11/36. 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 = 1keywords = nystagmus (Clic here for more details about this article) |
12/36. A central demyelinating disease with atypical features.There are clinical, laboratory and imaging criteria to distinguish multiple sclerosis (MS) from neuromyelitis optica (NMO) and acute disseminated encephalomyelitis (ADEM). While MS has unknown aetiology, NMO is commonly associated with vasculitis and ADEM is supposed to be parainfectious in origin. In the present study, six patients are described from a group of 67 with a central demyelinating disorder whose clinical presentation did not conform to existing diagnostic criteria for ADEM, NMO or MS. Their clinical, laboratory and imaging characteristics were studied and analysed. Some features suggested a particular diagnosis but some other features favoured another diagnosis. The features included spinal cord involvement in a large vertical segment with cord swelling, optic neuritis, no lesions in the cerebral cortex, paraplegia with urinary retention during the acute phase, no oligoclonal band in cerebrospinal fluid, absence of any evidence of vasculitis, wide time-gap between spinal cord and optic nerve involvement, good recovery from acute phase of disease and a relatively benign course. We conclude that there exists a subpopulation of patients with central demyelinating disease in this region with mixed clinical features. overall features suggested either a widened clinical spectrum of MS, NMO or ADEM or a possible overlap between them.- - - - - - - - - - ranking = 0.00011779747368322keywords = vertical (Clic here for more details about this article) |
13/36. Cutaneous ulcerations following subcutaneous interferon beta injection to a patient with multiple sclerosis.We report a case treated with interferon beta-1b for multiple sclerosis (MS), who developed severe cutaneous ulcers after six months of therapy. Interferon beta-1b had been used in a regimen of 8 million IU administered subcutaneously through oblique direction of the needle, twice a week. The cutaneous ulcers developed at inoculation sites, as a result of penetration of interferon beta into dermis. Other underlying diseases of coagulative or bleeding disorders or secondary infection were excluded. Histological features of non-specific inflammatory reactions including hyperplastic changes of blood vessels without any evidence of vasculitis were the prominent features in this case. Corticosteroid and interferon beta-1b therapy was continued on restricted sites on the extremities with care not to repeat injections at the same sites previously used. The administration of interferon beta into subcutaneous fatty tissues vertically reduced the incidence of dermal penetration of drug and occurrence of ulcerations in this patient. We review other case reports of severe cutaneous reactions associated with interferon beta-1b therapy in MS patients and conclude that local cytokine-mediated, adverse, immune reaction or non-specific cutaneous inflammatory reaction to interferon beta-1b initiated the skin ulceration long after institution of therapy at the injection sites, and the reaction might be related to the depth of injection.- - - - - - - - - - ranking = 0.00011779747368322keywords = vertical (Clic here for more details about this article) |
14/36. Positional nystagmus and vertigo due to a solitary brachium conjunctivum plaque.The authors describe two patients suffering from demyelinating central nervous system disease who developed intense vertigo and downbeat nystagmus upon tilting their heads relative to gravity. brain MRI revealed in both cases a single, small active lesion in the right brachium conjunctivum. The disruption of otolithic signals carried in brachium conjunctivum fibres connecting the fastigial nucleus with the vestibular nuclei is thought to be causatively involved, in agreement with a recently formulated model simulating central positional nystagmus. Insufficient otolithic information results in erroneous adjustment of the Listing's plane in off-vertical head positions, thus producing nystagmic eye movements.- - - - - - - - - - ranking = 6.0001177974737keywords = nystagmus, vertical (Clic here for more details about this article) |
15/36. Bilateral horizontal gaze palsy in multiple sclerosis.Bilateral horizontal gaze palsies are rare. In this case report, we present a 28-year-old woman with bilateral horizontal gaze palsies due to involvement of both paramedian pontine reticular formations (PPRFs) by multiple sclerosis (MS) plaques.- - - - - - - - - - ranking = 0.0121434965214keywords = horizontal (Clic here for more details about this article) |
16/36. 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 = 16.256988622565keywords = pendular nystagmus, nystagmus, pendular (Clic here for more details about this article) |
17/36. A case of childhood multiple sclerosis with peripheral neuropathy.A twelve-year-old girl with multiple sclerosis and peripheral neuropathy is reported. When nine years old, she was diagnosed as having Devic disease (optic atrophy and transverse myelitis). During the three years after onset of her illness, she suffered from three relapses and remissions of her multiple sclerosis. On the third occasion, neurological examination revealed signs of cerebellar dysfunction including ataxic gait, nystagmus and dysmetria, and absence of all tendon reflexes with muscle weakness especially on the left side. Markedly slowed conduction velocity in her ulnar nerve especially on the left and elevated CSF protein were noted. Biopsied sural nerve showed decreased density of myelinated fibers and a selective loss of large diameter fibers. Electron microscopy disclosed onion-bulb formation, myelin debris within Schwann cell cytoplasm and demyelinated axons. These findings showed demyelination and remyelination of the peripheral nervous system in this patient with multiple sclerosis. We discuss the relation of multiple sclerosis and peripheral neuropathy.- - - - - - - - - - ranking = 1keywords = nystagmus (Clic here for more details about this article) |
18/36. 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 = 7keywords = nystagmus (Clic here for more details about this article) |
19/36. Diffential diagnosis of the caloric nystagmus.Diagnostic considerations based upon the nystagmogram are limited. Quantitative assessment of horizontal canal sensitivity is available through the use of culmination frequency or culmination slow phase velocity. Qualitative characteristics of nystagmometry have been sought but with no satisfactory results. Three distinctive features of the caloric nystagmus were evaluated and were found to be suggestive or outrightly pathognomonic for retrolabyrinthine or central nervous system abnormalities. These are: (1) Vestibular decruitment. The disproportionate caloric responsiveness when a weak stimulus elicits a more intense nystagmic reaction than a strong stimulus is capable of creating. (2) Hyperactive vestibular responsiveness (3) Ocular fixation reversal phenomenon. Contrary to the normal behaviour, the elimination of fixation decreases the nystagmus intensity instead of facilitating the evoked nystagmus. The assessment of these qualitative features of the caloric nystagmus in addition to the quantitative measurements widens the scope of our diagnostic capabilities.- - - - - - - - - - ranking = 8.0020239160869keywords = nystagmus, horizontal (Clic here for more details about this article) |
20/36. electronystagmography in neurological diagnosis.electronystagmography (ENG) is a technique for recording nystagmus and other eye movements; our technique, based on the utilization of a bioelectrical potential which exists between the retina and the cornea, has been reported in detail elsewhere in a monograph [29]. ENG has been used particularly by otologists to record caloric nystagmus and study labyrinthine function [2, 4, 16, 19]. This technique should have even greater applications in the diagnosis of neurological disease, since nystagmus and abnormalities of ocular and vestibular functions are symptoms frequently encountered by the neurologist. This paper illustrates this point with three case reports.- - - - - - - - - - ranking = 3keywords = nystagmus (Clic here for more details about this article) |
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