Paralysis Of Ocular Muscles Research Articles

Clinical characteristics in patients with oculomotor paralysis caused by isolated midbrain infarction.

The aim of the study was to investigate the clinical characteristics of isolated oculomotor paralysis (OP) cases caused by pure midbrain infarction (MI) with pupil sparing. Patients with pure MI and pontine infarction (PI) at our hospital were included in this study. We compared the blood pressure and lipid levels between the two groups. And the clinical data and imaging features were summarized. In total, 33 and 35 patients were included in the MI and PI groups, respectively. There was no significant difference in the distribution of age (64.9 ±10.0 vs. 65.1 ±10.8 years, p = 0.927) and males (84.8% vs. 74.3%, p = 0.282) between the MI and PI groups, respectively. The pure MI group had a comparable level of serum lipoprotein and cardiovascular risk factors compared with the PI group except for a lower proportion of hypertension (57.6% vs. 85.7%, p = 0.010). The majority (72.7%) of culprit lesions in the pure MI group was located in the paramedian area of the midbrain, and the ocular muscle palsies mostly involved the medial rectus (75.8%). The Chinese patients with OP caused by pure MI were mainly characterized with rapidly progressive symptoms, multiple cerebrovascular risk factors, and typical MRI signs. Further efforts should be made in the differential diagnosis of this atypical midbrain syndrome.

Frequency of Neurogenic Strabismus in Al-Ibrahim Eye Hospital, Karachi

Purpose: To determine the frequency of Neurogenic Strabismus presenting at the Orthoptics Clinic in Al-Ibrahim Eye Hospital, Malir Karachi. Study Design: Cross-sectional study. Sampling Technique: Non-probability convenient sampling. Place and Duration of Study: Orthoptics Clinic of Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2018. Material and Methods: This study included 349 subjects age ranged from 5 to 75 years. All ocular examinations for strabismus were performed, including cover test, prism cover test and Hess chart. Demographic features and etiologies were recorded, and the causes of extra ocular muscle palsies were grouped as; trauma, diabetes, hypertension and others. SPSS version 20.0 was used to analyze the data. Results: Frequency of neurogenic strabismus was found to be 6%. Out of 21 subjects, 8 (38.1%) subjects had diabetes, followed by 2 (9.5%) subjects with hypertension, 5 (23.8%) subjects with ocular trauma and 6 (28.6%) subjects with other causes. The most commonly affected side was the right eye seen in 13 (61.9%) subjects. The most common ocular motor nerve involved was abducent (sixth) nerve in 13 (61.9%) subjects, followed by oculomotor (third) nerve in 4 (19%) subjects. Out of the patients with third nerve palsy 3 (14.3%) subjects had pupil sparing and only 1 (4.8%) subject had no pupil sparing. Conclusion: Sixth nerve was the most common nerve involved and most common etiology was uncontrolled diabetes. Keywords: Neurogenic Strabismus, Cranial nerve palsies, Paralytic strabismus

Clinical Study of Eleven Patients with Midbrain Infarction-Induced Oculomotor Nerve Palsy

Midbrain lesion-induced oculomotor nerve palsy can be divided into the nuclear and infranuclear types. In the infranuclear type, the degree of each subtype of ocular muscle palsy usually varies. The neuroradiological findings of 11 patients with midbrain infarction-induced oculomotor nerve palsy were analyzed. Their infarcts were grouped into rostral and caudal lesions. Each group was then divided into lesions that occurred in the paramedian and lateral regions before being subdivided further into lesions that occurred in the tegmental, central, and ventral areas. Unilateral and bilateral infarcts were seen in 9 and 2 patients, respectively. The ventrocentral area of the rostral paramedian region was the most commonly affected part. External ocular muscle palsy was observed in all 11 patients. Ten patients had infranuclear oculomotor nerve palsy. Of these 10 patients, 9 had adduction palsy. Internal ocular muscle palsy was detected in 4 patients. The patient with nuclear type had bilateral ptosis and bilateral elevation palsy and did not exhibit Bell's phenomenon; however, her lesion was unilateral. Vertical gaze palsy was detected in 3 patients who continued to exhibit Bell's phenomenon. In the 3 cases in which patients with vertical gaze palsy continued to exhibit Bell's phenomenon, it was considered that the palsy was caused by impairment of the rostral interstitial nucleus of the medial longitudinal fasciculus. Our study suggested that the intra-axial fascicular fibers innervating the medial rectus muscle are particularly susceptible to infarction, possibly because they are the most centrally located in the intra-axial oculomotor fascicular fibers.

