- Email: [email protected]
2-40-05 Optic neuritis: A prospective study
Neuro-ophthalmology
S126
lution and has minimally invasive, so it is useful method for evaluation of arteriosclerotic changes not only carotid arteries but also vertebral arteries. Before long the whole length of extracranial vertebral and carotid arteries will be able to be examined with improved device.
40
New-o-ophthalmology
on the one hand, and when charged with a task for the central executive (CE) of working memory in a dual-task paradigm on the other hand. Prosaccades had to be made reflexively to a peripherally appearing target. Antisaccades are directed opposite to the target. A random tap task was used as selective CE interference. In the dual task, a significant enhancement of the latency of the antisaccades was found, both in normals and in prefrontal patients. In normals, the latency of the prosaccades was also enhanced. We postulate that antisaccades and CE share the same prefrontal functions. Because of the interference with the CE, that is involved in non-automatic tasks, the prosaccade test is thought to be not entirely reflexive in se or to be brought under willed control by normal subjects.
2-40-04 12-40-01
1 U$$at
T.J. Anderson.
nystagmus
Department
on ophthalmoscopy:
of Neurolcg~
Christchurch
Hospital,
Electrophysiological and neuroimaging study of the partner eye in patients with first clinical attack of retrobulbar neuritis
A benign Christchurch,
K. Flabouriari,
Th. Papapetropoulos, of Patras, Greece
P. Papathanasopoulos.
Neurological
New Zealand
Clinic, University
Upbeat nystagmus is a form of central vestibular nystagmus. The presence of pure upbeat nystagmus is usually indicative of a disorder within the cerebellum or brainstem. The phenomenon has been reported as a transient feature in otherwise normal infants and in association with tobacco smoking in normal adults. Rarely congenital nystagmus may be purely upbeating. I have observed incidental upbeat nystagmus on ophthalmoscopy in nine patients presenting routinely to a general neurological outpatient clinic over the past three years. There was no apparent neurological cause and neuroimaging was normal. The jerk nystagmus is of small amplitude (appearing on fundoscopy as downward jerks of the optic disc with slow phase return) and is not visible on confrontational observation. It is proposed that the upbeat nystagmus in these cases is a benign entity possibly representing a type of congenital nystagmus. It may be that this nystagmus shares the same aetiology as the transient upbeat nystagmus in infants. On the basis of these cases, it is concluded that isolated upbeat nystagmus which is present only on ophthalmoscopy requires no further investigation.
20 patients were examined with MRI (Magnetic Resonance Imaging) of 0.N (Optic nerve), MRI of the brain, PRVEPs (Pattern Reversal Visual Evoked Potentials), and perimetry in the acute phase of retrobulbar neuritis (R.N) 55% patients revealed abnormal VEPs, 60% revealed abnormal perimetry, 66% revealed demyelination plaques in the MRI of the ON and 70% revealed demyelination plaques in the MRI of the brain. Theperimetry was elicited withTHRESHOLD test 36-2 Central ALLERGAN HUMPHREY and the visual evoked potentials were elicited in Nicolet compact four. All patients with abnormal PRVEPs and perimetry in the asymptomatic eye revealed demyelination plaques in the MRI of the brain, The combined examination of PRVEPs and perimetry in the asymptomatic eye help us to find out demyelination in the optic system and this group of patients should be evaluated with MRI.
