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The paper summarizes the clinical experience of professor ZHANG Ren in the staging treatment with characteristic acupuncture techniques for oculomotor paralysis. According to the symptoms of oculomotor paralysis, the staging treatment is given, in which acupuncture is dominant and the needling techniques are optioned in compliance with the symptoms. In the early, middle and late stages of illness, three different acupuncture therapies are delivered accordingly, i.e. the combination of the point-toward-point needling at the four acupoints located on the forehead and the electroacupuncture with disperse-dense wave, the surrounding needling and the triple needling at the acupoints around the eyeball, as well as the perpendicular needle insertion at the three acupoints within the orbit. Professor ZHANG Ren lays the stress on identifying the etiology and differentiating the symptoms, as well as the early intervention for the disease. For the intractable cases, the comprehensive regimen such as acupoint injection, dermal needling and auricular point sticking is supplemented. During treatment, the spirit harmonization is greatly considered to ensure the effectiveness. On the basis of the staging acupuncture therapy, the acupuncture technique for harmonizing the spirit and regulating qi is combined to obtain the favorable clinical effect on oculomotor paralysis.

Clinical characteristics in patients with oculomotor paralysis caused by isolated midbrain infarction.

INTRODUCTION: The aim of the study was to investigate the clinical characteristics of isolated oculomotor paralysis (OP) cases caused by pure midbrain infarction (MI) with pupil sparing. MATERIAL AND METHODS: Patients with pure MI and pontine infarction (PI) at our hospital were included in this study. We compared the blood pressure and lipid levels between the two groups. And the clinical data and imaging features were summarized. RESULTS: In total, 33 and 35 patients were included in the MI and PI groups, respectively. There was no significant difference in the distribution of age (64.9 ±10.0 vs. 65.1 ±10.8 years, p = 0.927) and males (84.8% vs. 74.3%, p = 0.282) between the MI and PI groups, respectively. The pure MI group had a comparable level of serum lipoprotein and cardiovascular risk factors compared with the PI group except for a lower proportion of hypertension (57.6% vs. 85.7%, p = 0.010). The majority (72.7%) of culprit lesions in the pure MI group was located in the paramedian area of the midbrain, and the ocular muscle palsies mostly involved the medial rectus (75.8%). CONCLUSIONS: The Chinese patients with OP caused by pure MI were mainly characterized with rapidly progressive symptoms, multiple cerebrovascular risk factors, and typical MRI signs. Further efforts should be made in the differential diagnosis of this atypical midbrain syndrome.

[YANG Jun's clinical experience of acupuncture for oculomotor paralysis].

Professor YANG Jun's clinical experience of acupuncture and moxibustion for oculomotor paralysis is summarized. Professor YANG Jun pays attention to disease differentiation and syndrome differentiation in the treatment of this disease. According to the characteristics of oculomotor paralysis, "early diagnosis and seeking treatment from the source" is advocated. According to the etiology and pathogenesis, professor YANG divides oculomotor paralysis into three types: the syndrome of wind-evil attacking collaterals, the syndrome of spleen-stomach weakness and the syndrome of qi-deficiency and blood-stasis. As such, the acupoints are selected according to syndrome differentiation, and several different acupuncture methods (pricking needling at eyelids, penetrating needling and lifting eyelids and contralateral- balance needling on the healthy side) are adopted to improve the symptoms of oculomotor paralysis. It is also suggested to use the combination of scalp acupuncture and electroacupuncture to achieve the best dose-effect state. Moreover, local stimulation around the eyes is important to achieve the effects of "qi reaching affected area".

YANG Jun's clinical experience of acupuncture for oculomotor paralysis / 中国针灸

Professor YANG Jun's clinical experience of acupuncture and moxibustion for oculomotor paralysis is summarized. Professor YANG Jun pays attention to disease differentiation and syndrome differentiation in the treatment of this disease. According to the characteristics of oculomotor paralysis, "early diagnosis and seeking treatment from the source" is advocated. According to the etiology and pathogenesis, professor YANG divides oculomotor paralysis into three types: the syndrome of wind-evil attacking collaterals, the syndrome of spleen-stomach weakness and the syndrome of qi-deficiency and blood-stasis. As such, the acupoints are selected according to syndrome differentiation, and several different acupuncture methods (pricking needling at eyelids, penetrating needling and lifting eyelids and contralateral- balance needling on the healthy side) are adopted to improve the symptoms of oculomotor paralysis. It is also suggested to use the combination of scalp acupuncture and electroacupuncture to achieve the best dose-effect state. Moreover, local stimulation around the eyes is important to achieve the effects of "qi reaching affected area".

Surgical clipping and endovascular embolization for senile patients with posterior communicating artery aneurysms complicated with oculomotor nerve palsy.