Role of Magnetic Resonance Imaging in Herpes Zoster Ophthalmicus Ophthalmoplegia

Aims: To hypothesize the mechanisms of herpes zoster ophthalmicus (HZO) related ophthalmoplegia by magnetic resonance imaging (MRI). Case Presentation: A 61-year-old Chinese man diagnosed with right sided HZO and a positive Hutchinson’s sign, subsequently developed right eye complete ptosis, mydriasis and limitation of elevation 1 month after the onset of HZO. MRI showed thickening and enhancement of right oculomotor nerve and enhancement of right extraocular muscles. CSF revealed leukocytosis and positive varicella zoster virus (VZV) DNA without any clinical signs of meningitis. The diagnosis HZO-related ophthalmoplegia and asymptomatic VZV meningitis was made based on the clinical and laboratory findings. The external ocular muscle palsies of this patient were due to both oculomotor nerve palsy and orbital myositis demonstrated by MRI. Conclusion: The pathogenesis of HZO associated ophthalmoplegia is attributed to multiple factors such as neuritis of the cranial nerve and orbital myositis which can be diagnosed with MRI.

Ocular Muscle Palsy in Diabetic Patients

Ocular Muscle Palsy in Diabetic Patients

MRI of the eye muscles in a case of ophthalmoplegia caused by common carotid artery occlusion suggests ischemic myopathy

Ocular muscle palsies following carotid artery disease is thought to be caused by ischemia of the cranial oculomotor nerves but it may also be due to ischemia of the extraocular muscles (EOM). We studied a patient with common carotid artery occlusion syndrome (CCAOS) to elucidate the two competing hypotheses. MRI and sonography of the orbita showed oedematous swelling of all left EOM. MRI short-tau inversion recovery (STIR) sequences showed hyperintensities and a prolonged T2-relaxation time in EOM indicating muscle oedema. It decreased within two weeks as ophthalmoplegia improved. For several reasons ischemic EOM myopathy rather than ischemic neuropathy seems to be the morphological correlate of ophthalmoplegia after ipsilateral CCAOS in this patient.

Role of Sildenafil in Neurological Disorders

Sildenafil, a phosphodiesterase-5 inhibitor commonly used for erectile dysfunction, may also have a beneficial therapeutic effect in the treatment of stroke, subarachnoid hemorrhage, dementia, learning, and neurodegenerative disorders by enhancing angiogenesis and neurogenesis. It also favorably influences the nitric oxide-cyclic guanosine monophosphate pathways, which are involved in the pathogenesis of a number of neurological diseases. Its potential therapeutic role in the treatment of the neurological disorders mentioned above is still under preclinical investigation. Sildenafil is currently being used to treat erectile dysfunction in patients with multiple sclerosis, Parkinson disease, multisystem atrophy, and spinal cord injury by improving their neurologically related erectile dysfunction. Conversely, it has been implicated in a number of neurological problems, such as intracerebral hemorrhage, migraine, seizure, transient global amnesia, nonarteritic anterior ischemic optic neuropathy, macular degeneration, branch retinal artery occlusion, and ocular muscle palsies. Thus, preclinical and very limited clinical data suggest that sildenafil may have therapeutic potential in selected neurological disorders. However, numerous reports are available regarding neurological adverse events ascribed to the drug. Although sildenafil shows some promise as a therapeutic agent in selected neurological disorders, well-designed clinical trials are needed before the agent can be recommended for use in any neurological disorder.

