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Nakamura K, Fuchigami T, Morioka S. Eye movement training and gaze analysis for a patient with binocular diplopia after traumatic brain injury: a case report. J Med Case Rep 2023; 17:551. [PMID: 38110994 PMCID: PMC10726626 DOI: 10.1186/s13256-023-04221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Patients with traumatic brain injury often develop sequelae such as eye movement disorders, including diplopia. Eye movement training is effective in diplopia management. However, few longitudinal follow-up studies have been conducted from the subacute disease stage, owing to the complexity of methods for quantifying diplopia. CASE PRESENTATION The patient is a 30-year-old Japanese man who presented with diplopia and underwent eye movement training for approximately 4 weeks. The angle of diplopia, distance of abduction of the eye, gaze analysis, and self-assessment of diplopia using Holmes' diplopia questionnaire were evaluated. The degree of diplopia increased from 12° to 40° on the right side. The distance of eye abduction increased from 10.4 to 12.8 mm. The self-assessment score improved from 76 to 12 points. Analysis of gaze transition revealed a reduction in the error between the target and gaze. CONCLUSION Eye movement training was successful in ameliorating the symptoms of diplopia in the patient with binocular diplopia. Furthermore, for patients with diplopia symptoms, it was suggested that the oculomotor approach to eye movement training should not only focus on the direction of the diplopia but also on the direction opposite to the diplopia (the weak side).
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Affiliation(s)
- Kaneharu Nakamura
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
| | - Takeshi Fuchigami
- Department of Rehabilitation, Eishinkai Kishiwada Rehabilitation Hospital, 2-8-10, Kanmatsucho, Kishiwada, Osaka, 596-0827, Japan.
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan.
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan.
| | - Shu Morioka
- Stroke Rehabilitation Research Laboratory, Eishinkai Kishiwada Rehabilitation Hospital, Kishiwada, Osaka, Japan
- Neurorehabilitation Research Center, Kio University, Kitakatsuragi-gun, Nara, Japan
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Sunyer-Grau B, Quevedo L, Rodríguez-Vallejo M, Argilés M. Comitant strabismus etiology: extraocular muscle integrity and central nervous system involvement-a narrative review. Graefes Arch Clin Exp Ophthalmol 2023:10.1007/s00417-022-05935-9. [PMID: 36680614 DOI: 10.1007/s00417-022-05935-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 01/22/2023] Open
Abstract
Strabismus is not a condition in itself but the consequence of an underlying problem. Eye misalignment can be caused by disease, injury, and/or abnormalities in any of the structures and processes involved in visual perception and oculomotor control, from the extraocular muscles and their innervations to the oculomotor and visual processing areas in the brain. A small percentage of all strabismus cases are the consequence of well-described genetic syndromes, acquired insult, or disease affecting the extraocular muscles (EOMs) or their innervations. We will refer to them as strabismus of peripheral origin since their etiology lies in the peripheral nervous system. However, in most strabismus cases, that is comitant, non-restrictive, non-paralytic strabismus, the EOMs and their innervations function properly. These cases are not related to specific syndromes and their precise causes remain poorly understood. They are generally believed to be caused by deficits in the central neural pathways involved in visual perception and oculomotor control. Therefore, we will refer to them as central strabismus. The goal of this narrative review is to discuss the possible causes behind this particular type of eye misalignment and to raise awareness among eyecare professionals about the important role the central nervous system plays in strabismus etiology, and the subsequent implications regarding its treatment. A non-systematic search was conducted using PubMed, Medline, Cochrane, and Google Scholar databases with the keywords "origins," "causes," and "etiology" combined with "strabismus." A snowball approach was also used to find relevant references. In the following article, we will first describe EOM integrity in central strabismus; next, we will address numerous reasons that support the idea of central nervous system (CNS) involvement in the origin of the deviation, followed by listing several possible central causes of the ocular misalignment. Finally, we will discuss the implications CNS etiology has on strabismus treatment.
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Affiliation(s)
- Bernat Sunyer-Grau
- School of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Lluïsa Quevedo
- School of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain.
| | | | - Marc Argilés
- School of Optics and Optometry, Universitat Politècnica de Catalunya, Terrassa, Spain
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3
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Ortiz JF, Eissa-Garces A, Ruxmohan S, Cuenca V, Kaur M, Fabara SP, Khurana M, Parwani J, Paez M, Anwar F, Tamton H, Cueva W. Understanding Parinaud's Syndrome. Brain Sci 2021; 11:brainsci11111469. [PMID: 34827468 PMCID: PMC8615667 DOI: 10.3390/brainsci11111469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/22/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Parinaud's syndrome involves dysfunction of the structures of the dorsal midbrain. We investigated the pathophysiology related to the signs and symptoms to better understand the symptoms of Parinaud's syndrome: diplopia, blurred vision, visual field defects, ptosis, squint, and ataxia, and Parinaud's main signs of upward gaze paralysis, upper eyelid retraction, convergence retraction nystagmus (CRN), and pseudo-Argyll Robertson pupils. In upward gaze palsy, three structures are disrupted: the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), interstitial nucleus of Cajal (iNC), and the posterior commissure. In CRN, there is a continuous discharge of the medial rectus muscle because of the lack of inhibition of supranuclear fibers. In Collier's sign, the posterior commissure and the iNC are mainly involved. In the vicinity of the iNC, there are two essential groups of cells, the M-group cells and central caudal nuclear (CCN) group cells, which are important for vertical gaze, and eyelid control. Overstimulation of the M group of cells and increased firing rate of the CCN group causing eyelid retraction. External compression of the posterior commissure, and pretectal area causes pseudo-Argyll Robertson pupils. Pseudo-Argyll Robertson pupils constrict to accommodation and have a slight response to light (miosis) as opposed to Argyll Robertson pupils were there is no response to a light stimulus. In Parinaud's syndrome patients conserve a slight response to light because an additional pathway to a pupillary light response that involves attention to a conscious bright/dark stimulus. Diplopia is mainly due to involvement of the trochlear nerve (IVth cranial nerve. Blurry vision is related to accommodation problems, while the visual field defects are a consequence of chronic papilledema that causes optic neuropathy. Ptosis in Parinaud's syndrome is caused by damage to the oculomotor nerve, mainly the levator palpebrae portion. We did not find a reasonable explanation for squint. Finally, ataxia is caused by compression of the superior cerebellar peduncle.
