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PubMedDate not supplied

[Reconstruction of the lower orbital wall in the remote posttraumatic period].

The authors share their experience gained in the treatment of 11 patients with different fractures of the lower orbital wall in remote periods after the injury (1 month to 4 years). A specific feature of late injury in all the patients we observed were disorders of binocular vision presenting as diplopia due to cicatricial changes in the orbit. X-Ray examinations showed deep fractures of the lower orbital wall involving the posterior half of the orbital space in all cases. An operation had to be performed in all the patients: inferior orbitotomy via a transcutaneous access combined with anterior highmorotomy and submucosal refracture of the upper wall of the maxillary sinus within the framework of improperly consolidated fracture along the borders of the orbital hernia. The choice of this operation was dictated by specific localization of the fractures (zones difficult to access), solidity of scar growth at the site of the fracture (because of long period elapsed after the injury), and by limited possibility of intervention via an isolated transorbital access. An accessory element: refracture of the lower deformed wall and its reposition in the proper state helped repair the defect in the wall with a homocartilage on the side of strips and the orbit. Binocular vision and mobility of the eyeball in the orbit were repaired in all the patients, the degree of posttraumatic enophtalmos was appreciably decreased.

Adult↗
PubMed1996

Effect of chronic alcohol intake on energy metabolism in human muscle.

We investigated the effect of alcohol on muscle energy metabolism by using 31P magnetic resonance spectroscopy in 12 chronic alcoholics [6 with neurological signs and symptoms (such as cerebellar ataxia or diplopia) and 6 without neurological signs or symptoms], compared with five healthy subjects who also received acute alcohol loading. Intracellular pH and phosphocreatine (PCr) index [PCr/ (PCr + Pi)] were measured during rest, exercise, and recovery in the left flexor digitorum superficialis muscle. In healthy subjects, acute alcohol loading did not influence the changes of muscle pH and PCr index. Alcoholics with neurological signs showed marked decreases in muscle intracellular pH and PCr index during exercise and a marked delay of pH recovery after exercise. There was no delay of PCr index recovery. Alcoholics without neurological signs showed slight decreases in intracellular pH and PCr index, but rapid recovery of both intracellular pH and PCr index was observed. Marked decrease and delayed recovery in pH, but rapid recovery of PCr index, indicate that the muscle of patients with neurological signs produced lactate during and after exercise to maintain the ATP level, which implies that anaerobic metabolism is favored over aerobic metabolism in these patients.

Adult↗
PubMed1996

[The coral orbital floor. Its value in traumatology. The results of a multicenter study of 83 cases].

A madreporic coral graft was used for orbital floor reconstruction following facial trauma. This report presents a multicentric study of 83 patients with a follow-up period of 15 to 24 months. The results of this study indicate no significant rejection or infection opposed to so many synthetic implants outcome. The radiological follow-up demonstrates a partially resorption of the implant within about 2 years and its replacements by new bone. Coral implant was used to correct enophthalmos or diplopia due to enlarged orbital dimensions. It was technically easy to insert and its anatomic shape does not require to be fashioned before use. Its inflexibility allows to bridge large bone defects and this implant should be considered as an attractive alternative to autogenous grafts, avoiding a second surgical site, in reconstructing orbital floor fractures.

Adolescent↗
PubMed1996

[Non-paralytic pontine exotropia with alternating exotropia].

We report a patient with pontine infarction who showed non-paralytic pontine exotropia (NPPE) with alternating exotropia. An 81-year old woman developed diplopia and gait disturbance. On the fourth day, she was admitted to our hospital. Oculomotor findings on admission showed that the ocular position of the left eye on forward gaze was fixed at the midline, while the right eye was abducted. When she was instructed to use the right eye for forward gaze, the left eye deviated outward. On right gaze, the left eye was not abducted and monocular nystagmus was noted in the abducted right eye. Upper gaze was limited in the right eye and convergence was not possible. The remaining ocular movements were intact. On cranial CT performed on eye closure, the left eye was abducted and the right eye was fixed at the midline. Brain MRI showed cerebral infarction located in the left paramedian portion of the middle pontine tegmentum with involvement of the medial longitudinum fasciculus (MLF) and in the ventral site of the upper pons. On the 16th day, right exotropia disappeared on eye opening without forward gaze, but forward gaze easily induced outward deviation of the right eye. On the 39th day, right exotropia on forward gaze had almost disappeared. However, left MLF syndrome and abnormal convergence were persistent when she discharged on the 76th day. In conjunction with oculomotor and neuroradiological findings, the NPPE with alternating exotropia in our patient may be due to severe MLF damage and secondary hyperactivity of the contralateral paramedian pontine reticular formation.

