Cases reported "Strabismus"

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1/75. Fourth cranial nerve palsy in pediatric patients with pseudotumor cerebri.

    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.
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2/75. 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.
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3/75. heart block following propofol in a child.

    We present the case of a nine-year-old boy afflicted with Ondine's curse, who developed complete atrioventricular heart block after a single bolus of propofol for induction of anaesthesia for strabismus surgery. Ondine's curse, the other name for congenital central hypoventilation syndrome, is characterized by a generalized disorder of autonomic function. propofol has no effect on the normal atrioventricular conduction system in humans but it reduces sympathetic activity and can highly potentiate other vagal stimulation factors. heart block has been documented after propofol bolus use in adults but, to our knowledge, not in children. It would appear that propofol is not a good choice for anaesthesia in congenital central hypoventilation syndrome.
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4/75. Congenital intraorbital optic nerve cyst. Case report.

    Congenital cystic lesions of the optic nerve are exceedingly rare; only one case is reported in the world literature. The authors describe a case of congenital simple glial cyst in the intraorbital portion of the optic nerve with a brief review of the literature and comment on its histogenesis. A 45-day-old male infant was admitted to the hospital because of progressive proptosis and hypotropia in the left eye, which had been present since birth. magnetic resonance imaging of the left orbit revealed an ovoid, well-demarcated, homogeneous cystic mass in the intraconal retrobulbar area. The mass compressed the left eyeball with downward and lateral displacement. The wall of the cystic mass was very thin, and a needle puncture of the cyst released clear, colorless, watery fluid. The cystic wall was lined by loose astroglial nerve fibers with some scattered glial cells.
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5/75. Diphenylhydantoin teratogenicity: ocular manifestations and related deformities.

    This patient illustrates a classical case of what many pediatricians call the diphenylhydantoin teratogenic syndrome. It suggests the possibility of an additional ocular finding of retinoschisis and optic nerve abnormalities which could conceivably have a teratogenic basis. The effects of epilepsy and diphenylhydantoin on these formations is discussed.
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6/75. Decompensated strabismus after laser in situ keratomileusis.

    We present a case of decompensated nerve IV palsy with vertical diplopia afer bilateral laser in situ keratomileusis. As the patient was given monovision, we believe diplopia occurred with a decrease in vision in 1 eye and interruption of fusion. Although corrective spectacles to restore equal vision at distance were prescribes, the patient needed a prism to eliminate her double vision. We suggest a careful cover/uncover test and versions assessment in all candidates for refractive surgery who want monovision correction and a full ocular motility evaluation if there is any doubt about binocular issues.
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7/75. Unilateral congenital oculomotor nerve palsy, optic nerve hypoplasia and pituitary malformation: a preliminary report.

    A newborn male presented with complete external third nerve palsy of his right eye immediately at birth. Pediatric examination and MRI of the skull revealed no abnormalities. At the age of six weeks, strabismus surgery was performed to facilitate amblyopia treatment. The muscles appeared small and fibrotic. At the age of ten weeks, a brow suspension of the upper lid and a second strabismus surgery were performed. The amblyopia treatment and patching, applied for half of the waking hours over a period of six weeks, were unsuccessful. At the age of six months, a relative pallor of the right optic nerve head became evident. At the age of three years, at a new examination because of growth deficiency, a second MRI revealed defects involving the pituitary region. We concluded that extraocular muscle abnormality or oculomotor nerve palsy was present together with optic nerve dysplasia and pituitary gland malformation.
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8/75. Delayed orbital hemorrhage after routine strabismus surgery.

    PURPOSE: To report a case of delayed rectus muscle hemorrhage after strabismus surgery. methods: Case report. RESULTS: Rectus muscle hemorrhage occurred 36 hours after strabismus surgery in a 26-year-old man, causing temporary loss of vision and reduced ocular motility. Urgent lateral cantholysis and orbital exploration to restore hemostasis were undertaken. Full recovery of vision occurred and a small residual motility disturbance was present 3 months postoperatively. CONCLUSION: Delayed rectus muscle hemorrhage poststrabismus surgery is rare but can have sight-threatening effects. When vision is threatened because of optic nerve compromise, urgent orbital exploration may allow full recovery of function.
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9/75. Abduction paralysis with hypotropia: sign of weakness of a contralateral superior oblique.

    background The clinical diagnosis of extraocular motor paralysis that is caused by severe cranial trauma can often be complicated. The resulting clinical picture can make the identification of all the components of potentially treatable oculomotor problems difficult. methods We examined five cases of complete abducens nerve paralysis with marked downshoot in attempted abduction seen after severe cranial trauma. results With the patients looking in the field of gaze of the paralysis, a marked infraductive movement of the paralytic eye occurred while the other eye maintained fixation. Other clinical findings confirmed this to be a secondary deviation due to a paresis of the contralateral superior oblique. conclusion patients with a paralysis of the lateral rectus following a severe cranial trauma who demonstrate a marked downshoot of the involved eye should be suspected of having a paresis of the contralateral superior oblique. This diagnosis has helped us effectively to treat this vertical incomitance by a simple weakening procedure of the contralateral inferior oblique.
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10/75. Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies.

    PURPOSE: To report an atypical case of Spontaneous intracranial hypotension (SIH) with bilateral trochlear nerve palsies and an oculomotor nerve palsy. DESIGN & METHOD: Case report and literature review. RESULTS (CASE REPORT): A 42 year old man was treated for SIH. His neurological symptoms resolved following neurosurgical treatment with the exception of diplopia due to bilateral trochlear nerve palsies and a pupil-sparing oculomotor nerve palsy. The cranial nerve palsies are believed to be secondary to brainstem ischemia and compression occurring during the acute phase of events. They did not spontaneously improve, but were treated successfully with eye muscle surgery. CONCLUSION: SIH is a rare disease that has been associated with a variety of symptoms and signs including cranial neuropathies. A diagnosis of SIH should be considered in a patient presenting with headache, diplopia secondary to cranial neuropathy and typical radiologic features. This is the first reported case in which bilateral trochlear nerve paresis has been reported in association with this condition.
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