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Affiliation(s)
- Juan Fernando Ortiz
- California Institute of Behavioral Neuroscience & Psychology, Faifield, CA 94534, USA;
- Correspondence:
| | - Ahmed Eissa-Garces
- School of Medicine, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito 170901, Ecuador; (A.E.-G.); (V.C.)
| | - Samir Ruxmohan
- Neurology Department, Larkin Community Hospital, South Miami, FL 33143, USA; (S.R.); (H.T.); (W.C.)
| | - Victor Cuenca
- School of Medicine, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito 170901, Ecuador; (A.E.-G.); (V.C.)
| | - Mandeep Kaur
- Government Medical College, Patiala 147001, India;
| | - Stephanie P. Fabara
- School of Medicine, Colegio de Ciencias de la Salud, Universidad Católica de Santiago de Guayaquil, Guayaquil 090615, Ecuador;
| | - Mahika Khurana
- Department of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Jashank Parwani
- School of Medicine, Neurology Department, Lokmanya Tilak Municipal Medical College, Mumbai 4000022, India;
| | - Maria Paez
- School of Medicine, Colegio de Ciencias de la Salud, Pontificia Universidad Católica del Ecuador, Quito 170143, Ecuador;
| | - Fatima Anwar
- California Institute of Behavioral Neuroscience & Psychology, Faifield, CA 94534, USA;
| | - Hyder Tamton
- Neurology Department, Larkin Community Hospital, South Miami, FL 33143, USA; (S.R.); (H.T.); (W.C.)
| | - Wilson Cueva
- Neurology Department, Larkin Community Hospital, South Miami, FL 33143, USA; (S.R.); (H.T.); (W.C.)
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Wang HP, Wong LC, Hsu CJ, Hu SC, Chu YJ, Lee WT. Eye motor manifestations in children with neurometabolic disorders. J Formos Med Assoc 2021; 121:736-748. [PMID: 34561118 DOI: 10.1016/j.jfma.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/11/2021] [Accepted: 09/05/2021] [Indexed: 01/15/2023] Open
Abstract
Neurometabolic diseases are complex group of rare neurogenetic disorders, which are difficult to diagnose. Patients may have toxic metabolite accumulation, inadequate energy supply, or neurotransmitter deficiency, resulting in a variety of clinical manifestations and severity with enzyme activity or transporter function defects. Multiple organ involvement is frequently seen, among which neurological symptoms and signs are one of the most encountered problems. Ocular motor problems deserve special attention for it occurs in some inborn error of metabolism. Furthermore, some are early signs or characteristic findings of certain diseases, such as the gaze palsy in Niemann-Pick disease type C and Gaucher disease or oculogyric crisis in neurotransmitter diseases. Early recognition and intervention are important for better prognosis in treatable neurometabolic disorders. In addition, ways to evaluate and describe eye movement problems also help to demonstrate the severity or clinical progression for those diagnosed with certain neurometabolic diseases. However, the complexity of eye movement and ocular motor control renders our clinical observation, recording and even anatomic localization of abnormal eye movements. Clinicians are more likely to detect early signs and unravel problems by gaining awareness of abnormal eye movement. This study amied to approach neurometabolic diseases in children via eye motor manifestations.
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Affiliation(s)
- Hsin-Pei Wang
- Department of Pediatrics, National Taiwan University Hospital YunLin branch, Yun-Lin, Taiwan
| | - Lee-Chin Wong
- Department of Pediatrics, Cathy General Hospital, Taipei, Taiwan
| | - Chia-Jui Hsu
- Department of Pediatrics, National Taiwan University Hospital Hsinchu branch, Hsinchu, Taiwan
| | - Su-Ching Hu
- Department of Pediatrics, Cathy General Hospital, Taipei, Taiwan
| | - Yen-Ju Chu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan.
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Jiam NT, Murphy OC, Gold DR, Isanhart E, Sinn DI, Steenerson KK, Sharon JD. Nonvestibular Dizziness. Otolaryngol Clin North Am 2021; 54:999-1013. [PMID: 34538360 DOI: 10.1016/j.otc.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Dizziness is a common chief complaint with an extensive differential diagnosis that ranges from peripheral, central, to nonvestibular conditions. An understanding of nonvestibular conditions will aid accurate diagnosis and initiation of appropriate management. Thus, the objective of this article is to present an overview of nonvestibular etiologies that may plague a dizzy patient and the recommended treatment options.
