: This is a report of a patient with diplopia, hypertropia, extorsion and a positive Bielschowsky Head Tilt Test following retrobulbar anesthesia, due to an inferior oblique muscle overaction-contracture. CASE REPORT: Oculomotor and sensorimotor examinations and ocular motility recordings and Bielschowsky Head Tilt Test demonstrated overaction characteristics overpowering the contracture characteristics of the involved inferior oblique muscle. RESULTS: Weakening of the overacting inferior oblique eliminated the vertical and torsional deviations and the forced head tilt difference upon tilting the head to either shoulder. It also normalized ocular motility and resulted in a symptom-free patient. CONCLUSION: Oblique muscle dysfunction with vertical and torsional deviations and a positive Bielschowsky Head Tilt Test can result from retrobulbar anesthesia.

Anesthesia, Local↗
PubMed2004

[A tolerability study of A cremophor-free albumin bound nanoparticle paclitaxel intravenously administered in patients with advanced solid tumor].

BACKGROUND & OBJECTIVE: Capxol is a Cremophor-free,protein stabilized, nanoparticle formulation of paclitaxel. This phase I study was designed to evaluate the tolerability/safety, toxicity profile, and maximum tolerated dose (MTD) of Capxol administered intravenously in Chinese patients with advanced solid tumor, and to provide the recommending dose for the phase II trial. METHOD: Capxol was administered intravenously over 30 minutes, no premedication was required. Doses of Capxol ranged from 135 to 350 mg/m(2). The treatment was repeated at 3 weeks interval. RESULTS: 22 patients were treated with Capxol and totally 94 treatments cycles were completed. No acute hypersensitivity reactions were observed during the infusion period. The treatment was tolerated well. Most of AEs (95%) were grade 1/2; >/= grade 3 AEs were only 5%. The most common toxicities were mild leucopenia and peripheral sensory neuropathy. The dose-limiting toxicities,which occurred at dose level of 350 mg/m(2),were grade 4 neutropenia (1 out of 3 patients) and grade 3 diplopia (1 out of 3 patients). The MTD was thus determined at 300 mg/m(2). Among 21 patients who were evaluable for efficacy, 1 CR, 7 PR, 9 SD, 4 PD were observed, overall response rate (CR+PR) was 38%. CONCLUSION: This phase I trial has demonstrated that Capxol has several advantages on clinical application, which include non-premedication required, shorter infusion time,higher paclitaxel MTD and safer toxicity. The results support for that a phase II clinical trial to further evaluate the antitumor activity of this drug in Chinese patients is worthy. The recommended dose for phase II clinical trial is 260 mg/m(2), I.V. over 30 minutes,and treatment repeats at every 3 weeks.

Adult↗
PubMed2005

A case of cyclic superior oblique paresis.

BACKGROUND: Cyclic strabismus, which generally has a 24 hours on-off cycle, is an unusual but interesting form of ocular motor disorder. Cyclic deviations are characterized by periods of significant deviation followed by periods of strict orthotropia. In the orthotropic periods, binocular sensoriality and motricity are normal. During the symptomatic phase, in which the deviation is usually significant and permanent, certain sensory anomalies can be found. Although most referred cases are cyclic esotropia, other cyclic oculomotor disorders have been described. In this report, we present a case with a 24 hours on-off cycle superior oblique paresis that resolved with surgery performed during the alternate day rhythm period. CASE REPORT: A 43 year old woman developed an alternate day hypertropia with bothersome diplopia. During the 24 hour "on" cycles she showed a unilateral left superior oblique paresis. The deviation had onset spontaneously 10 years ago with no previous history of strabismus, surgery or trauma. Following left inferior oblique recession and right inferior rectus recession surgery, the eyes have been straight and the cyclic pattern abolished. CONCLUSION: Cyclic vertical deviation due to a superior oblique paresis can be operated on by means of current surgical procedures in the course of the on-off cycle stage; i.e., before the cyclic pattern has been abolished and the deviation becoming permanent.

