1/23. Acquired convergence-evoked pendular nystagmus in multiple sclerosis.Nystagmus seen only with convergence is unusual. We describe four cases of acquired convergence-evoked pendular nystagmus in patients with multiple sclerosis. The nystagmus was horizontal and asymmetric in all patients. Eye movement recordings in one subject showed a conjugate rather than a convergent-divergent relationship of the phase of movement between the two eyes. All patients had evidence of optic neuropathy and cerebellar dysfunction. Occlusion of either eye during fixation of near targets led to divergent drift of the covered eye and a decrease in nystagmus. Intravenous scopolamine reduced nystagmus in one patient. Base-in prisms alleviated symptoms of oscillopsia at near and improving reading visual acuity. Convergence-evoked pendular nystagmus may be more common than currently appreciated, particularly among patients with multiple sclerosis.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
2/23. A pilot study of gabapentin as treatment for acquired nystagmus.The effects of the anticonvulsant gabapentin were measured on vision and eve movements in three patients with acquired pendular nystagmus. In two patients, the nystagmus was associated with multiple sclerosis and, in the other, it followed brainstem stroke. A single oral 600 mg dose of gabapentin produced improvement of vision due to changes in ocular oscillations in all three patients. The effect was sustained after five weeks of treatment in two patients who elected to continue taking gabapentin 900-1500 mg/day. The results of this pilot study suggest that a controlled trial of gabapentin should be conducted to evaluate its role in the treatment of acquired forms of nystagmus.- - - - - - - - - - ranking = 0.16666666666667keywords = sclerosis (Clic here for more details about this article) |
3/23. Combined pharmacologic and surgical approach to acquired nystagmus due to multiple sclerosis.PURPOSE: To describe a combined pharmacological and surgical approach to treating acquired nystagmus in a patient with multiple sclerosis. DESIGN: Interventional case report. methods: A 40-year-old patient with acquired horizontal and vertical nystagmus and severe oscillopsia secondary to multiple sclerosis had combined treatment with gabapentin and a vertical Kestenbaum-type procedure. RESULTS: After gabapentin treatment (3,000 mg orally daily) the horizontal nystagmus was significantly reduced, and the patient developed a marked chin-up position. The vertical nystagmus remained unchanged, dampening on downgaze. A recession of both inferior rectus muscles reduced the nystagmus significantly in primary position, the abnormal head position disappeared, and oscillopsia completely resolved. Treatment increased visual acuity from 6/24 in the right eye and 6/60 in the left eye to 6/9 in both eyes. CONCLUSIONS: Acquired nystagmus in multiple sclerosis can be significantly improved by using a combined pharmacological and surgical approach.- - - - - - - - - - ranking = 1.1666666666667keywords = sclerosis (Clic here for more details about this article) |
4/23. Improvement of acquired pendular nystagmus by gabapentin: case report.Acquired Pendular Nystagmus (APN) may cause distressing visual symptoms in patients who are already suffering a severe general disease. Averbuch-Heller et al. conducted the first double-blind controlled study on treatment for APN. They showed that gabapentin substantially reduces pendular nystagmus and significantly increases visual acuity in the majority of patients. We present a patient with APN due to multiple sclerosis who suffered severe oscillopsy and reduction of visual acuity and who substantially benefited from a trial treatment with this agent.- - - - - - - - - - ranking = 0.16666666666667keywords = sclerosis (Clic here for more details about this article) |
5/23. Opisthotonic posturing with neuromuscular irritability attributable to 4-aminopyridine ingestion by a healthy pediatric patient.INTRODUCTION: 4-aminopyridine (4-AP) is a potassium channel blocker used to increase muscle strength in the treatment of demyelinating diseases such as multiple sclerosis. We describe a case of ingestion by an 8-month-old child that resulted in severe but transient symptoms. CASE REPORT: An 8-month-old boy was found with greenish saliva, and a capsule with green 4-AP powder was missing. On arrival to an emergency department, he was jittery, tachycardic, and tachypneic. Activated charcoal, a cathartic, and midazolam (0.5 mg/kg) were administered before transfer to a tertiary pediatric hospital. On arrival, the infant remained tachycardic and tachypneic. His eyes deviated upward and he was noted to have 3 deep tendon reflexes bilaterally. He was administered 0.9% normal