Ophthalmic Branch Of Trigeminal Nerve Research Articles

PAINFUL OPHTHALMOPLEGIA IN CAROTID-CAVERNOUS FISTULA

Ophthalmoplegia is defined as a consequence of multiple cranial nerve paralysis innervated the extraocular muscles. The impairment of ophthalmic branch of trigeminal nerve will create a painful condition. Numerous underlying mechanism have been proposed related to painful ophthalmoplegia and carotid-cavernous fistula is one of the main causes with sight and life threatening outcome if left untreated. Carotid-cavernous fistula arises as an abnormal communication between carotid artery and cavernous sinus. Important signs and symptoms of carotid-cavernous fistula may include red eye, proptosis, painful ophthalmoplegia, headache and vision loss. Neuroimaging and angiography are mandatory in diagnosing the disease. Systematized approach and early recognition to the evaluation of carotid-cavernous fistula will lead to prompt management in avoiding morbidity and mortality in severe cases.

Rare case of headache, ptosis and dilated pupil- isolated oculomotor palsy secondary to zoster meningitis

Isolated oculomotor palsy secondary to herpes zoster is rare. We will discuss a case presenting with headache, ptosis and dilated pupil. (See Figs. 1 and 2.) A 43 years old Indonesian female, presented to Emergency department with headache of 2 days, double vision and drooping of left eye. She had crusted rash in ophthalmic distribution of the trigeminal nerve, partial left oculomotor nerve palsy with tonic dilated left pupil with partial left ptosis and restricted upgaze. CT brain, CT angiogram of head, MRI brain were unremarkable. Cerebrospinal fluid showed 100% lymphocytes with raised protein; Herpes simplex and Varicella zoster DNAP-PCR were negative. She was treated with IV acyclovir for 14 days, Gabapentin, followed by 14 days of Valacyclovir and tapering dose of steroids. She had minimal headaches and recovering ophthalmoplegia at 2 weeks follow-up. Fig. 1. Crusted lesion in the left ophthalmic branch of trigeminal nerve with left oculomotor palsy Fig. 2. Dilated tonic pupil of the left eye In presentations with headache, ptosis and dilated pupil, first rule out aneurysmal compression of third cranial nerve. Our patient had history of herpes zoster affecting the ophthalmic division of the trigeminal nerve and presented with isolated oculomotor palsy. Differential diagnosis includes zoster meningitis and should be treated appropriately. Isolated oculomotor palsy secondary to herpes zoster although rare should be considered in a patient with headache, ptosis and dilated pupil with history of herpes zoster. Treatment with antivirals and corticosteroids usually results in good prognosis.

Herpes Zoster Scars

A 30-year-old man presented with a unilateral painful eruption of grouped vesicles in the right upper eyelid and right glabella area 8 months ago. The vesicles coalesced to form bullous lesions in 48 hours. The patient had chickenpox at the age of 4 years. A diagnosis of herpes zoster involving the ophthalmic branch of the right trigeminal nerve was made. The patient was treated with oral acyclovir 800 mg, five times a day. The lesions resolved in 14 days but the post-herpetic neuralgia lasted for 3 months. The patient was left with atrophic scars in the right glabellum. Herpes zoster, also known as shingles, is caused by reactivation of endogenous latent varicella-zoster virus that resides in a sensory dorsal root ganglion of the spinal cord or the extramedullary cranial nerve ganglion usually after primary infection with varicella-zoster virus (i.e., varicella or chickenpox). Clinically, herpes zoster is characterized by a painful, unilateral vesicular eruption in a restricted dermatomal distribution. Herpes zoster may involve the eyelids and glabella when the ophthalmic branch of the trigeminal nerve is affected. Appearance of skin lesions at the side of the nose represents involvement of the nasociliary branch of ophthalmic nerve (Hutchinson’s sign) and predicts a higher likelihood of ocular involvement. Herpes zoster may be complicated by scarring, as is illustrated in the present case. Of academic interest, lesions of molluscum contagiosum, granuloma annulare, granulomatous folliculitis, psoriasis, cutaneous sarcoidosis, prurigo nodularis, lichen planus, lichen sclerosis et atrophicus, morphea, lymphoma, Kaposi’s sarcoma, and lichenoid graft-versus-host disease have been reported in preexisting herpes zoster scars [1]. This is known as Wolf ’s isotopic response which refers to the occurrence of a new skin disorder at the site of another, unrelated, and already healed skin disease.

