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Esser J. [Prevention of amblyopia in acute eyelid closure--a new method for keeping the optical axis open by insertion of a small tube]. Klin Monbl Augenheilkd 1998; 213:55-9. [PMID: 9743941 DOI: 10.1055/s-2008-1034945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Complete eyelid closure by capillary eyelid hemangioma or ptosis in the first months of life is an indication for acute measures to prevent amblyopia. Since it is sometimes not possible to hold up the affected upper eyelids with adhesive tape (mechanical obstacle, danger of skin maceration in involvement of the forehead) or not sufficiently (intense divergence), an alternative method will be presented for emergency treatment of blockade of the optical axis. METHODS The eyelids are kept open mechanically with a cylindrical tube of perspex (scleral immersion shell), which is normally used for echography of the anterior segment and for biometry (immersion technique). After surface anesthesia, it can be readily inserted. Its area of contact to the sclera has the form of a scleral shell. A drop of lubricant is applied into the tube at intervals of about five minutes. PATIENTS AND RESULTS In a six-week-old girl with complete eyelid closure owing to a facial hemangioma, adequate eyelid opening could only be achieved by insertion of the scleral immersion shell. In an eleven-months-old boy with complete ptosis and divergence as well as vertical deviation, the optical axis could only be kept open by insertion of the scleral immersion shell and by simultaneous displacement to the temporal side (adhesive tape). The uncomplicated performance for up to two hours daily was initially carried out in the hospital and later by the parents, and could be terminated after five and three and a half weeks, respectively, thanks to improvement due to therapy or spontaneous improvement. CONCLUSIONS Mechanical eyelid opening by insertion of a scleral immersion shell serves to bridge over the time interval to the onset of spontaneous improvement or the success of a causal therapy. The advantages consist in the good handling, also for parents, the low danger of injury and the ubiquitous and rapid availability (basic equipment of an ophthalmological ultrasonography unit).
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Lahbabi M, Levy JD, Laxenaire A, Scheffer P. [Bilateral paralysis of the 6th cranial nerve pair and minor head injury. Apropos of a case. Review of the literature]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 1997; 98:295-8. [PMID: 9471673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We report a case of bilateral switch nerve palsy following minor head trauma. We discuss available literature, frequency and pathophysiology of bilateral abducens nerve palsy after minor head trauma. We also present current knowledge of prognosis and treatment of oculomotor palsies after trauma.
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Otto RA. Restoration of function in the paralyzed rabbit orbicularis oculi muscle by direct functional electrical stimulation. Laryngoscope 1997; 107:101-11. [PMID: 9001273 DOI: 10.1097/00005537-199701000-00020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Restoration of the ability to blink and protect the eye in the patient with facial paralysis remains a challenge. Although many treatments exist, no one approach corrects all the deficits associated with the loss of orbicularis oculi function. In this study, the author investigated the feasibility of restoring function by direct electrical stimulation of the paralyzed orbicularis oculi muscle in the rabbit model. Using a pacing device developed by the author, functional restoration of a normal-appearing blink was produced throughout 30 days of continuous pacing in six rabbits with transected facial nerves. Histologic evaluations of the paced tissues demonstrated no evidence of detrimental effects attributable to the electrical stimulation. The findings of this study support the feasibility of employing direct electrical stimulation to restore the function of paralyzed orbicularis oculi muscles. Potential applications may also exist in other areas in which peripheral denervation creates functional impairment.
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Ducrey N. [Ocular lesions due to diabetes]. SCHWEIZERISCHE MEDIZINISCHE WOCHENSCHRIFT 1996; 126:1610-2. [PMID: 8927966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The main ophthalmological diabetic complications are reviewed, viz. oculomotor disturbance or deviation, optic neuropathy, rubeosis iridis leading to neovascular glaucoma, cataract, and diabetic retinopathy, which is particularly frequent. A brief overview of these various types is presented. The current methods of treatment, which serve to avoid blindness for most patients, are described.
