1/29. Clinical deterioration in Bickerstaff's brainstem encephalitis caused by overlapping guillain-barre syndrome.A 37-year-old man developed an acute encephalitic condition after respiratory infection. His condition rapidly deteriorated, and he experienced ophthalmoplegia, tetraplegia, loss of brainstem reflexes and deep tendon reflexes, and deep coma. Electrophysiological evaluations indicated involvement of the peripheral nerve as well as the brainstem. follow-up studies found acute progression of peripheral nerve damage. serum anti-GQ1b IgG antibody was present. The initial condition was diagnosed as Bickerstaff's brainstem encephalitis, and subsequent overlapping of guillain-barre syndrome probably was responsible for the clinical deterioration. When unusual worsening is observed in clinically suspected encephalitis, neurologists must take into account the possibility of associated guillain-barre syndrome and related disorders.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/29. Angle closure glaucoma following a combined blepharoplasty and ectropion repair.This paper reports an occurrence of angle closure glaucoma following a combined blepharoplasty and ectropion repair. We are unaware of any previous reports of such an incident. Specific to this case was the coexistence of a cataract that contributed to the narrowing of the anterior chamber. This condition, along with pupil dilation secondary to the anesthetic, precipitated a phacomorphic angle closure glaucoma attack, necessitating emergency cataract surgery. Because other procedures involve pupillary dilation as a potential side effect, we recommend an increased awareness of this potential postoperative complication.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
3/29. Ocular findings in mitochondrial neurogastrointestinal encephalomyopathy: a case report.PURPOSE: To describe the ocular features of a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) due to a homozygous G1443A mutation in the thymidine-phosphorylase gene. methods: A case report with extensive ophthalmological investigation over a 9-year period, until death at age 38 years. Measures used included standard ophthalmological examination, visual field examination and optical coherence tomography (OCT). RESULTS: Ptosis and external ophthalmoplegia progressively worsened during the follow-up, as did the neurological and general status. Corneal and optic disc alterations were also observed at the last visit. Glaucomatous changes of the optic disc were confirmed by the visual field examination and OCT. CONCLUSION: In addition to previously described alterations such as ptosis and external ophthalmoplegia, MNGIE may be associated with glaucomatous-like optic neuropathy.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
4/29. Long-term follow-up and prognosis of orbital apex syndrome resulting from nasopharyngeal rhabdomyosarcoma.PURPOSE: Nasopharyngeal rhabdomyosarcoma may present with a variety of ophthalmic symptoms. Direct extension of the tumor into the orbital apex can lead to ophthalmoplegia and loss of vision. The prognosis for recovery of vision and ocular motility in patients with an orbital apex syndrome due to nasopharyngeal rhabdomyosarcoma is examined. DESIGN: Retrospective case series. methods: Six eyes from four patients with nasopharyngeal rhabdomyosarcoma who presented to the Children';s Hospital of philadelphia with a clinical orbital apex syndrome were identified. Complete ophthalmic examination, including visual acuity and extraocular motility at the time of presentation, was reviewed. Tumor extension into the orbital apex was confirmed radiographically. Follow-up ophthalmic evaluations were reviewed for all patients with an average follow-up of 5.5 /- 3.1 years (range 1 to 8 years). RESULTS: Six eyes of four patients had limited ocular ductions along with marked loss of vision at presentation. All patients were treated with chemotherapy and radiation, with reduction of tumor mass. Ocular motility recovered in all patients, occurring by an average of 2.2 /- 1.8 months after initiation of therapy. Four of six eyes had little or no recovery of visual acuity detected at long-term follow-up. CONCLUSIONS: patients with ocular motor deficits in orbital apex syndromes caused by extension of nasopharyngeal rhabdomyosarcoma have an excellent prognosis for recovery after treatment of the tumor. The long-term prognosis for visual recovery, however, is poor.- - - - - - - - - - ranking = 8keywords = coma (Clic here for more details about this article) |
5/29. Painful ophthalmoplegia caused by neurotropic malignant melanoma.Progressive cranial nerve palsies and painful ophthalmoplegia developed in a 76-year-old man with lentigo maligna of the forehead 18 months after the excision of a spindle cell tumour of the forehead that proved on immunohistochemical study to be a malignant melanoma. The signs and symptoms were caused by neurotropic spread of the malignant melanoma into the cavernous sinus and subsequent neurosarcomatous transformation of the orbital metastasis.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
6/29. Ophthalmologic findings associated with arthrogryposis multiplex congenita: case report and review of the literature.arthrogryposis multiplex congenita is a birth defect characterized by multiple joint deformities and sometimes associated with various other congenital anomalies. There have been several reported cases of miscellaneous ocular abnormalities in conjunction with this syndrome. We report the first case of congenital ophthalmoplegia as well as juvenile onset glaucoma associated with arthrogryposis multiplex congenita. This case represented a unique therapeutic dilemma in that it was extremely difficult to surgically treat the patient's glaucoma because of her severe restrictions of ocular motility.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
7/29. oculomotor nerve palsy precipitating acute angle-closure glaucoma. A case report.A case of acute angle-closure glaucoma precipitated by oculomotor nerve palsy in a patient with shallow anterior chambers is reported. The different ways in which a palsy of the oculomotor nerve can influence the intra-ocular pressure are discussed.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
8/29. leiomyosarcoma of a lower limb presenting with multiple cranial nerve palsies.leiomyosarcoma is a relatively uncommon soft tissue sarcoma usually presenting as a mass at the primary site. It arises in the retroperitoneal region, in the cutaneous or subcutaneous tissue of the extremities or, less commonly, from a large vein. A case is described where a patient presented with unilateral third, fourth, and sixth cranial, and ophthalmic division of trigeminal nerve palsies in whom biopsy of a longstanding lower limb mass demonstrated leiomyosarcoma. The presentation of this type of pathology has not been described previously.- - - - - - - - - - ranking = 7keywords = coma (Clic here for more details about this article) |
9/29. diabetes mellitus in kearns-sayre syndrome.A 20-year-old woman with kearns-sayre syndrome (KSS) suddenly experienced two episodes of diabetic coma. She was studied to determine whether diabetes mellitus (DM) resulted from insulin resistance or from an insulin secretion abnormality, using the euglycemic glucose clamp technique and the glucagon tolerance test. She had a deficiency of insulin secretion from beta cells. It is important to recognize in practice the onset of DM in patients with mitochondrial myopathy. We would suggest that a genetic linkage or mitochondrial dysfunction may be responsible for the association of both disease states.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/29. Isolated ophthalmoplegia of abduction.A case of transient complete bilateral paresis of abduction is reported without esotropia. Loss of vestibular ocular reflex (VOR) responses of the abducting eye and intactness of all other slow VOR reactions were the leading symptoms. Since bilateral lesions of the pontine gaze centers in this initially comatose patient without signs of increased intracranial pressure were excluded, bilateral lesions of the abducens nerves appeared improbable. In view of normal function of the ascending tract of Deiters bilateral paramedian lesions between the vestibular and abducens nuclei appeared to be more likely. Clinical course with relatively rapid recovery after administration of thiamine, theoretical considerations, and some earlier reports led to the conclusion that in some metabolic-toxic disorders--apparently in this case of Wernicke's encephalopathy--intrapontine connections in the paraabducens area may be selectively vulnerable. A similar effect on oligosynaptic connections to the medial rectus nucleus could lead to a disordered inhibition of this muscle. The term "posterior INO of Lutz" should no longer be used because of the lack of any anatomical and physiological evidence for its existence.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
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