2-40-02
Horizontal conjugate gaze palsy of pontine origin. Clinical and MRI evaluation
E.E. Castillo, M.G. Cluster, J.A. CuRoVargas, M.B. Seijas, A.M. Malmierca, R.J. Giannaula. Department of Neurolcgx Hospital Espafiol, Buenos Aires, Reptiblica
Argentina
The abducens nucleus plays an important role in horizontal conjugate gaze (HCG) through its motoneurons and internuclear neurons, and it is influenced by the paramedian pontine reticular formation, the vestibular nuclei, and the nucleus prepositus hypoglossi. Homolateral paralysis of the HCG results from damage to those nuclei. Objective: To report 7 patients with HCG paralysis and contralateral hemiparesis due to pontine lesions confirmed by magnetic resonance imaging (MRI). Patients: Seven patients (5 men, 2 women), mean age 66.5 years (range 51 to 82 years) presented HCG paralysis associated to right hemiparesis (cases 1, 2, and 7); left hemiparesis (cases 3, 4, and 5) and quadriparesis (case 6). One of them, case 7, presented a one and a half syndrome. MR Imaging Results: MRls disclosed unilateral pontine ischemic infarcts in five patients (cases 1, 3,4,5, and 7) and bilateral infarcts in case 6. In case 2, a cerebellar hematoma with pontine compression was detected. Besides, supratentorial lacunes were observed in cases 3, 4,5, and 6, while case 6 also had right mesencephalic and cerebellar infarcts. Evolution: Two of the seven patients (cases 5 and 6) died during the first ten days after the event; of the remaining 5 patients, case 2 fully recovered HCG, and the rest (cases 1, 3, 4, and 7) partially recovered them. These 5 patients also presented partial recovery of their motor deficit. They continue under rehabilitation treatment and periodic follow up. Conclusion: HCG may be impaired by vascular lesions (ischemic or hemorrhagic damage), or by extrinsic pons compression. The presence of hemiparesis leads to the pontine localization of the lesion when it is contralateral to ocular paralysis.
2-40-03 L. Crevits,
Saccadic behaviour and working subjects and prefrontal patients K. Claeys.
E. Stuyven,
K. Van der Goten. A. Vandierendonck.
Departments of Neurology and Experimental and University of Gent, Belgium
We studied the performance
memory in normal
of prosaccades
Psychology,
University
and antisaccades
Hospital
on a single task
12-40-05
1 Optic neuritis: A prospective
study
M. Schweitzer, L. Lopez, S. Ochoa, N. Reyes, C. Luco, A. G6mez, L. Crovetto, J. Odoriz, G. Alvarez. Department of Neuro-OphthaL, Santa Lucia Hospital, Argentina, Asenjo Institute, Catholic Univefsif)! Chile, Cuyo UniversiM Inst. Chile Universiry; Chile
Chile, Concepci6n Hospital, Chile, Argentina, Neuroiogicel Sciences
Purpose: A prospective study was carried out during 1988-l 996 in four cities placed between 30-37 of south latitude in Chile and Argentina in order to describe the clinical profile and pronostic of optic neuritis (ON) in our countries. Patients and Methods: One hundred and one patients were included for whose, age, sex, uni or bilateral impairment and complaint of pain were recorded. Visual acuity (VA), pupilar reflexes and fundus oculy were analized; while visual field (VF) were examined by a Goldmann perimeter or similar device. Clinical check-up was performed at 7, 14,30 and 45 days. Results: Mean age was 32.5 years range (16-45) 71 patients were females and 36 males. Unilateral ON appeared in 81 and bilateral in 20. Pain was reported by 77.2% of patients. Presenting as anterior ON 49.7% (papillitis) and retrobulbar in 51.2%. A central scotoma was observed in 75% of the group. The recovery of visual function (VA, VF) was observed in 70% of the patients. Conclusion: (1) This finding are similar to other prospective study. (2) On comparing the final clinical follow-up there were not significant differences between anterior and retrobulbar ON. (3) The improvement of visual function at ending follow-up showed a good pronostic of this entity.
) 2-40-06 J.O. Susac.
1 Susac’s syndrome 50 Second
Street, SE.,
Winter
Haven,
FL, USA
In 1977, Professor John Selhorst and I described a syndrome that occurs primarily in young women who present with an encephalopathy associated with long tract signs, branch retinal artery occlusions, and vertigo/hearing loss. The helpful laboratory features include an abnormal fluorescein angiogram, a diffusely slow EEG, and the MRI scan appearance of multiple small white matter lesions that are often misdiagnosed as multiple sclerosis, particularly since the corpus callosum is usually involved. Often presenting in a psychiatric fashion, there is also a subset of patients who present with vertigo and hearing loss, and another subset who have primarily recurrent branch retinal artery occlusions. Fluorescein angiography helps differentiate these branch retinal artery occlusions from other types of retinal vascular disease. The optic nerve may also be involved.