Adult↗
PubMedDate not supplied

Anterior transposition of the inferior oblique muscle for a snapped inferior rectus muscle following functional endoscopic sinus surgery.

A 55-year-old woman was referred with a 4-month history of diplopia following functional endoscopic ethmoidectomy for chronic sinusitis. She had right hypertropia of 14 prism diopters in the primary position that increased to 30 prism diopters in down gaze. Her right eye showed a moderate limitation of motion in down gaze. Orbital imaging demonstrated a snapped right inferior rectus muscle. The inferior oblique muscle was transposed as an initial treatment for the snapped inferior rectus muscle. After surgery, the patient was orthophoric and obtained fusion in the primary position.

Diplopia↗
PubMed1992

Duane's retraction syndrome.

The clinical findings for 29 patients with Duane's retraction syndrome (DRS) are reported. Similar to other studies, a preponderance of females, left eye involvement, and type I DRS occurred. The incidence of both anisometropia and amblyopia was somewhat higher than for the normal population. Unexpectedly, complaints of diplopia existed for seven patients.

Adolescent↗
PubMedDate not supplied

Acute oculomotor impairment with anti-GQ1b IgG due to central nervous system dysfunction.

We report the case of a patient with isolated central oculomotor impairment and anti-GQ1b antibody. The patient was referred to us with acute vertical diplopia. The neurological examination revealed right internuclear ophthalmoplegia (INO), skew deviation and mild gait ataxia. Extensive laboratory analyses, CSF study, multimodal evoked potentials and brain MRI were normal. Eye movement recording showed saccade dysmetria in addition to the INO. The subjective visual vertical was abnormally tilted to the left. The anti-GQ1b IgG antibody was detectable on serum DOT-BLOT. The brainstem and cerebellar features of the oculomotor impairment suggested that in our patient the anti-GQ1b IgG antibody showed a preferential cross-reaction with central nervous system epitopes. This finding is at variance with previous reports on anti-GQ1b syndrome with acute ophthalmoplegia, all of which argue for a localization of GQ1b epitopes within the peripheral nervous system, even though, in the light of the description of the ocular motor disorder, a central involvement might have co-occurred in this case.

Adult↗
PubMed2006

Orbital metastatic tumour as initial manifestation of asymptomatic gastric adenocarcinoma.

INTRODUCTION: Metastatic orbital tumour from gastric cancer is rare. Patients with metastatic disease may present initially to the ophthalmologist with symptoms from metastases instead of from the primary cancer. CLINICAL PICTURE: We report a case, with clinicopathological correlation, of metastatic gastric adenocarcinoma presenting first in the orbit with diplopia. Computed tomography and magnetic resonance imaging of the orbit showed a well-defined enhancing right intraconal tumour. TREATMENT AND RESULTS: Excisional biopsy was performed and histopathology confirmed a metastatic adenocarcinoma. Focused gastrointestinal screening revealed an otherwise asymptomatic Stage IV gastric adenocarcinoma. Chemotherapy was initiated with good tumour response. CONCLUSION: Early biopsy of unusual orbital tumours is critical as orbital metastases may be the initial manifestation of an asymptomatic primary. Histopathological diagnosis can aid localisation of the primary tumour and allow prompt treatment to be instituted.

Biopsy↗
PubMedDate not supplied

[Cavernous hemangioma of the optical canal and superior palpebral fissure].

The paper describes a rare case of cavernous hemangioma spreading to the optical canal and superior palpebral fissure. The distinctive feature of the case is the location of cavernous hemangioma in anterior two thirds of the optical canal and superior palpebral fissure. In this connection, despite small sizes of a neoplasm, it caused a significant decrease in visual function during 10 months. The first sign of the disease within 10 months before surgery was periodic diplopia, which served as an indication for magnetic resonance imaging that revealed a pathological process and a correction decision was taken to follow up the patient due to visual preservation. Worse vision served as an indication for surgery as further follow-up might result in irreversible sequels. Undertaken active policy proved its worth despite its risk. The used respective supraorbital access permitted radical removal of a neoplasm to recover visual functions.

Adult↗