Septic Cavernous Sinus Thrombosis Complicated by Narrowing of the Internal Carotid Artery, Subarachnoid Abscess and Multiple Pulmonary Septic Emboli

A 56-year-old woman was admitted because of a high fever, right ptosis, chemosis, proptosis and ocular muscle palsy. Cranial MRI revealed a cavernous sinus thrombosis and a subarachnoid abscess. Carotid angio-gram demonstrated marked stenosis as well as aneurismal formation of the right internal carotid artery at the intracavernous portion. Chest radiograph showed bilateral multiple pulmonary nodules, some of which contained a cavity. Blood culture was positive for Streptococcus constellatus. She was diagnosed with septic cavernous sinus thrombosis complicated by narrowing of the internal carotid artery, subarachnoid abscess and multiple pulmonary septic emboli. She recovered with partial ocular sequelae as a result of seven weeks of intravenous antimicrobial therapy.

Guillain-Barré syndrome

Guillain-Barré syndrome (GBS) is an acute, demyelinating polyneuropathy involving the spinal roots, peripheral nerves, and often the cranial nerves. Although its exact mechanism remains unclear, an autoimmune etiopathology is theorized. It is characterized by rapidly progressing, symmetrical muscular weakness starting in the legs and ascending to the trunk and arms. Additionally, deep tendon reflexes are lost. Approximately half of the patients with GBS have cranial nerve palsies, with unilateral or bilateral facial nerve (CN VII) palsy being the most common. Paralysis of the muscles of the tongue, lips, palate, larynx, and pharynx from lesions involving cranial nerves IX, X, and XI and weakness of the muscles of mastication (CN V) are the next most common cranial nerve abnormalities. Ocular muscle palsy is not common, only occurring in approximately 10% of patients. The Miller Fisher variant of GBS is a distinct syndrome in which the only neurologic deficits are oculomotor palsies, areflexia, and ataxia. We present the rare case of a 45-year-old woman with GBS whose ocular muscles were affected. The oculomotor disturbance and limb weakness occurred within a few days of one another. Basic anatomic considerations are reviewed along with the pathophysiology and clinical features of GBS.

Clinical features and surgical treatment of congenital ocular muscle palsy characterized with double elevator dysfunction

To investigate the clinical features of congenital ocular elevator muscle palsy and to evaluate the efficacy of surgical treatment. Pre- and post-operative eye position, superior rectus muscle and inferior oblique muscle function, clinical features were examined and analyzed in 11 patients with congenital double elevator palsy of ocular muscles. When fixated with the nonparetic eye, ten of 11 patients showed hypotropia and pseudoblepharoptosis in the primary position; One of 11 patients fixated with the paretic eye and showed hypotropia in the primary position. All cases were a monocular elevation deficiency in abduction and adduction, and showed pseudoblepharoptosis. In ten patients fixated with the nonparetic eye, two of 10 were undergone inferior rectus recession on paretic eyes; six of 10 were undergone inferior rectus recession and superior oblique tenectomy on paretic eyes; two of 10 were applied inferior rectus recession and superior oblique tenectomy on paretic eyes, superior rectus recession was performed on healthy eyes in six months postoperation. The patient fixated with the paretic -eye were undergone superior rectus recession and inferior oblique tenectomy on healthy eyes. Seven patients with exotropia had lateral rectus muscle surgery performed at the time of their vertical operation. Strabismus were complete corrected in 81.8% (9/11) of patients in our study and 18.2% (2/11) of patients were partial corrected. The functions of superior rectus muscle and inferior oblique muscle were not corrected. Nine patients showed complete correction of the psuedoptosis, one patient showed partial correction of the psuedoptosis, one patient did not showed any improvement of the pseudoptosis. We conclude that superior rectus muscle and inferior oblique muscle insufficiency are the primary factors in the etiology of congenital double ocular elevator palsy. Vertical rectus recession and superior oblique tenectomy on paretic eyes is an effective way of surgical treatment the disease.

