Manifestaciones neuroftalmológicas como complicación de una infección por Mycoplasma pneumoniae y desarrollo posterior de una encefalitis aguda diseminada

The purpose of this article is to describe two paediatric neuro-ophthalmological clinical cases caused by a systemic infection due to Mycoplasma pneumoniae (M. pneumoniae). The cases are two girls aged 14 and 12 seen in the Emergency Department: The first one had internuclear ophthalmoplegia and second with loss of vision and headache. They had no other neurological foci. Magnetic resonance imaging showed hyperintense plaques in both, suggestive of a demyelinating disease. One month later, the neuro-ophthalmological symptoms resolved, with normal follow-up magnetic resonance imagings. The diagnosis was acute disseminated encephalitis secondary to M. pneumoniae. The diagnosis was made using PCR (gold standard) and/or IgM in serology. It is important to think about this possible aetiology in cases of suggestive demyelinating disease. There is controversy about the role of antibiotics and on whether corticosteroids are contemplated. In conclusion, M. pneumoniae must be a differential diagnosis in acute neuro-ophthalmological disorders in children.     

Complete recovery of filler-induced visual loss following subcutaneous hyaluronidase injection

The rise in popularity of hyaluronic acid (HA) dermal filler injection has caused an exceptional increase in the number of cases of reported irreversible blindness. Here, we reported a case of ischemic optic neuropathy and ophthalmoplegia following subcutaneous HA filler injection with complete visual recovery. A 31-year-old Chinese woman presented with sudden onset of right monocular visual impairment associated with diplopia. Patient had received a hyaluronic acid-containing ?ller injection for nasal dorsum augmentation twelve hours prior to presentation. Visual acuity of the right eye was counting finger. A right relative afferent pupillary defect was demonstrated with ophthalmoplegia. Humphrey visual field test disclosed a right inferior altitudinal field defect with impairment of colour vision. Computed tomography of the orbit revealed mild enlargement of the right medial and inferior recti muscles. Our patient showed a tremendous improvement of vision after a subcutaneous hyaluronidase injection with complete visual recovery within 2 weeks.     

糖尿病性眼肌麻痹的中西医研究进展

糖尿病性眼肌麻痹属于糖尿病神经系统的并发症之一,以累及周围神经最常见,临床常表现为眼球运动障碍、复视等症状。目前西医治疗以改善代谢障碍和微循环为主,但临床效果不理想。近年来中医综合治疗糖尿病性眼肌麻痹显示了其独特的优势,取得了较好的临床效果。本文通过全面检索中国知网、维普中文期刊数据库和PubMed数据库相关文献,将近年来中西医对糖尿病性眼肌麻痹的认识和治疗进行梳理、概括、分析,总结糖尿病性眼肌麻痹的中西医研究进展,并进行综述,以期为临床治疗提供参考。     

PD-1单抗治疗后发生单侧眼肌麻痹1例报告

接受免疫检查点抑制剂（ICIs）治疗的患者常发生免疫相关不良事件（Immune-related adverse events，irAEs），但免疫相关眼不良事件（Ocular immune-related adverse events，oAEs）的发生率不足1%。我们报道1例的PD-1单抗在治疗淋巴瘤后发生的孤立性眼肌麻痹，这是完整记录oAEs发病及治疗前后MRI变化的报道。患者在接受帕博丽珠单抗（pembrolizumab）治疗6个月后出现复视，左眼外展受限，全身MRI提示同侧眶周肌肉增粗、未发现全身其他肌肉受累。经停用帕博丽珠单抗及中剂量泼尼松治疗后，患者眼部症状很快恢复正常。在临床症状缓解后21个月，患者病变的眼外肌在MRI上也完全恢复正常。临床医生需掌握oAEs遗留的MRI改变与肿瘤浸润的鉴别。发生oAEs后长期的影像随访是必要的。     

One-and-a-half syndrome. Type II: a case with rostral brain stem infarction

This article is about a patient who suddenly developed a right hemiparesis and stupor. Her neuro-ophthalmological examination revealed a left-sided ptosis and a combined vertical gaze palsy in addition to right esotropia, right conjugate gaze palsy, and abduction paralysis of the left eye on attempted gaze to the left with adduction nystagmus of the right eye. The horizontal eye movement disorder was similar to that in one-and-a-half syndrome, except for an abduction paralysis and an adduction nystagmus. MRI showed a rostral brain stem infarction on the left side. Left-sided ptosis and adduction paralysis were attributed to a left oculomotor fascicular involvement in the presence of a right hemiparesis. Right-sided esotropia and abduction paresis were consistent with a ‘pseudo-abducens palsy’, which has been reported in thalamo-mesencephalic lesions. Combined vertical gaze palsy is a classical finding of rostral brain stem infarction. Left-sided abduction paralysis with adduction nystagmus on the right side on attempted gaze to the left is thought to be due to involvement of the para-MLF on the left side and is called internuclear ophthalmoplegia of abduction (INO-abd). To our knowledge, this type of horizontal eye movement disorder has never been reported before with rostral brain stem infarction.     

Dominant optic nerve atrophy with progressive hearing loss and chronic progressive external ophthalmoplegia (CPEO)

This paper describes a family where chronic progressive external ophthalmoplegia is associated with dominant optic atrophy and progressive sensorineural deafness. This may be a possible association in the same family of two diseases: progressive external ophthalmoplegia and dominant optic atrophy with progressive hearing loss. However, we believe that this family represents an unusual manifestation of ophthalmoplegia plus.     

老年人糖尿病眼肌麻痹临床分析

目的 探讨老年人糖尿病眼肌麻痹的临床特点、发病机理及预后。方法 对21例糖尿病并发眼肌麻痹患者行常规眼科检查及眼肌专项检查，并进行内科全身检查、实验室血生化检查及影像学检查。结果 21例患者均为单眼发病，动眼神经麻痹者无瞳孔改变。结论 糖尿病患者易合并眼肌麻痹，其微血管病变可能是临床发病的病理基础。本病经合理治疗预后良好。     

Ophthalmoplegic migraine with alternating unilateral and bilateral internal ophthalmoplegia

We describe a patient with ophthalmoplegic migraine and internal ophthalmoplegia with alternating unilateral involvement and bilateral involvement in whom brain MRI scan showed alternating gadolinium enhancement on the cisternal portion of the oculomotor nerve.