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Lorente L, Porcel JM, Ortíz P, Rubio-Caballero M. [A case of Miller Fisher syndrome with good response to immunoglobulins]. ANALES DE MEDICINA INTERNA (MADRID, SPAIN : 1984) 1996; 13:304. [PMID: 8962966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Yuki N. Tryptophan-immobilized column adsorbs immunoglobulin G anti-GQ1b antibody from Fisher's syndrome: A new approach to treatment. Neurology 1996; 46:1644-51. [PMID: 8649564 DOI: 10.1212/wnl.46.6.1644] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Sera from patients with Fisher's syndrome in the acute phase contain immunoglobulin (Ig)G anti-GQ1b ganglioside antibody. Removal of the autoantibody should lead to earlier recovery with less residual neurologic involvement. A tryptophan- or phenylalanin-immobilized polyvinyl alcohol gel column (IM-TR 350 or IM-PH 350) semiselectively adsorbs such autoantibodies as rheumatoid factor, anti-DNA antibody, or anti-acetylcholine receptor antibody. A batchwise adsorption test showed that an IM-TR gel adsorbed a larger amount of the IgG anti-GQ1b antibody than did an IM-PH column. Several patients with Fisher's syndrome therefore were given immunoadsorbent therapy using the IM-TR column without adverse reactions. An ex vivo plasma perfusion study done with the IM-TR column confirmed that it effectively adsorbs the IgG anti-GQ1b antibody. Results of adsorption tests done with various amino acid-immobilized gels suggest that both the hydrophobic force of the side chain and the anionic charge of the carboxylic acid in tryptophan are important in the adsorption of the autoantibody by the IM-TR gel. Immunoadsorption using the IM-TR column, which does not need replacement fluids, offers an alternative type of plasmapheresis for Fisher's syndrome.
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Mochizuki A, Ota K, Iijima M, Yamauchi T, Iwata M. [A case of relapsing Guillain-Barré syndrome following Miller Fisher syndrome]. Rinsho Shinkeigaku 1996; 36:675-9. [PMID: 8905988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Miller Fisher syndrome (FS) is thought to be a variant of Gullain-Barré syndrome (GBS), both of which rarely relapse. We report a rare case of GBS that followed FS. A 38-year-old woman had ophthalmoplegia, ataxia and areflexia following an upper respiratory tract infection with a diagnosis of FS. Serum anti-GQ1b IgG antibody was found to be increased, but decreased through immunoadsorption as the neurological symptoms of the patient improved. She became completely asymptomatic three months after the onset of FS. Following a common cold two months later, however, she developed weakness of all four limbs and dysesthesia of hands and feet with albuminocytologic dissociation of cerebrospinal fluid, which was consistent with the diagnosis of GBS. Moreover, serum anti-GQ1b IgG antibody had increased again. Anti-GQ1b IgG antibody frequently becomes positive not only in FS but also GBS with ophthalmoplegia. However, the antibody was positive in this particular patient with GBS, even in the absence of ophthalmoplegia. This case suggests that anti-GQ1b IgG antibody might be a common pathogenesis of both FS and GBS.