S126
lution and has minimally invasive, so it is useful method for evaluation of arteriosclerotic changes not only carotid arteries but also vertebral arteries. Before long the whole length of extracranial vertebral and carotid arteries will be able to be examined with improved device.
40
New-o-ophthalmology
on the one hand, and when charged with a task for the central executive (CE) of working memory in a dual-task paradigm on the other hand. Prosaccades had to be made reflexively to a peripherally appearing target. Antisaccades are directed opposite to the target. A random tap task was used as selective CE interference. In the dual task, a significant enhancement of the latency of the antisaccades was found, both in normals and in prefrontal patients. In normals, the latency of the prosaccades was also enhanced. We postulate that antisaccades and CE share the same prefrontal functions. Because of the interference with the CE, that is involved in non-automatic tasks, the prosaccade test is thought to be not entirely reflexive in se or to be brought under willed control by normal subjects.
2-40-04 12-40-01
1 U$$at
T.J. Anderson.
nystagmus
Department
on ophthalmoscopy:
of Neurolcg~
Christchurch
Hospital,
Electrophysiological and neuroimaging study of the partner eye in patients with first clinical attack of retrobulbar neuritis
A benign Christchurch,
K. Flabouriari,
Th. Papapetropoulos, of Patras, Greece
P. Papathanasopoulos.
Neurological
New Zealand
Clinic, University
Upbeat nystagmus is a form of central vestibular nystagmus. The presence of pure upbeat nystagmus is usually indicative of a disorder within the cerebellum or brainstem. The phenomenon has been reported as a transient feature in otherwise normal infants and in association with tobacco smoking in normal adults. Rarely congenital nystagmus may be purely upbeating. I have observed incidental upbeat nystagmus on ophthalmoscopy in nine patients presenting routinely to a general neurological outpatient clinic over the past three years. There was no apparent neurological cause and neuroimaging was normal. The jerk nystagmus is of small amplitude (appearing on fundoscopy as downward jerks of the optic disc with slow phase return) and is not visible on confrontational observation. It is proposed that the upbeat nystagmus in these cases is a benign entity possibly representing a type of congenital nystagmus. It may be that this nystagmus shares the same aetiology as the transient upbeat nystagmus in infants. On the basis of these cases, it is concluded that isolated upbeat nystagmus which is present only on ophthalmoscopy requires no further investigation.
20 patients were examined with MRI (Magnetic Resonance Imaging) of 0.N (Optic nerve), MRI of the brain, PRVEPs (Pattern Reversal Visual Evoked Potentials), and perimetry in the acute phase of retrobulbar neuritis (R.N) 55% patients revealed abnormal VEPs, 60% revealed abnormal perimetry, 66% revealed demyelination plaques in the MRI of the ON and 70% revealed demyelination plaques in the MRI of the brain. Theperimetry was elicited withTHRESHOLD test 36-2 Central ALLERGAN HUMPHREY and the visual evoked potentials were elicited in Nicolet compact four. All patients with abnormal PRVEPs and perimetry in the asymptomatic eye revealed demyelination plaques in the MRI of the brain, The combined examination of PRVEPs and perimetry in the asymptomatic eye help us to find out demyelination in the optic system and this group of patients should be evaluated with MRI.
