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Neurology
Published in Paul Bentley, Ben Lovell, Memorizing Medicine, 2019
As for myasthenia gravis, plus prominent anticholinergic effects: Eyes: Iridoplegia, mydriasis, cycloplegia (blurred vision and diplopia are always early symptoms)Abdominal: Nausea and vomiting (and vertigo); constipation; urinary retentionSystemic: Bradycardia, constipation
Trauma
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Pupillary size and reactivity should be recorded, with the diameter of the pupil measured in millimetres. Causes of fixed dilated pupils include traumatic iridoplegia, direct nerve damage, cerebral ischaemia or increased intracranial pressure. Detailed examination of the optic fundi can be delayed, but retinal haemorrhages suggest a major head injury and in a child less than 1 year of age, are strongly suggestive of non-accidental injury. Acute papilloedema developing within 2 hours of a head injury signifies grossly elevated intracranial pressure, which is usually fatal. Limbs are examined for their resting position, spontaneous movement and tone. Complete flaccidity (‘loss of muscle tone’) is seen with severe injury of the brainstem or high spinal cord transection. There is no spontaneous movement of the limbs. Patterns of rigidity include decerebrate rigidity and decorticate rigidity. In high brainstem lesions, rigidity usually is bilateral, whereas in injuries to one cerebral hemisphere, it is unilateral, with the head turned to the contralateral side. A down-going plantar response is considered normal except in infants. Where the response is equivocal, the examination should be repeated periodically. Bradycardia in the presence of increasing blood pressure is a late sign of increasing intracranial pressure. Hypotension associated with a head injury is usually caused by internal haemorrhage elsewhere, except (1) where there is obvious external haemorrhage from the scalp; (2) where a scalp haematoma is present in an infant; or (3) where intracranial haemorrhage occurs in the neonate and infant.
Ophthalmology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Unilateral:1 3rd nerve palsy (unilateral mydriasis + light and accommodation reflexes absent).2 Traumatic iridoplegia (h/o direct trauma + fixed, dilated, irregular pupil that neither accommodates nor reacts to light; confirmed by slit lamp examination of the anterior chamber).3 Holmes–Adie’s pupil (d/t ciliary ganglion degeneration).4 Mydriatic eye drops – unilateral.
Sphenoid sinus mucocele causing ptosis with pupil-spared ophthalmoplegia: a hint on carotid artery doppler ultrasound
Published in International Journal of Neuroscience, 2023
Aldo F. Costa, Paula Martínez A., Nazaret Peláez V., Alejandro Peral Q., José C. Estévez
As previously reported, SSM was causing marked thinning of the posterolateral wall with areas of bony erosion leading to dehiscent bone structures [7]. Since peripheral localization of pupillary fibers in the oculomotor nerve, iridoplegia is expected in a compressive lesion. On the other hand, pupillary sparing is most commonly seen in diabetic patients due to microvascular ischemia of the central region of the nerve. However, in the case of SSM, the pupillary sparing might be related to the anatomy of the oculomotor nerve which divides into two branches as it passes through the superior orbital fissure. The superior branch innervates the levator palpebrae superioris and the superior rectus while the inferior branches reach the other oculomotor nerve-dependent muscles as well as provides parasympathetic fibers to the pupil.
In Vivo Analysis and Comparison of Anterior Segment Structures of Both Eyes in Unilateral Herpetic Anterior Uveitis
Published in Ocular Immunology and Inflammation, 2021
Muhammet Derda Ozer, Muhammed Batur, Erbil Seven, Serek Tekin, Fatih Kebapci
Herpetic anterior uveitis (HAU) is a well-recognized, intraocular inflammatory disease in the daily practice of ophthalmologists that can cause a severe visual disturbance. The incidence is reported to be 3.2% of the annual anterior uveitis cases in Turkey.1 The common causative agent is the herpes simplex virus (HSV) type 1, a double-stranded DNA virus.2 The susceptibility to the disease is similar in both genders, and the affected individuals are mostly in their fourth decade of life.3 After the primary infection, the virus genome becomes dormant within the ciliary ganglion. During the reactivation of the latent virus, it is transported to the ocular structures through the axons, leading to intraocular inflammation.4 During an acute HAU attack, granulomatous keratic precipitates (KPs) accumulating within Arlt’s triangle is a well-recognized sign. Corneal scars could be present from the previous keratitis in 33% of cases.5 Moreover, sectoral iridoplegia and localized flattening of the pupil border of the affected eye could be observed.6 Moderate anterior chamber inflammation is usually expected, but hypopyon could also be seen.7 Posterior synechia might develop, and mild vitritis could be seen in 43% of cases.5 The elevation of intraocular pressure is likely due to trabeculitis.4,8 The destruction of the iris structure by the HSV leads to patchy or sectoral iris atrophy, which transilluminates (by up to 50%) after the resolution of the acute uveitis episode.9
Firework-Related Eye Trauma in Germany
Published in Current Eye Research, 2018
Jan Darius Unterlauft, Matus Rehak, Peter Wiedemann, Petra Meier
In the further course, 27 (36%) of the 75 eyes which suffered from major eye trauma developed scars of the lids and 10 (13.3%) developed corneal haze. Thirty-one (41.3%) eyes developed permanent iris defects which led to a permanent iridoplegia in 25 (33.3%) eyes. Four eyes (5.3%) developed retinal detachment. All four cases of retinal detachment were treated with encircling band and pars plana vitrectomy. In the further course, six eyes developed phthisis bulbi which made an enucleation necessary in two cases.