Photophobia is a common symptom seen in many neurologic disorders,however,its pathophysiology remains unclear.Even the term is ambiguous.In this paper,we review the epidemiology and clinical manifestations of photopho...Photophobia is a common symptom seen in many neurologic disorders,however,its pathophysiology remains unclear.Even the term is ambiguous.In this paper,we review the epidemiology and clinical manifestations of photophobia in neurological disorders,including primary headache,blepharospasm,progressive supranuclear palsy,and traumatic brain injury,discuss the definition,etiology and pathogenesis,and summarize practical methods of diagnosis and treatment.展开更多
AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent ...AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent bilateral lateral rectus muscle recession for IXT between 4 and 12 years old were reviewed retrospectively. They were categorized based on the surgical results;successful correction group(n=36) and overcorrection group(esotropia ≥10 PD at 3 mo postoperatively, n=18). Using CGT-2000 test for CS was performed binocularly, and subjective reports of photophobia was investigated preoperatively and at 3 mo postoperatively. Objective photophobia was defined as a significant decrease in CS in the presence of glare.RESULTS: Preoperatively, there was no difference in CS between the groups. Postoperatively, under mesopic conditions, significant improvement of CS was observed at 6.3°, 4°, and 2.5° in the successful correction group and at 6.3° and 4° in the overcorrection group, regardless of glare. Under photopic conditions, at all visual angles except 0.64°, improvement in CS was noted in both groups while CS worsened significantly at 0.64° in the overcorrection group postoperatively. At all visual angles under photopic conditions postoperatively, regardless of glare, CS in the overcorrected group was significantly worse than that in the successful correction group, and CS was significantly decreased by addition of glare in both groups. All patients except one(96.4%) in the successful correction group and 8 patients(61.5%) in overcorrection group showed improvement of photophobia postoperatively, which correlated with CS under photopic conditions(P=0.001, 0.03).CONCLUSION: After surgery for IXT, CS under photopic conditions improve at all visual angles except 0.64°, while CS is significantly worse in the overcorrection group postoperatively at 0.64°. Subjective photophobia havesignificant correlation with CS under photopic conditions, and may be used as an objective indicator of photophobia.展开更多
Stroke is a rapidly developing symptom or sign of loss of cerebral function secondary to interruption of the blood supply due to a thrombus or hemorrhage. These diseased vessels are usually affected by well-recognized...Stroke is a rapidly developing symptom or sign of loss of cerebral function secondary to interruption of the blood supply due to a thrombus or hemorrhage. These diseased vessels are usually affected by well-recognized risk factors, but in some cases other rare conditions may be related to stroke development. Herein, we introduce one of these rare stroke conditions in a 37-year-old previously healthy male who presented to the emergency department with misleading symptoms and signs of reduced level of consciousness, isolated medical 3rd nerve palsy and possible drug overdose. A thorough neurological examination and investigation demonstrated a case of acute ischemic stroke as a consequence of meningeal irritation with an underlying inflammatory response. The patient was treated simultaneously for both conditions and responded dramatically with full recovery upon discharge. Thus, consideration of acute stroke in patients with no previous known risk factors is highly recommended especially with unusual neurological findings.展开更多
Background:Retinopathy of prematurity(ROP)is a disorder of retinal development in the low birthweight preterm infant.Eye screening is routinely performed for infants at risk of developing this disorder.While these exa...Background:Retinopathy of prematurity(ROP)is a disorder of retinal development in the low birthweight preterm infant.Eye screening is routinely performed for infants at risk of developing this disorder.While these examinations help prevent blindness,they can be physiologically stressful for infants,with changes in oxygen saturation,blood pressure and heart rate occurring during the exam and increased apneic episodes reported the 24-48 hours period afterward.The cause of these increased apneic episodes is not currently known.Our Background is to evaluate the effect of decreasing light simulation during mydriasis using an eye mask on the frequency of stressful episodes after ROP screening.Methods:Multi-centre randomized clinical study.This study was approved by hospital ethics boards at all sites.After informed consent was obtained,infants with