[Acute bilateral angle-closure glaucoma induced by topiramate: contribution of Visante OCT]. / Crise bilatérale de glaucome aigu après traitement par topiramate : apport de l'OCT Visante.

INTRODUCTION: Topiramate, a sulfamate-substituted monosaccharide classically used as an antiepileptic medication, has been widely used since its recent indication for migraine prophylaxis. We report the case of a 68-year-old woman who developed bilateral acute glaucoma following topiramate migraine prophylaxis. OBSERVATION: A 68-year-old woman presented in the emergency department for ocular pain, redness, and bilateral reduced visual acuity associated with nausea and vomiting. Initial examination found a bilateral corneal edema with shallow anterior chambers and closed iridocorneal angles. Intraocular pressure was 40mmHg in the right eye and 45mmHg in the left eye. Ultrasound biomicroscopy diagnosed ciliochoroidal detachment and swollen ciliary processes with closed angles, which was also objectified using the Visante OCT. Topiramate treatment was interrupted and a local and general hypotonic treatment was started. After 4 days, examination showed deeper anterior chambers and normal intraocular pressures. Visante OCT and ocular echography follow-up examinations were normal, and Indoramin was prescribed for migraine prophylaxis with no relapse after 10 months. CONCLUSION: Bilateral acute angle-closure glaucoma is a possible complication of topiramate. Physicians and patients starting this therapy should be aware of this underestimated risk.

[Glucose tolerance of high-dose intravenous methylprednisolone therapy in ophthalmology]. / Tolérance glycémique des bolus intraveineux de méthylprednisolone en milieu ophtalmologique.

INTRODUCTION: Short-term, high-dose intravenous methylprednisolone therapy, also called pulse methylprednisolone, is widely used in a variety of inflammatory eye diseases. Monitoring blood glucose during this therapy is recommended. We evaluated the clinical implications of glycemia monitoring during repeated pulse methylprednisolone for eye disease. PATIENTS AND METHODS: During the year 2000, 224 patients received 120-1 000 mg daily intravenous methylprednisolone for 3 consecutive days for acute optic neuritis (n=91), severe uveitis (n=35), ocular infectious diseases (n=22), corneal graft rejection (n=17) and miscellaneous disorders (n=59). Serial morning fasting blood glucose, i.e., before the first pulse and the day after each pulse, and specific hypoglycemic drug interventions were recorded. RESULTS: All patients showed a median 50% increase in fasting glucose after the first pulse with no significant difference between diabetic and nondiabetic patients. Thereafter, the 196 nondiabetic patients showed a spontaneous decrease in their fasting glucose towards baseline values despite the following infusions. However, none of them required hypoglycemic intervention. In contrast, the 28 diabetic patients demonstrated further increases in blood glucose levels and seven received rapid-release treatment. CONCLUSION: Glucose tolerance of pulse methylprednisolone was excellent in nondiabetic patients; close glycemia monitoring seems necessary only for patients with diabetes.

[Spontaneous dissection of the internal carotid artery in ophthalmological milieu. Apropos of 10 cases]. / Dissection spontanée de la carotide interne en milieu ophtalmologique. A propos de dix cas.

PURPOSE: Spontaneous dissection of the internal carotid artery is a rare vascular emergency, but represents the first cause of cerebral ischaemia of young patients. Neuro-ophthalmologic symptoms often reveals the pathology. METHODS: Ten cases of spontaneous dissection of the internal artery are reported. The Claude Bernard Horner syndrome is the most frequent symptom typically associated with hemicranial headache. The headache involves the ipsilateral forequarter of the head and the neck. Other ophthalmologic symptoms may also reveal the carotid dissection. RESULTS: At first, the diagnosis is strongly suspected during Doppler ultrasonographic examination. During the acute phase, MRI and MRA replaces advantagiously arteriography, confirming this affection in a non invasive way, and permits investigation of associated vascular pathology like fibromuscular dysplasia (15% of the cases). The patients received anticoagulants in order to prevent thrombo-embolic complications (heparine during the acute phase relayed by AVK). The clinical course is usually favorable with the medical treatment. CONCLUSION: A painful Claude Bernard Horner syndrome strongly evokes a carotid dissection and the arterial check-up must be realised in emergency: at first, the exploratory methods associates Doppler ultrasonographic examination, MRI, and MRA.

[Unexplained bilateral optic disk edema. So-called idiopathic intracranial hypertension of drug origin should be suspected]. / Oedème papillaire bilatéral inexpliqué. Penser à l'hypertension intracrânienne dite idiopathique d'origine médicamenteuse.

