The authors investigated the evolution of third nerve palsy in patients with posterior communicating artery aneurysms who underwent coiling vs clipping.There was no statistical difference of complete third nerve palsy...The authors investigated the evolution of third nerve palsy in patients with posterior communicating artery aneurysms who underwent coiling vs clipping.There was no statistical difference of complete third nerve palsy recovery in both treatments.Both techniques were of clinical benefit.Older age,diabetes,delayed interventions,and complete third nerve palsy at presentation indicated a poor prognosis for recovery.展开更多
Context:The prevalence of visual impairment in the US public has not been surveyed nationally in several decades.Objective:To estimate the number of US individuals aged 12 years or older who have impaired distance vis...Context:The prevalence of visual impairment in the US public has not been surveyed nationally in several decades.Objective:To estimate the number of US individuals aged 12 years or older who have impaired distance vision due to uncorrected refractive error.Design,Setting,and Participants:The National Health and Nutrition Examination Survey(NHANES),using a multistage probability sampling design,included a vision evaluation in a mobile examination center.Visual acuity data were obtained from 13 265 of 14 203 participants(93.4%)-who visited the mobile examination center in 1999-2002.Visual impairment was defined as presenting distance visual acuity of 20/50 or worse in the better-seeing eye.Visual impairment due to uncorrected refractive error was defined as(presenting)visual impairment that improved,aided by automated refraction results,to 20/40 or better in the better-seeing eye.Main Outcome Measures:Presenting distance visual acuity(measured with usual corrective lenses,if any)and distance visual acuity after automated refraction.Results:Overall,1190 study participants had visual impairment(weighted prevalence,6.4% ;95% confidence interval CI,6.0%-6.8%),and of these,83.3% could achieve good visual acuity with correction(95% CI,80.9%-85.8%).Extrapolating these findings to the general US population,approximately 14 million individuals aged 12 years or older have visual impairment(defined as distance visual acuity of 20/50 or worse),and of these,more than 11 million individuals could have their vision improved to 20/40 or better with refractive correction.Conclusions:Visual impairment due to uncorrected refractive error is a common condition in the United States.Providing appropriate refractive correction to those individuals whose vision can be improved is an important public health endeavor with implications for safety and quality of life.展开更多
Objective:We evaluated the correlation between intracranial(ICP)and intraocular pressure(IOP).Methods:Of the 77 patients who underwent a lumbar puncture,27 were excluded secondary to a history of glaucoma,using drugs ...Objective:We evaluated the correlation between intracranial(ICP)and intraocular pressure(IOP).Methods:Of the 77 patients who underwent a lumbar puncture,27 were excluded secondary to a history of glaucoma,using drugs effective on IOP,and abnormal funduscopic examination.ICP was measured by lumbar puncture.IOP was measured by two scales of Schiotz tonometer in both eyes,and the mean was calculated.Results:We found a significant correlation between ICP and mean IOP(p< 0.001;r=0.955).Body mass index,age,and disease type had no significant effect on this correlation.Interpretation:IOP is correlated with ICP.展开更多
Background:Within the midbrain,the third nerve nucleus is composed of a complex of subnuclei.The fascicular portion of the nerve courses through the red nucleus and exists in themidbrain just medial to the cerebral pe...Background:Within the midbrain,the third nerve nucleus is composed of a complex of subnuclei.The fascicular portion of the nerve courses through the red nucleus and exists in themidbrain just medial to the cerebral peduncle.The cisternal portion of the nerve is a single structure that divides into a superior branch and an inferior branch in the region of the cavernous sinus and superior orbital fissure.Objective:To describe 2 patients with superior divisional third cranial nerve paresis resulting froma lesion involving the cisternal portion of the nerve prior to its anatomical bifurcation.Patients:Case 1 was a 77-year-old man with a superior divisional third nerve palsy as the presenting manifestation of a posterior communicating artery aneurysm.Case 2 was a 41-year-old woman who developed a superior divisional third nerve palsy following anterior temporal lobectomy for epilepsy.Results:In both cases,the presumed location of the lesion was the cisternal portion of the third cranial nerve.Conclusions:Although the anatomical division of the third cranial nerve occurs in the region of the anterior cavernous sinus or superior orbital fissure,there is a topographical arrangement of the motor fibers within the cisternal portion of the nerve.The clinical evaluation of a patient with a third cranial nerve paresis requires an understanding of the regional neuroanatomy and topographical organization of the nerve.展开更多
Background:There are few reports describing the coexistence of dystrophic features with those typical of mitochondrial myopathies in muscle biopsy.A recent study suggested that dystrophic features are frequent in pati...Background:There are few reports describing the coexistence of dystrophic features with those typical of mitochondrial myopathies in muscle biopsy.A recent study suggested that dystrophic features are frequent in patients with chronic progressive external ophthalmoplegia(CPEO)with a high mutation load,but the actual frequency of these abnormalities in CPEO remains undetermined.Objective:To review the occurrence of dystrophic abnormalities in a large series of patients with CPEO to assess the frequency of such abnormalities and to verify whether they are correlated with specific mitochondrial DNA(mtDNA)mutations.Methods:Retrospective survey of case series(86 patients with CPEO).Results:Only three cases with dystrophic abnormalities were found:two with a large scale mtDNA deletion and one with the A3251G mutation.All three patients showed predominantly proximal muscular weakness resembling limb girdle muscular dystrophy.Conclusions:Dystrophic abnormalities are rare in CPEO and are not correlated with a specific molecular defect.展开更多
Two patients are reported who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses,but recurred or increased in frequency or duration...Two patients are reported who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses,but recurred or increased in frequency or duration on higher doses.Both patients had complete resolution of palinopsia when topiramate was discontinued.A third patient is described who developed the “ Alice in Wonderland” syndrome about 1 week after starting topiramate for migraine prevention with complete resolution of symptoms about 1 month after stopping.Topiramate use may cause palinopsia and may be associated with the Alice in Wonderland syndrome through an unknown mechanism.展开更多
文摘The authors investigated the evolution of third nerve palsy in patients with posterior communicating artery aneurysms who underwent coiling vs clipping.There was no statistical difference of complete third nerve palsy recovery in both treatments.Both techniques were of clinical benefit.Older age,diabetes,delayed interventions,and complete third nerve palsy at presentation indicated a poor prognosis for recovery.