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Affiliation(s)
- Nicole T Jiam
- Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco School of Medicine, 2233 Post Street, UCSF Box 3213, San Francisco, CA 94115, USA
| | - Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Pathology 2-210, Baltimore, MD 21287, USA
| | - Daniel R Gold
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Pathology 2-210, Baltimore, MD 21287, USA
| | - Erin Isanhart
- Angular Momentum Physical Therapy, 4459 Scottsfield Drive, San Jose, CA 95136-1630, USA
| | - Dong-In Sinn
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Kristen K Steenerson
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA 94304, USA; Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Palo Alto, CA 94303, USA
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head & Neck Surgery, University of California San Francisco School of Medicine, 2233 Post Street, Room 315, San Francisco, CA 94115, USA.
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6
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Jiao S, Johnson K, Moreno C, Yano S, Holmgren M. Comparative description of the mRNA expression profile of Na + /K + -ATPase isoforms in adult mouse nervous system. J Comp Neurol 2021; 530:627-647. [PMID: 34415061 PMCID: PMC8716420 DOI: 10.1002/cne.25234] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/16/2021] [Accepted: 08/16/2021] [Indexed: 11/09/2022]
Abstract
Mutations in genes encoding Na+ /K+ -ATPase α1, α2, and α3 subunits cause a wide range of disabling neurological disorders, and dysfunction of Na+ /K+ -ATPase may contribute to neuronal injury in stroke and dementia. To better understand the pathogenesis of these diseases, it is important to determine the expression patterns of the different Na+ /K+ -ATPase subunits within the brain and among specific cell types. Using two available scRNA-Seq databases from the adult mouse nervous system, we examined the mRNA expression patterns of the different isoforms of the Na+ /K+ -ATPase α, β and Fxyd subunits at the single-cell level among brain regions and various neuronal populations. We subsequently identified specific types of neurons enriched with transcripts for α1 and α3 isoforms and elaborated how α3-expressing neuronal populations govern cerebellar neuronal circuits. We further analyzed the co-expression network for α1 and α3 isoforms, highlighting the genes that positively correlated with α1 and α3 expression. The top 10 genes for α1 were Chn2, Hpcal1, Nrgn, Neurod1, Selm, Kcnc1, Snrk, Snap25, Ckb and Ccndbp1 and for α3 were Sorcs3, Eml5, Neurod2, Ckb, Tbc1d4, Ptprz1, Pvrl1, Kirrel3, Pvalb, and Asic2.
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Affiliation(s)
- Song Jiao
- Molecular Neurophysiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Kory Johnson
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Cristina Moreno
- Molecular Neurophysiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Sho Yano
- Molecular Neurophysiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Miguel Holmgren
- Molecular Neurophysiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
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Gómez Iglesias P, Sanesteban Beceiro E, Gómez Ruíz M, Matías Guiu J. Síndrome del medio y medio como presentación de esclerosis múltiple. Neurologia 2021; 36:246-248. [DOI: 10.1016/j.nrl.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022] Open
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8
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Gómez Iglesias P, Sanesteban Beceiro E, Gómez Ruíz M, Matías Guiu J. Half and half syndrome as a presentation of multiple sclerosis. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Rowe FJ, Hepworth LR, Howard C, Hanna KL, Currie J. Impact of visual impairment following stroke (IVIS study): a prospective clinical profile of central and peripheral visual deficits, eye movement abnormalities and visual perceptual deficits. Disabil Rehabil 2020; 44:3139-3153. [PMID: 33347793 DOI: 10.1080/09638288.2020.1859631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM This study evaluates the spectrum of visual impairment in stroke survivors. METHODS The Impact of Visual Impairment after Stroke (IVIS) study is a multi-centre, acute stroke unit, prospective epidemiology study. Comprehensive visual examination was offered to all stroke survivors. RESULTS 1500 stroke admissions were recruited. 1204 stroke survivors had visual assessment. Reduced central vision was documented in 529, visual field loss in 308, ocular motility abnormalities in 533 stroke survivors, visual perception deficits in 59 stroke survivors and visual inattention in 315 stroke survivors. About half, regardless of visual impairment type, were visually asymptomatic. Recovery, whether full or partial, was best for central vision, ocular motility abnormalities and visual perception deficits (about 70% improvement) occurring over a mean follow-up period of 2-3 months. CONCLUSIONS Incidence of impaired central vision, visual field loss, ocular motility disorders and visual inattention was 29.4%, 24.8%, 39.3% and 26.2% respectively. Visual impairment was more likely to occur in more severe stroke and older stroke survivors. Asymptomatic cases raise concerns for acute stroke units where robust specialist vision screening is not routine. Those with partial/no recovery require specialist follow-up and management whilst the wide range of abnormalities highlight the need for specialist visual assessment acutely.Implications for rehabilitationVisual impairment is a common consequence of stroke.Incidence of visual impairment is about 60%.Significant numbers of stroke survivors are visually asymptomatic, highlighting the need for standardised vision assessments.Many stroke survivors have persistent long-term visual impairment, necessitating referral and access to specialist eye care services.
