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J. V. Trontelj - One of the best experts on this subject based on the ideXlab platform.
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Neuro-ophthalmic manifestations of the syndrome of Ophthalmoplegia, ataxia and areflexia. Observations on 20 patients.
Acta neurologica Scandinavica, 2009Co-Authors: A. S. Najim Al-din, Milne Anderson, O. Eeg-olofsson, J. V. TronteljAbstract:The neuro-ophthalmological manifestations of 20 patients with the syndrome of Ophthalmoplegia, ataxia and areflexia are described. The symmetrical nature of the Ophthalmoplegia and the associated cerebellar ataxia point to centrally placed lesions. Several supranuclear, nuclear and internuclear ophthalmological signs are identified. Some of these, like partial sparing of the levator palpebrae and normal downgaze in the presence of severe Ophthalmoplegia are noted too frequently to be just unusual signs of peripheral oculomotor dysfunction. Other identified features included upper lid retraction on attempted upgaze and preserved Bell's phenomenon in the presence of paralysis of the latter, as well as several other central ophthalmological signs. These findings contrast with those seen in the Guillain-Barre syndrome and, thus, the syndrome of Ophthalmoplegia, ataxia and areflexia is not a mere variant of it.
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neuro ophthalmic manifestations of the syndrome of Ophthalmoplegia ataxia and areflexia a review
Acta Neurologica Scandinavica, 2009Co-Authors: Najim S Aldin, Milne Anderson, O Eegolofsson, J. V. TronteljAbstract:Controversy regarding the nosological position of the syndrome of Ophthalmoplegia, ataxia and areflexia (Miller Fisher syndrome) exists. The oculomotor dysfunction was presumed to represent an unusually symmetrical peripheral cranial nerve dysfunction. To investigate the neuro-ophthalmic manifestations in this rare syndrome we reviewed 109 reports describing 243 cases. The Ophthalmoplegia was remarkable in its constant association with a cerebellar type ataxia. It was described to be remarkably symmetrical at all stages of development and recovery. From the early description of the syndrome by Fisher the Ophthalmoplegia was observed to evolve as a symmetrical failure of upgaze followed by loss of lateral gaze and last by downgaze, recovery develops in the opposite pattern. Despite the severe nature of the Ophthalmoplegia, 58 patients were reported to have sparing of downgaze and 192 (79%) had relative sparing of the eye lids. Active lid retraction and preserved Bell's phenomenon, despite upgaze paralysis, were described in 22 and 15 patients respectively. Upper lid jerks were described in 2, Parinaud's syndrome in 2, convergence spasm in 6, internuclear Ophthalmoplegia in 15 and horizontal dissociated nystagmus in 11. Interestingly 23 were reported to present with paralysis of abduction progressing to lateral gaze paralysis and 5 had paralysis of abduction and contralateral gaze paralysis. Four had defective vestibulo-ocular reflex despite recovery of upgaze, 10 had central type nystagmus including rotatory, retractory and rebound nystagmus. Relative preservation of optokinetic nystagmus and preservation of vestibulo-ocular reflex despite an otherwise complete Ophthalmoplegia were reported in 6 and 2 patients respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
S Y Kim - One of the best experts on this subject based on the ideXlab platform.
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teaching neuroimage wall eyed bilateral internuclear Ophthalmoplegia webino from midbrain infarction
Neurology, 2008Co-Authors: J S Kim, Seong-hae Jeong, Soon Y Yang, S Y KimAbstract:A 78-year-old man with hypertension and diabetes was referred because of 3 days of diplopia and Ophthalmoplegia. Neurologic examination disclosed exotropia of both eyes (wall-eyed) and bilateral internuclear Ophthalmoplegia (WEBINO) with impaired convergence (figure, A).1 Vertical saccades and smooth pursuit were also limited, but improved during the …
Jonathan P. Gladstone - One of the best experts on this subject based on the ideXlab platform.
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An approach to the patient with painful Ophthalmoplegia, with a focus on Tolosa-Hunt syndrome
Current Pain and Headache Reports, 2007Co-Authors: Jonathan P. GladstoneAbstract:The differential diagnosis of painful Ophthalmoplegia is extensive and consists of numerous sinister etiologies, including neoplasms (ie, primary intracranial tumors, local or distant metastases), vascular (eg, aneurysm, carotid dissection, and carotid-cavernous fistula), inflammatory (ie, orbital pseudotumor, giant cell arteritis, sarcoidosis, and Tolosa-Hunt syndrome), and infectious etiologies (ie, fungal and mycobacterial), as well as other miscellaneous conditions (ie, ophthalmoplegic migraine and microvascular infarcts secondary to diabetes). A systematic approach to the evaluation of painful Ophthalmoplegia can lead to prompt recognition of serious disorders that can be associated with significant morbidity or mortality if left untreated. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids but should be diagnoses of exclusion.
