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ACS Chemical Neuroscience Feb 2018Horner syndrome results from an interruption of the oculosympathetic pathway. Patients with Horner syndrome present with a slightly droopy upper lid and a smaller pupil... (Review)
Review
Horner syndrome results from an interruption of the oculosympathetic pathway. Patients with Horner syndrome present with a slightly droopy upper lid and a smaller pupil on the affected side; less commonly, there is a deficiency of sweating over the brow or face on the affected side. This condition does not usually cause vision problems or other significant symptoms, but is important as a warning sign that the oculosympathetic pathway has been interrupted, potentially with serious and even life-threatening processes. The oculosympathetic pathway has a long and circuitous course, beginning in the brain and traveling down the spinal cord to exit in the chest, then up the neck and into the orbit. Therefore, this syndrome with unimpressive clinical findings and insignificant symptoms may be a sign of serious pathology in the head, chest, or neck. This clinical review discusses how to identify the signs, confirm the diagnosis, and evaluate the many causes of Horner syndrome.
Topics: Horner Syndrome; Humans
PubMed: 29260849
DOI: 10.1021/acschemneuro.7b00405 -
The Neurohospitalist Oct 2015Neuro-ophthalmological emergencies constitute vision or life-threatening conditions if diagnosis and treatment are not promptly undertaken. Even with immediate therapy,... (Review)
Review
Neuro-ophthalmological emergencies constitute vision or life-threatening conditions if diagnosis and treatment are not promptly undertaken. Even with immediate therapy, these clinical entities carry a high rate of morbidity. They may present with diplopia, visual loss, and/or anisocoria. Arteritic anterior ischemic optic neuropathy is an ominous condition, which can cause permanent and severe vision loss, stroke, or aortic dissection, requiring immediate steroid therapy. Pituitary apoplexy may go unnoticed if only computed axial tomography is performed. Diseases affecting the cavernous sinus and orbital apex region, such as cavernous sinus thrombosis or mucormycosis, can give rise to simultaneous vision loss and diplopia and, if not treated, may extend to the brain parenchyma causing permanent neurological sequela. An isolated third nerve palsy may be the harbinger of a cerebral aneurysm, carrying a significant risk of mortality. Horner syndrome can be the initial presentation of a carotid dissection, an important cause of stroke in the young adult. The neurohospitalist should be familiar with the workup and management of neuro-ophthalmological emergencies.
PubMed: 26425250
DOI: 10.1177/1941874415583117 -
The Medical Clinics of North America May 2021Neuro-ophthalmology is the study of the neurologic underpinnings of vision and includes a fascinating variety of disorders that span the broad spectrum of ophthalmic and... (Review)
Review
Neuro-ophthalmology is the study of the neurologic underpinnings of vision and includes a fascinating variety of disorders that span the broad spectrum of ophthalmic and neurologic disease. This subspecialty relies heavily on accurate neuroanatomic localization and examination. This article discusses neuro-ophthalmic complaints that frequently present to the internist, including acute vision loss, double vision, and unequal pupils. It focuses on pertinent clinical features of the most common causes of these chief complaints and additionally highlights salient points of history, diagnosis, examination, and management with special emphasis on the signs and symptoms that should prompt expedited evaluation.
Topics: Anisocoria; Blindness; Cranial Nerve Diseases; Diplopia; Humans; Internal Medicine; Migraine Disorders; Nervous System Diseases; Ophthalmology; Optic Nerve Diseases
PubMed: 33926644
DOI: 10.1016/j.mcna.2021.01.005 -
International Ophthalmology Clinics 2019
Review
Topics: Adaptation, Ocular; Anisocoria; Humans; Magnetic Resonance Imaging; Photic Stimulation; Pupil
PubMed: 31233420
DOI: 10.1097/IIO.0000000000000276 -
Der Ophthalmologe : Zeitschrift Der... Jun 2021A 53-year-old female patient presented with increased light sensitivity 3 weeks after oral intake of moxifloxacin tablets for an upper respiratory tract infection. The...
A 53-year-old female patient presented with increased light sensitivity 3 weeks after oral intake of moxifloxacin tablets for an upper respiratory tract infection. The symptoms were anisocoria and the pupils did not react to light or accommodation. The examination of the anterior segment of the eye revealed extensive bilateral iris transillumination defects (ITD). We diagnosed a bilateral acute iris transillumination (BAIT) syndrome. The BAIT syndrome is a rare disorder associated with massive depigmentation of the iris and atrophy of the iris musculature. A risk factor for BAIT syndrome seems to be the oral intake of antibiotics, in particular moxifloxacin after an upper respiratory tract infection but cases of spontaneous occurrence have also been described. Middle-aged women are particularly affected. The exact cause of BAIT syndrome is so far unknown but a potential mechanism involves the concentration of the antibiotic in the vitreous body. Differential diagnoses include other causes for ITD, such as albinism, intraocular inflammation, pseudoexfoliation syndrome and pigment dispersion syndrome. To date there is no specific treatment for BAIT syndrome. Possible complications include increased light sensitivity and post-BAIT glaucoma. Knowledge of the rare BAIT syndrome can be useful in the clinical routine for the differential diagnostic classification of an anisocoria and can possibly contribute to avoidance of unnecessary diagnostic steps.
