| Tuberculous infection of the central nervous system is common in hong kong. A 39-year-old woman presented with isolated right sixth nerve palsy which was non-progressive for 10 months. Neuro-imaging revealed a right pontine lesion. cerebrospinal fluid (CSF) examination showed lymphocytic meningitis with negative bacteriological and cytological studies. Empirical antituberculous drugs with initial corticosteroid resulted in improved CSF parameters. A diagnosis of cerebral tuberculoma complicated by meningitis was made. She subsequently deteriorated clinically and radiologically. Despite a number of clinical features which were atypical of leptomeningeal metastasis, adenosquamous carcinoma was found on biopsy. Her relatively indolent clinical course might be due to the initial corticosteroid treatment. This report illustrates the importance of early tissue diagnosis in uncertain cases of chronic lymphocytic meningitis. ( info) |
2/123. Unifocal Langerhans' cell histiocytosis in the clivus of a child with abducens palsy and diplopia. histiocytosis X, described by Lichtenstein in 1953, is an uncommon disorder that is characterized by an abnormal proliferation of Langerhans' cells. The Langerhans' cell normally occurs in the epidermis and T-cell-dependent areas of lymph nodes and functions as a macrophage. histiocytosis X is predominantly a disease of childhood but can occasionally be seen in adults. eosinophilic granuloma of the skull is the most common presentation of the disease, and the associated symptoms depend on the location of the lesion. It has been reported to occur in the temporal bone, including the petrous apex. We present the first reported case, to our knowledge, of eosinophilic granuloma, or unifocal Langerhans' cell histiocytosis, in the clivus of a child. ( info) |
3/123. Unintentional paediatric subdural catheter with oculomotor and abducens nerve palsies. A 13-year-old female with a past history of lumbar laminectomy developed a subdural block 18 h after the commencement of an epidural infusion of bupivacaine 0.125% and fentanyl 2 micrograms.ml-1. Signs at presentation included bilateral abducens nerve palsies in the absence of headache and a previously unreported unilateral third cranial nerve palsy. An epidurogram displayed subdural placement. ( info) |
4/123. Fresnel membrane prisms: clinical experience. BACKGROUND: There are few published reports on the clinical application of Fresnel membrane prisms in the treatment of diplopia in adults. The authors describe the use of these prisms in patients with fourth and sixth cranial nerve palsies, restrictive motility caused by thyroid-related orbital disease, and convergence insufficiency. methods: Of 209 patients who had been treated with Fresnel prisms, 141 were selected. The database included patients from a private practice in Montreal, seen from 1988 to 1996, and patients seen by orthoptists in the ophthalmology department of a children's hospital in Montreal between 1992 and 1996. All the patients had diplopia associated with fourth (48 patients) or sixth (43 patients) cranial nerve palsy, thyroid-related orbitopathy (18 patients) or convergence insufficiency (32 patients). After qualitative and quantitative assessment of the ocular misalignment, a Fresnel prism was selected for power and axis and for appropriate location on the spectacle lens. Ocular dominance and side of paresis or restriction were also considered in the placement of the prism. The patient's response to treatment was documented. RESULTS: The Fresnel prisms were oriented horizontally in 72 patients (51%), vertically in 55 (39%) and obliquely in 14 (10%). They were placed on the spectacle lens before the nondominant eye in 127 cases (90%), either covering the entire lens, or on the upper or lower segment or both. The patients were followed for an average of 15 (range 2 to 96) months. Of the 141 patients 113 (80%) had a successful outcome, with relief of their diplopia. Twenty-seven patients (19%) eventually had the prismatic correction ground into the lens, 70 (50%) chose to wear the Fresnel prism on a permanent basis because incorporation into the lens was not possible or because of cost, and 17 (12%) used the Fresnel prism as a temporary device before or after surgery. Most patients who converted to incorporated prisms did so when the prismatic power became stable, usually after 6 to 8 months. Eight patients (6%) stopped using the prism because of associated side effects, such as blurred vision, persistent diplopia, torsion or optical aberrations. INTERPRETATION: The Fresnel prism is an excellent device in treating diplopia in adult patients. It is a reasonable permanent option when incorporating the prism into the spectacle lens is not possible. A fused blurred image caused by a Fresnel prism placed in front of the nondominant eye is preferable to double but clear images. ( info) |
