Chapter 9: Neuro-ophthalmic look-alikes |
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A B
Figure 9.14 The above young woman with painful diplopia. (A) Note mild conjunctival injection medially in the right eye.
(B) Axial post-contrast fat-suppressed T1-weighted MRI shows enlargement and intense enhancement of the right medial rectus muscle. There is also similar but milder enlargement of the left medial rectus muscle.
worse with eye movement. This historical feature is of great help in distinguishing these two mechanisms.
The clinical scenario: Isolated abduction deficit
The look-alikes: Sixth nerve palsy vs. orbital myositis
Tip: In a patient with acute diplopia, pain induced by eye movement indicates orbital inflammatory disease.
FURTHER READING
Optic neuritis vs. Leber’s hereditary optic neuropathy
N. J. Newman, Hereditary optic neuropathies: from the mitochondria to the optic nerve. Am J Ophthalmol, 140 (2005), 517–23.
Optic Neuritis Study Group, The clinical profile of acute optic neuritis: experience of the Optic Neuritis Treatment Trial, Arch Ophthalmol, 109 (1991), 1673–8.
P. Riordan-Eva, M. D. Sanders, G. G. Govan et al., The clinical features of Leber’s hereditary optic neuropathy defined by the presence of a pathogenic mitochondrial DNA mutation. Brain, 118 (1995), 319–37.
Acute unilateral mydriasis
R.H. Kardon, O. Bergamin, Adie’s pupil. In L. A. Levin, A. C. Arnold, eds., Neuro-Ophthalmology: The Practical Guide.
New York: Thieme, 2005, pp. 325–39.
H. S. Thompson, Segmental palsy of the iris sphincter in Adie’s syndrome. Arch Ophthalmol, 96 (1978), 1615–20.
Light near dissociation
D. M. Jacobson, R. A. Vierkant, Comparison of cholinergic supersensitivity in third nerve palsy and Adie’s syndrome. J Neuroophthalmol, 18 (1998), 171–5.
R.H. Kardon, J. J. Corbett, H. S. Thompson, Segmental denervation and reinnervation of the iris sphincter as shown by infrared videographic transillumination. Ophthalmology, 105 (1998), 313–21.
H.S. Thompson, Light-near dissociation of the pupil. Ophthalmologica, 189 (1984), 21–3.
H. S. Thompson, R. H. Kardon, The Argyll Robertson pupil.
J Neuroophthalmol, 26 (2006), 134–8.
Convergence spasm
R. V. P. Chan, J. D. Trobe, Spasm of accommodation associated with closed head trauma. J Neuroophthalmol, 22 (2002), 15–17.
L.R. Dagi, G. A. Chrousos, D. G. Cogan, Spasm of the near reflex associated with organic disease. Am J Ophthalmol, 103 (1987), 582–5.
154 Chapter 9: Neuro-ophthalmic look-alikes
N. J. Sarkies, M. D. Sanders, Convergence spasm. Trans Ophthalmol Soc UK, 104 (1985), 782–6.
Wernicke’s encephalopathy
E. Antunez, R. Estruch, C. Cardenal et al., Usefulness of CT and MR imaging in the diagnosis of acute Wernicke’s encephalopathy. AJR Am J Roentgenol, 171 (1998), 1131–7.
C. Harper, Thiamine (vitamin B1) deficiency and associated brain damage is still common throughout the world and prevention is simple and safe! Eur J Neurol, 13 (2006), 1078–82.
K. Juhasz-Pocsine, S. A. Rudnicki, R. L. Archer, S. I. Harik, Neurologic complications of gastric bypass surgery for morbid obesity. Neurol, 68 (2007), 1843–50.
S.Singh, A. Kumar, Wernicke encephalopathy after obesity surgery. Neurology, 68 (2007), 807–11.
Progressive supranuclear palsy
N. Kato, K. Arai, T. Hattori, Study of the rostral midbrain atrophy in progressive supranuclear palsy. J Neurol Sci, 210 (2003), 57–60.
J.Schmiedel, S. Jackson, J. Schafer, H. Reichmann, Mitochondrial cytopathies. J Neurol, 250 (2003), 267–77.
J.C. Steele, J. C. Richardson, J. Olszewski, Progressive supranuclear palsy: a heterogeneous degeneration involving the brain stem, basal ganglia and cerebellum, with vertical gaze and pseudobulbar palsy, nuchal dystonia and dementia. Arch Neurol, 10 (1964),
333–59.
B.T. Troost, R. B. Daroff, The ocular motor defects in progressive supranuclear palsy. Ann Neurol, 2 (1977), 397– 403.
Sixth nerve palsy vs. orbital myositis
G. E. Mannor, G. E. Rose, I. F. Moseley, J. E. Wright, Outcome of orbital myositis: clinical features associated with recurrence. Ophthalmology, 104 (1997), 409–14.
I. Mombaerts, L. Koornneef, Current status in the treatment of orbital myositis. Ophthalmology, 104 (1997), 402–8.
R. M. Siatkowski, H. Capo, S. F. Byrne, E. K. Gendron et al., Clinical and echographic findings in idiopathic orbital myositis. Am J Ophthalmol, 118 (1994), 343–50.