ABSTRACT
A 7-year-old boy presented with vertical double images. A paediatric examination and magnetic resonance imaging of the head did not show any pathological findings. The diagnosis was an acquired click syndrome of the superior oblique muscle. In cases with inflammatory and systemic origin the underlying disease should be treated. Local steroid therapy can be carried out for improvement of inflammation in the region of the superior oblique muscle with a high degree of suffering.
Subject(s)
Diplopia/diagnosis , Diplopia/etiology , Ocular Motility Disorders/complications , Ocular Motility Disorders/diagnosis , Adrenal Cortex Hormones/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Child , Diplopia/prevention & control , Humans , Male , Ocular Motility Disorders/drug therapyABSTRACT
Ocular neuromyotonia is a rare disease that is diagnosed mainly in patients treated with radiation. All such patients described in the literature presented with temporary diplopic images as a common symptom. In our case, the patient described an abducens paresis of the right eye combined with a sporadic exotropia half a year after radiation treatment of an epipharynx carcinoma. An adduction deficit on the right side could be triggered by holding the gaze to the right over a longer period of time, leading to exotropia in the primary position and gaze to the left. Symptoms were reduced with carbamazepine.
Subject(s)
Diplopia/diagnosis , Diplopia/etiology , Isaacs Syndrome/diagnosis , Isaacs Syndrome/etiology , Radiation Injuries/diagnosis , Radiation Injuries/etiology , Radiotherapy, Conformal/adverse effects , Abducens Nerve Diseases/diagnosis , Abducens Nerve Diseases/etiology , Female , Humans , Middle AgedABSTRACT
BACKGROUND: We report on an eight-year-old boy, who was presented in our clinic because of head turn. The cause of the tortecollis (ocular or general) in this case was and still cannot be explained. Only by applying extensive prism adaptation tests it was possible to prove the ocular character of the head turn. CASE REPORT: An eight-year-old boy with Brown's syndrome was referred to us because of a head tilt to the left side. Six months previously surgery on the M. obl. superior of the right eye was performed in another clinic. No improvement of the head tilt could be observed after the operation. In addition, an exotropia became decompensated. Under a 3-day occlusion of one eye, no change of the head turn and the squint could be measured. No other cause of the head turn could be found by an orthopaedist and a paediatrist. Under a prism of 20 cm/m basis in and 10 cm/m basis against the positive vertical deviation, the head tilt decreased, so that we decided to do a second surgery. The head tilting had not resumed at one year after the surgery. CONCLUSIONS: Although the initial diagnostic findings ruled out an ocular cause, it was possible to lessen the head tilting with the aid of the prism adaptation test. This case study emphasises the usefulness of a prism adaptation test of several days duration in order to validate an ocular cause of head turn and to determine an adequate indication for surgery.
