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Clinical Examination in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Selvakumar Ambika, Krishnakumar Padmalakshmi
The best way to elicit a direct pupillary reflex is to have the patient fixate at a distance at least 3 m away and then shine the light approaching from slightly below. This would prevent the patient looking directly at the source of light and hence falsely generating an accommodation reflex (Figure 1.6).
Brain death and ethical issues
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
The pupillary light reflex assesses the function of the II and III cranial nerves. Pupillary reflex must be tested in each eye separately and consensual responses has to be evaluated.16,17 Initially, the medical professional checks that the patient’s pupils are the same size. Then the medical professional shines the light on each pupil and checks to see that both pupils have constricted to the same size.
Case 74: Red eye and photosensitivity
Published in Eamon Shamil, Praful Ravi, Dipak Mistry, Janice Rymer, 100 Cases in Emergency Medicine and Critical Care, 2018
Eamon Shamil, Praful Ravi, Dipak Mistry
Physical examination is difficult to perform, as the patient is reluctant to open his right eye under usual room lighting. Visual acuity is 6/6 in the left eye, and 6/12 that improves to 6/6 with pinhole in the right eye. The pupillary reflex is normal with no relative apparent pupillary defect (RAPD). Slit lamp examination shows an injected conjunctiva with an increased marginal tear film. There is a 1 mm reflective metallic flake with a brown halo on the cornea at the 6 o-clock position.
Apraxia of eyelid opening secondary to possible progressive supranuclear palsy: a case report
Published in International Journal of Neuroscience, 2021
Wei Jiang, Lin Gan, Yang Sun, Ming Dong, Peng Yu
Neurological examination revealed upward gaze palsy with no nystagmus. Bilateral pupillary reflex was normal and symmetrical. Bradykinesia and cogwheeling tone were observed; however, there were no resting tremors. Deep tendon reflexes in the upper limbs were normal, while those in the lower limbs were diminished. Rapid alternating movements were slower than normal. He had a medical history of hepatitis B and indulged in moderate smoking and occasional alcohol intake. Brain magnetic resonance imaging, laboratory tests for anti-muscle-specific tyrosine kinase and anti-acetylcholine receptor antibodies, and single-fiber electromyography were unremarkable. Brain positron emission tomography (PET) revealed a reduction in glucose metabolism in the left part of the medial frontal lobe, basal ganglia, and temporal, occipital, and cingulate cortex. According to the diagnostic criteria of the National Institute of Neurological Disorders and Stroke and the Society for Progressive Supranuclear Palsy (NINDS-SPSP), the patient was diagnosed with possible progressive supranuclear palsy (PSP) [1]. Here, we present a video showing AEO in this patient in order to provide a better understanding of the clinical manifestation of this rare condition (Supplementary Video).
Morning Glory Disc Anomaly with Contractile Peripapillary Staphyloma in an 18-Month-Old Girl
Published in Neuro-Ophthalmology, 2021
Kalina Trifonova, Kiril Slaveykov
An 18-month-old girl was examined in the outpatient clinic in Stara Zagora, Bulgaria due to strabismus. She was born at term with a birth weight of 3150 g. The mother had undergone normal pregnancy and delivery without any complications. There were no facial anomalies pointing to a genetic disease. The child had undergone normal development so far. There was no family history of ocular disease, except for a cousin with strabismus. According to the grandmother the child hadhad strabismus since birth. Due to the young age of the child the visual acuity could not be formally recorded. The left eye had an esotropia, which was intermittent and variable measuring 10–15 prism dioptres. When the left eye was covered the child tried to look behind the hand and was bothered. Fixation of the right eye was centred and steady while that of the left was intermittent. No changes were discovered on biomicroscopy of both eyes. Pupillary reflex testing showed a relative afferent pupillary defect in the left eye. The interpupillary distance was 51 mm.
Safely performing neurosurgical procedures during COVID-19 pandemic
Published in Neurological Research, 2020
Laura K. Reed, Jun Wen, Buqing Liang, Xiangyu Wang, Dongxia Feng, Jason H. Huang
Case 1: A 67-year-old male patient with a past medical history of atrial fibrillation on Warfarin was found unconscious at his backyard by family members. His original GCS was 2/2/5 and he was intubated for airway protection. Workup in the emergency department revealed a 1.8 cm acute left subdural hematoma with 7 mm midline shift. His left pupil was 6 mm without pupillary reflex. Patient’s INR was 1.9 and prothrombin complex concentrate was initiated for reversal. Patient was immediately transported to the OR for emergent left craniotomy and evacuation of the subdural hematoma. All abovementioned precautions for COVID-19 were taken and the surgery went well without complications. Patient was transported to a COVID-19 unit intubated post-operatively. His RT-PCR and blood antibody tests were all negative and he was transferred to a regular ICU on postoperative day 2.