Horizontal Gaze Palsy and Ipsilateral Facial Nerve Palsy in Older Patient as Initial Manifestation of Very Late-Onset Multiple Sclerosis Successfully Treated with Oral Corticosteroids: A Case Report.

Introduction: Multiple sclerosis (MS) is a demyelinating condition of the central nervous system (CNS) that primarily affects young adults. Very late-onset multiple sclerosis (VLOMS) is an uncommon form of MS, accounting for only 0.5 percent of all MS patients. Eye movement impairments such as internuclear ophthalmoplegia are common in MS, while horizontal gaze palsy is an uncommon occurrence. Case Presentation: We report a case of a patient diagnosed with VLOMS who presented with left horizontal gaze palsy and ipsilateral facial nerve palsy. Brain magnetic resonance imaging showed Dawson's fingers in the left and right periventricular white matter; multiple small, round, hyperintense lesions in the left and right cortex and juxtacortical cerebellar hemisphere; and small hyperintense lesion in the left paramedian pontine reticular formation, suggesting the diagnosis of MS. Oral corticosteroids led to complete resolution of ocular movement and ipsilateral facial nerve palsy. Conclusion: We propose that neuroimaging should be performed in ophthalmoplegia with a pattern representing CNS lesion and oral corticosteroids may be an effective alternative to high-cost intravenous corticosteroids.

Carotid cavernous fistula (CCF) with coil embolization in interventional radiology: A case report.

Carotid cavernous fistula (CCF) is a condition with abnormal flow from the carotid artery to the cavernous sinus. The characteristic clinical findings are ophthalmic monoplegia, ptosis, exophthalmos, chemosis, Horner's syndrome, facial pain, loss of sensation in the distribution of the trigeminal nerve, and headache. Digital subtraction angiography (DSA) is the gold standard modality for evaluating CCF. An 18-year-old patient came with decreased bilateral visual acuity after a traffic accident. CT angiography was performed on the patient and found a dilated right superior ophthalmic vein. CCF is present in the patient. The DSA procedure was performed on the patient, and embolization was performed on the right ophthalmic vein. On post-embolization angiography, the tubular structure is no longer visible, which is bilateral superior ophthalmic vein dilatation.

Masking Colour Blindness: A Case Report.

Colour vision is an important aspect of visual function that might help individuals in doing daily activities. Some occupations require and test for good colour discrimination. We describe a case of a 20-year-old man who was referred to our centre to establish if he had colour vision deficiency (CVD). He had been tested for this twice as part of his assessment to enter the police force. At the first examination, he had normal colour vision, while the second examination revealed CVD, thus the patient was referred for confirmation. Colour vision tests using the Ishihara plates showed normal results with each eye, while a Roth test revealed an unspecified CVD in the right eye and deuteranopia in the left eye. During the evaluation, we noticed he was using a red-tinted contact lens in the right eye, and was wearing a red mask with transparent red plastic in the upper part. After removal of the contact lens and mask, he was asked to repeat the examinations and it revealed deuteranopia in both eyes. A tinted contact lens is a corrective device that can help to enhance colour discrimination in CVD subjects. However, in this case the tinted contact lens was used inappropriately to manipulate the colour vision examination. We highlight the case to raise awareness that the use of red contact lenses and red filters can mask CVD.