1/21. Spasm of the near reflex mimicking deteriorating accommodative esotropia.PURPOSE: To describe a patient with accommodative esotropia who developed spasm of the near reflex. CASE REPORT: A 6-year-old girl with a history of successfully treated refractive, accommodative esotropia suddenly developed spasm of the near reflex after the death of a relative. The condition resolved after 2 months. CONCLUSION: Spasm of the near reflex should be considered in children with accommodative esotropia who seem to deteriorate and become esotropic once again while wearing their hyperopic glasses.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/21. Acquired unilateral visual loss attributed to an accommodative spasm.BACKGROUND: Accommodative spasm (AS) has been reported to be a rare cause of an acquired unilateral visual loss. We describe a unique case of acquired visual loss due to an apparent unilateral AS triggered by occlusion of the contralateral eye. Clinical examination and photorefraction techniques were performed during the acute phase of the disorder and in the follow-up evaluations. CASE REPORT: An otherwise healthy 27-year-old woman presented with a 2-month decrease of vision in her left eye. Unaided visual acuity in the right eye was 20/20 and in the left eye was finger counting. Orthophoria existed at distance and near. The decrease in vision in the left eye was attributed to an apparent unilateral AS of 5 D, which occurred only when the right eye was occluded. Under the occluder, the right eye also manifested an AS. With the left eye occluded or with binocular viewing, the right eye and left eye accommodated normally. With a 5 D convex lens before the right eye, the visual acuity in the left eye was 20/20. Refractive error with cycloplegia revealed low hyperopia in each eye. CONCLUSION: AS can be the cause of acquired unilateral visual loss. To our knowledge, this is the first documented report of an apparent unilateral AS triggered by occlusion of the contralateral eye.- - - - - - - - - - ranking = 0.14285714285714keywords = near (Clic here for more details about this article) |
3/21. Vasospastic dystrophy of the hand. Case report.The author reports a patient with a history of left arm pain and wasting of the hand who had absent radial and ulnar pulses. sympathectomy restored the arterial circulation to the hand with nearly complete return of function.- - - - - - - - - - ranking = 0.14285714285714keywords = near (Clic here for more details about this article) |
4/21. Spasm of the near reflex associated with head injury.Spasm of the near reflex is characterized by intermittent miosis, convergence spasm and pseudomyopia with blurred vision at distance. Usually, it is a functional disorder in young patients with underlying emotional problems. Only rarely is it caused by organic disorder. We report a patient who developed convergent spasm associated with miosis after head trauma at the age of 84 years.- - - - - - - - - - ranking = 0.71428571428571keywords = near (Clic here for more details about this article) |
5/21. Near reflex accommodation spasm: unusual presentation of generalized photosensitive epilepsy.We report on a 9 year old girl admitted with prolonged and recurrent episodes of near reflex accommodation spasm (NRAS), which was the sole clinical manifestation of primary generalized photosensitive epilepsy. Four days prior to admission, the patient started to experience intermittent episodes of adduction of both eyes and miosis, namely near reflex accommodation spasm, which apparently became fixed three hours prior to admission, with no other perturbations. On examination she was fully alert showing a fixed NRAS, but otherwise unremarkable neurological examination. time locked with NRAS, the EEG demonstrated generalized spike/wave discharges, also induced with photic stimuli, compatible with generalized photosensitive epilepsy. Assuming an epileptic etiology for the diagnosed NRAS, she was started on a small dose of valproate and became asymptomatic within the first day of treatment, along with EEG normalization. She remained asymptomatic within seven months when the valproic acid was erroneously discontinued. After a few days she began experiencing short lived episodes of NRAS, which could also be induced by photic stimulation and a concurrent EEG again demonstrated generalized epileptiform discharges.Searching the literature, this is the first report associating generalized photosensitive epilepsy with NRAS, and hence complete resolution of NRAS in response to antiepileptic therapy along with normalization of the EEG. An epileptic disorder should be therefore taken into account in any patient with new onset NRAS, especially when other epileptic phenomena are absent.- - - - - - - - - - ranking = 0.28571428571429keywords = near (Clic here for more details about this article) |
