PRESUMPTIVE X-LINKED INTERMEDIATE TRANSMISSION OF RETINAL DEGENERATIONS. VARIATIONS AND COINCIDENTAL OCCURRENCE WITH ATAXIA IN A LARGE FAMILY

Tapetoretinal Degenerations in Spinocerebellar Degenerations (Heredoataxias)

The association of hereditary spino-ponto-cerebellar degenerations with tapetoretinal degenerations of varying types, and particularly with Stargardt's macular degeneration, is not rare, as at the present time more than 200 cases are known. Therefore the one-gene hypothesis seems to be the most plausible. The fact that there exist complex neuroophthalmological forms near purely neurological or purely retinal forms, is also in favour of one gene with polyphenic manifestation.

Ophthalmologic findings in patients with ataxia

PURPOSE

To determine the frequency and spectrum of ophthalmologic findings in a large, heterogeneous group of patients with ataxia.

METHODS

Medical records of 184 patients from a university-based ataxia clinic were retrospectively reviewed. Patients were classified as having Friedreich's ataxia, spinocerebellar degeneration, cerebellar degeneration, familial or sporadic olivo-pontocerebellar atrophy, multisystem atrophy, spastic ataxia, myoclonic ataxia, or other diagnoses such as mitochondrial myopathy. All had complete ophthalmologic examinations, and 107 underwent electro-oculography.

RESULTS

Among 184 patients with ataxia, diplopia was present in 52 (28%), best-corrected visual acuity was decreased in 29 (16%), and oscillopsia was present in 10 (5%). Diplopia was usually caused by an intermittent, small-angle heterotropia. The reduction in best-corrected visual acuity varied from mild to profound and was caused by optic atrophy, retinal degeneration, or both. Optic atrophy was present most frequently in spastic ataxia (five of 22 patients) and myoclonic ataxia (two of eight patients), followed by Friedreich's ataxia (three of 26 patients). Retinal degeneration and ophthalmoplegia were most characteristically associated with familial olivopontocerebellar atrophy and mitochondrial myopathy. Laboratory testing of ocular motility showed frequent abnormalities in all groups. Fixation instability was most characteristic of Friedreich's ataxia, whereas saccadic slowing was noticeably absent from patients with purely cerebellar degenerations.

CONCLUSIONS

The ataxias may be associated with visual dysfunction caused by retinal degeneration, optic atrophy, oculomotor disturbance, or a combination of these.

ERG and EOG abnormalities in carriers of X-linked retinitis pigmentosa

The diagnosis of X-linked retinitis pigmentosa (XL-RP) relies on the identification of the female carriers, in whom fundal abnormalities are often minimal and variable. The electroretinogram (ERG) has been reported as abnormal in 54-96% of heterozygote females. This study examines the combined use of electro-oculogram (EOG) and standardised ERG in 31 obligate and 33 non-obligate carriers of XL-RP. In the obligate carrier group, the EOG was abnormal in 13 carriers (41%), the ERG abnormal in 21 carriers (68%) and a combined EOG and ERG abnormality occurred in 24 carriers (77%). An EOG abnormality alone occurred in 2 carriers (6.5%). Fourteen obligate carriers (45%) showed a peak to peak delay of the ERG scotopic b wave, this being a previously unreported phenomenon. Similarly, in the non-obligate carrier group, the EOG was abnormal in 11 carriers (44%) and the ERG abnormal in 19 carriers (73%). The results of this study suggest that the use of both tests, including measurement of the scotopic b wave latency, may increase the carrier detection rate.

Psychophysical tests in X-linked retinitis pigmentosa carrier status

Psychophysical tests were performed in 22 normal women and 17 X-linked carriers of retinitis pigmentosa. The tests consisted of luminance contrast sensitivity, grating at the fovea and broken annulus at the periphery, color contrast sensitivity, letters for the fovea and broken annulus for the periphery, along the three known confusion axes of protan, deutan and tritan observers. Statistical analysis of the data shows that there were significant differences between the carriers and age-similar normal subjects with all the tests. The most significant differences (P < 0.001) were found with the color contrast sensitivity at the periphery along the protanopic and deutanopic axes and the luminance contrast sensitivity at the periphery. The influence of the age is discussed.

Hereditary spastic ataxia with congenital miosis: four cases in one family

Images

X-linked retinitis pigmentosa

Of 107 consecutive patients with genetically-determined retinitis pigmentosa, 23 were provisionally diagnosed as having inherited the disease in an X-linked fashion. 42 affected males and 61 females were examined, and from the data obtained the following conclusions were drawn: (1) X-linked retinitis pigmentosa exists and is distinct from choroideremia. (2) In contrast to the results of previous surveys, X-linked retinitis pigmentosa is a common form of this disease and over 20 per cent. of retinitis pigmentosa is probably transmitted in an X-linked manner. (3) (a) In contradistinction to the findings of previous investigators, most if not all adult heterozygous females have detectable degenerative changes in the ocular fundus. (b) The ocular changes in heterozygous females are most easily detected by fundus examination, visual field testing, dark adaptation measurements, and estimation of retinal rhodopsin concentration. The single most frequent abnormality is peripheral retinal pigment epithelial atrophy, which is found in all adult heterozygous females. (c) The pattern of retinal dysfunction in heterozygous females, and in particular preservation of the ocular electrical responses, suggests that the disease in women is qualitatively different from that in men and in other genetic forms of retinitis pigmentosa. There is some evidience that the disease in heterozygous women is patchy. (d) Degeneration in heterozygous females is usually symmetrical, but great variation was found in the severity of degeneration amongst heterozygotes of similar ages. No non-genetic influences were found to account for this. No evidence came to light by which the importance of X-chromosome inactivation could be assessed in determining the phenotype of heterozygous women. (4) No evidience is available to determine the number of X-linked genes transmitting the disease.

A-beta-lipoproteinaemia and colour-blindness

Images

Familial intracranial aneurysms

✓ Six cases of intracranial aneurysms are described in three families: two sisters, identical twins, and a mother and daughter. The cases suggest a hereditary basis for some intracranial aneurysms.