Restrictive extraocular myopathy: A presenting feature of acromegaly.

A 45-year-old man presented with binocular diplopia in primary gaze for 1 year. Orthoptic evaluation showed 10-prism diopter right eye hypotropia and 6-prism diopter right eye esotropia. The elevation and abduction of the right eye were mechanically restricted. This was associated with systemic features suggestive of acromegaly. Magnetic resonance imaging (MRI) of the brain demonstrated a pituitary macroadenoma. An elevated serum insulin-like growth factor I level and the failure of growth hormone suppression after an oral glucose load biochemically confirmed the diagnosis of acromegaly. Computed tomography (CT) of the orbit demonstrated bilateral symmetrical enlargement of the medial rectus and inferior rectus muscle bellies. All tests regarding Graves-Basedow disease were negative. Although rare, diplopia due to a restrictive extraocular myopathy could be the presenting symptom of acromegaly.

Atypical presentation of an unusual foreign body.

A 14-year-old boy presented with intractable diplopia for 10 days following an assault. A thorough history revealed that he was unaware of any penetrating injury. However, imaging demonstrated a radiolucent foreign body between the globe and the orbital floor. On surgical exploration, it was found to be the proximal part of a ball point pen. Its removal resulted in complete resolution of diplopia. Thorough clinical and radiological examination is recommended when a foreign body is suspected in pediatric patients. Prompt diagnosis will aid in early intervention and prevention of long-term complications.

Aneurisma gigante de carótida derecha / Giant aneurysm of right carotid

Los aneurismas se definen como dilataciones localizadas y permanentes que suponen un incremento del calibre del vaso mayor del 50%. En la carótida interna son poco frecuentes, de etiología casi siempre aterosclerótica y aparecen con mayor frecuencia en mujeres mayores de 60 años. La porción cavernosa de la arteria carótida interna raramente sufre ruptura y tiene una clínica variada que incluye cefalea, diplopía, parálisis de los nervios oculomotores y dolor facial. Presentamos el caso clínico de un paciente del Hospital Vargas de Caracas con aneurisma gigante de arteria carótida derecha en seno cavernoso, quien inició de forma súbita cefalea holocraneana, acompañada de oftalmoplejía, midriasis, disminución de la agudeza visual y sin signos de irritación meníngea, que se manejó de forma médica conservadora con evolución satisfactoria

Aneurysms are defined as permanent expansions of the artery with an increase of arterial blood of 50 %. The ethiology is mostly atherosclerotic, and they appear more frequently in 60-year old women. The clinical presentation is more frequent with migraine, diplopya, paralysis of the oculomotor nerves and facial pain. We present a case of a patient with a gigantic aneurysm of the cavernous sinus of the carotid artery treated at the Hospital Vargas de Caracas, Venezuela. This patient had a sudden severe migraine, accompanied of ophthalmoplegia, mydriasis, impaired vision, without signs of meningeal irritation. The treatment was medical with satisfactory progress of the patient

Otomastoiditis por Tsukamurella tyrosinosolvens, en un paciente HIV positivo / Tsukamurella tyrosinosolvens, otomastoiditis in an HIV positive patient

Tsukamurella spp. es un bacilo gram positivo, aeróbico, catalasa positivo, no móvil, no esporulado, que pertenece al orden de los actinomicetales. Los géneros incluidos en este orden son Nocardia, Gordonia, dietza, Skermania, Williamsia, Turicella, Streptomyces y Rhodococcus. Otros géneros relacionados son Corynebacterium y Mycobacterium. Las infecciones por esos microorganismos se han asociado con neumopatías crónicas, inmunodepresión (leucemia, tumores, infección por el HIV) e infecciones postoperatorias de heridas. Se notificó la presencia de tsukamurella en hemocultivos asociada al uso de sondas o catéteres, otros dispositivos médicos y en casos individuales de tenosinovitis necrosante con abscesos subcutáneos, infecciones óseas y cutáneas, meningitis, peritonitis y conjuntivitis y también como germen colonizante. Se presenta un caso de otomastoiditis en un paciente HIV positivo causado por este germen.

Afección de los oblicuos superiores en la enfermedad de Graves / Superior oblique muscle disorder in Graves'Disease

El objetivo del trabajo es describir las características clínicas y tomográficas de pacientes con estrabismo por Enfermedad de Graves, en quienes se verificó la afección de los músculos oblicuos superiores, hallazgo poco frecuente y escasamente reportado en la bibliografía médica.

Ophthalmic manifestations in cases of occlusion of posterior cerebral artery

Twelve cases were included in the study. For each case the following was done: Visual and non-visual history taking, routine ophthalmological examination, plotting of visual fields. All cases were examined neurologically. A computerized tomography [CT] scan confirming the diagnosis of occipital lobe infarction was required as an inclusion criterion. Follow up for at least 3 months was done. The most frequent ophthalmic finding was the presence of field defect in 83% of cases. This was in form of homonymous hemianopia in 41.7% of cases, double hemianopia with macular sparing in 25% of cases. The occipital lobe infarction was unilateral in 58.3% of cases and bilateral in 41.7% of cases. Amnestic aphasia was the most common non-ophthalmological finding [25%]. The ophthalmologist must be aware of findings in cases of occlusion of posterior cerebral artery. The two most important investigations required are plotting of the visual fields and performing a brain CT scan

Cyclic vertical squint.

A rare case of cyclic vertical squint which developed after surgery on medial rectus muscle and its subsequent management by the Faden operation is described.