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Affiliation(s)
- Fiona J Rowe
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Lauren R Hepworth
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Claire Howard
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Kerry L Hanna
- Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Jim Currie
- Patient and Public Representative, Different Strokes, UK
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Case Report: Bilateral Horizontal Gaze Palsy (1 + 1 Syndrome): A Supranuclear Gaze Palsy. Optom Vis Sci 2020; 96:898-904. [PMID: 31834148 DOI: 10.1097/opx.0000000000001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE A rare case of bilateral horizontal gaze palsy with intact vertical gaze eye movements and largely intact vestibulo-ocular reflex is presented owing to demyelinating lesions of the patient's bilateral paramedian pontine reticular formations and left infranuclear abducens nerve from the patient's recently diagnosed multiple sclerosis. PURPOSE The purpose of this study was to report on a rare case of bilateral horizontal gaze palsy from a supranuclear lesion in a patient with a recent diagnosis of multiple sclerosis. CASE REPORT A 43-year-old African American woman presented urgently for evaluation of her inability to move her eyes into either horizontal gaze. Vertical conjugate movements remained intact, as did three of four extraocular muscles with horizontal vestibulo-ocular reflex testing, suggesting a supranuclear palsy. Magnetic resonance imaging revealed two demyelinating lesions in her inferior pons, which spared her nuclear and internuclear horizontal gaze pathways, as well as three of four extraocular muscles of her infranuclear horizontal gaze pathway as evidenced by her largely intact vestibulo-ocular reflex. This suggested bilateral paramedian pontine reticular formation lesions (supranuclear) and a mild left abducens nerve palsy (infranuclear). CONCLUSIONS Close evaluation of extraocular motilities and a solid understanding of the supranuclear, nuclear, internuclear, and infranuclear components of the horizontal gaze pathway can help identify challenging gaze palsies when encountered in a clinical setting. Appropriate neuroimaging can then be performed with an emphasis on the suspected location of the lesion(s) based on the patient's clinical findings.
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Nij Bijvank J, Petzold A, Coric D, Tan H, Uitdehaag B, Balk L, van Rijn L. Saccadic delay in multiple sclerosis: A quantitative description. Vision Res 2020; 168:33-41. [DOI: 10.1016/j.visres.2020.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
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Orbital Metastasis From Urothelial Carcinoma: A Comprehensive Literature Review. Ophthalmic Plast Reconstr Surg 2020; 35:213-217. [PMID: 30489454 DOI: 10.1097/iop.0000000000001256] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the clinical features of orbital and choroidal metastases from urothelial carcinomas of the urinary tract among cases reported in the literature, and to describe a case of orbital metastasis from bladder cancer presenting as apparent internuclear ophthalmoplegia. METHODS Case reports of orbital and choroidal metastases from urothelial carcinomas published in the literature from 1965 to 2018 were reviewed. Data collected included patient demographics, cancer stage and primary site, time to onset of ocular symptoms, length of presenting ocular symptoms, types of primary ocular symptoms, diagnostic imaging, histology, systemic and ocular treatments, and survival time. RESULTS Twenty-eight cases of urothelial carcinoma with metastasis to the orbit or choroid were reviewed. Men were significantly more likely to suffer from this condition than women (p = 0.011). The average age of presentation with orbital symptoms was 63 years, with an average time of 19 months between primary cancer diagnosis and onset of orbital symptoms. Twenty-two patients had metastasis to the orbit and 6 to the choroid. In 4 cases, ocular deficits secondary to orbital and/or choroidal metastases were the initial presenting symptoms in patients with previously undiagnosed urothelial carcinoma. The most commonly noted primary ocular symptoms and signs consisted of decreased visual acuity, decreased ocular motility, proptosis, and diplopia. Average survival from onset of ocular symptoms was 4.67 months. CONCLUSIONS Urothelial carcinoma may metastasize to the orbit or choroid; furthermore, its presentation may mimic internuclear ophthalmoplegia. It is recommended that any patient with visual symptoms and known urothelial cancer should undergo expedited workup for metastatic disease.
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Liatis T, Furtado AR, Mantis P, Cherubini GB. Convergence-Retraction Nystagmus in a Dog With Presumptive Ischemic Encephalopathy Following Acute Cervicothoracic Myelopathy. Top Companion Anim Med 2019; 38:100381. [PMID: 32115081 DOI: 10.1016/j.tcam.2019.100381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 11/28/2022]
Abstract
A 6.5-year-old male neutered Trailhound was admitted for hyperacute, nonprogressive, left-sided hemiparesis. Physical and neurologic examination revealed nonpainful, left-sided poorly ambulatory hemiparesis, decreased left-sided postural reactions and thoracic limbs hyporeflexia. Neuroanatomic localisation was consistent with a left-sided C6-T2 myelopathy. Haematology and biochemistry revealed nonspecific abnormalities. Magnetic resonance imaging of the neck revealed a focal intramedullary lesion at the level of C6-C7 vertebrae compatible with acute hydrated noncompressive nucleus pulposus extrusion or ischemic myelopathy. During the second day of hospitalization, the dog developed convergence-retraction nystagmus, up-gaze palsy and eyelid retraction (Collier's sign) compatible with dorsal midbrain syndrome. Magnetic resonance imaging of the brain revealed a focal lesion compatible with dorsal midbrain ischemic infarct. Further clinicopathologic testing, thoracic and abdominal imaging were unremarkable. Ischemic encephalopathy of unknown etiology was additionally diagnosed. Physiotherapy was performed therapeutically. At 1-year follow-up the dog was normal. This is an unusual report of a dog with myelopathy followed by ischemic encephalopathy with manifestation of convergence-retraction nystagmus in the absence of vestibular signs. This saccadic intrusion is a characteristic clinical manifestation of a dorsal midbrain syndrome localization. The importance of a complete differential diagnoses list formation in a dog with ischemic encephalopathy which leads to a thorough diagnostic investigation plan is highlighted. Moreover, this report contributes to the enrichment of the clinical reasoning veterinary literature on convergence-retraction nystagmus. To the authors' knowledge, this is the second case report (fourth dog) to describe convergence-retraction nystagmus in dogs as a manifestation of dorsal midbrain syndrome.