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Painful Ophthalmoplegia: overview with a focus on Tolosa-Hunt syndrome.
Current Pain and Headache Reports, 2004Co-Authors: Jonathan P. Gladstone, David William DodickAbstract:Painful Ophthalmoplegia is an important presenting complaint to emergency departments, ophthalmologists, and neurologists. The etiological differential diagnosis of painful Ophthalmoplegia is extensive and consists of numerous sinister etiologies including vascular (eg, aneurysm, carotid dissection, carotid-cavernous fistula), neoplasms (eg, primary intracranial tumors, local or distant metastases), inflammatory conditions (eg, orbital pseudotumor, sarcoidosis, Tolosa-Hunt syndrome), infectious etiologies (eg, fungal, mycobacterial), and other conditions (eg, microvascular infarcts secondary to diabetes, ophthalmoplegic migraine, giant cell arteritis). A systematic approach to the evaluation of painful Ophthalmoplegia can lead to prompt recognition of serious disorders that if left untreated, can be associated with significant morbidity or mortality. Inflammatory conditions such as Tolosa-Hunt syndrome and orbital pseudotumor are highly responsive to corticosteroids, but should be diagnoses of exclusion.
Kazuo Misu - One of the best experts on this subject based on the ideXlab platform.
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Anti-GQ1b ganglioside antibody and Ophthalmoplegia of undetermined cause
2016Co-Authors: Tone Suzuki, Atsuro Chiba, Susumu Kusunoki, Makoto Chikuda, Tsuneaki Fujita, Kazuo MisuAbstract:Background/aim—Serum antibody against ganglioside GQ1b is reported to be closely associated with immune mediated Ophthalmoplegia in the Fisher and Guillain-Barré syndromes. Its presence against glycolipids, in particular ganglio-side GQ1b, was investigated in patients with Ophthalmoplegia of unknown origin. Methods—16 patients with ophthalmople-gia, the cause of which could not be confirmed from clinical findings or diag-nostic testing, were tested. 34 patients who had Ophthalmoplegia of definite cause, 16 healthy people, and 23 patients wit
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anti gq1b ganglioside antibody and Ophthalmoplegia of undetermined cause
British Journal of Ophthalmology, 1998Co-Authors: Tone Suzuki, Atsuro Chiba, Susumu Kusunoki, Makoto Chikuda, Tsuneaki Fujita, Kazuo MisuAbstract:BACKGROUND/AIM Serum antibody against ganglioside GQ1b is reported to be closely associated with immune mediated Ophthalmoplegia in the Fisher and Guillain-Barre syndromes. Its presence against glycolipids, in particular ganglioside GQ1b, was investigated in patients with Ophthalmoplegia of unknown origin. METHODS 16 patients with Ophthalmoplegia, the cause of which could not be confirmed from clinical findings or diagnostic testing, were tested. 34 patients who had Ophthalmoplegia of definite cause, 16 healthy people, and 23 patients with typical Fisher syndrome served as the controls. The ELISA was used to check for serum antibodies against glycolipids in all study participants. RESULTS Two of the 16 patients with Ophthalmoplegia of unknown cause had serum IgG antibody against GQ1b but not against other glycolipids, and 22 of the 23 patients with typical Fisher syndrome had this antibody. No anti-GQ1b antibodies were found in the patients with Ophthalmoplegia of definite cause or in the normal controls. CONCLUSION A common underlying cause appears to bring about the pathogenesis of palsy in Fisher syndrome and in the Ophthalmoplegia with positive anti-GQ1b IgG antibody, called atypical Fisher syndrome. This antibody may prove a useful clinical marker for differentiating Fisher syndrome, typical and atypical, in patients with Ophthalmoplegia.
Ruth Ruscheweyh - One of the best experts on this subject based on the ideXlab platform.
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From Ophthalmoplegic Migraine to Cranial Neuropathy
Current Pain and Headache Reports, 2015Co-Authors: Stefanie Förderreuther, Ruth RuscheweyhAbstract:Ophthalmoplegic migraine (OM)/recurrent painful ophthalmoplegic neuropathy (RPON) is a rare disease consisting of recurrent unilateral headache accompanied or followed by ipsilateral Ophthalmoplegia. Because MRI findings suggest neuropathy and the relationship to typical migraine remains unclear, the disease has been renamed from “ophthalmoplegic migraine” to “recurrent painful oculomotor neuropathy” in the third edition of the International Classification of Headache Disorders (ICHD). However, it remains a fact that most cases of OM/RPON described in the literature have a history of migraine and that the headache during OM/RPON often has migrainous features. A more detailed clinical description of the headache during OM/RPON and additional results from imaging and possibly histology will be needed to better understand the pathophysiology of the disease and its relationship to typical migraine.
