Introduction. Visual disturbances are common after severe head trauma. Some au thors report 50p.cent of theses patients having damage to the visual system, ocu lar motor nerve palsies, or central eye movement disturba...Introduction. Visual disturbances are common after severe head trauma. Some au thors report 50p.cent of theses patients having damage to the visual system, ocu lar motor nerve palsies, or central eye movement disturbances. Visual disturbanc es influence prognosis and outcome of neurological rehabilitation, and, in most cases, diagnosis and treatment require interdisciplinary care. Case report. We r eport here a 50-year-old patient who suffered from severe head trauma at age 2 0. After coming out of a 4-week coma, he suffered visual disturbances such as b lurred vision and diplopia. Visual acuity was 1.0 and the visual fields were int act. The symptoms remained unexplained for a long time. One year after the traum a, right trochlear palsy was diagnosed and surgical treatment was performed. How ever, the symptoms persisted, and one year later, a second operation was perform ed without changing the symptoms. During many years, prisms or refractive correc tions were used to improve the visual disturbances, and finally, a psychiatric t reatment was started. At age 40, the patient became presbyopic and his visual pr oblems increased, especially for reading. When he was examined for the first tim e in our consultation, corrected visual acuity was 1.0 with a small hyperphoria of the right eye. During careful examination of the eye downgaze, a conjugate pu re torsional nystagmus was observed, which disappeared in primary gaze position. Conclusion. Pure torsional nystagmus is difficult to diagnose, especially when it is provoked only by one gaze direction such as in our patient. As a sequel of the . severe head trauma with brainstem contusion, this type of nystagmus is a rare form of central vestibular nystagmus, and may by modified by head rotation or suppressed by convergence. The “treatment”of the patient’s burred vision w hen reading was easy by ordering goggles with a near part placed near the primar y gaze position and a base down prismatic correction. Reading was then possible without provoking to rsional nystagmus.展开更多
In general, intermittent diplopia evokes suspicion of ocular myasthenia gravis . However, other etiologies such as Brown syndrome or myokymia of the superior o blique may provoke intermittent diplopia. We present a ca...In general, intermittent diplopia evokes suspicion of ocular myasthenia gravis . However, other etiologies such as Brown syndrome or myokymia of the superior o blique may provoke intermittent diplopia. We present a case of intermittent dipl opia due to a tumor in the cavernous sinus. A 59-year-old patient reported int ermittent diplopia after prolonged downward gaze to the right. All other gaze di rections failed to provoke symptoms. In 1992, the diagnosis of inactive macroade noma of the pituitary gland was established and the patient underwent surgery an d radiation therapy. At physical examination, prolonged downward gaze to the rig ht of about 2 minutes provoked paresis of abduction, slight ptosis, and restrict ion of elevation on the left side, corresponding to sixth nerve palsy and palsy of the superior branch of the third nerve on the left side. MRI showed a relapse of the macroadenoma with infiltration of the cavernous sinus on the left side. The patient underwent surgery then focal radiation (gamma-knife). The clinical course was favourable and at the follow-up examination six months later, no dip lopia was reported.展开更多
文摘Introduction. Visual disturbances are common after severe head trauma. Some au thors report 50p.cent of theses patients having damage to the visual system, ocu lar motor nerve palsies, or central eye movement disturbances. Visual disturbanc es influence prognosis and outcome of neurological rehabilitation, and, in most cases, diagnosis and treatment require interdisciplinary care. Case report. We r eport here a 50-year-old patient who suffered from severe head trauma at age 2 0. After coming out of a 4-week coma, he suffered visual disturbances such as b lurred vision and diplopia. Visual acuity was 1.0 and the visual fields were int act. The symptoms remained unexplained for a long time. One year after the traum a, right trochlear palsy was diagnosed and surgical treatment was performed. How ever, the symptoms persisted, and one year later, a second operation was perform ed without changing the symptoms. During many years, prisms or refractive correc tions were used to improve the visual disturbances, and finally, a psychiatric t reatment was started. At age 40, the patient became presbyopic and his visual pr oblems increased, especially for reading. When he was examined for the first tim e in our consultation, corrected visual acuity was 1.0 with a small hyperphoria of the right eye. During careful examination of the eye downgaze, a conjugate pu re torsional nystagmus was observed, which disappeared in primary gaze position. Conclusion. Pure torsional nystagmus is difficult to diagnose, especially when it is provoked only by one gaze direction such as in our patient. As a sequel of the . severe head trauma with brainstem contusion, this type of nystagmus is a rare form of central vestibular nystagmus, and may by modified by head rotation or suppressed by convergence. The “treatment”of the patient’s burred vision w hen reading was easy by ordering goggles with a near part placed near the primar y gaze position and a base down prismatic correction. Reading was then possible without provoking to rsional nystagmus.
文摘In general, intermittent diplopia evokes suspicion of ocular myasthenia gravis . However, other etiologies such as Brown syndrome or myokymia of the superior o blique may provoke intermittent diplopia. We present a case of intermittent dipl opia due to a tumor in the cavernous sinus. A 59-year-old patient reported int ermittent diplopia after prolonged downward gaze to the right. All other gaze di rections failed to provoke symptoms. In 1992, the diagnosis of inactive macroade noma of the pituitary gland was established and the patient underwent surgery an d radiation therapy. At physical examination, prolonged downward gaze to the rig ht of about 2 minutes provoked paresis of abduction, slight ptosis, and restrict ion of elevation on the left side, corresponding to sixth nerve palsy and palsy of the superior branch of the third nerve on the left side. MRI showed a relapse of the macroadenoma with infiltration of the cavernous sinus on the left side. The patient underwent surgery then focal radiation (gamma-knife). The clinical course was favourable and at the follow-up examination six months later, no dip lopia was reported.
