Isolated superior division oculomotor palsy in a child with spontaneous recovery

A 10 year old boy with a superior division palsy of the left oculomotor nerve is reported. He had a flu-like illness 1 week before the onset. The computed tomography and magnetic resonance imaging scans were normal. Laboratory data for evaluation of infection, diabetes mellitus and myasthenia gravis were normal. The symptoms spontaneously disappeared after 2 months. The course of the illness in conjunction with the negative laboratory findings made this case an example of partial paralysis of the third nerve related to viral infection. In the literature, only several cases with isolated divisional palsy of the oculomotor nerve were found after a viral infection. Inferior division palsy has been reported in five children. Superior division palsy has been published in only two cases. Divisional palsy is more common among children and resolves spontaneously. This rare but important clinical entity is one of the differential diagnoses in oculomotor nerve palsies, particularly in children, which are neuroradiologically undiagnosed. It occurs after a viral infection and may affect a superior or inferior division alone.

Regulatory cells generated by testicular tolerization to retinal S-antigen: possible involvement of IL-4, IL-10, and TGF-beta in the suppression of experimental autoimmune uveoretinitis

Intratesticular injection of a retinal protein (S-antigen) into Lewis rats induces systemic immunotolerance (designated orchidic tolerance) and renders animals refractory to experimental autoimmune uveoretinitis (EAU) produced by S-antigen immunization. We demonstrated in this work that the immunotolerance could be transferred to syngeneic naive rats by both CD4+ and CD8+ regulatory cells. Attempts were then made to characterize the cytokines involved in the immunosuppressive activity of these regulatory cells. Using the in vitro lymphoproliferation assay, the inhibitory effect of CD4+ cells on effector cells was found to be reversed by antibodies against IL-4 and IL-10 but not by anti-TGF-beta antibody. IL-4 (IC50 = 1.6 ng/10(6) cells) and IL-10 (IC50 = 0.6 ng/10(6) cells) added to the assay medium were potent inhibitors of effector cell proliferation. Increased immunoreactivity and mRNA expression for IL-4 and IL-10 was observed for CD4+ regulatory cells. The inhibitory effect of CD8+ regulatory cells was reversed by anti-TGF-beta antibody but not by antibodies against IL-4 and IL-10. Compared with control CD8+ cells, CD8+ cells from tolerized rats demonstrated higher immunoreactivity for TGF-beta but did not show an enhanced expression of mRNA for TGF-beta. TGF-beta 1 and TGF-beta 2 added to effector cells showed dichotomous effects; both isoforms stimulated cell proliferation at 2.5 ng/10(6) cells and inhibited at lower or higher concentrations. These results led us to conclude that IL-4 and IL-10 are important cytokines for the immunosuppressive effect of CD4+ regulatory cells generated in orchidic tolerance. TGF-beta is an important immunosuppressive cytokine for CD8+ regulatory cells but further studies will determine whether other cytokines are also involved.

Correlation of electroretinographic changes with visual prognosis in central retinal artery occlusion

Recent advances in the treatment of central retinal artery occlusion (CRAO) have resulted in a relatively good prognosis, but few studies have been reported. In the present study, electroretinography (ERG) was used to evaluate visual function recovery in 15 cases of CRAO. All patients were treated with ocular massage, intravenous urokinase and hyperbaric oxygenation. Of 15 cases, 8 had improved vision after treatment. A single flash ERG of 40 J from a xenon lamp was recorded before and during treatment. For ERG evaluation, the a- and b-wave amplitudes and the b/a wave amplitude ratio were analyzed. As control, the nonaffected eye of each patient was used. Before treatment, no significant difference was found in the a-wave amplitude between the two eyes, while a significant attenuation was found in the b-wave of the affected eye (p < 0.01). The b/a ratio was 0.73 +/- 0.04 (mean +/- SE) in the affected eye group and 1.08 +/- 0.03 in the nonaffected eye group. It was significantly higher (p < 0.01) in eyes with improved visual acuity (0.83 +/- 0.03) than in those with unimproved visual acuity (0.62 +/- 0.05). The b-wave amplitude increased in accordance with visual improvement. We could thus demonstrate the temporal changes of ERG before and after treatment and show their correlation with the visual prognosis in patients with CRAO.