Magnetoreception systems in birds: A review of current research

At least two independent systems of magnetoreception are currently believed to exist in birds, based on different biophysical principles, located in different parts of their bodies, and with different neuroanatomical mechanisms. One magnetoreceptory system is located in the retina, and may be based on photochemical reactions on the basis of cryptochrome. Information from these receptors is processed in a specialized part of visual Wulst, the so-called Cluster N. There are good reasons to believe that this visual magnetoreceptor processes compass magnetic information necessary for migratory orientation. The second magnetoreceptory system is probably iron-based (biogenic magnetite), located somewhere in the upper beak (its exact location and ultrastructure of receptors remain unknown) and innervated by the ophthalmic branch of trigeminal nerve. It cannot be ruled out that this system participates in spatial representation and helps forming either a kind of map or more primitive signpost sense (identification of specific geographic regions), based on regular spatial variation of the geomagnetic field. The magnetic map probably enables navigation of migrating birds across hundreds and thousands of kilometres. Apart from these two systems, whose existence has been convincingly shown (even if some details are not fully clear yet), there is evidence for the existence of magnetoreceptors based on the vestibular system. It cannot be ruled out that iron-based magnetoreception takes place in lagena (a part of inner ear in fishes, amphibians, reptiles and birds), and the information perceived is processes in vestibular nuclei. The very existence of this magnetoreception system needs verification, and its function remains completely open.

Gillies lift induced Asystole!

The oculocardiac reflex occurring after orbital surgical procedures is a well recognised peri operative complication which has been well reported in the literature. In this reflex the ophthalmic branch of trigeminal nerve transmits the afferent impulse to the sensory nucleus of trigeminal nerve (V) in the brain stem via the gasserion ganglion. The efferent arc involves the motor nucleus of the vagus nerve through short internuntial fibres in the brain stem, stimulation of which is responsible for the bradycardia.

Mode of detection of HIV infection — A retrospective study of 612 cases

Background: Trends in mode of detection of HIV infection in the Armed Forces required to be analyzed to formulate future strategies for early detection. Methods: A retrospective study was thus conducted in 612 newly diagnosed HIV-positive cases between January 1997 to August 2002. Results: 182(29.74%) patients had already developed Category C conditions when detected to be HIV-positive, 176(96.70%) with mycobacterial disease, majority (67.61%) of them being pulmonary tuberculosis, followed by recurrent bacterial pneumonia in 3 (1.65%), pneumocystis carinii pneumonia (PCP) in 2(1.1%) and oesophageal candidiasis in one (0.55%). Herpes zoster was the third most common mode of detection accounting for 86 (14.05%) of the cases (24.6% of them with involvement of ophthalmic branch of trigeminal nerve), after tuberculosis in 176(28.76%) and blood donors in 98(16.01%), followed by constitutional symptoms in 59(9.64%) cases, investigation for STDs in 56(9.15%), bacterial pneumonia in 6(0.98%) and oral mucosal candidiasis in only one (0.16%) case. None was detected during acute retroviral illness and only 5(0.82%) cases were detected while being investigated for generalized lymphadenopathy. Amongst the cases detected during investigation for STDs, majority (26.79%) were on STD surveillance. 22(3.60%) cases tested positive when their spouses were detected to be HIV-positive, 20(3.27%) while being screened for surgery, 4(0.65%) for posting abroad and 2(0.32%) each during investigation when child was found HIV-positive and investigation for HBV infection. Remaining 69(11.27%) patients were detected during investigation of various related or unrelated conditions including one (0.16%), which reported voluntarily after a high-risk exposure. Conclusion: There is a need to encourage voluntary reporting and identify more number of cases during acute retroviral syndrome and PGL stage.