1126
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Ruttum MS. Effect of prior orbital decompression on outcome of strabismus surgery in patients with thyroid ophthalmopathy. J AAPOS 2000; 4:102-5. [PMID: 10773808 DOI: 10.1067/mpa.2000.103872] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare strabismus surgery outcomes of patients who have had prior orbital decompression for thyroid ophthalmopathy with those of patients who have not had decompression. METHODS The records of all patients operated on by the author for strabismus related to thyroid ophthalmopathy were retrospectively reviewed. RESULTS Fifty patients were included in this study. Seventeen patients had previously undergone orbital decompression, and 33 patients had not. Seventy-six percent of patients who had had orbital decompression had a good or excellent outcome compared with 91% of those who had not had orbital decompression. Patients in the orbital decompression group had an average of 1.4 operations compared with 1.2 in the no-decompression group. The average numbers of muscles operated on were 3.1 in the decompression group and 1.9 in the no-decompression group. Patients who had been decompressed were more than 4 times as likely to require surgery for both a horizontal and vertical deviation than patients who had not been decompressed. CONCLUSIONS Patients with thyroid ophthalmopathy who have had orbital decompression have a lower success rate of surgery for strabismus, more frequently need correction for both horizontal and vertical deviations, and have more muscles operated on than patients who have not had orbital decompression. The need for orbital decompression in patients with Graves' disease is reflective of a worse degree of orbitopathy. In addition, ocular changes from decompression surgery may interfere with a successful result from strabismus surgery.
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1127
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Pearce IA, McCready PM, Watson MP, Taylor RH. Vertical diplopia following local anaesthetic cataract surgery: predominantly a left eye problem? Eye (Lond) 2000; 14 ( Pt 2):180-4. [PMID: 10845013 DOI: 10.1038/eye.2000.50] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Vertical diplopia is an uncommon but disappointing complication of otherwise successful local anaesthetic cataract surgery. We studied strabismus patterns in a group of such patients to identify the nature and extent of extraocular muscle involvement. METHODS A retrospective review identified 15 cases of vertical diplopia following local anaesthetic cataract surgery between July 1994 and January 1998. Peribulbar anaesthesia was used in all cases and given by right-handed professionals. RESULTS All cases had otherwise successful cataract surgery (mean age 80.5 years; median pre-operative VA 6/18; median post-operative VA 6/9). The mean level of vertical diplopia was 7.2 prism dioptres (PD) in the primary position (range 2-25 PD). The left inferior rectus (IR) was paretic in 6 cases and restricted in 5 cases. The left superior rectus (SR) was not affected in any of the cases. The right IR was restricted in a single case. The right SR was paretic in 2 cases and restricted in a single case. None of the cases had clinical involvement of the oblique muscles. Eleven of the cases were managed successfully with prisms. Two of the cases required strabismus surgery. CONCLUSIONS The incidence of left eye extraocular muscle involvement was greater than right eye involvement, although this did not reach statistical significance (73% vs 27%; p = 0.075). This may be due to the more difficult access of right-handed individuals giving left eye peribulbar injections with the needle tract being directed more closely to the muscle cone. The IR muscle is more commonly affected than the SR (80% vs 20%; p = 0.019). An equal incidence of paretic and restricted rectus muscle pathology was found in this study (53% vs 47%; p = 0.818). The exact aetiology of muscle injury is unknown but could be due to direct muscle or nerve trauma, anaesthetic toxicity, periocular haemorrhage or a combination of these.
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1128
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Larner AJ, Thomas DJ. Can myasthenia gravis be diagnosed with the 'ice pack test'? A cautionary note. Postgrad Med J 2000; 76:162-3. [PMID: 10684328 PMCID: PMC1741529 DOI: 10.1136/pmj.76.893.162] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The ice pack test may be helpful in establishing that ptosis is due to ocular myasthenia gravis, since cold improves neuromuscular transmission. However, the role of the test in determining whether diplopia is of myasthenic origin has yet to be established.