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Chida K, Watanabe S, Okita N, Takase S, Tagawa Y, Yuki N. [Immunoadsorption therapy for Fisher's syndrome: analysis of the recovery process of external ophthalmoplegia and the removal ability of anti-GQ1b antibodies]. Rinsho Shinkeigaku 1996; 36:551-6. [PMID: 8810848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The beneficial effect of plasma exchange, plasmapheresis or immunoadsorption therapy on Fisher's syndrome, suggested previously, has not been proved since no controlled studies have been conducted. In order to assess the effect of any treatment on Fisher's syndrome, simple and reasonable grading scales for evaluating the major neurological signs are needed. We tried immunoadsorption therapy in four patients with Fisher's syndrome, whose sera had anti-GQ1b antibodies. The clinical course was observed, with assessment of the severity of the major neurological signs based on grading scores; ranging from 0 to 30 for external ophthalmoplegia, from 0 to 10 for ataxia, and from 0 to 16 for areflexia. Tryptophan- or phenylalanine-linked polyvinyl alcohol gel column (TR-350, PH-350) was used as an adsorbent. In a patient who had IgG anti-GQ1b antibody and another patient who had both IgG and IgM anti-GQ1b antibodies, we compared the effectiveness of TR-350 and PH-350 to remove the anti-GQ1b antibody during the therapy. Two patients underwent immunoadsorption therapy at the height of clinical manifestations: in one patient, the therapy was discontinued because of critical hypotension and arrhythmia; the other was given only three sessions of therapy. The other two patients received six or seven sessions during the early recovering stage. All patients recovered without major neurological sequelae. Since ataxia was improved earlier than external ophthalmoplegia, the duration of hospitalization and the time of return to social life depended upon the recovery of external ophthalmoplegia. Analysis of the time course of external ophthalmoplegia score indicated that the improving period and the 50%-recovery day came earlier in the patients who were given a sufficient number of sessions than those who received an insufficient number of sessions. The treatment with TR-350 reduced the IgG anti-GQ1b antibody titer more than that with PH-350, but reduced the IgM anti-GQ1b antibody titer similarly. Immunoadsorption therapy using TR-350 has a probable beneficial effect on Fisher's syndrome even though it is carried out after the height of illness. The evaluation method for the severity of external ophthalmoplegia that we used in the present study is useful for assessing the effect of therapy on Fisher's syndrome.
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Ichikawa H, Suzuki M, Kawamura M, Sugita K, Watanabe Y, Yuki N. [Removal ability of IgG anti-GQ1b antibody in immunoadsorption therapy for Fisher syndrome--comparison of the removal ability between tryptophane column and phenylalanine column]. Rinsho Shinkeigaku 1996; 36:323-329. [PMID: 8752688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Anti-GQ1b antibody seems to be a pathogenetic factor in the development of Fisher syndrome (FS). Although several patients received immunoadsorption therapy (IAT), whether it can remove the autoantibody has not yet been clarified. We treated two patients with FS by IAT using tryptophane column (TR-C) and phenylalanine column (PH-C) (TR-C; 9 times altogether in 2 patients, PH-C: twice altogether in 2 patients), and compared the removal ability of IgG anti-GQ1b antibody and immunoglobulin between TR-C and PH-C. TR-C removed the IgG anti-GQ1b antibodies, IgG, IgA and IgM more than PH-C did. TR-C removed the IgG anti-GQ1b antibody more selectively than non-specific immunoglobulin. In practicing IAT on FS, the use of TR-C rather than PH-C is recommended in view of the removal ability of the autoantibody.
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Deguchi K, Takeuchi H, Takahashi N, Yuki N. [Immunoadsorption therapy on Fisher's syndrome--removal ability of anti-ganglioside antibodies by tryptophan-linked immunoadsorbent]. Rinsho Shinkeigaku 1995; 35:884-8. [PMID: 8665731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
There have been several reports describing that immunoadsorption therapy improves the neurologic involvement in Fisher's syndrome (FS). However, few studies have assessed the usefulness of immunoadsorption therapy in view of the removal ability of anti-GQ(1b) antibody, which may function the development of FS. We examined the ability of immunoadsorbents for the anti-GQ(1b) antibody in a patient with FS. A 28-year-old woman developed diplopia and giddiness following a cough, fever and diarrhea. On admission (day 22), neurologic examination showed bilateral moderate oculomotor paralysis and bilateral complete abducens paralysis. She had areflexia, numbness of middle and ring fingers on the left and mild ataxic gait. Her serum had IgG anti-GQ(1b) and anti-GD(1b) antibodies. We examined the absorption of anti-ganglioside antibodies onto a polyvinyl alcohol gel (PVA), a phenylalanine-linked PVA (PH-350) and a tryptophan-linked PVA (TR-350) by the batchwise adsorption method. TR-350 absorbed the autoantibodies, but the removal ability of autoantibody by PVA and PH-350 was not proved. The FS patient was treated with TR-350 (days 29, 34 and 43) and PH-350 (day 39). Anti-GQ(1b) and anti-GD(1b) antibodies were significantly removed by the TR-350, in accordance with the results of the in vivo study. There was little loss of albumin as compared with the immunoglobulins and complements. The numbness and ataxia disappeared on day 44. The diplopia disappeared on day 106. TR-350 would be better than PH-350 in the treatment of FS by immunoadsorption therapy.