a birthweight<1,500 g or gestational age of≤32 weeks and scheduled for their first ROP screening were randomized to receive either standard of care or a phototherapy mask during pupil dilation in addition to routine care.Dilated retinal exams were performed by retinal surgeons and fellows.The primary outcome was the frequency of any desaturation,bradycardic event,or apneic event 12 hours following the examination,compared to a baseline rate 12 hours prior to the exam.Heart rate,respiratory rate and oxygen saturation were recorded for up to 48 hours following the examination and compared to baseline.Results:A total of 51 infants were examined;28 randomized to the masked group and 23 to the control group.Ten and 13 infants were on ventilator support at the time of examination in each group,respectively.There was a 57.7%decrease in the total number of all stressful events in the masked group compared to controls in the 12-hour post exam period(rate ratio 0.42,95%CI,0.2-0.9,P=0.024).There was a 61.3%decrease in the number of bradycardic events in the masked group compared to controls(RR 0.39,95%CI,0.2-1.0,P=0.042).Heart rate was significantly higher in both groups after the exam(Mean HR:164.67 bpm post vs.157.3 bpm pre;P=0.04),with no difference in between groups(Effect by group P=0.31).There was no significant difference seen in either group in respiratory rate or oxygen saturation at 2 or 4 hours after the ROP examination compared to baseline.Risk factors that were associated with increased stress included younger gestational age(RR=1.3295%CI,1.2-1.5 per week),lower birthweight[RR=1.39(1.2-1.5)per 100 g],ventilator support around the time of exam[RR=2.67(1.3-5.6)],diagnosis of intraventricular hemorrhage[RR=3.78(1.9-7.3)],and hyponatremia[RR=3.42(1.8-6.6)].No adverse events occurred while using eye masks.Conclusions:The infants who wore a phototherapy mask during pupillary dilation had lower rates of stressful episodes following screening for retinopathy of prematurity,particularly lower episodes of bradycardia.展开更多
Introduction: Albinism is a rare hereditary genetic disorder, characterized by melanogenesis disorders associated to varying degrees of cutaneous, atrial and visual disorders. In Libreville, no data on the subject is ...Introduction: Albinism is a rare hereditary genetic disorder, characterized by melanogenesis disorders associated to varying degrees of cutaneous, atrial and visual disorders. In Libreville, no data on the subject is available. Purpose: To describe the ocular manifestations found in albinos living in Libreville. Patients and methods: This was a cross-sectional and descriptive study that took place in Libreville during a year from and that concerned 43 albinos. The inclusion criteria were any albino with oculocutaneous albinism present in Libreville who has agreed to participate in the investigation. The variables studied were age, sex, visual acuity, ametropia, iris color, iris transillumination, strabismus, nystagmus, torticollis, amblyopia, optic disc, photophobia, foveal hypoplasia and retinal hypopigmentation. Data was collected and analyzed using Epi infoTM 7.2.0.1 CDC and?IBM®?SPSS®?V21 Statistic software. Results: The mean age was 21.2 ± 17 years with a (F/M) ratio of 0.53. Visual acuity by far without correction (AVLCSC) < 3/10 was found in 88.4% of cases. Astigmatism, two-tone iris and torticollis were found respectively in 52.7%, 51% and 26% of cases. Retinal hypopigmentation and foveal hypoplasia were noted in 65.1% and 86% of cases. Divergent strabismus was noted in 71.4% and small and pale papilla in 95.1% of cases. Photophobia, iris transillumination, nystagmus and amblyopia were noted in 100% of cases. Conclusion: The ocular manifestations encountered in our series are similar to those described in literatures.展开更多
目的通过对梅尼埃病患者畏光畏声伴随症状的临床分析,探讨其产生机制以及对于梅尼埃病诊治的临床意义。方法回顾分析能准确提供主诉症状的105例梅尼埃病确诊病例,根据性别、年龄、听力分期、头痛情况进行分组,了解其与畏光畏声症状之间...目的通过对梅尼埃病患者畏光畏声伴随症状的临床分析,探讨其产生机制以及对于梅尼埃病诊治的临床意义。方法回顾分析能准确提供主诉症状的105例梅尼埃病确诊病例,根据性别、年龄、听力分期、头痛情况进行分组,了解其与畏光畏声症状之间的关系。结果 (1)所有梅尼埃确诊病例105例,畏光或(和)畏声出现率60%(63/105)。(2)男性44例,畏光或(和)畏声出现率47.7%(21/44);女性61例,畏光或(和)畏声出现率68.9%(42/61);性别差异有统计学意义(P<0.05)。(3)20岁2例,畏光或(和)畏声出现率100%(2/2);20~40岁22例,畏光或(和)畏声出现率54.5%(12/22);41~60岁54例,畏光或(和)畏声出现率63.0%(34/54);60岁27例,畏光或(和)畏声出现率55.6%(15/27);年龄差异无统计学意义(P>0.05)。(4)25d BHL 8例,畏光或(和)畏声出现率62.5%(5/8);26~40 d BHL 30例,畏光或(和)畏声出现率46.7%(14/30);41~70 d BHL 50例,畏光或(和)畏声出现率68.0%(34/50);70 d BHL 17例,畏光或(和)畏声出现率68.0%(34/50);听力差异无统计学意义(P>0.05)。(5)头痛32例,畏光或(和)畏声出现率68.8%(22/32);未曾出现头痛73例,畏光或(和)畏声出现率56.2%(41/73);出现畏光或(和)畏声与头痛之间无关联性(P>0.05)。结论梅尼埃病出现畏光畏声伴随症状,女性患者较男性多见,与年龄、听力损失程度、头痛无明显相关性,从而推断其产生原因与梅尼埃病理机制以及中枢调节、中枢功能紊乱的共患疾病等多因素相关。展开更多
基金The work was supported by the National Natural Science Foundation of China(No.81200981,81,371,407)the Innovation Program of Shanghai Municipal Education Commission(No.13YZ026)the Intramural Program of the National Institute of Neurological Disorders and Stroke.