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1129
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Obisesan KA, Ogunbiyi AO. Antiphospholipid antibody syndrome: two case reports and review of literature. AFRICAN JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2000; 29:65-70. [PMID: 11379473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Antiphospholipid antibody syndrome (APAs) is an acquired multisystemic disorder characterised by hyper coagulation. It manifest clinically with arterial and venous thrombosis. It is not a rare phenomenon, but there are paucity of reports of this disorder in our environment. We present two cases of APAs with the hope that it will stimulate the awareness of clinicians in the recognition of this disorder in our environment.
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1130
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Castro Alonso FJ, Pina Latorre MA, Zabala López S. [Atypical presentation of metastatic gastric adenocarcinoma]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2000; 92:176-7. [PMID: 10866482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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1131
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Johnson LN, Stetson SW, Krohel GB, Cipollo CL, Madsen RW. Aspirin use and the prevention of acute ischemic cranial nerve palsy. Am J Ophthalmol 2000; 129:367-71. [PMID: 10704554 DOI: 10.1016/s0002-9394(99)00362-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To assess the relationship of aspirin use and ischemic cranial nerve palsies among patients with diabetes mellitus and hypertension. METHODS This retrospective case-control study involved 100 patients with ischemic cranial nerve palsies in association with diabetes, hypertension, or both (palsy cases) and 163 age-matched and sex-matched patients with diabetes, hypertension, or both but without ischemic cranial nerve palsies (nonpalsy control subjects). Comparisons were made with respect to duration of diabetes, dose and duration of aspirin use, dose and duration of tobacco use, and presence of cardiac or cerebrovascular disease. RESULTS There were 20 oculomotor, 33 trochlear, 37 abducens, and 10 facial nerve palsy cases. The median duration of diabetes was 6 years for cases and 7 years for control subjects. There were 34 cases (34%) who had used aspirin for a mean duration of 5.5 years before the onset of the cranial nerve palsy and 49 control subjects (30.1%) who had used aspirin for a mean duration of 4.3 years. There were no significant differences between cases and control subjects for duration of diabetes (P =.94); aspirin use (P =.51), duration (P =.50), and dosage (P =.89); tobacco use (P =.73) and consumption (P =.45); and proportion of cardiac disease (P =.17). Cerebrovascular disease was significantly less common among palsy cases than nonpalsy control subjects (P<.001). There was no significant difference in the odds of a patient having cranial nerve palsy in the aspirin group compared with the nonaspirin group (odds ratio, 1.12; 95% confidence interval, 0.70-2.04). CONCLUSION Aspirin use was not associated with a reduced rate of ischemic third, fourth, sixth, and seventh nerve palsies among patients with diabetes mellitus and hypertension. Aspirin appears to be ineffective in preventing ischemic third, fourth, sixth, and seventh cranial nerve palsies. Patients with ischemic cranial nerve palsy have a significantly lower rate of strokes and transient ischemic attacks than patients who have diabetes or hypertension but who do not have a history of cranial nerve palsy.
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1132
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Ohyagi Y, Yamada T, Okayama A, Sakae N, Yamasaki T, Ohshima T, Sakamoto T, Fujii N, Kira J. Vergence disorders in patients with spinocerebellar ataxia 3/Machado-Joseph disease: a synoptophore study. J Neurol Sci 2000; 173:120-3. [PMID: 10675655 DOI: 10.1016/s0022-510x(99)00309-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diplopia, a common symptom in spinocerebellar ataxia 3/Machado-Joseph disease (SCA3/MJD) cases, is not always due to asymmetric ophthalmoplegia. We found a Japanese SCA3/MJD family, in which three patients clearly had an impairment of divergence eye movement. We thus quantitatively examined the vergence ranges in eight Japanese SCA3/MJD cases using the synoptophore test. An impairment of the vergence eye movements was found in all patients, and the vergence impairment pattern, but not the ophthalmoplegia pattern, was found to be compatible with the diplopia pattern. The diplopia in SCA3/MJD cases is, therefore, attributed, at least in part, to the impairment of the vergence eye movements.