5/123. Etiology and surgical management of horizontal pontine gaze palsy with ipsilateral esotropia. INTRODUCTION: An esotropia ipsilateral to a horizontal pontine gaze palsy has been infrequently reported. We discuss the etiology and review the surgical management of this ocular motility defect. methods: Four patients with radiographically documented dorsal pontine lesions and persistent horizontal gaze palsy with esotropia ipsilateral to the gaze palsy were treated. In each patient, the esotropia was present in attempted primary gaze, producing symptomatic diplopia. An anomalous face turn was required to attain single binocular vision. RESULTS: All 4 patients underwent surgical correction to alleviate the anomalous head position and diplopia. Bilateral, asymmetric surgery was required to achieve a long-term successful result. Single binocular vision in the primary position with elimination or marked improvement of the compensatory head posture was initially achieved in all 4 patients. One patient, who had not undergone asymmetric strabismus surgery to reconcile incomitance produced by the esotropia, rapidly developed a residual esotropia. CONCLUSIONS: Ophthalmologists should recognize that concurrent esotropia may occur in patients with horizontal pontine gaze palsy. Single binocular vision in the primary position, an expanded binocular visual field, and alleviation of a compensatory head position are achievable with strabismus surgery. ( info) |
6/123. Bilateral sixth nerve palsy associated with MDMA ("ecstasy") abuse. PURPOSE:To report the association of methylenedioxymetamphetamine (MDMA, "ecstasy") abuse and bilateral sixth nerve palsy. methods: Case report. RESULTS: A 17-year-old male presented with horizontal diplopia in all directions of gaze after having taken MDMA tablets at 5-day to 7-day intervals during a 2-month period. Examination showed bilateral sixth nerve palsy. Ocular motility returned to normal within 5 days without use of MDMA and with no other treatment. CONCLUSION: Methylenedioxymetamphetamine "ecstasy" abuse should be considered in the differential diagnosis in otherwise unexplained sixth nerve palsy. ( info) |
| A 27-year-old woman visited our hospital with chief complaints of abducens nerve palsy and cerebellar symptoms. On computerized tomographic scanning and magnetic resonance imaging, a tumor with strong enhancement was found on the dorsal side of the medulla oblongata. A tumor was excised by suboccipital craniotomy and C1 laminectomy. Histologically, many Rosenthal fibers together with pilocytic tumor cells were found in some regions, but a very high Ki-67 labeling rate accompanied by cells with nuclei of irregular size and giant cells was observed in other regions. The tumor was diagnosed as malignant pilocytic astrocytoma originating from pilocytic astrocytoma by transformation. The biological behavior of pilocytic astrocytoma is obscure in several respects. We report our experience of a case of malignant pilocytic astrocytoma that developed in the brain stem and progressed extremely rapidly. ( info) |
8/123. hemangioma of the mandibular branch of the trigeminal nerve in the Meckel cave presenting with facial pain and sixth nerve palsy. In a 25-year-old woman with episodic periorbital-temporal pain who eventually developed a sixth nerve palsy, magnetic resonance imaging revealed a lesion predominantly in the Meckel cave that was found to be a capillary hemangioma arising from the mandibular division of the trigeminal nerve. Hemangiomas of the Meckel cave must be considered in cases of facial pain with a sixth nerve palsy. even if there are no clinical findings of trigeminal neuropathy. ( info) |
9/123. abducens nerve paresis as first symptom of trigeminal neurinoma. Report of two cases and review of the literature. Two cases of neurinoma of the Gasserian ganglion with abducens nerve paresis as the first symptom are described and 27 cases culled from the literature are reviewed. The anatomo-surgical and clinical-radiological features of this pathology were re-assessed in an attempt to identify the pathogenetic mechanism responsible for a trigeminal neurinoma manifesting with VI cranial nerve palsy. ( info) |
10/123. Osteosarcomatosis involving craniofacial bones presenting with cranial nerve palsies. Osteosarcomatosis (also known as multifocal osteosarcoma or multiple sclerotic osteosarcoma) is a rare condition, characterized by multiple skeletal lesions at initial presentation. We describe a case of osteosarcomatosis involving craniofacial bones presenting with cranial nerve palsies. In addition, a brief review of the literature is given, with a discussion of this highly aggressive form of osteosarcoma. ( info) |