文摘Photophobia is a common symptom seen in many neurologic disorders,however,its pathophysiology remains unclear.Even the term is ambiguous.In this paper,we review the epidemiology and clinical manifestations of photophobia in neurological disorders,including primary headache,blepharospasm,progressive supranuclear palsy,and traumatic brain injury,discuss the definition,etiology and pathogenesis,and summarize practical methods of diagnosis and treatment.
文摘AIM: To compare contrast sensitivity(CS) based on the surgical results for intermittent exotropia(IXT) and to examine the relationship between CS and photophobia.METHODS: Medical records of the patients who underwent bilateral lateral rectus muscle recession for IXT between 4 and 12 years old were reviewed retrospectively. They were categorized based on the surgical results;successful correction group(n=36) and overcorrection group(esotropia ≥10 PD at 3 mo postoperatively, n=18). Using CGT-2000 test for CS was performed binocularly, and subjective reports of photophobia was investigated preoperatively and at 3 mo postoperatively. Objective photophobia was defined as a significant decrease in CS in the presence of glare.RESULTS: Preoperatively, there was no difference in CS between the groups. Postoperatively, under mesopic conditions, significant improvement of CS was observed at 6.3°, 4°, and 2.5° in the successful correction group and at 6.3° and 4° in the overcorrection group, regardless of glare. Under photopic conditions, at all visual angles except 0.64°, improvement in CS was noted in both groups while CS worsened significantly at 0.64° in the overcorrection group postoperatively. At all visual angles under photopic conditions postoperatively, regardless of glare, CS in the overcorrected group was significantly worse than that in the successful correction group, and CS was significantly decreased by addition of glare in both groups. All patients except one(96.4%) in the successful correction group and 8 patients(61.5%) in overcorrection group showed improvement of photophobia postoperatively, which correlated with CS under photopic conditions(P=0.001, 0.03).CONCLUSION: After surgery for IXT, CS under photopic conditions improve at all visual angles except 0.64°, while CS is significantly worse in the overcorrection group postoperatively at 0.64°. Subjective photophobia havesignificant correlation with CS under photopic conditions, and may be used as an objective indicator of photophobia.
文摘Stroke is a rapidly developing symptom or sign of loss of cerebral function secondary to interruption of the blood supply due to a thrombus or hemorrhage. These diseased vessels are usually affected by well-recognized risk factors, but in some cases other rare conditions may be related to stroke development. Herein, we introduce one of these rare stroke conditions in a 37-year-old previously healthy male who presented to the emergency department with misleading symptoms and signs of reduced level of consciousness, isolated medical 3rd nerve palsy and possible drug overdose. A thorough neurological examination and investigation demonstrated a case of acute ischemic stroke as a consequence of meningeal irritation with an underlying inflammatory response. The patient was treated simultaneously for both conditions and responded dramatically with full recovery upon discharge. Thus, consideration of acute stroke in patients with no previous known risk factors is highly recommended especially with unusual neurological findings.