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1133
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Neugebauer A, Fricke J, Pink U, Rüssmann W. Vertical and cyclotorsional deviations following peribulbar anesthesia. Graefes Arch Clin Exp Ophthalmol 2000; 238:119-22. [PMID: 10766279 DOI: 10.1007/pl00007878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Motility disorders may occur consecutive to peribulbar anesthesia. The underlying pathology is still debated. The aim of the study was to contribute to the discussion by a meticulous orthoptic examination of a series of patients. METHODS In a series of 16 patients with diplopia after peribulbar anesthesia, measurements of the angle of squint in the nine directions of gaze, Bielschowsky's headtilt test and motility analysis were performed. The findings were discussed with regard to the possible types of muscular lesions. RESULTS Hypotropia and deorsoadduction accompanied by relatively small cyclotropia were found in all cases. Bielschowsky's head-tilt test mostly revealed neutral findings. CONCLUSION The findings were discussed under the hypothesis of a fibrotic muscular change in the superior oblique and inferior rectus muscle. This hypothesis turned out to be concordant with the orthoptic measurements, implying that treatment of the disorder should consist in low-dosage recession of the fibrotic muscles, which in our experience was rewarding.
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1134
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Galm O, Fabry U, Osieka R. Pseudotumor cerebri after treatment of relapsed acute promyelocytic leukemia with arsenic trioxide. Leukemia 2000; 14:343-4. [PMID: 10673758 DOI: 10.1038/sj.leu.2401671] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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1135
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Carton A, Hislop S. Orbital floor injury with extraocular muscle entrapment following functional endoscopic sinus surgery. Br J Oral Maxillofac Surg 2000; 38:82-3. [PMID: 10783460 DOI: 10.1054/bjom.2000.0401] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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1136
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Versino M, Beltrami G, Uggetti C, Cosi V. Auditory saccade impairment after central thalamus lesions. J Neurol Neurosurg Psychiatry 2000; 68:234-7. [PMID: 10644797 PMCID: PMC1736800 DOI: 10.1136/jnnp.68.2.234] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Visual and auditory saccades were studied in three patients with an isolated lesion located in the central thalamus. Visual saccades proved to be normal, whereas for auditory stimuli, the amplitude of the first saccade was asymmetric: saccades ipsilateral to the lesion were significantly smaller than those directed to the contralateral side. The patients were able to make a corrective saccade and hence to improve gain and to decrease gain asymmetry. It is suggested that patients were able to localise auditory targets correctly, but did not correctly take into account eye position during the saccade, probably as a consequence of an inaccurate efference copy (corollary discharge) signal. The findings are in keeping with the hypothesis that the central thalamus deals with saccades that are based on extraretinal signals.
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1137
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Zolog I. [The clinico-evolutionary neuro-ophthalmological aspects in multiple sclerosis]. OFTALMOLOGIA (BUCHAREST, ROMANIA : 1990) 2000; 47:53-4. [PMID: 10641103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
The paper presents the dynamic of the more important neuro-ophthalmologic signs in 112 patients with multiple sclerosis from the first attack to the second one using an interdisciplinary methodology. The existence of ocular signs at the first attack as well as the fortuitous association of the signs of the disease make doubtfully the utility of defining a neuro-ophthalmologic clinical form of the disease. The more significant dominance of the ocular signs at the first attack points out the importance of the ophthalmologic examination for the early diagnosis of the multiple sclerosis.
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1138
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Widjaja A, Rademaker J, Gölkel C, Holstein A, Leifke E, Wat N. [Graves ophthalmopathy and ocular myasthenia]. Ophthalmologe 2000; 97:38-40. [PMID: 10663788 DOI: 10.1007/s003470050008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND An 18-year-old woman presented with thyrotoxic symptoms - right sided lid retraction and exophthalmus. She complained of diplopia on lateral gaze. Laboratory investigations confirmed Grave's disease with hyperthyroidism and TSH receptor antibodies. PATIENTS AND METHODS Her clinical symptoms improved after thyrostatic and steroid therapy. However, diplopia recurred 2 weeks after withdrawal of steroid therapy and a ptosis of the left lid appeared for the first time. RESULTS A positive Tensilon test and electromyographic findings confirmed the diagnosis of myasthenia gravis with a predominantly ocular manifestation. Diplopia and ptosis improved with oral pyridostigmine. CONCLUSIONS The coexistence of myasthenia gravis should be taken into consideration in the management of patients with Graves' ophthalmopathy.