Topics: Anisocoria; Female; Glaucoma, Open-Angle; Humans; Iris; Iris Diseases; Middle Aged; Moxifloxacin
PubMed: 32588124
DOI: 10.1007/s00347-020-01153-y -
Current Opinion in Ophthalmology Nov 2016Anisocoria is a finding seen on a daily basis in nearly every eye clinic. Although often benign, it can also represent the sole sign of a life-threatening disease making... (Review)
Review
PURPOSE OF REVIEW
Anisocoria is a finding seen on a daily basis in nearly every eye clinic. Although often benign, it can also represent the sole sign of a life-threatening disease making an up-to-date understanding of pathophysiology and diagnosis essential for anyone practicing medicine.
RECENT FINDINGS
Many aspects of the traditional approach to anisocoria still hold true today, but advancements in imaging technology and changing trends in pharmacologic diagnosis and localization have led many to rethink that approach. In addition, the differential diagnosis for anisocoria continuously expands with identification and improved understanding of causal disease processes.
SUMMARY
The present article discusses an approach to the classic anisocoria diagnostic algorithm modified by current knowledge from the most recent literature.
Topics: Algorithms; Anisocoria; Autoimmune Diseases; Autonomic Nervous System Diseases; Diagnosis, Differential; Ganglia, Autonomic; Horner Syndrome; Humans; Neuroanatomy; Oculomotor Nerve Diseases; Tonic Pupil; Trigeminal Autonomic Cephalalgias
PubMed: 27585208
DOI: 10.1097/ICU.0000000000000316 -
Seminars in Neurology Oct 2015Functional vision disorder (FVD) is a common problem seen in many neurologic and ophthalmologic practitioners' offices and may occur in isolation or in the presence of... (Review)
Review
Functional vision disorder (FVD) is a common problem seen in many neurologic and ophthalmologic practitioners' offices and may occur in isolation or in the presence of medical illness. This disorder presents with visual or oculomotor symptoms and manifests as vision loss in one or both eyes, visual field loss, double vision, oscillopsia, anisocoria, blepharospasm, or ptosis. Manual perimetry is the most effective method for determining functional visual loss, and the presence of a central scotoma in a functional visual field signifies that a neuropathophysiologic process is almost certainly present. The exact neuropathophysiologic mechanism of this disorder is unknown; however, information can be drawn from the small studies of FVD samples and studies examining neuropsychiatric factors in other conversion disorder semiologies. Psychological and psychiatric interventions can be useful in treating these patients.
Topics: Conversion Disorder; Humans; Vision Disorders
PubMed: 26444401
DOI: 10.1055/s-0035-1563580 -
Neurocritical Care Aug 2017Basilar artery occlusion can cause locked-in syndrome, which is characterized by quadriplegia, anarthria, and limited communication via eye movements. Here, we describe...
BACKGROUND
Basilar artery occlusion can cause locked-in syndrome, which is characterized by quadriplegia, anarthria, and limited communication via eye movements. Here, we describe an uncommon stroke syndrome associated with endovascular recanalization of the top of the basilar artery: "reverse locked-in syndrome."
METHODS
We report the case of a patient with atypical neurological deficits caused by acute ischemic stroke of the midbrain tegmentum. We perform neuroanatomic localization of the patient's infarcts by mapping the magnetic resonance imaging (MRI) data onto a brainstem atlas.
RESULTS
A 61-year-old man presented with acute coma and quadriplegia due to top of the basilar artery occlusion. He underwent emergent endovascular thrombectomy, with successful recanalization of the basilar artery at 4 h and 43 min post-ictus. The patient regained consciousness and purposeful movement in all four extremities, but the post-procedure neurological examination demonstrated bilateral ptosis with complete pupillary and oculomotor paralysis. MRI revealed infarction of the bilateral oculomotor nuclei in the midbrain tegmentum. At 9-month follow-up, he had anisocoria and dysconjugate gaze, but was living at home and required minimal assistance in performing all activities of daily living.
CONCLUSIONS
Since the patient's deficits were the exact opposite of those described in locked-in syndrome, we propose the term "reverse locked-in syndrome" to describe this neurological entity characterized by bilateral ptosis, non-reactive pupils, and ophthalmoplegia with preservation of consciousness and extremity motor function.
Topics: Basilar Artery; Blepharoptosis; Cerebral Infarction; Humans; Male; Middle Aged; Ophthalmoplegia; Tegmentum Mesencephali; Thrombectomy
PubMed: 28324264
DOI: 10.1007/s12028-017-0391-x