Nutritional Deficiencies
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Subacute onset over hours to days of one or, more often, various combinations of: Gait ataxia.Ophthalmoplegia: due to involvement of cranial nerves III or VI. Patient presents with supranuclear horizontal and/or vertical gaze palsies, internuclear ophthalmoplegia, and/or lateral rectus palsies, often causing diplopia.Nystagmus: horizontal and/or vertical.Mental state disturbance: global confusional state causing apathy, inattention, disorientation, minimal spontaneous speech, forgetfulness, drowsiness, and even coma.
Positron Emission Tomography in Progressive Supranuclear Palsy
W. R. Wayne Martin in Functional Imaging in Movement Disorders, 2019
The clinical diagnosis can receive some support from ancillary investigations but the abnormalities seen are not diagnostic. The electroencephalogram shows only minor abnormalities on a well-organized background rhythm, but prolonged polygraphic recording has shown a marked disturbance of sleep, consisting of hyposomnia, disorganization of nonrapid eye movement and absent or markedly reduced rapid eye movement sleep.9–11 Computed tomography often shows enlargement of the third ventricle without conspicuous cortical atrophy,12 and atrophy of the midbrain,13 better visualized by magnetic resonance imaging.14 Hence the diagnosis relies on the association of the characteristic clinical features, especially the ophthalmoplegia. However, there are no published diagnostic criteria specific for PSP, and sometimes the diagnosis can be confirmed only post mortem.
Arthropod-borne virus encephalitis
Avindra Nath, Joseph R. Berger in Clinical Neurovirology, 2020
Powassan virus appears to produce a multifocal and diffuse gray matter infection of all levels of the central nervous system so that no one presentation is characteristic. The incubation period ranges from 8 to 34 days. Fever may be absent at the beginning, but is a consistent finding thereafter. Signs of CNS involvement can be diffuse with headache, obtundation and vomiting. Focal or generalized seizures can occur. Motor weakness can manifest as a monoparesis, hemiparesis, or quadriparesis and be of the upper or lower motor type. Gait ataxia has also been observed. POWV shares with its TBE counterparts the capacity to produce acute spinal cord clinical disorders, followed by muscular atrophy. A case has been reported resembling herpes simplex encephalitis [93]. Ophthalmoplegia has been documented [91].
Infantile and Early Acquired Ophthalmoplegic Syndromes
Published in Journal of Binocular Vision and Ocular Motility, 2018
CCDDs, extraocular muscle dysgenesis, and profound congenital myopathy should be considered when static ophthalmoplegia presents at birth. Episodic ophthalmoplegia could be ophthalmoplegic migraine, while acute and profound ophthalmoplegia in association with respiratory distress could be botulism. Progressive ophthalmoplegia with a variable course or in association with ptosis raises the possibility of myasthenia, while ophthalmoplegia with relentless progression to systemic weakness or in association with generalized weakness could be associated with neurodegenerative disease, muscular dystrophy, or other rare, progressive myopathies. Nonsurgical treatment of ophthalmoplegia in children and adults is reviewed by Arnoldi,22 and surgical management is reviewed by Archer23 elsewhere in this issue. Treatment of each of these conditions is challenging, and by necessity must be context-dependent.
Recurrent Painful Ophthalmoplegic Neuropathy with Unilateral Oculomotor and Trochlear Nerve Palsy in an 8-year-old Girl
Published in Journal of Binocular Vision and Ocular Motility, 2022
Javad Akhondian, Farah Ashrafzadeh, Farrokh Seilanian Toosi, Mahla Esmaeilzadeh, Mehran Beiraghi Toosi, Shima Imannezhad, Nazanin Saeedi Zand, Narges Hashemi
Ultimately, she was diagnosed with RPON based on clinical and laboratory findings, so we started prednisolone treatment (1 mg/Kg.day) for a week. There was no response to prednisolone; therefore, we also added indomethacin 25 mg/day, and the treatment continued. By the end of the second week of the treatment, the patient’s ptosis relatively improved and we started to taper prednisolone to 0.5 mg/Kg/day. By the end of the third week, the ptosis had completely resolved. By the end of the fourth week of the treatment, the ophthalmoplegia partially improved. On the fifth week of treatment, all symptoms were completely gone.
Ophthalmoplegia: Definition and Clinical Diagnostic Techniques
Published in Journal of Binocular Vision and Ocular Motility, 2018
The general textbook definition of ophthalmoplegia is the paralysis or weakness of one or more of the eye muscles. Internal ophthalmoplegia refers to paralysis of the intrinsic (iris and ciliary) muscles of the eye, and external refers to the extraocular muscles. Complete ophthalmoplegia affects both groups of muscles, resulting in a total lack of motility, pupillary mydriasis, and absence of accommodation. Partial ophthalmoplegia varies greatly both in the muscles involved and the severity of limitation. It may be monocular or binocular, and may present as a single or multiple gaze deficit.
Related Knowledge Centers
- Extraocular Muscles
- Eye Movement
- Neurology
- Orbital Cellulitis
- Orbit
- Graves' Disease
- Muscle
- Chronic Progressive External Ophthalmoplegia
- Kearns–Sayre Syndrome
- Neuromuscular Junction