6/21. Reversible spongiform leucoencephalopathy after inhalation of heated heroin.OBJECTIVE: To describe the clinical course and imaging findings in a young man who developed a spongiform leucoencephalopathy from heroin-vapour inhalation, and to discuss the treatments which may have contributed to the unexpected favourable outcome in this case. DESIGN: Case report. SETTING: intensive care unit of a university teaching hospital. PATIENT: A patient who developed a near fatal toxic leucoencephalopathy with impressive clinical recovery and reversible white matter changes on imaging. MEASUREMENTS AND RESULTS: Successive computed tomography scans and magnetic resonance imaging over 7 months showed evolution from bilateral extensive involvement of the cerebral white matter to almost complete resolution accompanied by the development of periventricular lesions suggestive of necrosis. Despite the fact that the patient had stretching spasms for several days, the outcome was favourable with prolonged supportive care and antioxidant therapy by ubiquinone (coenzyme Q). CONCLUSION: This case demonstrates that prolonged intensive care is of paramount importance in patients with spongiform leucoencephalopathy after inhalation of heated heroin, that abnormalities of cerebral white matter may be slowly regressive, and supports the use of coenzyme Q in severe forms of the disease.- - - - - - - - - - ranking = 0.14285714285714keywords = near (Clic here for more details about this article) |
7/21. Cricopharyngeal myotomy in a patient with situs inversus totalis.Otolaryngologists must remain vigilant in understanding the complex anatomy of the head and neck and must always be cognizant of deviations from normal anatomy. This text discusses an interesting case that should remind surgeons of the variable course that the recurrent laryngeal nerve takes on either side of the neck and the special consideration that must be taken in performing surgery near the nerve.- - - - - - - - - - ranking = 0.14285714285714keywords = near (Clic here for more details about this article) |
8/21. Spasm of the near reflex triggered by disruption of normal binocular vision.A 26-year-old healthy female was referred by her optometrist to the binocular vision clinic of our institution for the investigation of an accommodative spasm occurring during monocular conditions. Corrected binocular visual acuity was 20/20 (6/6), with normal pupils and good ocular alignment. When the fellow eye was covered, visual acuity was <20/200 (6/60) in each eye, miosis was present in both eyes, and the occluded eye was in esodeviation, indicating a spasm of the near reflex. The spasm disappeared when a translucent occluder was used instead of an opaque black occluder. Further investigation permitted us to establish that dioptric and nondioptric blur, as well as reduced light transmission, also triggered the spasm of the near reflex, but only for specific power, opacity, or density. Cycloplegia did not eliminate the spasm. Comparisons are made with the single other similar case found in the literature. Assumptions are made as to the possible causes of that intermittent spasm.- - - - - - - - - - ranking = 0.85714285714286keywords = near (Clic here for more details about this article) |
9/21. Spasm of the near reflex associated with cerebrovascular accident.Spasm of the near reflex most often has a functional basis, but may be associated with organic disease. This case report describes a patient with a progressive 11-year history of spasm of the near reflex associated with cerebrovascular accidents and reviews the differential diagnosis, management and aetiology of this disease.- - - - - - - - - - ranking = 0.85714285714286keywords = near (Clic here for more details about this article) |
10/21. Familial hemifacial spasm.Three male patients in successive generations of the same family developed acquired left-sided hemifacial spasm. magnetic resonance imaging of the proband demonstrated a pontine vertebral artery anomaly near the root of the affected facial nerve. This family and a similar family that was recently presented illustrate several interesting features: (1) hemifacial spasm, from whatever cause, may be autosomal dominant; (2) the spasms involve the same side of the face in affected individuals within an affected family; and (3) the age of onset in familial cases may be younger than in nonfamilial cases.- - - - - - - - - - ranking = 0.14285714285714keywords = near (Clic here for more details about this article) |
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