Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
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A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) presented with an isolated unilateral adduction deficit and ptosis. Investigations were negative until the onset of limb weakness and fatigue 2 years later. At that time, electroneuromyography, cerebrospinal fluid examination, and magnetic resonance imaging confirmed the diagnosis of CIDP. Thus, ophthalmic signs can precede extremity and bulbar signs with a long latency in CIDP.
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A patient developed an isolated unilateral internuclear ophthalmoplegia (INO) after head trauma. An uncommon complication of closed head trauma, INO usually occurs bilaterally and is often associated with other neurologic deficits. The mechanism may be shear injury caused by angular acceleration leading to downward displacement of the posterior brainstem downward, stretching of the nerve fibers of the medial longitudinal fasciculus, or compression and tearing of its arterial supply.
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Case Reports
Neuro-ophthalmic manifestations of sarcoidosis: clinical spectrum, evaluation, and management.
To familiarize the reader with the neuro-ophthalmic manifestations of sarcoidosis. ⋯ Neuro-ophthalmic manifestations of sarcoidosis are rare. They may be the presenting signs of otherwise occult disease. Suspicion and inclusion in the differential are a key to establishing the diagnosis. A strategy for the detection and evaluation of these cases is presented.
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Case Reports
Superior oblique palsy in a patient with a history of perineural spread from a periorbital squamous cell carcinoma.
A 74-year-old man experienced vertical diplopia. Two years earlier, he was diagnosed with a squamous cell carcinoma of the periorbital frontal skin, with perineural spread involving the ophthalmic division of the right trigeminal nerve and the right facial nerve. The clinical findings were consistent with a right fourth cranial nerve palsy. ⋯ The authors believe this case to be the first report of superior oblique underaction due to involvement of the muscle by squamous cell carcinoma, presumably because of perineural spread. Diagnosis was made possible by neuroimaging and histopathology. There was good short-term resolution of the patient's diplopia after radiotherapy.
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The cases of two young women with a homonymous hemianopia are described. Both women had a progressively enlarging mass lesion that was seen with neuroimaging studies. ⋯ Multiple sclerosis infrequently presents as a mass lesion. The atypical clinical and radiographic features of large demyelinating plaques may lead to an erroneous diagnosis of a brain tumor, infection, or demyelination from other causes.