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1139
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1140
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1141
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Cirak B, Guven MB, Ugras S, Kutluhan A, Unal O. Fronto-orbitonasal intradiploic meningioma in a child. Pediatr Neurosurg 2000; 32:48-51. [PMID: 10765139 DOI: 10.1159/000028897] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intradiploic meningioma, which may be classified as a subgroup of intraosseous meningioma, is a rarely encountered disorder. To date, less than 10 cases have been reported. Here, we report a case of fronto-orbitonasal intradiploic meningioma. A 12-year-old female with exophthalmos and diplopia was operated on for a cranial intradiploic mass lesion. Histopathological evaluation of the specimen confirmed the diagnosis of intradiploic psammomatous meningioma. Her exophthalmos did not change, but the diplopia disappeared. This case is unique in that it is an extensive case of intradiploic meningioma of the orbital roof and frontal base in a child. Intradiploic meningiomas generally are of psammomatous type. Especially tumors adjacent to the orbita cause exophthalmos; cases located on the other side of the calvarium may not cause any symptom or sign other than headache or sometimes a mass on the scalp. Treatment, as with meningiomas located in the intracranial cavity, is total resection of the lesion.
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1142
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Lee J. Preplanned correction of enophthalmos using diced cartilage grafts. BRITISH JOURNAL OF PLASTIC SURGERY 2000; 53:17-23. [PMID: 10657444 DOI: 10.1054/bjps.1999.3244] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A simple technique for correcting post-traumatic enophthalmos is presented. Autogenous costal cartilage was chopped into small pieces and used to fill up the medial orbital wall defect in five patients. The measured degrees of enophthalmos ranged from 2 to 4 mm, and 3-5. 5 ml of filler material was introduced into the periorbital space. A conservative approach via upper and lower eyelid incisions was used. It was found that 1.37-1.5 ml of graft material results in 1 mm advancement of globe position. This correlation appears to be a useful treatment guideline for medial orbital wall blow-out fractures. Transient diplopia developed in three cases, but settled within 4 months. There were no other major sequelae after the operation. The follow-up period ranged from 8 months to 3 years. The improved appearance and the stable results confirm the validity of this approach.
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1143
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1144
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Mann WJ, Kahaly GJ, Pitz S, Bumb P, Müller-Forell W, Krummenauer F, Goerzen N, Mewes T, Pfeiffer N. Decompression surgery for thyroid-associated orbitopathy--a ten year experience. Exp Clin Endocrinol Diabetes 1999; 107 Suppl 5:S212-3. [PMID: 10614925 DOI: 10.1055/s-0029-1212188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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1145
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Vignal-Clermont C. [Diplopia. Diagnostic orientation]. LA REVUE DU PRATICIEN 1999; 49:2263-70. [PMID: 10731814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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1146
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Ng SH, Wan YL, Ko SF, Lee ST, Wong HF, Chen YL, Cheung YC. Bilateral traumatic carotid-cavernous fistulas successfully treated by detachable balloon technique. THE JOURNAL OF TRAUMA 1999; 47:1156-9. [PMID: 10608552 DOI: 10.1097/00005373-199912000-00033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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1147
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Lepore FE. Divergence paresis: a nonlocalizing cause of diplopia. J Neuroophthalmol 1999; 19:242-5. [PMID: 10608677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVES To determine the causes, clinical characteristics, and localizing value of divergence paresis, which is characterized by acquired and uncrossed diplopia when viewing distant targets, fusion when viewing near targets, and no limitation of ocular ductions. Controversy persists regarding the diseases underlying divergence paresis and the existence of a divergence "center." MATERIALS AND METHODS The charts of 15 patients with divergence paresis examined between 1983 and 1998 were reviewed. All patients underwent neuroimaging and detailed ocular motility testing, with measurement of esotropia in prism