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Affiliation(s)
- Theophanes Liatis
- Neurology & Neurosurgery Service, Dick White Referrals, Station Farm, Cambridgeshire, United Kingdom.
| | - Ana Rita Furtado
- Diagnostic Imaging Service, Dick White Referrals, Cambridgeshire, United Kingdom
| | - Panagiotis Mantis
- Diagnostic Imaging Service, Dick White Referrals, Cambridgeshire, United Kingdom
| | - Giunio Bruto Cherubini
- Neurology & Neurosurgery Service, Dick White Referrals, Station Farm, Cambridgeshire, United Kingdom
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14
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Nij Bijvank JA, Petzold A, Coric D, Tan HS, Uitdehaag BMJ, Balk LJ, van Rijn LJ. Quantification of Visual Fixation in Multiple Sclerosis. Invest Ophthalmol Vis Sci 2019; 60:1372-1383. [PMID: 30938772 DOI: 10.1167/iovs.18-26096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Eye movement abnormalities are common in multiple sclerosis (MS), and infrared oculography is a noninvasive method for quantification. This study aims to describe and classify abnormalities of visual fixation and their clinical relevance in MS. Methods A validated standardized infrared oculography protocol, Demonstrate Eye Movement Networks with Saccades, was used for quantifying gaze stability during a fixation task in MS patients and healthy controls. Saccadic intrusions, gaze drift, and stability of fixation around the drift line were used to subclassify MS patients by performing receiver operating characteristic analyses of different parameters. The relationship between the presence of abnormalities of fixation and visual functioning was analyzed using logistic regression models, which was adjusted for possible confounders. Results This cross-sectional study included 213 subjects with MS and 57 healthy controls. Square wave jerk abnormalities were present in 24% of MS patients. The prevalence was higher in more disabled subjects. The presence of larger square wave jerks (with a higher amplitude) in the MS patients was related to complaints of focusing on stationary objects (odds ratio, 2.2; P = 0.035) and a lower vision-related quality of life (odds ratio, 2.56; P = 0.012). Conclusions This study provided a comprehensive overview of the characteristics of problems with visual fixation in subjects with MS. The most important and most common finding was the presence of larger square wave jerks during fixation, which was related to visual functioning in daily life.
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Affiliation(s)
- Jenny A Nij Bijvank
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Axel Petzold
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, the University College London Institute of Neurology, London, United Kingdom
| | - Danko Coric
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - H Stevie Tan
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Bernard M J Uitdehaag
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Lisanne J Balk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Neurology, Multiple Sclerosis Center and Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Department of Ophthalmology, Neuro-ophthalmology Expertise Center, Neuroscience Amsterdam, Amsterdam, The Netherlands.,Onze Lieve Vrouwe Gasthuis, Department of Ophthalmology, Amsterdam, The Netherlands
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Affiliation(s)
- Zen Kobayashi
- Department of Neurology, JA Toride Medical Center, Japan
| | - Yoshiyuki Numasawa
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
- Department of Family Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
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Coric D, Nij Bijvank JA, van Rijn LJ, Petzold A, Balk LJ. The role of optical coherence tomography and infrared oculography in assessing the visual pathway and CNS in multiple sclerosis. Neurodegener Dis Manag 2018; 8:323-335. [DOI: 10.2217/nmt-2018-0011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In this review, a current overview is provided of how optical coherence tomography and infrared oculography can aid in assessing the visual system and CNS in multiple sclerosis (MS). Both afferent and efferent visual disorders are common in MS and visual complaints can have a tremendous impact on daily functioning. Optical coherence tomography and infrared oculography can detect and quantify visual disorders with high accuracy, but could also serve as quantitative markers for inflammation, neurodegeneration and network changes including cognitive decline in MS patients. The assessment of the efferent and afferent visual pathways is relevant for monitoring and predicting the disease course, but is also potentially valuable as an outcome measure in therapeutic trials.