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Bingisser R, Speich R, Fontana A, Gmür J, Vogel B, Landis T. Lupus erythematosus and Miller-Fisher syndrome. ARCHIVES OF NEUROLOGY 1994; 51:828-30. [PMID: 8042933 DOI: 10.1001/archneur.1994.00540200108024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To compare the clinical course of an unusual case of Miller-Fisher syndrome in systemic lupus erythematosus with therapeutic interventions, in particular with plasma exchanges. DESIGN The clinical state and laboratory and electrophysiologic parameters were controlled for over a year and related to therapeutic attempts with immunoglobulins, steroids, and plasma exchanges. SETTING Medical intensive care unit of a university hospital. PATIENT A 17-year-old black female student with known systemic lupus erythematosus who developed ataxia, are flexia, and ophthalmoplegia (Miller-Fisher syndrome) and later became tetraplegic and required full mechanical ventilatory support. RESULTS High-dose immunoglobulin treatment combined with corticosteroid pulse therapy was not beneficial. However, plasma exchange (performed five times over a period of 4 months) was followed by a striking clinical improvement within hours after each plasma exchange. CONCLUSIONS Plasma exchange appears to remove a yet unknown agent producing a distal motor nerve conduction block and is efficacious in severe neuropathy associated with Miller-Fisher syndrome in lupus erythematosus.
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Sado K, Kimura T, Hotta Y, Sakuma H, Hayakawa M, Kato K, Kanai A. Acute retinal necrosis syndrome associated with herpes simplex keratitis. Retina 1994; 14:260-3. [PMID: 7973122 DOI: 10.1097/00006982-199414030-00013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although acute retinal necrosis (ARN) syndrome is caused by a herpes group virus, association of herpetic keratitis with ARN syndrome is uncommon. A case of unilateral ARN syndrome with herpes simplex keratitis is discussed. METHODS A 40-year-old man developed unilateral keratitis, necrotic retinitis, retinal vasculitis, vitritis, and iritis consistent with ARN syndrome 1 month after treatment for ipsilateral facial nerve palsy and auricular herpetic vesicles (Tolosa-Hunt syndrome). Impression cytologic examination of the corneal epithelial ulcer that developed concurrent with the intraocular findings and of the aqueous humor (obtained by paracentesis) was performed. RESULTS Cells that reacted with anti-herpes simplex virus type 1 (HSV-1) antibody were detected on impression cytology, and DNA fragments corresponding to the HSV-1 DNA sequence were detected in the aqueous humor. CONCLUSION This case shows that ARN syndrome may, on rare occasions, be associated with herpes keratitis secondary to HSV-1.
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Zifko U, Drlicek M, Senautka G, Grisold W. High dose immunoglobulin therapy is effective in the Miller Fisher syndrome. J Neurol 1994; 241:178-9. [PMID: 8164023 DOI: 10.1007/bf00868348] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Yuki N, Miyatake T, Ohsawa T. Beneficial effect of plasmapheresis on Fisher's syndrome. Muscle Nerve 1993; 16:1267-8. [PMID: 8413383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Thomas R, Mathai A, Rajeev B, Sen S, Jacob P. Botulinum toxin in the treatment of paralytic strabismus and essential blepharospasm. Indian J Ophthalmol 1993; 41:121-4. [PMID: 8125543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
As an alternative to conventional medical and surgical modalities that have met little success in the treatment of paralytic strabismus and essential blepharospasm, we explored the use of botulinum toxin as a treatment of choice in these two disorders. We used botulinum toxin in three patients with paralytic strabismus and in nine patients with essential blepharospasm. In three patients with paralytic strabismus, the botulinum toxin was injected into the ipsilateral antagonist of the paralysed muscle. The preinjection deviations ranged from 18 to 60 prism diopters. Two of these three patients achieved orthotropia around the thirtieth day and thereafter maintained it. The third patient became orthotropic on the eighteenth day, but deviation recurred and therefore required another injection of toxin. In nine patients with essential blepharospasm, botulinum toxin was injected into the orbicularis oculi muscles. Both objective and subjective improvement occurred in all nine patients within seven days and the effect lasted 12 to 15 weeks. Further injection of the toxin produced extremely beneficial results. However, the only significant complication that we encountered in both groups of strabismus and blepharospasm was ptosis, which was usually partial and temporary. From our experience, we advocate the use of botulinum toxin in the treatment of essential blepharospasm.