External ophthalmoplegia due to ocular myositis in a patient with ophthalmic herpes zoster

External ocular muscle palsies in patients with ophthalmic zoster are traditionally interpreted as diseases of III, IV or VI cranial nerves. Orbital myositis associated with zoster ophthalmicus has been diagnosed only rarely. We describe a patient with ophthalmic zoster and external ophthalmoplegia due to ocular myositis demonstrated by MR imaging. Treatment with aciclovir and cortisone resulted in a rapid improvement of the ophthalmoplegia. In ophthalmic herpes zoster associated with external ocular muscle palsies, ocular myositis is an important differential diagnosis to inflammatory involvement of the cranial nerves III, IV, and VI.

Ocular Effects of Topical and Systemic Steroids

Topical and systemic steroids have proven to be invaluable agents in the treatment of a wide range of disorders, but their use is not without potential complications. Before initiation of therapy with systemic steroids, a personal or family history of cataracts, glaucoma, hypertension, diabetes, hyperlipidemia, renal stones, peptic ulceration, and current infection or pregnancy should be ascertained, because these patients have an increased risk of complications. Prior to long-term therapy with systemic steroids, blood pressure measurement, tuberculin skin test, and anergy panel are recommended. Monthly follow-up may include measurements of weight, blood pressure, electrolytes, and blood sugar and guaiac testing of the stool. To prevent the ocular complications of steroid therapy, routine screening is indicated (Table 1). Screening for cataracts, which occur most commonly as a sequela of continuous systemic steroid use, may be performed by slit-lamp examinations conducted three or four times a year for patients on long-term therapy and twice a year for patients taking intermittent topical ocular or systemic steroids. Glaucoma is more often associated with topical ocular or periocular steroids than with systemic steroids; recommended screening includes a baseline intraocular pressure measurement, then routine pressure measurements taken every few weeks initially, then every few months. Ocular rebound inflammation may develop secondary to rapid tapering or abrupt discontinuation of topical ocular steroid use and is best prevented with gradual tapering. Opportunistic infections of the eye include bacterial, viral, and fungal infections and are most often associated with the use of topical ocular steroids. Ophthalmologic evaluation is indicated promptly if patients treated with ocular steroids develop ocular discharge, pain, photophobia, or redness.

3 - Current approaches to hypothalamic-pituitary radiology

Currently computed tomography (CT) is the primary imaging modality for pituitary and hypothalamic lesions, although it is probable that NMR will supersede it. The range of size of the normal pituitary is considerable, with relatively larger glands occurring in adolescence and females of childbearing age. Asymptomatic microadenomas and cysts are not infrequent so that small low-density lesions in a gland on the borderline of enlargement can only be assessed in relation to clinical presentation. Patients presenting with clinical or biochemical evidence of abnormal pituitary hormone secretion or with an enlarged sella but without evidence of any neurological abnormality are likely to have either a small pituitary tumour or an empty sella and are investigated by thin section high resolution CT to produce coronal and sagittal images. Visual defects, paralysis of ocular muscles or hypothalamic disturbances, in the absence of clinical evidence of hypersecretion of pituitary hormones, may be due to a variety of pathologies. These cases are elucidated by plain plus contrast-enhanced CT, supplemented as necessary by angiography and computed cysternography after injection of non-ionic contrast media. Hypothalamic disturbances may occasionally complicate cerebral malformations which are also elucidated by cranial CT.

Symptomatic Pituitary Tumor Enlargement After Induced Pregnancy

✓ A case is presented and 11 others are reviewed in which symptomatic pituitary tumor enlargement occurred during pregnancies that resulted from induced ovulation. The syndrome is usually characterized by headache and visual disturbances with bitemporal visual field abnormalities, but may present with ocular muscle palsies. The cases are divided into two groups. The patients in one group had a shorter duration of amenorrhea (3.8 years), developed symptoms before the 14th week of pregnancy, and were usually treated by tumor removal. Patients in the second group had a longer period of amenorrhea (10.2 years), developed symptoms after the 24th week of pregnancy, and their symptoms regressed with delivery of the infant. Tumor removal or termination of the pregnancy both resulted in resolution of symptoms. All pregnancies resulted in normal infants. This series provides guidelines for management of future cases.