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Affiliation(s)
- Danko Coric
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jenny A Nij Bijvank
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Laurentius J van Rijn
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Axel Petzold
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
- Moorfields Eye Hospital & The National Hospital for Neurology & Neurosurgery, London, UK
| | - Lisanne J Balk
- Department of Neurology, Amsterdam Neuroscience, VU University Medical Centre, Amsterdam, The Netherlands
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Rowe FJ, Hanna K, Evans JR, Noonan CP, Garcia‐Finana M, Dodridge CS, Howard C, Jarvis KA, MacDiarmid SL, Maan T, North L, Rodgers H. Interventions for eye movement disorders due to acquired brain injury. Cochrane Database Syst Rev 2018; 3:CD011290. [PMID: 29505103 PMCID: PMC6494416 DOI: 10.1002/14651858.cd011290.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acquired brain injury can cause eye movement disorders which may include: strabismus, gaze deficits and nystagmus, causing visual symptoms of double, blurred or 'juddery' vision and reading difficulties. A wide range of interventions exist that have potential to alleviate or ameliorate these symptoms. There is a need to evaluate the effectiveness of these interventions and the timing of their implementation. OBJECTIVES We aimed to assess the effectiveness of any intervention and determine the effect of timing of intervention in the treatment of strabismus, gaze deficits and nystagmus due to acquired brain injury. We considered restitutive, substitutive, compensatory or pharmacological interventions separately and compared them to control, placebo, alternative treatment or no treatment for improving ocular alignment or motility (or both). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (containing the Cochrane Eyes and Vision Trials Register) (2017, Issue 5), MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, AMED Ovid, PsycINFO Ovid, Dissertations & Theses (PQDT) database, PsycBITE (Psychological Database for Brain Impairment Treatment Efficacy), ISRCTN registry, ClinicalTrials.gov, Health Services Research Projects in Progress (HSRProj), National Eye Institute Clinical Studies Database and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The databases were last searched on 26 June 2017. No date or language restrictions were used in the electronic searches for trials. We manually searched the Australian Orthoptic Journal, British and Irish Orthoptic Journal, and ESA, ISA and IOA conference proceedings. We contacted researchers active in this field for information about further published or unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of any intervention for ocular alignment or motility deficits (or both) due to acquired brain injury. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data. We used standard methods expected by Cochrane. We employed the GRADE approach to interpret findings and assess the quality of the evidence. MAIN RESULTS We found five RCTs (116 participants) that were eligible for inclusion. These trials included conditions of acquired nystagmus, sixth cranial nerve palsy and traumatic brain injury-induced ocular motility defects. We did not identify any relevant studies of restitutive interventions.We identified one UK-based trial of a substitutive intervention, in which botulinum toxin was compared with observation in 47 people with acute sixth nerve palsy. At four months after entry into the trial, people given botulinum toxin were more likely to make a full recovery (reduction in angle of deviation within 10 prism dioptres), compared with observation (risk ratio 1.19, 95% CI 0.96 to 1.48; low-certainty evidence). These same participants also achieved binocular single vision. In the injection group only, there were 2 cases of transient ptosis out of 22 participants (9%), and 4 participants out of 22 (18%) with transient vertical deviation; a total complication rate of 24% per injection and 27% per participant. All adverse events recovered. We judged the certainty of evidence as low, downgrading for risk of bias and imprecision. It was not possible to mask investigators or participants to allocation, and the follow-up between groups varied.We identified one USA-based cross-over trial of a compensatory intervention. Oculomotor rehabilitation was compared with sham training in 12 people with mild traumatic brain injury, at least one year after the injury. We judged the evidence from this study to be very low-certainty. The study was small, data for the sham training group were not fully reported, and it was unclear if a cross-over study design was appropriate as this is an intervention with potential to have a permanent effect.We identified three cross-over studies of pharmacological interventions for acquired nystagmus, which took place in Germany and the USA. These studies investigated two classes of pharmacological interventions: GABAergic drugs (gabapentin, baclofen) and aminopyridines (4-aminopyridines (AP), 3,4-diaminopyridine (DAP)). We judged the evidence from all three studies as very low-certainty because of small numbers of participants (which led to imprecision) and risk of bias (they were cross-over studies which did not report data in a way that permitted estimation of effect size).One study compared gabapentin (up to 900 mg/day) with baclofen (up to 30 mg/day) in 21 people with pendular and jerk nystagmus. The follow-up period was two weeks. This study provides very low-certainty evidence that gabapentin may work better than baclofen in improving ocular motility and reducing participant-reported symptoms (oscillopsia). These effects may be different in pendular and jerk nystagmus, but without formal subgroup analysis it is unclear if the difference between the two types of nystagmus was chance finding. Quality of life was not reported. Ten participants with pendular nystagmus chose to continue treatment with gabapentin, and one with baclofen. Two participants with jerk nystagmus chose to continue treatment with gabapentin, and one with baclofen. Drug intolerance was reported in one person receiving gabapentin and in four participants receiving baclofen. Increased ataxia was reported in three participants receiving gabapentin and two participants receiving baclofen.One study compared a single dose of 3,4-DAP (20 mg) with placebo in 17 people with downbeat nystagmus. Assessments were made 30 minutes after taking the drug. This study provides very low-certainty evidence that 3,4-DAP may reduce the mean peak slow-phase velocity, with less oscillopsia, in people with downbeat nystagmus. Three participants reported transient side effects of minor perioral/distal paraesthesia.One study compared a single dose of 4-AP with a single dose of 3,4-DAP (both 10 mg doses) in eight people with downbeat nystagmus. Assessments were made 45 and 90 minutes after drug administration. This study provides very low-certainty evidence that both 3,4-DAP and 4-AP may reduce the mean slow-phase velocity in people with downbeat nystagmus. This effect may be stronger with 4-AP. AUTHORS' CONCLUSIONS The included studies provide insufficient evidence to inform decisions about treatments specifically for eye movement disorders that occur following acquired brain injury. No information was obtained on the cost of treatment or measures of participant satisfaction relating to treatment options and effectiveness. It was possible to describe the outcome of treatment in each trial and ascertain the occurrence of adverse events.