Aged↗
PubMed1997

[The current potentials of maxillofacial surgery].

Autotransplants of membranous origin and titanium constructions were used in 462 patients with posttraumatic defects and deformations of the upper and medium zones of the facial skeleton. Stable functional and cosmetic results were attained in repair of diplopia and enophthalmos. Surgical methods proposed by the authors accelerate patients' rehabilitation.

Bone Transplantation↗
PubMed1997

[Painful ophthalmoplegia disclosing dural fistula of the anterior cranial fossa].

We report the case of a 54-year-old man without previous medical history who presented with sudden vertical diplopia and frontal headache. Clinical examination and Lancaster's test were consistent with superior rectus muscle palsy. Brain CT scan, MRI and CSF examination were normal. Cerebral angiography revealed a dural arteriovenous fistula at the base of the anterior cranial fossa with bilateral arterial supply from small branches of the ophthalmic artery. The causal relationship, the pathophysiology and the therapeutic approaches are discussed.

Arteriovenous Fistula↗
PubMed1997

Neuro-ophthalmologic aspects of aneurysms.

The visual pathways and the ocular motor cranial nerves are frequently injured by expanding cerebral aneurysms. Neuro-ophthalmologic signs and symptoms may be the only indications of an aneurysm prior to rupture. Acute or chronic visual loss may herald an aneurysm prior to rupture. Acute or chronic visual loss may herald an aneurysm in the carotidophthalmic, supra clinoid carotid, internal carotid bifurcation, or anterior communicating artery distributions. Diplopia and retro-orbital pain may be warning signs that precede the discovery of a posterior communicating, basilar, or cavernous sinus aneurysm.

Acute Disease↗
PubMed1976

Complications in the treatment of facial fractures.

The evaluation and treatment of the more common and severe complications of facial fractures are reviewed. This analysis includes such conditions as nonunion and malunion of the maxilla, mandible, and zygoma, temporomandibular ankylosis, diplopia, enophthalmos, hypertelorism, dacrocystitis, and cerebrospinal otorhinorrhea. The discussion attempts to stress the importance of diagnosis regarding cosmesis and functional abnormalities. When possible, the pathophysiology is elucidated and evaluated to decide about methods of prevention. Preferred traditional and improved techniques of management are noted and compared to some of the less satisfactory procedures.

Ankylosis↗
PubMed1996

[Internuclear bilateral pseudo-ophthalmoplegia and dermatomyositis].

A 60 year-old woman complaining of diplopia presents an ocular motility disturbance mimicking internuclear ophthalmoplegia. Idiopathic dermatomyositis is diagnosed by the help of clinical, biological, electrophysiological and histological data. The outcome is favorable under corticotherapy. Ocular muscle involvement is rare in dermatomyositis. An overlap syndrome with another auto-immune disorder like myasthenia should be excluded in this kind of manifestation.

Dermatomyositis↗
PubMed1997

[Complications of silastic implants used in orbital repair].

Several questions concerning the material to be used for surgical repair of fractures of the orbit are still under debate. Surgeons may choose between autologous or heterologous grafts or different biomaterials. We conducted a retrospective analysis of 137 patients treated in our unit for fractures of the floor of the orbit over the last 20 years who received a silastic implant. After 20 years, the rate of complications requiring removal of the implant was 13.8%. Complications observed were dacryocystitis, implant migration to the skin and the maxillary sinus, skin fistula, persistent diplopia, communication between the orbit and the sinus, periorbit cellulitis.

Biocompatible Materials↗
PubMed1998

Ocular tilt reaction with vertical eye movement palsy caused by localized unilateral midbrain lesion.

A 60-year-old man developed diplopia and experienced difficulty moving his eyes. Vertical movement of each eye, including vestibulo-ocular reflex and smooth pursuit, was extremely limited. Horizontal eye movements were normal. His head position was tilted toward his left. There was 10 prism diopters of exotropia and 10 prism diopters of right hypertropia. Fundus photographs revealed a clockwise torsion of both eyes. These signs indicate leftward ocular tilt reaction. Magnetic resonance imaging showed a small area of an increased signal intensity localized in the midbrain dorsomedial to the red nucleus on the right side. Based on recent experimental evidence, it may be assumed that the unilateral lesion involving the right interstitial nucleus of Cajal most probably caused leftward ocular tilt reaction in our patient.

Cerebral Hemorrhage↗
PubMed1998

Pseudotumor cerebri sine papilledema with unilateral sixth nerve palsy.