Symptomatic pituitary tumor enlargement after induced pregnancy

A case is presented and 11 others are reviewed in which symptomatic pituitary tumor enlargement occurred during pregnancies that resulted from induced ovulation. The syndrome is usually characterized by headache and visual disturbances with bitemporal visual field abnormalities, but may present with ocular muscle palsies. The cases are divided into two groups. The patients in one group had a shorter duration of amenorrhea (3.8 years), developed symptoms before the 14th week of pregnancy, and were usually treated by tumor removal. Patients in the second group had a longer period of amenorrhea (10.2 years), developed symptoms after the 24th week of pregnancy, and their symptoms regressed with delivery of the infant. Tumor removal or termination of the pregnancy both resulted in resolution of symptoms. All pregnancies resulted in normal infants. This series provides guidelines for management of future cases.

Eye Movement Disorders

When a patient develops a disorder of ocular motility, the average ophthalmologist feels reasonably confident in pursuing the work-up for strabismus or an ocular muscle palsy. If the findings do not clearly fit into one of these two categories, the ophthalmologist must then turn to the literature for help or refer the patient to another physician. The literature on normal and abnormal eye movements is complex and often contradictory, and the further one delves into it, the more confusing it becomes. The authors of Eye Movement Disorders are to be congratulated for removing some of the confusion from this field. As they state in the preface, this book deals with the topic in a pragmatic and often oversimplified way. It is just this approach that makes this book so valuable. It deals primarily with supranuclear disorders, a field that most other ophthalmology texts largely ignore. The authors have culled

Ocular muscle palsy. Results following alcohol injection of infraorbital nerve.

Injection of 1 ml of absolute alcohol into the infraorbital canal was followed by temporary partial ophthalmoplegia. Limitation of the volume of alcohol injected probably will prevent this transient but unwelcome complication.

Episodic unilateral mydriasis in otherwise normal patients.

Eight patients, who are otherwise normal, presented with a clinical syndrome of episodic unilateral mydriasis. Episodes are of various lengths in different patients and occur at random intervals. Head pain and blurring of vision are typical. There is no ocular muscle palsy or lid involvement. Prognosis appears good. There are various syndromes which include the feature of episodic unilateral mydriasis.

Ophthalmoplegia and retinal degeneration associated with spinocerebellar ataxia.

Introduction The predominant ocular findings reported in the familial and heredodegenerative ataxias are nystagmus, optic atrophy, and ocular muscle palsies. Nystagmus is said to be characteristic of the so-called spinal form of familial ataxia (Friedreich's ataxia) and optic atrophy and ocular muscle palsies of the spinocerebellar (Marie's ataxia) and cerebellar forms of heredodegenerative ataxia.1We are concerned in this paper with some aspects of the ocular findings in the heredodegenerative ataxias which fit broadly within the classification of the spinocerebellar and cerebellar forms of the disease. In the literature we found a group of heredodegenerative ataxias associated with progressive ophthalmoplegia, a group associated with retinal degeneration, and a group associated with both ophthalmoplegia and retinal degeneration. Stephans et al.2in 1958 reported 4 cases of heredodegenerative ataxia associated with progressive ophthalmoplegia in which the ophthalmoplegia was characterized by an impairment of upward gaze with a preservation of

STATISTICAL CONTROL STUDIES IN NEUROLOGY

We became interested in control studies in neurology while investigating the significance of objective signs in cases of head injury. It is evident that as a result of the medicolegal importance of many of these problems a great deal of emphasis is usually placed on objective signs. More weight is usually placed on a Babinski sign or an ocular muscle palsy than on the most intense subjective distress. We often wondered how many of these positive neurologic signs existed before the accident. The subject of the frequency of these signs in people who were not injured began to attract our attention. Considering the great number of injuries in large industrial organizations, it would be important to know the incidence of positive neurologic signs in control groups. Control groups do not necessarily imply normal people. In this study control groups refer to persons not under observation or treatment for head injuries