文摘Context:The prevalence of visual impairment in the US public has not been surveyed nationally in several decades.Objective:To estimate the number of US individuals aged 12 years or older who have impaired distance vision due to uncorrected refractive error.Design,Setting,and Participants:The National Health and Nutrition Examination Survey(NHANES),using a multistage probability sampling design,included a vision evaluation in a mobile examination center.Visual acuity data were obtained from 13 265 of 14 203 participants(93.4%)-who visited the mobile examination center in 1999-2002.Visual impairment was defined as presenting distance visual acuity of 20/50 or worse in the better-seeing eye.Visual impairment due to uncorrected refractive error was defined as(presenting)visual impairment that improved,aided by automated refraction results,to 20/40 or better in the better-seeing eye.Main Outcome Measures:Presenting distance visual acuity(measured with usual corrective lenses,if any)and distance visual acuity after automated refraction.Results:Overall,1190 study participants had visual impairment(weighted prevalence,6.4% ;95% confidence interval CI,6.0%-6.8%),and of these,83.3% could achieve good visual acuity with correction(95% CI,80.9%-85.8%).Extrapolating these findings to the general US population,approximately 14 million individuals aged 12 years or older have visual impairment(defined as distance visual acuity of 20/50 or worse),and of these,more than 11 million individuals could have their vision improved to 20/40 or better with refractive correction.Conclusions:Visual impairment due to uncorrected refractive error is a common condition in the United States.Providing appropriate refractive correction to those individuals whose vision can be improved is an important public health endeavor with implications for safety and quality of life.
文摘Objective:We evaluated the correlation between intracranial(ICP)and intraocular pressure(IOP).Methods:Of the 77 patients who underwent a lumbar puncture,27 were excluded secondary to a history of glaucoma,using drugs effective on IOP,and abnormal funduscopic examination.ICP was measured by lumbar puncture.IOP was measured by two scales of Schiotz tonometer in both eyes,and the mean was calculated.Results:We found a significant correlation between ICP and mean IOP(p< 0.001;r=0.955).Body mass index,age,and disease type had no significant effect on this correlation.Interpretation:IOP is correlated with ICP.
文摘Background:Within the midbrain,the third nerve nucleus is composed of a complex of subnuclei.The fascicular portion of the nerve courses through the red nucleus and exists in themidbrain just medial to the cerebral peduncle.The cisternal portion of the nerve is a single structure that divides into a superior branch and an inferior branch in the region of the cavernous sinus and superior orbital fissure.Objective:To describe 2 patients with superior divisional third cranial nerve paresis resulting froma lesion involving the cisternal portion of the nerve prior to its anatomical bifurcation.Patients:Case 1 was a 77-year-old man with a superior divisional third nerve palsy as the presenting manifestation of a posterior communicating artery aneurysm.Case 2 was a 41-year-old woman who developed a superior divisional third nerve palsy following anterior temporal lobectomy for epilepsy.Results:In both cases,the presumed location of the lesion was the cisternal portion of the third cranial nerve.Conclusions:Although the anatomical division of the third cranial nerve occurs in the region of the anterior cavernous sinus or superior orbital fissure,there is a topographical arrangement of the motor fibers within the cisternal portion of the nerve.The clinical evaluation of a patient with a third cranial nerve paresis requires an understanding of the regional neuroanatomy and topographical organization of the nerve.
文摘Background:There are few reports describing the coexistence of dystrophic features with those typical of mitochondrial myopathies in muscle biopsy.A recent study suggested that dystrophic features are frequent in patients with chronic progressive external ophthalmoplegia(CPEO)with a high mutation load,but the actual frequency of these abnormalities in CPEO remains undetermined.Objective:To review the occurrence of dystrophic abnormalities in a large series of patients with CPEO to assess the frequency of such abnormalities and to verify whether they are correlated with specific mitochondrial DNA(mtDNA)mutations.Methods:Retrospective survey of case series(86 patients with CPEO).Results:Only three cases with dystrophic abnormalities were found:two with a large scale mtDNA deletion and one with the A3251G mutation.All three patients showed predominantly proximal muscular weakness resembling limb girdle muscular dystrophy.Conclusions:Dystrophic abnormalities are rare in CPEO and are not correlated with a specific molecular defect.
文摘Two patients are reported who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses,but recurred or increased in frequency or duration on higher doses.Both patients had complete resolution of palinopsia when topiramate was discontinued.A third patient is described who developed the “ Alice in Wonderland” syndrome about 1 week after starting topiramate for migraine prevention with complete resolution of symptoms about 1 month after stopping.Topiramate use may cause palinopsia and may be associated with the Alice in Wonderland syndrome through an unknown mechanism.