2-40-02
Horizontal conjugate gaze palsy of pontine origin. Clinical and MRI evaluation
E.E. Castillo, M.G. Cluster, J.A. CuRoVargas, M.B. Seijas, A.M. Malmierca, R.J. Giannaula. Department of Neurolcgx Hospital Espafiol, Buenos Aires, Reptiblica
Argentina
The abducens nucleus plays an important role in horizontal conjugate gaze (HCG) through its motoneurons and internuclear neurons, and it is influenced by the paramedian pontine reticular formation, the vestibular nuclei, and the nucleus prepositus hypoglossi. Homolateral paralysis of the HCG results from damage to those nuclei. Objective: To report 7 patients with HCG paralysis and contralateral hemiparesis due to pontine lesions confirmed by magnetic resonance imaging (MRI). Patients: Seven patients (5 men, 2 women), mean age 66.5 years (range 51 to 82 years) presented HCG paralysis associated to right hemiparesis (cases 1, 2, and 7); left hemiparesis (cases 3, 4, and 5) and quadriparesis (case 6). One of them, case 7, presented a one and a half syndrome. MR Imaging Results: MRls disclosed unilateral pontine ischemic infarcts in five patients (cases 1, 3,4,5, and 7) and bilateral infarcts in case 6. In case 2, a cerebellar hematoma with pontine compression was detected. Besides, supratentorial lacunes were observed in cases 3, 4,5, and 6, while case 6 also had right mesencephalic and cerebellar infarcts. Evolution: Two of the seven patients (cases 5 and 6) died during the first ten days after the event; of the remaining 5 patients, case 2 fully recovered HCG, and the rest (cases 1, 3, 4, and 7) partially recovered them. These 5 patients also presented partial recovery of their motor deficit. They continue under rehabilitation treatment and periodic follow up. Conclusion: HCG may be impaired by vascular lesions (ischemic or hemorrhagic damage), or by extrinsic pons compression. The presence of hemiparesis leads to the pontine localization of the lesion when it is contralateral to ocular paralysis.
2-40-03 L. Crevits,
Saccadic behaviour and working subjects and prefrontal patients K. Claeys.
E. Stuyven,
K. Van der Goten. A. Vandierendonck.
Departments of Neurology and Experimental and University of Gent, Belgium
We studied the performance
memory in normal
of prosaccades
Psychology,
University
and antisaccades
Hospital
on a single task
12-40-05
1 Optic neuritis: A prospective
study
M. Schweitzer, L. Lopez, S. Ochoa, N. Reyes, C. Luco, A. G6mez, L. Crovetto, J. Odoriz, G. Alvarez. Department of Neuro-OphthaL, Santa Lucia Hospital, Argentina, Asenjo Institute, Catholic Univefsif)! Chile, Cuyo UniversiM Inst. Chile Universiry; Chile
Chile, Concepci6n Hospital, Chile, Argentina, Neuroiogicel Sciences
Purpose: A prospective study was carried out during 1988-l 996 in four cities placed between 30-37 of south latitude in Chile and Argentina in order to describe the clinical profile and pronostic of optic neuritis (ON) in our countries. Patients and Methods: One hundred and one patients were included for whose, age, sex, uni or bilateral impairment and complaint of pain were recorded. Visual acuity (VA), pupilar reflexes and fundus oculy were analized; while visual field (VF) were examined by a Goldmann perimeter or similar device. Clinical check-up was performed at 7, 14,30 and 45 days. Results: Mean age was 32.5 years range (16-45) 71 patients were females and 36 males. Unilateral ON appeared in 81 and bilateral in 20. Pain was reported by 77.2% of patients. Presenting as anterior ON 49.7% (papillitis) and retrobulbar in 51.2%. A central scotoma was observed in 75% of the group. The recovery of visual function (VA, VF) was observed in 70% of the patients. Conclusion: (1) This finding are similar to other prospective study. (2) On comparing the final clinical follow-up there were not significant differences between anterior and retrobulbar ON. (3) The improvement of visual function at ending follow-up showed a good pronostic of this entity.
) 2-40-06 J.O. Susac.
1 Susac’s syndrome 50 Second
Street, SE.,
Winter
Haven,
FL, USA
In 1977, Professor John Selhorst and I described a syndrome that occurs primarily in young women who present with an encephalopathy associated with long tract signs, branch retinal artery occlusions, and vertigo/hearing loss. The helpful laboratory features include an abnormal fluorescein angiogram, a diffusely slow EEG, and the MRI scan appearance of multiple small white matter lesions that are often misdiagnosed as multiple sclerosis, particularly since the corpus callosum is usually involved. Often presenting in a psychiatric fashion, there is also a subset of patients who present with vertigo and hearing loss, and another subset who have primarily recurrent branch retinal artery occlusions. Fluorescein angiography helps differentiate these branch retinal artery occlusions from other types of retinal vascular disease. The optic nerve may also be involved.