Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
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The topographic arrangement within the midbrain oculomotor nerve is not adequately elucidated in humans. Two patients with a partial oculomotor palsy because of a localized infarction or hematoma were treated. Both patients had bilateral ptosis, impaired adduction, and supraduction. ⋯ Based on the different neuro-ophthalmologic findings in the authors' cases (sparing or affecting pupillary component and infraduction), the nerves of the inferior rectus and inferior oblique for infraduction pass more rostrally than those of medial rectus, superior rectus, and levator palpebrae. The nuclear and fascicular arrangement within the midbrain oculomotor nerve is speculated to be pupillary, extraocular, and eyelid elevation in the rostro-caudal order, based on the neuro-ophthalmologic impairment and magnetic resonance imaging findings in the authors' patients and in previous animal experiments. Knowing the fascicular and nuclear arrangement within the midbrain in detail will offer diagnostic clues for differentiation of causes for partial oculomotor palsy.
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Case Reports
Anomalous optic disc elevation associated with ultrasonographic evidence of increased subarachnoid fluid.
The presence of increased subarachnoid fluid around the optic nerve as measured by ultrasound has been shown to be associated with elevated intracranial pressure, as well as a number of other conditions. This finding has proved useful for distinguishing optic disc elevation secondary to papilledema from disc elevation attributable to other causes. This report describes a patient with anomalous optic disc elevation and increased subarachnoid fluid around the optic nerve.
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Case Reports
Horner syndrome with equal-sized pupils in a case with underlying physiologic anisocoria.
A case is presented in which Horner syndrome occurred on the side of the larger pupil in underlying physiologic anisocoria. The unusual coincidence resulted in ipsilateral ptosis, but with clinically equal-sized and normally reactive pupils.
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Case Reports
Optic nerve enhancement on magnetic resonance imaging in arteritic ischemic optic neuropathy.
Although optic nerve enhancement may be seen in magnetic resonance imaging of radiation-induced ischemic optic neuropathy, similar enhancement in ischemic optic neuropathy has not been previously reported in the English-language neuroophthalmologic literature. We report three cases of optic nerve enhancement in biopsy-proven arteritic ischemic optic neuropathy. Clinicians should consider giant cell arteritis in the differential diagnosis of an optic neuropathy with optic nerve enhancement on magnetic resonance imaging.
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An anisocoria produces a small relative afferent pupillary defect in the eye with the smaller pupil.
To determine whether an anisocoria can produce a relative afferent pupillary defect of clinical importance. ⋯ Clinically, approximately 0.1 log unit of relative afferent pupillary defect is produced in the eye with the smaller pupil for every millimeter of anisocoria. Therefore, the anisocoria must be larger than 2 mm in diameter difference to induce a clinically significant relative afferent pupillary defect.