| PURPOSE: To describe three children with acute fourth cranial nerve palsy secondary to pseudotumor cerebri. methods: We reviewed the medical records of children younger than 18 years who were diagnosed with pseudotumor cerebri between 1977 and 1997. pseudotumor cerebri was defined by normal neuro-imaging, elevated intracranial pressure measured by lumbar puncture, and normal cerebrospinal fluid composition. RESULTS: Three children with pseudotumor cerebri presented with vertical diplopia and clinical signs of fourth cranial nerve palsy including a hypertropia of the affected eye, which increased with adduction and ipsilateral head tilt. The fourth cranial nerve palsy resolved after reduction of the intracranial pressure in all three children. CONCLUSIONS: Fourth cranial nerve palsy may occur in children with pseudotumor cerebri and may be a nonspecific sign of elevated intracranial pressure. ( info) |
2/600. Improvement of visual function in an adult amblyope. PURPOSE: In this case report, the efficacy of occlusion therapy was investigated in a strabismic amblyope above the currently accepted age for treatment. Success was assessed not simply by a change in visual acuity, but by examining a number of parameters which relate to both sensory and motor aspects of visual function. methods: As well as routine orthoptic and optometric evaluation, additional tests were administered as follows: high and low contrast LogMAR Crowded Acuity, repeat letter acuity, and hyperacuity measurements. RESULTS: A functional loss in each of the tests used was demonstrated, and occlusion therapy appeared to improve all aspects of the amblyopia, with a significant difference in pre- and post-therapy results. CONCLUSIONS: The results of this study suggest that: (1) occlusion therapy can produce substantial improvements in visual function in adult amblyopia; (2) many aspects of visual function can improve beyond the traditional critical periods for development in amblyopia; and (3) with good patient compliance and cooperation, age should not be the critical factor in the initiation of treatment for amblyopia. ( info) |
3/600. Tonic ocular tilt reaction simulating a superior oblique palsy: diagnostic confusion with the 3-step test. BACKGROUND: The tonic ocular tilt reaction (OTR) consists of vertical divergence of the eyes (skew deviation), bilateral conjugate ocular torsion, and paradoxical head tilt. The head and superior pole of both eyes are rotated toward the hypotropic eye. OBJECTIVE: To describe ocular motility and torsion findings in 5 patients with OTRs that mimicked superior oblique palsies (SOPs). RESULTS: In 5 patients, results of the 3-step test suggested an SOP (bilateral in 1 patient); however, no patient had the expected excyclotorsion of the hypertropic eye. Two patients had conjugate ocular torsion (intorsion of the hypertropic eye and extorsion of the hypotropic eye), and 2 patients had only intorsion of the hypertropic eye. All had other neurologic features consistent with more widespread brainstem disease. CONCLUSIONS: Vertical ocular deviations that 3-step to an SOP are not always caused by fourth nerve weakness. When a patient with an apparent fourth nerve palsy has ocular torsion that is inconsistent with an SOP, OTR should be suspected, especially if vestibular system or posterior fossa dysfunction coexists. The rules for the 3-step test for an SOP may be fulfilled by damaging the otolithic projections corresponding to projections of the contralateral anterior semicircular canal. Because results of the Bielschowsky head tilt test may be positive in patients with the OTR, the feature distinguishing OTR from an SOP is the direction of torsion. We advocate use of a fourth step-evaluation of ocular torsion-in addition to the standard 3 steps. ( info) |
4/600. Biofeedback reinforcement in the training of limitation of gaze: a case report. A 22-year-old patient having a history of congenital strabismus with surgery at age 6 and again at age 14 suffered from a limitation of dextroversion following 2 surgical procedures with diplopia initially experienced beyond 18 degrees. Ten sessions of treatment by traditional visual training methods and biofeedback reinforcement were compared in extending the deficient range of dextroversion. Biofeedback was found to be significantly better than conventional approaches in this treatment. ( info) |
5/600. Atypical vertical retraction syndrome: a case study. A case of unilateral retraction of the eyeball in downward gaze as well as downshoot with the retraction when an outward horizontal movement of the contralateral eye was attempted has been introduced. The case has an exotropia with inability to adduct involved eye. The face turned to the left to minimize diplopia in the primary position. During the retraction, the lid widened slightly. An analyses by electrooculography and electromyography suggested that there was an abnormal neural connection between the vertical recti of the involved eye and the contralateral lateral rectus muscle. Co-contraction of vertical recti and loss of the reciprocal innervation were seen at the involved eye. Surgical treatment for exotropia, and total transplantation of vertical recti to the insertion of the involved medial rectus resulted in a slight reduction of the exotropia with the face straight, but not in the retraction as well as adduction and elevation of the involved eye. Based on the results, a central mechanism to produce above abnormality was described. ( info) |
6/600. Adverse response to prism therapy in strabismus. The recent literature on prism therapy in strabismus is reviewed. A case is reported in which an esotrope, treated by means of prism neutralization to effect sensory orthotropia, responded with a marked increase in the angle of squint. Guidelines are suggested to minimize risk of such adverse effect when prism therapy is attempted. ( info) |
7/600. The automatic occluder, a new concept. An electro-mechanical occluder is described for use in treating problems of binocular vision. A number of methods of achieving the automatic occluder goal are reviewed. Early results of clinical studies now in progress indicate that the "autocluder" has unique clinical usefulness. ( info) |
8/600. Anterior segment ischemia and sector iris atrophy: after strabismus surgery in a patient with chronic lymphocytic leukemia. A 69-year-old woman with chronic lymphocytic leukemia developed segmental iris atrophy and iridocyclitis after routine surgery for exotropia. Both the clinical picture and fluorescein angiogram indicated anterior segment ischemia. It is postulated that this was related to hyperviscosity of the blood caused by a high white blood cell count (114,000/cu mm). The possibility of anterior segment ischemia should be kept in mind when contemplating strabismus or retinal detachment surgery in the presence of hematologic disorders likely to increase blood viscosity. In these cases a minimal amount of surgery should be done with proper supportive therapy. strabismus surgery should be done in stages allowing for hemodynamic compensation between procedures. ( info) |
9/600. Multiple systemic and periocular malformations associated with the fetal hydantoin syndrome. anticonvulsants remain necessary during pregnancy and the removal of such drugs is not recommended. However, on the available evidence, the physician may expect an increased risk of malformation including eye abnormalities as has been outlined. The abnormalities include growth deficiencies and delayed motor/mental development together with dysmorphic features, the most common of which seems to be cleft lip/cleft palate. Additionally, many of these children suffer from eye abnormalities including hypertelorism, ptosis, strabismus, epicanthal folds, and in this case abnormalities of the lacrimal apparatus. ( info) |
| PURPOSE: To present a case of rhabdomyolysis which developed in a child with a known history of Duchenne's muscular dystrophy, following an anesthetic which included sevoflurane. CLINICAL FEATURES: An 11 yr old boy with a known history of Duchenne's muscular dystrophy underwent anesthesia for strabismus repair. The anesthetic consisted of sevoflurane and nitrous oxide without the use of a muscle relaxant. His postoperative course was complicated by a complaint of heel pain and the development of myoglobinuria. He was treated with dantrolene sodium and discharged home after two days, without further complication. CONCLUSION: Sevoflurane anesthesia has not been shown previously to be associated with the development of acute rhabdomyolysis in a child with a history of Duchenne's muscular dystrophy. As with halothane and isoflurane, the continued use of sevoflurane in the presence of Duchenne's muscular dystrophy should be questioned. ( info) |