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Affiliation(s)
- Fiona J Rowe
- University of LiverpoolDepartment of Health Services ResearchWaterhouse Building (B211)1‐3 Brownlow StreetLiverpoolUKL69 3GL
| | - Kerry Hanna
- University of LiverpoolDepartment of Health Services ResearchWaterhouse Building (B211)1‐3 Brownlow StreetLiverpoolUKL69 3GL
| | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Carmel P Noonan
- Aintree University Hospitals NHS Foundation TrustDepartment of OphthalmologyLower LaneLiverpoolUKL9 7AL
| | - Marta Garcia‐Finana
- University of LiverpoolBiostatisticsBlock F, Waterhouse Bld1‐5 Brownlow StreetLiverpoolUKL69 3GL
| | - Caroline S Dodridge
- Oxford University Hospitals NHS TrustOrthopticsOxford Eye Hospital, John Radcliffe Hospital, Headley WayOxfordUKOX3 9DU
| | - Claire Howard
- Salford Royal NHS Foundation TrustOrthopticsStott LaneSalfordManchesterUKM6 8HD
| | - Kathryn A Jarvis
- University of LiverpoolOccupational TherapyBrownlow HillLiverpoolUKL69 3GB
| | - Sonia L MacDiarmid
- Warrington and Halton Hospitals NHS Foundation TrustDepartment of OrthopticsLovely LaneWarringtonUKWA5 2QQ
| | - Tallat Maan
- Pennine Care NHS Foundation TrustCommunity Eye Service225 Old StreetAshton‐under‐LyneUKOL6 7SR
| | - Lorraine North
- Frimley Park NHS Foundation TrustOrthopticsPortsmouth RoadFrimleySurreyUKGU16 7UJ
| | - Helen Rodgers
- Newcastle UniversityInstitute of NeuroscienceNewcastleUKNE2 4HH
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Chilton JK, Guthrie S. Axons get ahead: Insights into axon guidance and congenital cranial dysinnervation disorders. Dev Neurobiol 2017; 77:861-875. [DOI: 10.1002/dneu.22477] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 11/12/2022]
Affiliation(s)
- John K. Chilton
- Wellcome Wolfson Centre for Medical Research; University of Exeter Medical School, Wellcome-Wolfson Centre for Medical Research; Exeter EX2 5DW United Kingdom
| | - Sarah Guthrie
- School of Life Sciences; University of Sussex; Falmer Brighton, BN1 9QG
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Man BL, Fu YP. Raymond syndrome and conjugate gaze palsy from a paramedian pontine infarct. BMJ Case Rep 2015. [PMID: 26215110 DOI: 10.1136/bcr-2015-211433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Bik Ling Man
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Yat Pang Fu
- Department of Medicine, Tuen Mun Hospital, Hong Kong, Hong Kong
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Samadani U, Farooq S, Ritlop R, Warren F, Reyes M, Lamm E, Alex A, Nehrbass E, Kolecki R, Jureller M, Schneider J, Chen A, Shi C, Mendhiratta N, Huang JH, Qian M, Kwak R, Mikheev A, Rusinek H, George A, Fergus R, Kondziolka D, Huang PP, Smith RT. Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip. J Neurosurg 2014; 122:707-20. [PMID: 25495739 DOI: 10.3171/2014.10.jns14762] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECT Automated eye movement tracking may provide clues to nervous system function at many levels. Spatial calibration of the eye tracking device requires the subject to have relatively intact ocular motility that implies function of cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducent) and their associated nuclei, along with the multiple regions of the brain imparting cognition and volition. The authors have developed a technique for eye tracking that uses temporal rather than spatial calibration, enabling detection of impaired ability to move the pupil relative to normal (neurologically healthy) control volunteers. This work was performed to demonstrate that this technique may detect CN palsies related to brain compression and to provide insight into how the technique may be of value for evaluating neuropathological conditions associated with CN palsy, such as hydrocephalus or acute mass effect. METHODS The authors recorded subjects' eye movements by using an Eyelink 1000 eye tracker sampling at 500 Hz over 200 seconds while the subject viewed a music video playing inside an aperture on a computer monitor. The aperture moved in a rectangular pattern over a fixed time period. This technique was used to assess ocular motility in 157 neurologically healthy control subjects and 12 patients with either clinical CN III or VI palsy confirmed by neuro-ophthalmological examination, or surgically treatable pathological conditions potentially impacting these nerves. The authors compared the ratio of vertical to horizontal eye movement (height/width defined as aspect ratio) in normal and test subjects. RESULTS In 157 normal controls, the aspect ratio (height/width) for the left eye had a mean value ± SD of 1.0117 ± 0.0706. For the right eye, the aspect ratio had a mean of 1.0077 ± 0.0679 in these 157 subjects. There was no difference between sexes or ages. A patient with known CN VI palsy had a significantly increased aspect ratio (1.39), whereas 2 patients with known CN III palsy had significantly decreased ratios of 0.19 and 0.06, respectively. Three patients with surgically treatable pathological conditions impacting CN VI, such as infratentorial mass effect or hydrocephalus, had significantly increased ratios (1.84, 1.44, and 1.34, respectively) relative to normal controls, and 6 patients with supratentorial mass effect had significantly decreased ratios (0.27, 0.53, 0.62, 0.45, 0.49, and 0.41, respectively). These alterations in eye tracking all reverted to normal ranges after surgical treatment of underlying pathological conditions in these 9 neurosurgical cases. CONCLUSIONS This proof of concept series of cases suggests that the use of eye tracking to detect CN palsy while the patient watches television or its equivalent represents a new capacity for this technology. It may provide a new tool for the assessment of multiple CNS functions that can potentially be useful in the assessment of awake patients with elevated intracranial pressure from hydrocephalus or trauma.
