Internuclear ophthalmoplegia (INO) is a sign of exquisite localizing value, of ten due to either multiple sclerosis or infarction. To demonstrate that unusual causes of INO are more common than the 11%reported in prev...Internuclear ophthalmoplegia (INO) is a sign of exquisite localizing value, of ten due to either multiple sclerosis or infarction. To demonstrate that unusual causes of INO are more common than the 11%reported in previous series, this rev iew considers a case series of 410 inpatients whom I personally examined during a 33-year period. In this series, the cause of INO was infarction in 157 patien ts (38%), multiple sclerosis in 139 (34%), and unusual causes in 114 (28%). U nusual causes included trauma (20 cases), tentorial herniation (20 cases), infec tion (17 cases), tumor (17 cases), iatrogenic injury (12 cases), hemorrhage (13 cases), vasculitis (7 cases), and miscellaneous (8 cases). Internuclear ophthalm oplegia was unilateral in 136 of the infarct cases (87%), 38 of those with mult iple sclerosis (27%), and 48 of the unusual cases (42%). Because unusual cause s compose more than one quarter of the cases, the differential diagnosis of INO should be tripartite: multiple sclerosis, stroke, and other causes.展开更多
PURPOSE: To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively. DESIGN: A prospective, consecutive case series. MET...PURPOSE: To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively. DESIGN: A prospective, consecutive case series. METHODS: Children found to have an abnormal head posture on routine pediatric examination underwent an evaluation by a pediatric ophthalmologist, pediatric orthopedist, and pediatric neurologist. The study was conducted in northwestern Italy. RESULTS: In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5. In 8 patients, no specific cause could be found. The most common orthopedic cause was congenital muscular torticollis, which accounted for 31 patients. The most common ocular cause was superior oblique muscle palsy, which accounted for 12 patients. In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior obliquemuscle palsy. CONCLUSIONS: When the cause of an abnormal head posture is not obvious, a multi-disciplinary approach including ophthalmologic, neurologic, and orthopedic specialists may be helpful.展开更多
文摘Internuclear ophthalmoplegia (INO) is a sign of exquisite localizing value, of ten due to either multiple sclerosis or infarction. To demonstrate that unusual causes of INO are more common than the 11%reported in previous series, this rev iew considers a case series of 410 inpatients whom I personally examined during a 33-year period. In this series, the cause of INO was infarction in 157 patien ts (38%), multiple sclerosis in 139 (34%), and unusual causes in 114 (28%). U nusual causes included trauma (20 cases), tentorial herniation (20 cases), infec tion (17 cases), tumor (17 cases), iatrogenic injury (12 cases), hemorrhage (13 cases), vasculitis (7 cases), and miscellaneous (8 cases). Internuclear ophthalm oplegia was unilateral in 136 of the infarct cases (87%), 38 of those with mult iple sclerosis (27%), and 48 of the unusual cases (42%). Because unusual cause s compose more than one quarter of the cases, the differential diagnosis of INO should be tripartite: multiple sclerosis, stroke, and other causes.
文摘PURPOSE: To determine the relative frequency that abnormal head postures in children are caused by orthopedic, ophthalmologic, or neurologic disorders, respectively. DESIGN: A prospective, consecutive case series. METHODS: Children found to have an abnormal head posture on routine pediatric examination underwent an evaluation by a pediatric ophthalmologist, pediatric orthopedist, and pediatric neurologist. The study was conducted in northwestern Italy. RESULTS: In the 63 children evaluated, the cause of the abnormal head posture was orthopedic in 35, ocular in 25, and neurologic in 5. In 8 patients, no specific cause could be found. The most common orthopedic cause was congenital muscular torticollis, which accounted for 31 patients. The most common ocular cause was superior oblique muscle palsy, which accounted for 12 patients. In 2 patients neck muscle contracture suggested an orthopedic cause, however, the tight neck muscles were secondary to a head tilt caused by superior obliquemuscle palsy. CONCLUSIONS: When the cause of an abnormal head posture is not obvious, a multi-disciplinary approach including ophthalmologic, neurologic, and orthopedic specialists may be helpful.
