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Archives de Pediatrie : Organe Officiel... Feb 2019Opsoclonus consists of massive erratic rapid eye jerks. They may occur in isolation or in association with myoclonus and ataxia, i.e., opsoclonus-myoclonus syndrome... (Review)
Review
Opsoclonus consists of massive erratic rapid eye jerks. They may occur in isolation or in association with myoclonus and ataxia, i.e., opsoclonus-myoclonus syndrome (OMS). We report the case of a 9-year-old girl who suffered from headaches for several days and was shown to have opsoclonus and left peripheral facial palsy. Work-up excluded the diagnosis of neuroblastoma, but CSF analysis showed aseptic meningitis, and serology for Borrelia burgdorferi (Lyme) was positive. The outcome was favorable with complete regression of symptoms after treatment with ceftriaxone 2g/day for 3 weeks. Although rare, the diagnosis of Lyme neuroborreliosis must be raised in the presence of isolated opsoclonus, particularly if the clinical picture is incomplete and if other features, such as peripheral facial palsy and pleocytosis in the CSF, are present.
Topics: Borrelia burgdorferi; Child; Female; Humans; Lyme Neuroborreliosis; Ocular Motility Disorders
PubMed: 30655046
DOI: 10.1016/j.arcped.2018.11.013 -
The British Journal of Ophthalmology Apr 1996Ocular neuromyotonia is characterised by spontaneous spasm of extraocular muscles and has been described in only 14 patients. Three further cases, two with unique... (Review)
Review
AIMS/BACKGROUND
Ocular neuromyotonia is characterised by spontaneous spasm of extraocular muscles and has been described in only 14 patients. Three further cases, two with unique features, are described, and the underlying mechanism reviewed in the light of recent experimental evidence implicating extracellular potassium concentration in causing spontaneous firing in normal and demyelinated axons.
METHODS
Two patients had third nerve neuromyotonia, one due to compression by an internal carotid artery aneurysm, which has not been reported previously, while the other followed irradiation of a pituitary tumour, a common association in the published reports. Selective activation occurred in both, where neuromyotonic activity was triggered by prolonged voluntary activation of specific extraocular muscles with or without spread of activity to other third nerve muscles. The other patient had fourth nerve involvement, where spasms of the superior oblique muscle were induced only by alcohol, a phenomenon which has not been described.
RESULTS
The two patients with third nerve involvement responded to carbamazepine and in one, an improvement in a chronic partial third nerve paresis occurred. The other has not required treatment and remains asymptomatic by refraining from alcohol.
CONCLUSIONS
A careful examination, including the effects of prolonged voluntary muscle action is required to initiate episodes and to demonstrate selective activation. Imaging is mandatory to exclude compressive intracranial lesions, particularly where there is no history of pituitary fossa irradiation. A trial of anticonvulsants should be considered in all patients. Extracellular potassium may play a role in spontaneous firing and ephatic transmission in ocular neuromyotonia.
Topics: Adult; Anticonvulsants; Carbamazepine; Carotid Artery Diseases; Carotid Artery, Internal; Ethanol; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Myotonia; Neurologic Examination; Ocular Motility Disorders; Oculomotor Nerve; Pituitary Neoplasms; Spasm
PubMed: 8703889
DOI: 10.1136/bjo.80.4.350 -
Transactions of the American... 1999
Comparative Study
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Diagnosis, Differential; Eye Movements; Female; Head Movements; Humans; Infant; Infant, Newborn; Male; Middle Aged; Ocular Motility Disorders; Oculomotor Muscles; Posture; Prospective Studies; Vision, Binocular
PubMed: 10703144
DOI: No ID Found -
Middle East African Journal of... 2015Strabismus in myopes can be related to anisometropia, accommodation/convergence effects, and/or muscle path deviations. This review article highlights management... (Review)
Review
Strabismus in myopes can be related to anisometropia, accommodation/convergence effects, and/or muscle path deviations. This review article highlights management considerations in myopic patients.
Topics: Accommodation, Ocular; Anisometropia; Convergence, Ocular; Humans; Myopia; Ocular Motility Disorders; Strabismus
PubMed: 26180467
DOI: 10.4103/0974-9233.159728 -
Journal of Vestibular Research :... 2020To determine if middle-aged and aging men and women with HIV disease (HIV+) should be screened for vestibular and oculomotor dysfunction.
OBJECTIVE
To determine if middle-aged and aging men and women with HIV disease (HIV+) should be screened for vestibular and oculomotor dysfunction.
METHODS
Age- and sociodemographically matched HIV+ and HIV- men and women were tested on vestibular evoked myogenic potential (VEMP), bi-thermic caloric testing, Dix-Hallpike maneuvers and saccades.
RESULTS
HIV+ men had more caloric weakness than HIV- men. HIV+ subjects had more saccade abnormalities than HIV- subjects. A saccade abnormality was positively associated with being HIV+. Among the HIV+ sample, abnormalities were associated with increasing age, being male, ever taking monotherapy, and having an undetectable viral load. Only being male and having an undetectable viral load were statistically significant. Unilateral caloric weakness had a decreased prevalence with age per 10 years, and being HIV+ showed an increased prevalence. In HIV+ subjects only, these abnormalities decreased with age and being male but increased with undetectable viral load and ever taking antiretroviral monotherapy. No statistically significant differences were found.
CONCLUSION
Women are at greater risk of vestibular and oculomotor abnormalities than men. HIV+ adults are at greater risk than HIV- adults. Physicians who care for HIV+ men and women should monitor the symptoms of vestibular and oculomotor impairment.
