ABSTRACT
We used [18F]fluorodeoxyglucose with positron emission tomography to explore the functional basis of lid opening apraxia (LOA). We studied four patients with LOA without associated pyramidal or extrapyramidal motor dysfunction (mean age 65.5 +/- 4.7 years). We compared measures of glucose metabolism with those calculated for 10 age-matched normal volunteers (mean age 60.6 +/- 11.4). All four patients demonstrated significant metabolic reductions (> 2 SD) in the medial frontal lobe: bilaterally in two, unilaterally in two. Significant abnormal unilateral metabolic reductions in the left basal ganglia were evident in two patients. These findings suggest that medial frontal lobe hypometabolism is associated with LOA. Abnormal striatofrontal interactions may be involved in the pathogenesis of this condition.
Subject(s)
Apraxias/diagnostic imaging , Blepharoptosis/diagnostic imaging , Blood Glucose/metabolism , Dominance, Cerebral/physiology , Eyelids/innervation , Frontal Lobe/diagnostic imaging , Tomography, Emission-Computed , Aged , Apraxias/physiopathology , Basal Ganglia Diseases/diagnostic imaging , Basal Ganglia Diseases/physiopathology , Blepharoptosis/physiopathology , Blepharospasm/diagnostic imaging , Blepharospasm/physiopathology , Brain/diagnostic imaging , Brain/physiopathology , Deoxyglucose/analogs & derivatives , Female , Fluorodeoxyglucose F18 , Frontal Lobe/physiopathology , Humans , Image Processing, Computer-Assisted , Male , Pyramidal Tracts/diagnostic imaging , Pyramidal Tracts/physiopathologyABSTRACT
We report four patients who sustained direct injury to the brain after insertion of intraventricular shunts and pressure monitoring lines, which resulted in permanent neuro-ophthalmic deficits. These included hemianopsia from an optic tract lesion, esotropia and residual bilateral facial paresis from dorsal pontine injury, unilateral blindness from damage to the optic nerve, and dorsal midbrain syndrome from catheter compression in the region of the posterior commissure. Although presumably rare, such injuries should be considered in diagnosing patients with neuro-ophthalmic complaints after insertion of such devices.
Subject(s)
Catheterization/adverse effects , Cerebrospinal Fluid Shunts/adverse effects , Cranial Nerve Injuries , Intraoperative Complications/etiology , Nerve Compression Syndromes/etiology , Postoperative Complications/etiology , Adult , Blindness/etiology , Child , Esotropia/etiology , Facial Paralysis/etiology , Female , Hemianopsia/etiology , Humans , Middle Aged , Nystagmus, Pathologic/etiology , Peritoneal Cavity , PleuraABSTRACT
Selective downgaze paralysis was correlated with discrete bilateral lesions at the mesencephalic-diencephalic junction in a 9-year-old girl following severe pneumococcal meningitis, and in a 64-year-old man who suffered an embolic infarction. Magnetic resonance imaging demonstrated bilateral lesions in the region of the rostral interstitial nucleus of the medial longitudinal fasciculus. Clinical-radiologic correlation allowed identification of the likely vascular cause in both patients.
Subject(s)
Cerebral Infarction/complications , Diencephalon/pathology , Magnetic Resonance Imaging , Meningitis, Pneumococcal/complications , Mesencephalon/pathology , Ophthalmoplegia/diagnosis , Child , Female , Humans , Male , Middle Aged , Ophthalmoplegia/etiology , Ophthalmoplegia/pathology , OphthalmoscopySubject(s)
Collateral Circulation , Neck Injuries , Thrombosis/etiology , Vertebral Artery , Cerebral Angiography , Humans , Male , Middle Aged , Thrombosis/complications , Thrombosis/diagnostic imaging , Vertebral Artery/abnormalities , Vertebral Artery/diagnostic imaging , Vertebrobasilar Insufficiency/diagnostic imaging , Vertebrobasilar Insufficiency/etiologyABSTRACT
Six patients (11 eyes) with virologically confirmed cytomegalovirus (CMV) retinitis involving the posterior pole of the eye were treated with a new drug, ganciclovir. Treatment with intravenous ganciclovir consistently halted progression of retinitis and produced improvement in measures of visual function. However, within three weeks after cessation of therapy renewed CMV activity and worsening of visual function were observed in most cases. Maintenance therapy with ganciclovir extended the period of remission from CMV retinitis.