In 2 clinical cases of bilateral optic disk oedema, the optic disk oedema was part of a so-called benign, or rather idiopathic, intracranial hypertension. Aetiological investigations were unable to detect any intracranial or systemic anomaly, except the fact that both patients had been on a long-term treatment. The first, a 35-year-old man, was taking Roaccutane (isotretinoin) for acne, for at least 5 years, Supradyne (containing vitamin A) minimum 1 pill per day. The second patient, aged 16 years, had also been treated for acne with Roaccutane and Mynocine (minocyclin) for several months. Minocyclin and vitamin A, contained in these substances, are likely to have induced the idiopathic intracranial hypertension, and consequently the optic disk oedema. Indeed, discontinuing the treatment and rachicentesis led to a significant resolution of symptoms. A good history of the clinical cases thus remains a key-element in the process of diagnosis-making and should be strictly conducted in cases with bilateral optic disk oedema, particularly when seen in young patients.

[Ocular myasthenia: an etiology to consider in unexplained oculomotor paralysis]. / Myasthénie oculaire: une étiologie à évoquer devant une paralysie oculomotrice inexpliquée.

Three cases of ocular myasthenia gravis were observed. The first patient, a 74-year-old man was found to have complete left ophthalmoplegia and ptosis unchanged at examination on month after onset. The second patient, a 42-year-old man, developed incomplete right ophthalmoplegia with pseudoanterior internuclearis ophthalmoplegia, then ptosis two days later. The third patient, a 70-year-old man, presented with sudden onset complete right palsy of the third nerve. Diabetes mellitus or intra-cranial lesions were suspected in all three patients although laboratory tests, tomodensitometry, nuclear magnetic resonance imaging, or arteriography gave no confirmation. Ptosis was relieved and eye movement was improved after the intravenous edrophonium test, but electromyography was negative. The three patients were treated with anticholinesterase agents and showed unequivocal improvement. The second patient underwent thymectomy. Clinicians should inform patients of the contraindications of drugs in this disease. The diagnosis of pure oculomotor forms of myasthenia gravis is sometimes difficult to establish and should be suspected in cases of unexplained oculomotor palsy.

Abnormal cerebral vasodilation in aneurysmal subarachnoid hemorrhage: use of serial 133Xe cerebral blood flow measurement plus acetazolamide to assess cerebral vasospasm.

A patient with cerebral vasospasm following subarachnoid hemorrhage (SAH) was investigated by serial measurement of cerebral blood flow (CBF) using the xenon-133 emission tomography method. The CBF was measured before and after acetazolamide injection. On Day 2 after SAH, there was early local hyperperfusion in the middle cerebral artery (MCA) territory, ipsilateral to the left posterior communicating artery aneurysm. The regional CBF of this arterial territory decreased slightly after acetazolamide injection, probably because of vasoplegia and the "steal" phenomenon, and thus surgery was delayed. A right hemiplegia with aphasia and disturbed consciousness occurred 4 days later (on Day 6 after SAH) due to arterial vasospasm, despite treatment with a calcium-channel blocker. The initial hyperemia of the left MCA territory was followed by ischemia. The vasodilation induced by acetazolamide administration was significantly subnormal until Day 13, at which time CBF and vasoreactivity amplitude returned to normal and the patient's clinical condition improved. Surgery on Day 14 and outcome were without complication. It is concluded that serial CBF measurements plus acetazolamide injection are useful for monitoring the development of cerebral vasospasm to determine the most appropriate time for aneurysm surgery.

[Computed x-ray tomographic aspects of intra-orbital hydatid cyst. Apropos of 10 cases]. / Aspects tomodensitométriques du kyste hydatique intra-orbitaire. A propos de 10 observations.

Echinococcus taenia occurs in human accidentally after contamination by infected dust of dog. Although it may localize in all parts of the body as a hydatic cyst, liver, lung and kidney are the most frequent sites. Intra-orbital localization is rare since all statistical studies estimate it to be one per cent of orbital tumours. Using computerized axial tomography (C.A.T. Scanner) ten cases of intra-orbital hydatic cyst originating from Algiers, Tunis Hospitals and C.N.O. des Quinze-Vingts of Paris were studied. The inclusion of C.A.T. scanning in the orbital evaluation enables more positive preoperative diagnosis and facilitates the choice of the most efficient surgical approach.