ABSTRACT
We describe three patients with spontaneous pendular oscillation of the eye during funduscopy. All patients had blurred, shimmering vision or oscillopsia, exacerbated by concentration, reading, or trivial head movements, and had a history of unsteadiness. Examination revealed a fine head tremor, mild unsteadiness, absent vestibulo-ocular reflex (VOR), and otherwise normal neurologic and ocular motor findings. Rigid immobilization of the head abolished the retinal oscillations. Simultaneous precision recordings of head and eye movements showed that the eye movement was in the compensatory direction to the head tremor but that, in contrast to normal VOR, it was in phase error. We conclude that the essential head tremor was provoking oscillopsia and retinal oscillation because of the absence of VOR. Recognizing the association of head tremor with absent VOR is important since in all these patients the presence of this pendular pseudonystagmus on ophthalmoscopy raised the diagnostic possibility of brainstem disease.
Subject(s)
Head , Nystagmus, Pathologic/etiology , Tremor/complications , Vestibular Diseases/complications , Aged , Eye Movements , Female , Head/physiopathology , Humans , Middle Aged , Movement , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/physiopathology , Ophthalmoscopy , Reference ValuesSubject(s)
Cocaine/adverse effects , Migraine Disorders/chemically induced , Substance-Related Disorders/complications , Cerebral Cortex/diagnostic imaging , Cerebral Hemorrhage/chemically induced , Cerebral Hemorrhage/diagnostic imaging , Cerebral Infarction/chemically induced , Cerebral Infarction/diagnostic imaging , Humans , Male , Middle Aged , Migraine Disorders/diagnostic imaging , Neurologic Examination , Substance-Related Disorders/diagnostic imaging , Tomography, X-Ray ComputedSubject(s)
Nystagmus, Physiologic , Vestibule, Labyrinth/physiology , Darkness , Electrooculography , Humans , Photic Stimulation , Rotation , Time FactorsABSTRACT
A case of convergence nystagmus associated with an Arnold-Chiari type I malformation is presented. The nystagmus appeared in the absence of fixation, was provoked during Valsalva's maneuver and neck flexion and extension, and attenuated on deep inspiration. Sagittal magnetic resonance images showed that the diameter of the cerebral aqueduct increased with the neck in full flexion and in full extension. Surgical foramen magnum decompression considerably reduced the nystagmus and abolished the postural variation of aqueduct diameter. It is postulated that this nystagmus was due to a combination of mechanical distortion and abnormal transmission of cerebrospinal fluid pressure to the aqueductal region.
Subject(s)
Arnold-Chiari Malformation/complications , Nystagmus, Pathologic/etiology , Adolescent , Arnold-Chiari Malformation/physiopathology , Electrooculography , Humans , Magnetic Resonance Imaging , Male , Nystagmus, Pathologic/physiopathologyABSTRACT
Two patients with cervical spondylotic myelopathy presented with features suggesting syringomyelia. One patient had a Charcot joint of the wrist, and both had dissociated sensory loss in the upper limbs. The possible vascular basis of these central cord lesions is discussed.
Subject(s)
Spinal Cord Diseases/diagnosis , Spinal Osteophytosis/diagnosis , Aged , Humans , Male , Spinal Cord Diseases/etiology , Spinal Osteophytosis/complicationsABSTRACT
Lactic acid concentrations in the synovial fluid of 71 patients with inflammatory arthritis were determined by an enzyme method. In 63 samples from 54 patients with a variety of non-septic arthritides, including rheumatoid arthritis, reactive arthritis and gout, the concentration of lactic acid was never greater than 10.2 mmol/l, whereas all twelve patients with septic arthritis had concentrations of 11 mmol/l or greater. Two patients with gonococcal arthritis did not have raised lactic acid concentrations. The enzyme method of lactic acid estimation is an accurate reproducible means of differentiating septic from nonseptic arthritis prior to the isolation of the infecting organism. However, caution is necessary when interpreting the results in those patients who have recently received antibiotic therapy, or in whom gonococcal arthritis is suspected.
