A case of recurrent Miller Fisher syndrome mimicking botulism

Abstract Miller Fisher syndrome (MFS) is a rare and usually monophasic polyradiculoneuropathy characterised by ophthalmoplegia, decreased or absent tendon reflexes, and ataxia. The objective of this study was to report a case of recurrent MFS with a clinical presentation virtually indistinguishable from botulism. The patient was a young man with two episodes of increasing external ophthalmoplegia, ptosis, and ataxia with a long asymptomatic interval in between. The second episode occurred after consumption of rotten fish and was accompanied by gastrointestinal symptoms and an anticholinergic syndrome. Very rarely, MFS can present with a recurrent course. The importance of this case of recurrent MFS lies not only in its long asymptomatic period and identical clinical presentation, but also in its instructiveness regarding the differential diagnosis of MFS, particularly life-threatening botulism.     

Strabismus and diplopia as complications after cataract surgery with IOL implantation

Summary In our Department of Orthoptics we have seen an increasing number of patients suffering from diplopia after cataract surgery with IOL implantation. Between 1993 and 1997 the total number of patients with this problem was 24 (2.7 % of all patients, mean age 71 years, age range 38–88). We addressed the question of whether there is a common pattern of motility dysfunction. Methods: After evaluation of the clinical history and the basic ophthalmological findings the following parameters were examined: binocular function (Bagolini test), squint angles (Maddox cross), ocular motility. Results: The 24 patients could be divided up into three groups. Group 1 consisted of 9 patients (mean age 82 years, range 64–88) who complained about diplopia because of strabismus incomitans with vertical deviation and restricted motility on the first day after surgery. In 8 of the 9 patients strabismus surgery was done. Group II consisted of 10 patients (mean age 66 years, range 38–77) who noticed diplopia and strabismus within 7 days after surgery. We found various kinds of heterotropia. Seven of these patients were operated on and two had a prism correction. Group III consisted of 5 patients (mean age 67 years, range 61–78). Their already known strabismus paralyticus or concomitans deteriorated, leading to diplopia in some cases. All patients in this group were operated on. Discussion: For group I we believe that retro-, para- or peribulbar anesthesia caused the motility dysfunction. In groups II and III it is unlikely that local anesthesia had a causative role. The prolonged disruption of binocular vision and the abrupt change in the sensory situation after the cataract operation with lens implantation may be the leading causes for strabismus or deterioration of a preexisting strabism, respectively. Conclusions: These patients need a subtil meticulous diagnostic work-up and follow-up because of the possibility of early surgical therapy, which has a good prognosis. Evaluation of binocular vision and eye movements prior to cataract surgery appears to be helpful for later strabismic surgery.      

Ophthalmic Complication Following Posterior Superior Alveolar Nerve Block for Tooth Extraction! A Rare Occurrence

One of the most commonly asked question by a patient who comes for extraction especially in the rural areas is whether the procedure will cause problems to the eye!! In reality however, ophthalmic complications following routine maxillary molar extractions are practically unheard of. When they occur they can be extremely unnerving not just to the patient but also to the surgeon. Patients generally panic which makes it tougher for the clinician to assess the situation. We present a case of a 26 year old female patient developing ophthalmic complication following local anesthesia administration during extraction of upper left maxillary third molar. In this article, ophthalmic complications arising from posterior superior alveolar nerve block are discussed and management guidelines are highlighted.     

盐酸莫西沙星致复视CSCD

1例32岁男性患者因肺部感染服用盐酸莫西沙星400 mg、1次/d。服药4 d后,患者出现头晕、视物模糊、复视等症状,颅脑CT检查未见异常。考虑与莫西沙星有关,停用该药。停药3 d后症状无改善,眼部检查示双侧瞳孔等大等圆,对光反射灵敏,左眼球外展障碍,右眼球活动正常;无面瘫及肌肉异常表现。颅部磁共振等辅助检查均未见明显异常。给予甲钴胺、鼠神经生长因子和呋喃硫胺等神经营养药物治疗,患者症状逐渐好转,停药25 d后患者症状完全消失。     

脑梗死后复视患者康复训练中不同时间介入主动运动的效果比较

目的探讨脑梗死后双眼复视患者康复训练中不同时间介入主动运动的效果。方法将40例脑梗死后双眼复视患者按发病住院时间分为2组，发病1-5d住院的患者设为观察组，共24例，住院当天常规药物等治疗的同时开始做主动运动的视物操训练；发病≥6d住院的患者为对照组，共16例，住院当天常规治疗的同时也开始做主动运动的视物操训练。经过10d常规治疗加主动运动的视物操训练后，评估2组患者复视恢复情况。结果观察组复视恢复有效率达95．8％（23／24），对照组复视恢复有效率为62．5％（10／16），2组比较差异有统计学意义（P〈0．05）。结论脑梗死后双眼复视患者康复训练中，主动运动在发病1-5d介入优于5d以后介入。     

Characterization of diplopia in non-demented patients with Parkinson's disease

IntroductionAlthough diplopia is considered a frequent symptom of Parkinson's disease (PD), little is known about its clinical manifestation, associated mechanisms and treatment. Here we characterized binocular diplopia in non-demented PD patients in an interdisciplinary setting.MethodsPD patients were prospectively screened for diplopia, visual hallucinations, problems with spatial perception, contrast sensitivity, presence of blurred vision, and history of ophthalmological comorbidities via interview. Two groups of PD patients, one with and one without diplopia, underwent clinical and ophthalmological assessment to characterize diplopia in these patients. Clinical features were investigated using the Unified Parkinson's Disease Rating Scale and the Non-Motor Symptoms Scale.ResultsThe frequency of binocular diplopia was 29.6% (n = 37) in our cohort of 125 Parkinson's disease patients. Related mechanisms were heterogeneous including convergence insufficiency, strabismus, and motor fluctuations, as well as symptoms related to visual hallucinations. Diplopia was associated with other visual disturbances like visual hallucinations, blurred vision and problems with spatial perception. Beyond that, diplopia was found to be a predictive factor (3.2, odds ratio) for the occurrence of visual hallucinations in PD.ConclusionBinocular diplopia represents a frequent and relevant symptom in PD patients. Different subtypes should be considered due to different associated mechanisms including ophthalmic pathology and motor fluctuation, as well as intermediate to higher level visual processes. Diplopia seems to be part of a continuous spectrum of positive visual symptoms in Parkinson's disease.     

Results of transantral decompression in hyperthyroid exophthalmos

For the moment, transantral orbital decompression is the best procedure for the treatment of manifest exophthalmos because it is a simple and effective method with hardly any postoperative complications. If some ocular motility disturbances do not disappear spontaneously postoperatively, they can be treated successfully by muscle surgery.We found that the postoperative reduction of exophthalmos further improved during the first year with an average of 3 mm. For this reason, it is not advisable to section the infraorbital nerve in order to obtain a better immediate reduction.We are convinced that this operation is justified for some patients with a manifest exophthalmos for cosmetic reasons only. Good preoperative photographic documentation is necessary in each case.