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Eggenberger ER, Coker S, Menezes M. Pediatric Miller Fisher syndrome requiring intubation: a case report. Clin Pediatr (Phila) 1993; 32:372-5. [PMID: 8344052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In 1956, C. Miller Fisher described a clinical syndrome of ophthalmoplegia, ataxia, and areflexia. This syndrome, which now bears his name, shares certain features with the Guillain-Barré syndrome (GBS) and generally follows a benign, restricted clinical course, especially in the pediatric population. The authors report a pediatric case of Miller Fisher syndrome (MFS) who subsequently required intubation and mechanical ventilation.
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Saldana KK, Rouse MW. Differential diagnosis of an isolated inferior oblique paresis vs. Brown's syndrome: a case report. JOURNAL OF THE AMERICAN OPTOMETRIC ASSOCIATION 1993; 64:353-8. [PMID: 8320419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The primary care optometrist is often faced with evaluating and diagnosing oculomotor anomalies. Non-concomitant deviations can be especially challenging because of the additional skill and knowledge needed for differential diagnosis. The following case illustrates the diagnostic process involved in differentiating inferior oblique paresis from Brown's syndrome. The clinical features, incidence, etiology and management considerations of each condition are discussed.
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Arakawa Y, Yoshimura M, Kobayashi S, Ichihashi K, Miyao M, Momoi MY, Yanagisawa M. The use of intravenous immunoglobulin in Miller Fisher syndrome. Brain Dev 1993; 15:231-3. [PMID: 8214351 DOI: 10.1016/0387-7604(93)90071-f] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We report a patient with Miller Fisher syndrome who was treated with an intravenous high-dose of immunoglobulin. This syndrome is considered to be a benign variety of acute inflammatory demyelinating polyneuropathy (Guillain-Barré syndrome). However, there have been several reports of the need for ventilatory support and a few cases have had a fatal outcome. We observed a case of progressive Miller Fisher syndrome in a 3-year-old boy. Following 2 episodes of apnea lasting about 50 s each, he was treated with intravenous immunoglobulin (400 mg/kg/day) for 5 consecutive days. His respiratory state, general muscle strength, truncal ataxia and emotional state improved remarkably after this therapy.
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Abstract
We present the work-up and treatment for 25 patients with inferior oblique palsy, including 2 with bilateral inferior oblique palsy and 23 with unilateral inferior oblique palsy. Nineteen patients were adults over the age of 21 years, and six were children under the age of 10 years. Sixteen adults and two children underwent CT scanning of the head. All scans were normal. Eight adults also underwent MRI evaluation of the head. These also were all normal. All adults had a negative Tensilon test for myasthenia gravis. The majority presented with a head tilt to the side of the paretic muscle. None of these patients complained of tilting images, but incyclotorsion was measurable in all cases that were tested. The most important conclusion from this study is that inferior oblique palsy is a benign entity, with none of these patients having a brain tumor or myasthenia gravis.
