1/13. Acute onset of a bilateral areflexical mydriasis in Miller-Fisher syndrome: a rare neuro-ophthalmologic disease.Miller-Fisher syndrome (MFS) is characterized by variable ophthalmoplegia, ataxia, and tendon areflexia. It seems to be a variant of guillain-barre syndrome (GBS), but unlike in GBS, there is a primitive involvement of the ocular motor nerves, and in some cases there is brainstem or cerebellum direct damage. The unusual case of MFS in the current study started with a bilateral areflexical mydriasis and a slight failure of accommodative-convergence. Ocular-movement abnormalities developed progressively with a palsy of the upward gaze and a bilateral internuclear ophthalmoplegia to a complete ophthalmoplegia. In the serum of this patient, high titers of an IgG anti-GQ1b ganglioside and IgG anti-cerebellum. anti-purkinje cells in particular, were found. The former autoantibody has been connected to cases of MFS, of GBS with associated ophthalmoplegia, and with other acute ocular nerve palsies. The anti-cerebellum autoantibody could explain central nervous system involvement in MFS. The role of these findings and clinical implications in MFS and in other neuro-ophthalmologic diseases are discussed.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
2/13. Dilated pupil during endoscopic sinus surgery: what does it mean?Endoscopic sinus surgery has become the standard of care for the surgical management of chronic sinus disease. Sinus disease and its surgical treatment carry the risk of orbital complications, irrespective of the approach. Orbital complications associated with sinus surgery include nasolacrimal duct damage, extraocular muscle injury, intraorbital hemorrhage/emphysema, and direct optic nerve damage, resulting in blindness. The finding of an unequal pupil at the end of a procedure would be a cause of considerable concern, but it is most likely due to the topical contamination of the eye with a mydriatic pharmacological agent commonly used in endoscopic sinus surgery.- - - - - - - - - - ranking = 1.1307316296842keywords = injury (Clic here for more details about this article) |
3/13. Dorsal midbrain syndrome secondary to a pineocytoma.BACKGROUND: Dorsal midbrain syndrome is a triad of signs consisting of vertical gaze palsy, light-near dissociation of the pupils, and convergence retraction nystagmus. Associated findings may also be present. The most-common etiologies are pineal gland tumors and midbrain infarction. pineal gland tumors are rare tumors that show a predilection for males. The specific tumor reported herein, a pineocytoma, shows no gender predilection and is most common in mid- to late adulthood. CASE REPORT: A 38-year-old Native American man came to us with signs and symptoms consistent with dorsal midbrain syndrome. A neurological evaluation revealed the presence of a pineocytoma, which was later excised unsuccessfully. An explanation of the findings associated with dorsal midbrain syndrome is provided. CONCLUSION: patients who demonstrate signs consistent with dorsal midbrain syndrome should be referred for a neurological evaluation--including an MRI--to rule out any midbrain lesion.- - - - - - - - - - ranking = 10keywords = brain (Clic here for more details about this article) |
4/13. Anticholinergic toxicity associated with lupin seed ingestion: case report.We describe a case of acute poisoning in a 51-year-old female patient who presented to the Emergency Department with weakness, anxiety, dry mouth, bilateral mydriasis and lid drop. In differential diagnosis, botulism, guillain-barre syndrome and myasthenia gravis were considered, as well as cerebral haematoma because of a cranial injury a week before. Symptoms, which resolved within 12 h without any therapy, were instead related to the ingestion of lupin seeds.- - - - - - - - - - ranking = 1.1307316296842keywords = injury (Clic here for more details about this article) |
5/13. Paroxysmal autonomic alterations mimicking epilepsy: a case report.A 22-year-old male patient presented with paroxysmal hyperhidrosis, mydriasis, hypertension, and tachycardia. Cranial and cervical MRI revealed focal atrophy in the high order zone of the central autonomic network and syringomyelia. His physical and neurological examinations were unremarkable. Physiological testing included EEG, SPECT, serum/urine tests and autonomic testing. A poor response was achieved with the medical and interventional procedures employed. As the central autonomic network is an integral component of the internal regulation system of the brain, any lesion, no matter where in the network, may lead to paroxysmal autonomic alterations mimicking epilepsy (Published with videosequences).- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
