Tag Archives: Visual disturbance

Kearns-Sayre Syndrome KSS

Clinical features: Onset before 20 years of age. Progressive external opthalmoplegia (restricted eye movements, usually movements are not dysconjugated) and pigmentory retinopathy. Also myopathy, heart block, CNS deficits, short stature. Pathology: Muscle biopsy: Gomori trichrome: Ragged red fibres Variation in muscle size COX negative fibres Brainstem and cerebellum: neuronal loss. Spongy to vacuolar myelinopathy. May … Continue reading Kearns-Sayre Syndrome KSS

Cranial Neuropathies

Here are some lists to help with the cranial neuropathies. Please see the underlying sections. Also see the section on vertigo for cranial nerve VIII diseases. Synonyms: Cranial neuropathy Causes of Oculomotor nerve palsy (CN III): think of anatomy Nuclear & fasciular: Tumours: Glioma Part of a brainstem stroke syndrome Basilar area: Meningitis: Bacterial, Meningovascular … Continue reading Cranial Neuropathies

Diabetic Neuropathy

There are various types of diabetic neuropathy Diabetic polyneuropathy (sensory type and sensorimotor type): Diagnosis: Features of polyneuropathy and meeting criteria for diabetes mellitus Clinical features: Symmetric sensory polyneuropathy, loss of vibration, pain, touch and temperature sensation and in some cases proprioception loss and Charcot joints Areflexia Painful May become sensorimotor Pathology, nerve biopsy: Nonspecific … Continue reading Diabetic Neuropathy

Giant Cell Arteritis

Synonyms: a.k.a. cranial arteritis a.k.a. temporal arteritis: Diagnosis: Biopsy of the temporal artery within 7 days of starting steroids: With serial sectioning Or clinical features plus raised ESR or CRP plus response to steroids Pathology: Panarteritis: Intimal thickening and proliferation, Lymphocytic infiltration of media and adventitia, giant cells, Disruption of elastic lamina Chronic phase: intimal … Continue reading Giant Cell Arteritis

Acquired Oculomotor Apraxia

Synonyms: a.k.a. Roth-Bielschowsky syndrome (supranuclear palsy of gaze due to corticotectal/corticotegmental tract lesions) Diagnosis: A form of supranuclear palsy diagnosed clinically and by isolating the underlying cause Clinical features: Inability to perform horizontal saccades Vertical eye movements may be intact Oculocephalic reflexes are intact Caloric testing shows slow deviation without saccades Optokinetic nystagmus remains without … Continue reading Acquired Oculomotor Apraxia

Superior Orbital Fissure Syndrome

Synonyms: Anterior cavernous sinus syndrome, Rochon-Duvigneaud’s syndrome Diagnosis: This is a clinical diagnosis. Underlying causes are identified by investigations and clinical assessment. Dysfunction of cranial nerves oculomotor (III), trochlear (IV), abducens (VI) and first division of the trigeminal nerve (V1). Also sympathetic fibers may be involved causing a Horner syndrome (this becomes cavernous sinus syndrome). … Continue reading Superior Orbital Fissure Syndrome

Cavernous Sinus Syndrome

Diagnosis: This is a clinical diagnosis. Dysfunction of cranial nerves III, IV, and VI, and the superior divisions of cranial nerve V. Investigations to consider: Blood tests: FBC, U&E, fasting Glucose Vasculitic screen, ESR, CRP, ANCA, ANA, ENA SPEP, ACE Tests for infections: Borrelia serology, HIV MRI pre and post contrast: Pituitary tumors, meningioma, metastasis … Continue reading Cavernous Sinus Syndrome

Internuclear Ophthalmoplegia (INO)

Diagnosis: This is a clinical diagnosis. The underlying cause is determined by investigations Clinical features: Diplopia Classic variant, posterior INO: On lateral gaze: Failure of adduction of the contralateral eye, nystagmus of the abducting eye Medial rectus is less weak on testing each eye separately Anterior INO variant: Divergent eyes bilaterally, paralysis of both medial … Continue reading Internuclear Ophthalmoplegia (INO)

Abducens (cranial nerve VI palsy)

Diagnosis: This is a clinical diagnosis Clinical features: Horizontal diplopia In neutral gaze, normal appearance or head is slightly turned to the unaffected side (compensation for unopposed medial rectus) On movement: Affected eye fails to abduct Investigations to consider: Blood tests: ESR: giant cell arteritis TFT, glucose ANCA: Wegner’s granulomatosus HbA1c ESR CT: Out rules … Continue reading Abducens (cranial nerve VI palsy)

Trochlear Nerve Palsy (Cranial IV palsy)

Diagnosis: This is a clinical diagnosis Clinical features: Rare in isolation In neutral gaze: slight head tilted contralateral to the weak superior oblique muscle (loss of in-torsion) Test with eye adducted and moved inferiorly. This is also the position of worse diplopia If bilateral: on horizontal gaze, the abducting eye drifts downwards (inferior rectus of … Continue reading Trochlear Nerve Palsy (Cranial IV palsy)