diopters in 14 patients. RESULTS Divergence paresis in 15 patients was idiopathic in three patients, was associated with central nervous system microangiopathy or infarct in seven patients, and clivus lymphoma, chronic lymphocytic leukemia with sinusitis, Wernicke ophthalmoplegia, Parkinson disease, myasthenia gravis, cryptic cerebellar vascular malformation, and childhood esotropia in one patient each (two patients had two diagnoses). The mean maximum esotropia was 10.4 prism diopters, and there was no significant correlation (Fisher exact test) between the magnitude of esotropia and vasculopathic etiology or posterior fossa lesion site. Although six patients had posterior fossa disease, neuroimaging showed no common circumscribed lesion site or evidence of increased intracranial pressure. CONCLUSIONS Divergence paresis is an uncommon cause of acquired diplopia. Divergence paresis is associated with diverse central nervous system diseases and can be mimicked by myasthenia. The absence of a single consistent lesion in our study, which is the largest reported series, suggests that divergence paresis is a nonlocalizing cause of horizontal diplopia and that multiple or diffusely distributed neural structures may govern divergence. Alternatively, elusive divergence "centers" may not exist, and divergence paresis may arise from impaired inhibition or from defective passive antagonism of orbital structures to convergence.
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1148
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Hagan JC, Whittaker TJ, Byars SR. Diplopia cases after periocular anesthesia without hyaluronidase. J Cataract Refract Surg 1999; 25:1560-1. [PMID: 10609193 DOI: 10.1016/s0886-3350(99)00315-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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1149
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Roccia F, Servadio F, Gerbino G. Maxillofacial fractures following airbag deployment. J Craniomaxillofac Surg 1999; 27:335-8. [PMID: 10870750 DOI: 10.1054/jcms.1999.0082] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Maxillofacial fractures and associated lesions following airbag deployment were studied in six patients who suffered frontal or fronto-lateral car crashes. Installation of airbags in motor vehicles has reduced the morbidity and the mortality following motor vehicle accidents, but the appearance of new types of trauma directly related to airbag deployment raise questions about the potential danger of these devices when used improperly. The results of this limited study suggest that airbag injuries can be aggravated if: (1) seat belts are not worn; and (2) if the driver's chest is too close to the steering wheel as can easily happen with small people (in our study, two women). There needs to be a way of disconnecting the system.
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1150
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Franco E, Gil-Peralta A, Salinas E, Pérez-Errazquin F, Garzón F. [Spontaneous intracranial hypotension]. Rev Neurol 1999; 29:1038-40. [PMID: 10637867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
INTRODUCTION AND CLINICAL CASE A 38 year old woman, with no previous history of trauma, presented complaining of interscapular pain followed by pulsating headache clearly related to posture, alleviated on lying down and worse on standing up. Subsequently, she also complained of diplopia. On examination there was paresia of the left sixth cranial nerve. Low opening pressure on lumbar puncture confirmed the presence of intracranial hypotension. The protein level of the cerebrospinal fluid was slightly raised. On CT the cortical sulci and small ventricles had disappeared. Cerebral MR (without gadolinium) showed marked diffuse meningeal hyper-intensity and apparent absence of the basal cisterni. Isotopic cisternography showed a pattern compatible with hypotension, without signs of fistulas. On spinal MR no spinal meningeal defects were seen. With conservative treatment the patient improved in a few days and the headache and diplopia disappeared. The absence of traumatism or spinal operations mean that the hypotension may be considered to be spontaneous. We discuss the CSF, neuroimaging and cisternography findings characteristic of the spontaneous intracranial hypotension syndrome. CONCLUSION Unawareness of this syndrome, the particular neuroimaging changes and the usual CSF anomalies may lead to confusion over diagnosis, leading to the use of invasive techniques unsuitable for a condition which often has a good prognosis and in which the symptoms resolve in a few days or weeks with conservative treatment.
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