6/13. Angel's trumpet (Brugmansia arborea) and mydriasis in a child--a case report.We report a case of anisocoria in a 6-year old child who felt out of an inflatable swimming pool in the garden. After instillation of pilocarpine 1% the dilated pupil constricted, which is an important clinical sign associated with intracranial trauma. There was evidence of exposure to angel's trumpet (Brugmansia arborea), a plant known to contain anticholinergic substances. As the results of further neurological examination turned out to be normal, we believe the mydriasis was due to an accidental exposure to angel's trumpet. The time lag between exposure and presentation at the emergency room, the probably low volume of the plant extract in the eye and the unpredictable concentration of alkaloids in the plant, can influence and question the reliability of the pilocarpine test in this case.- - - - - - - - - - ranking = 0.10978613347711keywords = trauma (Clic here for more details about this article) |
7/13. Unilateral hyperhydrosis in Pourfour du Petit syndrome.Upper limp hyperhydrosis is an idiopathic disease with bilateral involvement. However, Pourfour du Petit syndrome, the opposite of horner syndrome, may result in unilateral upper limb hyperhydrosis. It occurs following hyperactivity of the sympathetic cervical chain as a consequence of irritation secondary to trauma. We report herein two cases with Pourfour du Petit syndrome showing unilateral upper limb hyperhydrosis. The patients presented with right-sided mydriasis and ipsilateral hemifacial hyperhydrosis. The onset of disease was followed by a trauma in both patients. They underwent upper thoracic sympathectomy with favorable outcome. A history of an antecedent trauma in patients with unilateral upper limb hyperhydrosis and anisocoria may imply a possible diagnosis of Pourfour du Petit syndrome.- - - - - - - - - - ranking = 0.32935840043132keywords = trauma (Clic here for more details about this article) |
8/13. Ophthalmic complications of dental anesthesia: three new cases.Two patients had ipsilateral optic neuropathy and one patient had an ipsilateral abduction deficit and a dilated, poorly reactive pupil immediately after anesthesia of upper alveolar teeth. In one patient with optic neuropathy, the optic disc was not swollen, brain and orbit computed tomography (CT) was negative, and vision recovered completely within 2 weeks. In the other patient with optic neuropathy, the optic disc was swollen, brain and orbit CT were negative, and vision did not recover. In the patient with ductional and pupil deficits, recovery was complete within 24 hours. Since 1960, 39 cases of ophthalmic complications have been reported in the English literature. A majority have followed anesthesia of upper alveolar teeth. In all but three cases, the deficits were temporary. diffusion, inadvertent needle penetration into the orbit, venous injection, or retrograde arterial injection is postulated as the mechanism by which the anesthetic agent reaches the cavernous sinus or orbit to cause the deficits.- - - - - - - - - - ranking = 2keywords = brain (Clic here for more details about this article) |
9/13. A 10-year-old child with status asthmaticus, hypercapnia and a unilateral dilated pupil.This article reports the case of a 10-year-old child with an exacerbation of asthma requiring mechanical ventilation. His immediate course was complicated by significantly elevated arterial CO(2) tensions and a unilateral dilated pupil. A computed tomography scan of his brain failed to demonstrate any evidence of intracranial hypertension or cerebral edema, and he went on to make an uncomplicated recovery, with no evidence of neurological sequelae. The most likely diagnosis appeared to be local contamination with ipratropium when he was receiving frequent nebulizers prior to mechanical ventilation. Similar cases reported in the literature are reviewed, with a discussion of clinical management, implications of permissive hypercapnia and neurological complications in ventilating asthmatic patients and the importance of safe drug handling by staff members.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
10/13. Internal ophthalmoplegia associated with migraine attacks.The case of a young woman presenting with repeated headache episodes associated with right eye midriasis is described. CT scan, MR of the brain and selective cerebral angiography were unremarkable. tyramine eyedrop response suggested parasympathetic hypofunction on the affected side. The diagnosis of ophthalmoplegic migraine is proposed.- - - - - - - - - - ranking = 1keywords = brain (Clic here for more details about this article) |
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