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Affiliation(s)
- Uzma Samadani
- New York Harbor Health Care System, Manhattan Veteran's Administration;
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Profile of Gaze Dysfunction following Cerebrovascular Accident. ISRN OPHTHALMOLOGY 2013; 2013:264604. [PMID: 24558601 PMCID: PMC3914228 DOI: 10.1155/2013/264604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 08/21/2013] [Indexed: 11/17/2022]
Abstract
Aim. To evaluate the profile of ocular gaze abnormalities occurring following stroke. Methods. Prospective multicentre cohort trial. Standardised referral and investigation protocol including assessment of visual acuity, ocular alignment and motility, visual field, and visual perception. Results. 915 patients recruited: mean age 69.18 years (SD 14.19). 498 patients (54%) were diagnosed with ocular motility abnormalities. 207 patients had gaze abnormalities including impaired gaze holding (46), complete gaze palsy (23), horizontal gaze palsy (16), vertical gaze palsy (17), Parinaud's syndrome (8), INO (20), one and half syndrome (3), saccadic palsy (28), and smooth pursuit palsy (46). These were isolated impairments in 50% of cases and in association with other ocular abnormalities in 50% including impaired convergence, nystagmus, and lid or pupil abnormalities. Areas of brain stroke were frequently the cerebellum, brainstem, and diencephalic areas. Strokes causing gaze dysfunction also involved cortical areas including occipital, parietal, and temporal lobes. Symptoms of diplopia and blurred vision were present in 35%. 37 patients were discharged, 29 referred, and 141 offered review appointments. 107 reviewed patients showed full recovery (4%), partial improvement (66%), and static gaze dysfunction (30%). Conclusions. Gaze dysfunction is common following stroke. Approximately one-third of patients complain of visual symptoms, two thirds show some improvement in ocular motility.
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Stalcup ST, Tuan AS, Hesselink JR. Intracranial Causes of Ophthalmoplegia: The Visual Reflex Pathways. Radiographics 2013; 33:E153-69. [DOI: 10.1148/rg.335125142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ramakrishnan S, Narayanaswamy VR. Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo-subthalamic paramedian infarct: An interesting case report. J Neurosci Rural Pract 2013; 4:220-3. [PMID: 23914112 PMCID: PMC3724314 DOI: 10.4103/0976-3147.112775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A 42-year-old young lady presented with acute onset of dizziness, drooping of left eye with binocular diplopia and inability to walk unassisted. She had past history of uncontrolled diabetes mellitus and hypertension. On examination, she had left fascicular type of third nerve palsy, vertical one and half syndrome (VOHS), left internuclear ophthalmoplegia and skew deviation with ipsilesional hypertropia. She also had thalamic astasia and right unilateral asterixis. Her MRI revealed T2 and Flair hyper intense signal changes with restricted diffusion in the left thalamus, subthalamus and left midbrain. MR Angiography was normal. Thalamic-subthalamic paramedian territory infarct is relatively uncommon. It can present with oculomotor abnormalities including vertical one and half syndrome, skew deviation, thalamic astasia and asterixis. This case is reported for the rarity of the presenting clinical findings in unilateral thalamo-mesencephalic infarcts.
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Affiliation(s)
- Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Grondona JM, Hoyo-Becerra C, Visser R, Fernández-Llebrez P, López-Ávalos MD. The subcommissural organ and the development of the posterior commissure. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2012; 296:63-137. [PMID: 22559938 DOI: 10.1016/b978-0-12-394307-1.00002-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Growing axons navigate through the developing brain by means of axon guidance molecules. Intermediate targets producing such signal molecules are used as guideposts to find distal targets. Glial, and sometimes neuronal, midline structures represent intermediate targets when axons cross the midline to reach the contralateral hemisphere. The subcommissural organ (SCO), a specialized neuroepithelium located at the dorsal midline underneath the posterior commissure, releases SCO-spondin, a large glycoprotein belonging to the thrombospondin superfamily that shares molecular domains with axonal pathfinding molecules. Several evidences suggest that the SCO could be involved in the development of the PC. First, both structures display a close spatiotemporal relationship. Second, certain mutants lacking an SCO present an abnormal PC. Third, some axonal guidance molecules are expressed by SCO cells. Finally, SCO cells, the Reissner's fiber (the aggregated form of SCO-spondin), or synthetic peptides from SCO-spondin affect the neurite outgrowth or neuronal aggregation in vitro.
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Affiliation(s)
- Jesús M Grondona
- Departamento de Biología Celular, Genética y Fisiología, Facultad de Ciencias, Universidad de Málaga, Spain.
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