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De La Paz MA, Chung SM, McCrary JA. Bilateral internuclear ophthalmoplegia in a patient with Wernicke's encephalopathy. JOURNAL OF CLINICAL NEURO-OPHTHALMOLOGY 1992; 12:116-20. [PMID: 1629372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The most common cause of bilateral internuclear ophthalmoplegia is multiple sclerosis. Wernicke's encephalopathy has been reported as a cause of unilateral internuclear ophthalmoplegia but not of bilateral internuclear ophthalmoplegia. In this report, we present the case of a patient with a history of alcohol abuse and acute onset of bilateral internuclear ophthalmoplegia whose clinical course and diagnostic studies are most consistent with a diagnosis of Wernicke's encephalopathy.
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Watson NJ, Dick AD, Hutchinson CH. A case of sinusitis presenting with spheno-cavernous syndrome: discussion of the differential diagnosis. Scott Med J 1991; 36:179-80. [PMID: 1805379 DOI: 10.1177/003693309103600606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 60 year old gentleman presented with a left spheno-cavernous syndrome resulting in impaired ocular motility, proptosis and visual loss in an otherwise clinically quiet eye. The history led to a clinical suspicion of posterior ethmoiditis, which was confirmed on C.T. scanning. Surgical drainage and antibiotic treatment resolved the symptoms, but visual impairment persisted. The differential diagnosis and management of spheno-cavernous syndrome is discussed in context with this atypical presentation of orbital cellulitis.
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Bakheit AM, Behan PO, Melville ID. Bilateral Internuclear Ophthalmoplegia as a False Localizing Sign. Med Chir Trans 1991; 84:627. [PMID: 1744854 PMCID: PMC1295569 DOI: 10.1177/014107689108401024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Wong CL, Chiu WT, Wang JH. [Tolosa-Hunt syndrome--case report]. ZHONGHUA YI XUE ZA ZHI = CHINESE MEDICAL JOURNAL; FREE CHINA ED 1991; 48:71-5. [PMID: 1653097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This is a case of a 38-year-old male who developed painful ophthalmoplegia two years after head injury. Under the impression of Tolosa-Hunt syndrome, the patient received long term unsustained oral steroid therapy for two years. Persistent growth of the parasellar lesion was confirmed by computed tomography. Due to the aggravation of the symptoms, craniotomy and partial parasellar granulation tissue extirpation were performed. Symptoms were then gradually subsided. The pathological study confirmed the presence of granulation tissue with marked acute and chronic inflammatory cells. No evidence of malignancy was noted. No further steroid treatment was rendered to the patient and he was well in the following 18 months after the operation.
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Salerno GM, Bleicher JN, McBride DM. Restoration of paralyzed orbicularis oculi muscle function by controlled electrical current. J INVEST SURG 1991; 4:445-56. [PMID: 1777439 DOI: 10.3109/08941939109141175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A canine model of facial nerve paralysis was studied to apply controlled electrical current to the peripherally denervated orbicularis oculi muscle, in the attempt to effectively restore the absent function of this denervated muscle. After unilateral facial nerve neurotmesis was performed in eight dogs, the denervated orbicularis oculi muscles of four dogs were electrically stimulated for 75 postoperative days (40 min/day). Denervated and normal orbicularis oculi muscles were electrophysiologically studied and compared with the Student t test. During the study period, minimum closure of denervated treated orbicularis oculi muscles was evoked with average stimulus strength (80-ms duration) of 1.61 +/- 0.22 log mA x ms, not significantly different from that of denervated nontreated or normal orbicularis oculi muscles. From days 10 through 30 only, maximum closure of denervated treated orbicularis oculi muscles was achieved with mean pulse strength (80-ms duration) of 2.37 +/- 0.09 log mA x ms, significantly lower (P less than .01) than that evoking the same type of contraction from denervated nontreated muscles (80-ms duration, mean 2.83 +/- 0.10 log mA x ms). In addition, denervated treated muscle pulse strength eliciting maximum contraction was not significantly different from that of normal orbicularis oculi muscles during the same period. This finding was not observed, however, from day 40 through the end of the study. This investigation demonstrates (1) the transient reversal of denervation changes of paralyzed orbicularis oculi muscle by daily electrical stimulation, and (2) the feasibility of restoring orbicularis oculi muscle function by controlled electrical current.
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