摘要:

The objective of this article was to evaluate the etiologies, findings, and treatment of ocular neuromyotonia (ONM) in three case reports. The etiologies of ONM were determined by the histories, neuroradiologic tests, or biopsies. Clinical observations, videotaping, and electronic eye movement recordings documented the eye movement abnormalities. Intermittent diplopia developed several years after myelography with thorium dioxide (Thorotrast), radiation treatment for a pituitary tumor, and radiotherapy for medulloblastoma of the posterior fossa. All of the patients had intermittent, variable tropias that occurred spontaneously or were induced by eccentric gaze. One patient had a partial third nerve palsy, and another had a unilateral internuclear ophthalmoplegia (INO). ONM involved the paretic third nerve, extraocular muscles, and ipsilateral lateral rectus muscle in one patient, the paretic medial rectus muscle (INO) in one patient, a lateral rectus muscle (INO) in one patient, and a lateral rectus muscle in the last patient. Eye movement recordings were consistent with spasms of the involved muscles. Carbamazepine (Tegretol) abolished the ONM in two patients. The other patient had been taking carbamazepine for seizures and developed ONM when the dose was decreased. Increasing the dose abolished the ONM. ONM is an unusual cause of intermittent diplopia and strabismus, but its distinctive history and signs identify it easily. Damage to the peripheral cranial nerves might produce segmental demyelination, axonal hyperexcitability, and a self-perpetuating, reverberating circuit that causes spasms of the extraocular muscles.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Our objective was to describe and expand the clinical spectrum of a rarely detected, previously reported photoreceptor disorder restricted to the foveal cones. Three patients with bilaterally decreased acuity and hemeralopia were examined to exclude a structural, vascular, inflammatory, or degenerative process. Each patient underwent a full neuroophthalmic examination, including full-field and focal cone electroretinogram (ERG). All three patients had normal-appearing fundi, mild dyschromatopsia, central or paracentral visual field depressions, normal full-field photopic and scotopic ERGs, and markedly reduced focal, foveal cone ERG responses. One patient had a ring scotoma and an asymptomatic family member with abnormal full-field and focal cone ERG. The syndrome of acquired foveal cone dysfunction presents as a bilateral, painless, progressive central visual loss with minimal or absent fundus changes. It eludes diagnosis until focal, foveal cone ERG is performed.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article describes the effects of topically applied capsaicin (a nociceptive substance-P suppressor) in patients with neuropathic periocular or facial pain. Peripheral neuropathic pain is a major cause of periocular or facial discomfort and usually follows injury to a subcutaneous peripheral nerve. Though the damage is local, the pain tends to radiate. We studied three patients who complained of a 2− to 30-year history of fluctuating pain in the periocular area. All three had an area of point tenderness that responded to the topical application of capsaicin cream.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A 2-year and 7-month-old boy had sudden visual loss in both eyes and showed bilateral optic neuritis without systemic symptoms. Steroid therapy improved his visual acuity from 0.077 and 0.053 to 1.0 at 7 months after onset. Magnetic resonance imaging (MRI) of the brain showed high density in both optic nerves and multiple lesions in the white matter that were enhanced by gadolinium. We considered the diagnosis of demyelinating disease. Follow-up MRI showed no abnormal lesion. Both transient and steady-state pattern visually evoked cortical potentials were nondetectable at the onset, and the P100 component of the transient pattern reversed visually evoked cortical potential appeared to be delayed thereafter. It has since become shorter in parallel with visual acuity improvement.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A 37-year-old man with bilateral optic neuropathy who recovered on steroid treatment is described. He was subsequently found to be human immunodeficiency virus 1 (HIV-1) positive prior to the onset of his visual symptoms, and no other cause of his optic neuropathy could be found. There is some evidence that HIV itself may be a cause of symptomatic optic neuropathy. A spontaneously relapsing and remitting multiple sclerosis-like syndrome has previously been described in HIV-positive patients, and this may present with optic neuritis. A chronic optic neuritis in HIV-positive patients that is not usually symptomatically important has also been described. We review the literature related to these topics and our patient.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Progressive, sequential visual loss in the left and then right eye was reported in a 73-year-old male over three months. The presence of a family history of visual loss and the lack of other findings in association with bilateral cecocentral scotomata led to a diagnosis of new onset Leber's hereditary optic neuropathy, confirmed by the presence of a mutation at the 11778 position. This case illustrates that Leber's hereditary optic neuropathy may manifest late in life.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

A 37-year-old man with a history of sarcoidosis, hypertension, asthma, depression and prior intravenous drug use presented with complaints of difficulty in finding his way around the house, headache, and blurred vision in both eyes. The symptoms had been increasing in severity over the prior several months. Physical examination showed normal visual acuity, pupil reactions, and fundi but severe, circumferential constriction of the visual fields bilaterally. The visual fields enlarged appropriately on increasing the distance from the patient to the tangent screen. Neuroimaging revealed bilateral, occipital meningeal involvement and parenchymal lesions consistent with sarcoidosis. Treatment with oral corticosteroids produced a mild subjective improvement in the patient's symptoms and stabilized the visual fields, without improving them. This case represents an unusual presentation of presumed neurosarcoidosis involving the visual pathways at the level of the occipital lobes.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The eyelid-mounted accelerometer can pick up the acceleration waveform of the eye during horizontal eye movements. The acceleration profile comprises high-amplitude pulsatile activity in the saccade and changes in the level of background ocular microtremor related to eye position. Adducting saccades of 20° were recorded in eight patients with partial internuclear ophthalmoplegias caused by multiple sclerosis and in eight age-matched healthy subjects. The initial pulse of acceleration activity was reduced by 85% in the patients. In the worst-affected cases, adducting saccades were associated only with an increase in the level of background ocular microtremor in the acceleration trace. The results confirm the hypothesis that an internuclear ophthalmoplegia is due to the loss of the pulse signal to ocular motor neurons, with preservation of the step signal in an adducting saccade.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

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.

ISSN:1070-8022    

出版商:OVID    

年代:1998

数据来源: OVID