1/5. anisocoria associated with the medical treatment of irritable bowel syndrome.A case of anisocoria associated with oral pharmacologic treatment of irritable bowel syndrome is reported. A 26-year-old woman developed sudden onset of anisocoria and compromised accommodation that lasted 2 days after the use of oral scopolamine methylbromide for treatment of irritable bowel syndrome. The anisocoria and compromised accommodation occurred after contamination of the ocular surface after administration of scopolamine methylbromide and resolved within 1 week without further contamination. Oral preparations used for the pharmacologic treatment of irritable bowel syndrome can cause anisocoria due to anticholinergic pharmacologic blockade of the iris sphincter muscle.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/5. Reversible Horner's syndrome and dysthyroid ocular myopathy associated with Hashimoto's disease.BACKGROUND: Although it has been frequently stated that thyroid disease induces Horner's syndrome, there have been few reports describing the anatomical relation of goiter to the cervical preganglionic sympathetic nerve fibers in acquired Horner's syndrome, which is identified by the eye-drop test for adrenergic sensitivity. CASE: A 40-year-old woman with Hashimoto's disease presented with vertical diplopia, and blepharoptosis and miosis on the left side. OBSERVATIONS: Computed tomography scan showed hypertrophy of the right inferior rectus muscle, which resulted from a dysthyroid process, causing the limitation of upward movement of the right eye. The eye-drop test for adrenergic sensitivity revealed that only the left pupil dilated significantly after administration of 5% tyramine, and the Mueller's muscle on the left side did not respond. These results suggest that Horner's syndrome was due to a preganglionic sympathetic lesion. magnetic resonance imaging (MRI) of the neck showed chronic inflammatory lesions in both lobes of the thyroid gland identified by a high-intensity signal. CONCLUSION: The reconstruction technique of MRI demonstrated that the swollen left lobe of the thyroid gland was compressing the pathway of the cervical preganglionic sympathetic nerve fibers.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
3/5. Inferior oblique paresis, mydriasis, and accommodative palsy as temporary complications of sinus surgery.A 15-year-old boy had temporary hypertropia, supraduction deficit, ipsilateral mydriasis, and accommodative paresis after bilateral endoscopic ethmoidectomy, bilateral partial inferior turbinectomy, septoplasty, and Caldwell-Luc procedures for chronic sinusitis. Postoperative imaging did not disclose any intra-orbital abnormalities. The patient was treated with oral prednisolone 70 mg/day on a tapering schedule. Within two months, the ophthalmic abnormalities had resolved. This is the second report to describe such findings, which are attributed to damage of the inferior division of the third cranial nerve secondary to manipulation of adjacent ethmoid tissues.- - - - - - - - - - ranking = 5720.7873519778keywords = paresis (Clic here for more details about this article) |
4/5. Horner's syndrome caused by intra-oral trauma.A 7-year-old boy developed a Horner's syndrome after falling on a stick that penetrated his peritonsillar soft palate. He did not suffer from any major vascular injury, and pharmacologic testing indicated a preganglionic lesion. We review previously reported cases of oculosympathetic paresis caused by surgical and nonsurgical intra-oral trauma. Because of the proximity between sympathetic and vascular structures in the lateral and parapharyngeal space, Horner's syndrome in the setting of intra-oral trauma should prompt evaluation of the internal carotid artery. magnetic resonance imaging may be a reasonable noninvasive method for this investigation.- - - - - - - - - - ranking = 1144.1574703956keywords = paresis (Clic here for more details about this article) |
5/5. Concomitant ectatic posterior communicating artery and tentorial meningioma as a source of oculomotor palsy: case report.OBJECTIVE AND IMPORTANCE: Although non-aneurysmal vascular compression of the oculomotor nerve is rare, it should be considered in the evaluation of unilateral oculomotor palsy. CLINICAL PRESENTATION: A 36-year-old non-diabetic man presented with two months of intermittent retro-orbital headache and third nerve paresis caused by compression of the oculomotor nerve between an ectatic, atherosclerotic posterior communicating artery (PComA) and a small tentorial meningioma. At operation, the subarachnoid portion of the nerve, prevented from migrating posteriorly and laterally by the meningioma, was grooved by the apex of the artery's loop. INTERVENTION: Microvascular decompression (MVD) of the artery loop from the nerve and resection of the meningioma were performed. Postoperatively, the patient's retro-orbital headache and oculomotor paresis, with the exception of mild anisocoria, resolved. Tumor infiltrating the posterior tentorium and lateral cavernous sinus was treated by Cyberknife radiosurgery five months later. One year after surgery, the patient had improvement in his headaches, full extra-ocular movements, and minimal residual anisocoria. CONCLUSION: Only one other report describes MVD of the third nerve from PComA compression. A review is presented of MVD carried out for similar cases of non-aneurysmal vascular compression of the oculomotor nerve. By analogy from cases in which an aneurysm is the compressing vascular structure, prompt surgical treatment is advocated. Complete evaluation of an isolated third nerve palsy should include MRI sequences designed to detect vascular compression of cranial nerves.- - - - - - - - - - ranking = 2288.3149407911keywords = paresis (Clic here for more details about this article) |