saline (20 mL/kg) for a wide pulse pressure with low diastolic blood pressure. The patient developed dramatic opisthotonic posturing and vermiform tongue fasciculations. The symptoms responded well to repeated intravenous doses of benzodiazepines. In this case, we used 2 doses of lorazepam (0.05 mg/kg each). During opisthotonic posturing, an electroencephalogram performed in the intensive care unit revealed no evidence of seizure activity. Within 20 hours after admission, the patient became asymptomatic. CONCLUSION: This case is, to our knowledge, the first documented pediatric 4-AP ingestion. Clinical signs and symptoms are described as well as the response to therapy with benzodiazepines. The electroencephalogram performed while the patient was symptomatic was negative for seizures.- - - - - - - - - - ranking = 0.16666666666667keywords = sclerosis (Clic here for more details about this article) |
6/23. Horizontal monocular saccadic failure: an unusual clinically isolated syndrome progressing to multiple sclerosis.This paper describes an unusual clinically isolated syndrome of inflammatory demyelination that was characterized by a right VI nerve palsy and right internuclear ophthalmoparesis (INO), along with an unusual form of dissociated nystagmus. magnetic resonance imaging (MRI) revealed an isolated lesion within the right dorsomediolateral pontine tegmentum. Four years later, the subject developed a partial sensory transverse myelitis, confirming clinically definite multiple sclerosis (MS). This paper extends the range of isolated syndromes associated with MS.- - - - - - - - - - ranking = 0.83333333333333keywords = sclerosis (Clic here for more details about this article) |
7/23. Successful treatment of acquired pendular elliptical nystagmus in multiple sclerosis with isoniazid and base-out prisms.We treated 3 multiple sclerosis patients who had pendular nystagmus with isoniazid (800 to 1,000 mg/d). isoniazid abolished the nystagmus and relieved oscillopsia in 2 patients but was ineffective in the 3rd in whom the nystagmus was damped with convergence and vision improved with converging (base-out) prisms.- - - - - - - - - - ranking = 0.83333333333333keywords = sclerosis (Clic here for more details about this article) |
8/23. Downbeat nystagmus secondary to multiple sclerosis.Downbeat nystagmus has been associated with an increasing number of neurologic disorders, yet, it has only rarely been described in multiple sclerosis. Two patients with downbeat nystagmus secondary to multiple sclerosis are presented. In one, the nystagmus cleared completely in three weeks. In the other, it has persisted unchanged for 2 1/2 years.- - - - - - - - - - ranking = 1keywords = sclerosis (Clic here for more details about this article) |
9/23. Lateral gaze deficit suggesting multiple sclerosis.The case of a 26-year-old white man with multiple sclerosis is presented. Although the patient was unaware of his condition, the signs and symptoms that he presented were highly suggestive of multiple sclerosis. The case is unusual in that initial diagnosis was made by a senior dental student in a social rather than a clinical setting and without a presenting complaint by the patient. The significance of a thorough clinical examination and the responsibility of a general practitioner as a primary health provider to be observant of signs of disease such as multiple sclerosis are discussed.- - - - - - - - - - ranking = 1.1666666666667keywords = sclerosis (Clic here for more details about this article) |
10/23. Neuro-ophthalmologic findings in vestibulocerebellar ataxia.A young adult who presents with periodic vertigo, diplopia, and tinnitus, later followed by progressive ataxia, may not have multiple sclerosis as might initially be suspected, but rather may represent a type of familial spinocerebellar degeneration previously described by Farmer and Mustian as "vestibulocerebellar ataxia." We recently encountered a patient who presented with these symptoms, and who was found to have downbeat nystagmus, ocular dysmetria, skew deviation, optokinetic dissociation, and a vertical gain bias on horizontal eye movements. Although family involvement was specifically denied by the patient, seven members of her family representing four generations were examined, and found to have similar findings. The importance of a careful neuro-ophthalmologic examination in each available family member of any patient presenting with this constellation of symptoms is emphasized. A discussion of the spinocerebellar degenerations, differential diagnosis, and literature review are included.- - - - - - - - - - ranking = 0.16666666666667keywords = sclerosis (Clic here for more details about this article) |
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