文摘Background:Retinopathy of prematurity(ROP)is a disorder of retinal development in the low birthweight preterm infant.Eye screening is routinely performed for infants at risk of developing this disorder.While these examinations help prevent blindness,they can be physiologically stressful for infants,with changes in oxygen saturation,blood pressure and heart rate occurring during the exam and increased apneic episodes reported the 24-48 hours period afterward.The cause of these increased apneic episodes is not currently known.Our Background is to evaluate the effect of decreasing light simulation during mydriasis using an eye mask on the frequency of stressful episodes after ROP screening.Methods:Multi-centre randomized clinical study.This study was approved by hospital ethics boards at all sites.After informed consent was obtained,infants with a birthweight<1,500 g or gestational age of≤32 weeks and scheduled for their first ROP screening were randomized to receive either standard of care or a phototherapy mask during pupil dilation in addition to routine care.Dilated retinal exams were performed by retinal surgeons and fellows.The primary outcome was the frequency of any desaturation,bradycardic event,or apneic event 12 hours following the examination,compared to a baseline rate 12 hours prior to the exam.Heart rate,respiratory rate and oxygen saturation were recorded for up to 48 hours following the examination and compared to baseline.Results:A total of 51 infants were examined;28 randomized to the masked group and 23 to the control group.Ten and 13 infants were on ventilator support at the time of examination in each group,respectively.There was a 57.7%decrease in the total number of all stressful events in the masked group compared to controls in the 12-hour post exam period(rate ratio 0.42,95%CI,0.2-0.9,P=0.024).There was a 61.3%decrease in the number of bradycardic events in the masked group compared to controls(RR 0.39,95%CI,0.2-1.0,P=0.042).Heart rate was significantly higher in both groups after the exam(Mean HR:164.67 bpm post vs.157.3 bpm pre;P=0.04),with no difference in between groups(Effect by group P=0.31).There was no significant difference seen in either group in respiratory rate or oxygen saturation at 2 or 4 hours after the ROP examination compared to baseline.Risk factors that were associated with increased stress included younger gestational age(RR=1.3295%CI,1.2-1.5 per week),lower birthweight[RR=1.39(1.2-1.5)per 100 g],ventilator support around the time of exam[RR=2.67(1.3-5.6)],diagnosis of intraventricular hemorrhage[RR=3.78(1.9-7.3)],and hyponatremia[RR=3.42(1.8-6.6)].No adverse events occurred while using eye masks.Conclusions:The infants who wore a phototherapy mask during pupillary dilation had lower rates of stressful episodes following screening for retinopathy of prematurity,particularly lower episodes of bradycardia.
文摘Introduction: Albinism is a rare hereditary genetic disorder, characterized by melanogenesis disorders associated to varying degrees of cutaneous, atrial and visual disorders. In Libreville, no data on the subject is available. Purpose: To describe the ocular manifestations found in albinos living in Libreville. Patients and methods: This was a cross-sectional and descriptive study that took place in Libreville during a year from and that concerned 43 albinos. The inclusion criteria were any albino with oculocutaneous albinism present in Libreville who has agreed to participate in the investigation. The variables studied were age, sex, visual acuity, ametropia, iris color, iris transillumination, strabismus, nystagmus, torticollis, amblyopia, optic disc, photophobia, foveal hypoplasia and retinal hypopigmentation. Data was collected and analyzed using Epi infoTM 7.2.0.1 CDC and?IBM®?SPSS®?V21 Statistic software. Results: The mean age was 21.2 ± 17 years with a (F/M) ratio of 0.53. Visual acuity by far without correction (AVLCSC) < 3/10 was found in 88.4% of cases. Astigmatism, two-tone iris and torticollis were found respectively in 52.7%, 51% and 26% of cases. Retinal hypopigmentation and foveal hypoplasia were noted in 65.1% and 86% of cases. Divergent strabismus was noted in 71.4% and small and pale papilla in 95.1% of cases. Photophobia, iris transillumination, nystagmus and amblyopia were noted in 100% of cases. Conclusion: The ocular manifestations encountered in our series are similar to those described in literatures.
文摘目的通过对梅尼埃病患者畏光畏声伴随症状的临床分析,探讨其产生机制以及对于梅尼埃病诊治的临床意义。方法回顾分析能准确提供主诉症状的105例梅尼埃病确诊病例,根据性别、年龄、听力分期、头痛情况进行分组,了解其与畏光畏声症状之间的关系。结果 (1)所有梅尼埃确诊病例105例,畏光或(和)畏声出现率60%(63/105)。(2)男性44例,畏光或(和)畏声出现率47.7%(21/44);女性61例,畏光或(和)畏声出现率68.9%(42/61);性别差异有统计学意义(P<0.05)。(3)20岁2例,畏光或(和)畏声出现率100%(2/2);20~40岁22例,畏光或(和)畏声出现率54.5%(12/22);41~60岁54例,畏光或(和)畏声出现率63.0%(34/54);60岁27例,畏光或(和)畏声出现率55.6%(15/27);年龄差异无统计学意义(P>0.05)。(4)25d BHL 8例,畏光或(和)畏声出现率62.5%(5/8);26~40 d BHL 30例,畏光或(和)畏声出现率46.7%(14/30);41~70 d BHL 50例,畏光或(和)畏声出现率68.0%(34/50);70 d BHL 17例,畏光或(和)畏声出现率68.0%(34/50);听力差异无统计学意义(P>0.05)。(5)头痛32例,畏光或(和)畏声出现率68.8%(22/32);未曾出现头痛73例,畏光或(和)畏声出现率56.2%(41/73);出现畏光或(和)畏声与头痛之间无关联性(P>0.05)。结论梅尼埃病出现畏光畏声伴随症状,女性患者较男性多见,与年龄、听力损失程度、头痛无明显相关性,从而推断其产生原因与梅尼埃病理机制以及中枢调节、中枢功能紊乱的共患疾病等多因素相关。
