1/11. Isolated superior division oculomotor palsy in a child with spontaneous recovery.A 10 year old boy with a superior division palsy of the left oculomotor nerve is reported. He had a flu-like illness 1 week before the onset. The computed tomography and magnetic resonance imaging scans were normal. Laboratory data for evaluation of infection, diabetes mellitus and myasthenia gravis were normal. The symptoms spontaneously disappeared after 2 months. The course of the illness in conjunction with the negative laboratory findings made this case an example of partial paralysis of the third nerve related to viral infection. In the literature, only several cases with isolated divisional palsy of the oculomotor nerve were found after a viral infection. Inferior division palsy has been reported in five children. Superior division palsy has been published in only two cases. Divisional palsy is more common among children and resolves spontaneously. This rare but important clinical entity is one of the differential diagnoses in oculomotor nerve palsies, particularly in children, which are neuroradiologically undiagnosed. It occurs after a viral infection and may affect a superior or inferior division alone.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
2/11. Congenital oculo-bulbar palsy.A girl developed progressive weakness of bulbar and ocular muscles starting before the age of two years. electromyography revealed a widespread subclinical myopathy. An intercostal muscle biopsy showed complex abnormalities including occasional neurofilamentous accumulations and honeycomb-like membranous material in terminal axons. Endplates were small and some secondary synaptic clefts were abnormally deep. acetylcholine receptors extended unusually deeply into the clefts of the junctional folds. Muscle fibres showed subsarcolemmal vacuolation at some places. This form of congenital oculo-bulbar palsy does not appear to have been described previously.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
3/11. Lacrimal gland prolapse in craniosynostosis syndromes and poor function congenital ptosis.Lacrimal gland prolapse is an important, though uncommon, feature found in craniofacial abnormalities as well as in cases of poor function congenital ptosis. It occurs secondary to a number of conditions, including increased posterior pressure secondary to decreased orbital volume; also, supportive structures of the gland often may be weak in conjunction with a poor function ptosis or as a result of trauma at the time of major reconstruction. Recognition of the prolapsed gland and its replacement into the lacrimal gland fossa in craniosynostosis syndromes, as well as in cases of poor function congenital ptosis in general, allows the temporal eyelid to approach a more normal position, yielding an improved functional and cosmetic result.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
4/11. 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 = 1keywords = junction (Clic here for more details about this article) |
5/11. Unilateral ptosis and Hering's law.In 21 patients with unilateral ptosis, only 1 was found to have lid retraction of the fellow eye--a sign regarded as evidence of Hering's law of equal innervation governing levator function. Hering's law may influence levator function in select cases of ptosis due to disease at or distal to the neuromuscular junction. Alternatively, the relatively autonomous contraction of orbicularis oculi or inhibition of frontalis may mask unilateral lid retraction.- - - - - - - - - - ranking = 3736.2444430319keywords = neuromuscular junction, junction (Clic here for more details about this article) |
6/11. edrophonium test in myasthenia: quantitative oculography.The response of eye movements to edrophonium is easily missed by clinical observation alone. Binocular horizontal ten degree saccades were recorded by infrared oculography, whilst the vision of one eye was occluded, before and after fatigue repeated intravenous injection of dilute edrophonium, and fatigue induced during anticholinesterase inhibition by intravenous edrophonium, in 26 patients with diplopia or ptosis of uncertain aetiology. The most reliable criterion of a positive response was an increase in the amplitude of the saccades of the fixating eye by 10% or more after each of several injections of dilute edrophonium. The response was positive in 13 patients and was difficult to observe clinically when the responses of the saccades of the eyes moving conjugately were unequal and when the patient presented with ptosis and no diplopia. edrophonium infrared oculography proved to be a sensitive test for weakness due to the neuromuscular junction defect of myasthenia gravis affecting extraocular muscles.- - - - - - - - - - ranking = 3736.2444430319keywords = neuromuscular junction, junction (Clic here for more details about this article) |
7/11. Treatment of eyelid retraction with two pedicle tarsal rotation flaps.Five patients with eyelid retraction (seven eyelids, four upper and three lower eyelids) associated with blepharoptosis surgery, Graves' disease, and vertical extraocular muscle surgery were effectively treated with a new technique involving recessing the respective eyelid retractor beyond the tarsal border. Direct attachment of the levator aponeurosis or the inferior aponeurosis (capsulopalpebral head of the inferior rectus muscle) into the tarsus was maintained through an extended framework created by two pedicle tarsal rotation flaps. This anatomic retention of the tarsal-retractor junction enhanced transfer of muscle contracture into eyelid movement. The only adverse effect was a 4-mm gap in the eyelashes of one patient.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
8/11. Myasthenic sustained gaze fatigue.Sustained gaze fatigue was found in two patients whose diplopia was the first manifestation of myasthenia gravis. Although ocular excursions initially appeared full, a slow drift toward the primary position occurred during sustained extreme gaze. This motility pattern signifies pathologic extraocular muscle fatigue and strongly implicates myoneural junction disease. When myasthenia gravis is suspected, the presence of sustained gaze fatigue provides a tentative clinical diagnosis to be confirmed by pharmacologic testing.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
9/11. ophthalmoplegia with bilateral ptosis secondary to midbrain hemorrhage. A case with clinical and radiologic correlation.A 65-year-old white female presented with the sudden onset of headaches, bilateral ptosis, and complete ophthalmoplegia. Other than a mild decrease in mental status, she was neurologically intact. magnetic resonance imaging (MRI) and computed tomography (CT) examinations showed a midline hemorrhage extending from the caudal diencephalon to the pontomesencephalic junction affecting the oculomotor complex, the medial longitudinal fasciculus (MLF), and the rostral parapontine reticular formation (PPRF). Ischemic changes were also noted in the midline pontine tegmentum possibly affecting root fibers from the abducens nuclei. angiography was negative for a vascular anomaly. The radiologic findings are correlated with current models of oculomotor organization to provide an explanation for this patient's unique clinical presentation.- - - - - - - - - - ranking = 1keywords = junction (Clic here for more details about this article) |
10/11. Myasthenia-like syndrome induced by overdosage of cibenzoline.A case of cibenzoline-induced myasthenia-like syndrome is reported. A 67-year-old woman with renal failure and no previous disorder of neuromuscular junction complained of fatigue during climbing up a flight of stairs and experiencing heavy eyelids after administration of 100 mg/day of cibenzoline. Repetitive nerve stimulation tests revealed decrement at 5-10 Hz. After reduction of the dosage, myasthenia-like signs and symptoms disappeared. The peak cibenzoline concentration was still high even after the dose reduction (666.4 ng/ml). In conclusion, cibenzoline, at a high plasma level, may induce myasthenia-like syndrome without any disorder of the neuromuscular junction.- - - - - - - - - - ranking = 7472.4888860637keywords = neuromuscular junction, junction (Clic here for more details about this article) |
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