Can J Ophthalmol
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Comparative Study
Relative afferent pupillary defects in multiple sclerosis.
Relative afferent pupillary defects were found in 69 of 386 patients (18%) seen by the author at the University of British Columbia Multiple Sclerosis Clinic between Feb. 1, 1985, and Apr. 30, 1987. Pupil defects were more common in patients with clinically definite multiple sclerosis, those with recent or unilateral optic neuritis and those with unilateral or asymmetric optic atrophy. A relative afferent pupillary defect was found in 15 patients with no history of optic neuritis, 5 patients with no optic atrophy and 2 patients with normal visual evoked potentials. The frequency of relative afferent pupillary defects after optic neuritis in this group of patients was much lower than that found in a previous study of patients who presented with optic neuritis.
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At present, MR imaging is recommended as the primary imaging procedure in investigating neuro-ophthalmic disease of the orbit, chiasm, brain stem, optic radiations and craniocervical junction and in any lesion suspected to contain a hematoma. MR imaging and CT are complementary in investigating disease of the paranasal or cavernous sinus. ⋯ The field of imaging is rapidly changing. The evolution of MR imaging and the expansion of our knowledge may soon relegate these recommendations to the file of early indications.
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Case Reports
Ocular and auditory toxicity of long-term, high-dose subcutaneous deferoxamine therapy.
There have been few reported ocular side effects of parenterally administered deferoxamine when used for the treatment of transfusional iron overload or acute iron poisoning. No auditory side effects have previously been reported. We describe two siblings with beta-thalassemia major who, while receiving daily subcutaneous infusions of deferoxamine, experienced visual loss secondary to optic neuropathy and sensorineural hearing loss. ⋯ Patients receiving deferoxamine should be closely monitored for ocular and auditory side effects. When such effects are detected the drug should be discontinued and the patient observed for improvement. When improvement has stabilized, therapy should be restarted at a reduced dosage.
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Arteriovenous malformations (AVMs) of the brain usually present with acute hemorrhage or epilepsy. Of 54 patients with AVMs limited to the posterior cerebral hemispheres some 60% had intermittent or acute visual symptoms. ⋯ Because of the possible neurologic consequences of an AVM it is important to distinguish the headaches and visual symptoms of this lesion from those of classic migraine, a more common condition. In this paper this differentiation and the pathogenesis of the symptoms are reviewed.