Topics: Adult; Aged; Caloric Tests; Female; HIV Infections; Humans; Male; Middle Aged; Ocular Motility Disorders; Pilot Projects; Vestibular Diseases; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests
PubMed: 32741798
DOI: 10.3233/VES-200707 -
Journal of Vestibular Research :... 2019This paper presents a classification and definitions for types of nystagmus and other oscillatory eye movements relevant to evaluation of patients with vestibular and... (Review)
Review
This paper presents a classification and definitions for types of nystagmus and other oscillatory eye movements relevant to evaluation of patients with vestibular and neurological disorders, formulated by the Classification Committee of the Bárány Society, to facilitate identification and communication for research and clinical care. Terminology surrounding the numerous attributes and influencing factors necessary to characterize nystagmus are outlined and defined. The classification first organizes the complex nomenclature of nystagmus around phenomenology, while also considering knowledge of anatomy, pathophysiology, and etiology. Nystagmus is distinguished from various other nystagmus-like movements including saccadic intrusions and oscillations.View accompanying videos at http://www.jvr-web.org/ICVD.html.
Topics: Diagnosis, Differential; Eye Movements; Humans; Nystagmus, Pathologic; Ocular Motility Disorders; Saccades; Terminology as Topic; Vestibular Diseases; Vestibular Function Tests; Vestibule, Labyrinth
PubMed: 31256095
DOI: 10.3233/VES-190658 -
Survey of Ophthalmology 1994Ocular myasthenia is a localized form of myasthenia clinically involving only the extraocular, levator palpebrae superioris, and/or orbicularis oculi muscles. Ocular... (Review)
Review
Ocular myasthenia is a localized form of myasthenia clinically involving only the extraocular, levator palpebrae superioris, and/or orbicularis oculi muscles. Ocular manifestations can masquerade as a variety of ocular motility disorders, including cranial nerve and gaze palsies. A history of variable and fatiguable muscle weakness suggests this diagnosis, which may be confirmed by the edrophonium (Tensilon) test and acetylcholine receptor antibody titer. Anticholinesterases, corticosteroids and other immunosuppressive agents, and other therapeutic modalities, including thymectomy and plasmapheresis, are used in treatment. As the pathophysiology of myasthenia has been elucidated in recent years, newer treatment strategies have evolved, resulting in a much more favorable prognosis than several decades ago. This review provides historical background, pathophysiology, immuno-genetics, diagnostic testing, and treatment options for ocular myasthenia, as well as a discussion of drug-induced myasthenic syndromes.
Topics: Circadian Rhythm; Humans; Myasthenia Gravis; Ocular Motility Disorders; Oculomotor Muscles
PubMed: 7878520
DOI: 10.1016/0039-6257(94)90194-5 -
Neurosciences (Riyadh, Saudi Arabia) Jul 2016A rare kind of antibody, known as anti-glutamic acid decarboxylase (GAD) autoantibody, is found in some patients. The antibody works against the GAD enzyme, which is... (Review)
Review
A rare kind of antibody, known as anti-glutamic acid decarboxylase (GAD) autoantibody, is found in some patients. The antibody works against the GAD enzyme, which is essential in the formation of gamma aminobutyric acid (GABA), an inhibitory neurotransmitter found in the brain. Patients found with this antibody present with motor and cognitive problems due to low levels or lack of GABA, because in the absence or low levels of GABA patients exhibit motor and cognitive symptoms. The anti-GAD antibody is found in some neurological syndromes, including stiff-person syndrome, paraneoplastic stiff-person syndrome, Miller Fisher syndrome (MFS), limbic encephalopathy, cerebellar ataxia, eye movement disorders, and epilepsy. Previously, excluding MFS, these conditions were calledhyperexcitability disorders. However, collectively, these syndromes should be known as "anti-GAD positive neurological syndromes." An important limitation of this study is that the literature is lacking on the subject, and why patients with the above mentioned neurological problems present with different symptoms has not been studied in detail. Therefore, it is recommended that more research is conducted on this subject to obtain a better and deeper understanding of these anti-GAD antibody induced neurological syndromes.
Topics: Autoantibodies; Baclofen; Cerebellar Ataxia; Diazepam; Epilepsy; GABA Modulators; GABA-B Receptor Agonists; Glutamate Decarboxylase; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Limbic Encephalitis; Miller Fisher Syndrome; Ocular Motility Disorders; Plasmapheresis; Stiff-Person Syndrome
PubMed: 27356651
DOI: 10.17712/nsj.2016.3.20150596 -
BMJ Case Reports Sep 2021Eight-and-a-half syndrome is a rare entity characterised by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia and ipsilateral lower motor neuron...
Eight-and-a-half syndrome is a rare entity characterised by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia and ipsilateral lower motor neuron type facial palsy. It is due to a lesion affecting median longitudinal fasciculus, paramedian pontine reticular formation and facial nerve fascicle on the same side at the level of pons. The diagnosis is easily missed as it needs detailed ocular movement examination. It is mainly caused due to infarction or demyelinating conditions. We are reporting an interesting case of a 54-year-old man with right-side eight-and-a-half syndrome due to acute ischaemic stroke and ST-elevation myocardial infarction of the inferior wall.
Topics: Brain Ischemia; Facial Paralysis; Humans; Male; Middle Aged; Ocular Motility Disorders; Ophthalmoplegia; Pons; Stroke
PubMed: 34479896
DOI: 10.1136/bcr-2021-244338 -
Pediatric Neurology Apr 2021
Topics: COVID-19; Child, Preschool; Encephalitis; Humans; Infant; Ocular Motility Disorders; Opsoclonus-Myoclonus Syndrome; Receptors, N-Methyl-D-Aspartate; SARS-CoV-2
PubMed: 33662888
DOI: 10.1016/j.pediatrneurol.2020.12.009