A 17-year-old woman presented with a history of 1-week of headache and 3 days of horizontal diplopia. Examination revealed 20/20 vision in both eyes, no papilledema, and an abduction deficit in her left eye. Lumbar puncture revealed an opening pressure of 440 mm H2O. After treatment with acetazolamide, the headache and abduction deficit resolved. Papilledema never developed. This is a unique case of pseudotumor cerebri sine papilledema with a unilateral abduction deficit. We suggest that young women with headache and unilateral abduction deficits may be unrecognized cases of pseudotumor cerebri.

Abducens Nerve↗
PubMed1998

[Ocular myasthenia: clinical course and strategies for treatment].

INTRODUCTION: Ocular myasthenia gravis is a localized form of myasthenia in which only the extra-ocular muscles are clinically affected, namely the levator palpebrae superioris and orbicularis oculi. Two years after onset of the ocular condition, it became generalized in 44-53% of the patients. OBJECTIVE: 1. To describe the clinical features, diagnostic characteristics and clinical course of seven patients who fulfilled the criteria for diagnosis of ocular myasthenia and in whom the condition did not become generalized: 2. Review recent papers on this. Material and methods. We studied seven patients (two men and two women) diagnosed as having ocular myasthenia gravis, and followed them up for at least three years. RESULTS: The average age was 56.5. The clinical findings were of ptosis of the eyelids and diplopia. All seven patients were treated with pyridostigmine. In six cases prednisone was also given and in one patient thymectomy was done. There was a satisfactory result in all cases. CONCLUSIONS: The basic treatment of ocular myasthenia is with anticholinesterases and corticosteroids. Occasionally other immunosuppressives may be required. Prednisone seems to reduce the number of patients who go on to develop the generalized form.

Adult↗
PubMed1998

[Midbrain ptosis with diurnal fluctuation like myasthenia].

A 51-year-old man was admitted because of bilateral fatigable blepharoptosis with diurnal fluctuation. He had a tendency to take much instant foods before onset. On admission, he showed symmetrical bilateral ptosis, supranuclear upward gaze palsy and vertical diplopia. Ptosis mildly improved on lateral or upward gaze. Bell's phenomenon and pupillary response were intact. Intravenous edrophonium infusion test and serum antiacetylcholine receptor antibody were negative. Cranial MRI and CT demonstrated the lesion in the periaqueductal gray (PAG) region from superior colliculus to upper pontine level, which was remarkably enhanced by Gd-DTPA infusion. He was diagnosed as midbrain ptosis, probably due to atypical Wernicke's encephalopathy. It was conceivable that the PAG lesion might be contributory to fatigable blepharoptosis (pseudomyasthenia) and supranuclear upward gaze palsy in the present case, because the PAG controls levator palpebrae neurons of central caudal nucleus in oculomotor nucleus complex and receives afferents from the limbic system., reticular formation and posterior commissure.

Blepharoptosis↗
PubMed1998

Elevation of serum tumor marker CA 15.3 levels as the first manifestation of metastatic breast cancer to the cavernous sinus.

We report rising tumor marker levels of CA 15.3 as the presenting manifestation of metastatic breast cancer to the cavernous sinus and orbit. A 39-year-old woman with a history of breast cancer developed increasing levels of tumor marker CA15.3. Ten months later, she developed vision loss in the right eye, diplopia, and right-sided ptosis. A magnetic resonance scan of the head showed a mass involving the right cavernous sinus and superior orbital fissure. Biopsy of the lesion showed metastatic breast cancer. She was treated with surgery and radiotherapy and did well. Ophthalmologists should be aware of the significance of increasing levels of tumor markers, such as CA 15.3, in patients with a history of breast cancer and new neuroophthalmologic signs or symptoms.

Adenocarcinoma↗
PubMedDate not supplied

[Retraction nystagmus of vascular origin].

We report a case of a 42-year-old woman who was referred for diplopia. She appeared to have a convergence retraction syndrome and loss of vertical gaze. The clinical course led to a diagnosis of thromboembolic cerebrovascular event in the region of the posterior commissure on the basis of risk factors such as smoking and oral contraceptive use. The final outcome was rapidly favorable.

Adult↗
PubMed1998

[Nervous system borreliosis with pseudo-lymphoma cells in cerebrospinal fluid].

We report the case of a 44-year-old woman, who experienced acute back pains, leg paraesthesia, and diplopia. Analysis of the cerebrospinal fluid revealed, in addition to increased protein and decreased glucose levels, an elevated number of large atypical cells, resembling lymphoma cells. Magnetic resonance imaging of the brain and spine was normal. High levels of antibodies against Borrelia burgdorferi were found in both serum and cerebrospinal fluid. The patient completely recovered with ceftriaxone therapy.

Adult↗