OBJECTIVE: To explore the clinical effect of the surgical clipping and endovascular embolization for senile patients with posterior communicating artery aneurysms (PComA) complicated with oculomotor nerve palsy (ONP) and their neurological recovery. METHODS: A total of 96 senile patients with PComA complicated with ONP admitted to our hospital from May 2018 to May 2019 were selected and assigned into the experimental group and the control group according to the randomization method, with 48 cases in each group. The patients in the control group underwent surgical clipping, whereas the patients in the experimental group received the endovascular embolization. Subsequently, their surgical therapeutic effect, postoperative blood chemistry parameters, the incidence of complications, the recovery of neurological function and prognosis were analyzed and compared. RESULTS: The operation duration, bleeding volume, respiratory recovery time and the time to extubation were significantly in favor of the experimental group when compared with the control group (P < 0.001); Senile patients in the experimental group had markedly lower levels of blood chemistry parameters than the control group (P < 0.001); The neurological recovery in the experimental group was found to be remarkably better than that in the control group (P < 0.05); The experimental group showed a distinct decrease in the incidence of complications compared to the control group (P < 0.05); A significant difference in good prognosis was observed between the control group and the experimental group (P < 0.05). CONCLUSION: Endovascular embolization is more effective in the treatment of senile PComA with ONP. It is superior to the traditional surgical clipping, and has a lower incidence of complications, thereby contributing to the better recovery of neurological function and prognosis.

[Primary leptomeningeal lymphoma with oculomotor paralysis as the initial presentation].

An 85-year-old man presented with right eye ptosis and visual abnormalities. Due to a lack of abnormal findings on plain magnetic resonance imaging (MRI) and laboratory examination, prednisolone therapy was initiated, and ocular myasthenia gravis and ocular symptoms subjectively improved. However, anorexia and conscious disorder appeared during the same period, and he was hospitalized for scrutiny. After admission, left eye adduction disorder and bilateral abduction nerve paralysis were also observed. Enhanced MRI revealed cranial nerve and leptomeninx enhancement. Subsequently, the patient developed seizures and died on the 10th day of hospitalization without being diagnosed. An autopsy revealed infiltration of B-cell lymphoma cells into the subarachnoid space, particularly in the parietal lobe. Similar infiltration was observed in the cerebellum, brainstem, spinal cord, and bilateral oculomotor nerve. Primary leptomeningeal lymphoma is a rare form of primary central nervous system lymphoma without simultaneous parenchymal brain lesions. Clinicians should be aware of this form of lymphoma and carefully monitor its possible occurrence, even when patients are already being treated for other neurological diseases.

[Botulism: A case report and literature review]. / Botulisme : à propos d'un cas et revue de la littérature.

INTRODUCTION: Botulism is a rare syndrome resulting from the action of a neurotoxin produced by Clostridium botulinum, that it is potentially life threatening if diagnosis is delayed. CASE REPORT: We report a 26-year-old woman who presented an acute onset of bilateral cranial neuropathies associated with an anticholinergic syndrome in the absence fever leading to consider and confirm the diagnosis of botulism. At the end of follow-up, 7 weeks later, the outcome was favorable with an almost complete neurologic recovery. CONCLUSION: Although botulism is uncommon, better awareness of its manifestations and high clinical suspicion should shorten diagnostic delay that makes the use of specific antitoxin ineffective. An acute onset of a bilateral oculomotor palsy, a fixed pupillary dilation and descending weakness in the absence of fever is typical of botulism. Outcome is usually favorable with a slow but full neurological recovery.

Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature.

BACKGROUND: Whether conservative treatment or surgical management is the most appropriate treatment for pituitary apoplexy (PA) is controversial. In general, if severe symptoms of compression occur, such as oculomotor nerve palsy, neurosurgery is performed to relieve the compression of anatomical structures near the PA. CASE DESCRIPTION: We describe the case of a 79-year-old man who was found to have an intrasellar pituitary incidentaloma. The tumor was discovered accidentally, during an investigation into the cause of his dizziness. Two months later, he suddenly developed headaches, left ophthalmoplegia, decreased vision, severe blepharoptosis and diplopia. He was diagnosed with PA and hypocortisolemia based on magnetic resonance imaging (MRI) and blood tests, respectively. His symptoms of oculomotor palsy and optic nerve compression were serious, but his ophthalmological deficits were nonprogressive and his hormone levels improved through conservative treatment (hydrocortisone supplementation). Due to this older patient's poor physical condition and serious coronary heart disease, after multidisciplinary consultation and according to his family's wishes, we continued the conservative treatment and watched closely for any changes in the patient's condition. After 6 months of conservative treatment, the patient's symptoms of oculomotor nerve paralysis, pupil and vision defects completely disappeared, and no new complications occurred. Repeated MRI tests showed that the PA lesion gradually improved. The patient's hypocortisolemia was completely relieved through oral supplementation with low-dose hydrocortisone. CONCLUSION: In older PA patients who have surgical contraindications, even with symptoms of compression, such as oculomotor nerve palsy, according to the international guidelines, if conservative treatment is effective and the condition is not progressing, it is possible to monitor patients' condition closely and continue conservative treatment, which may yield good results.

Two Siblings with Adolescent/Adult Onset Niemann-Pick Disease Type C in Korea.

Niemann-Pick disease, type C (NP-C), is caused by NPC1 or NPC2 gene mutations. Progressive neurological, psychiatric, and visceral symptoms are characteristic. Here, we present cases of a brother (Case 1) and sister (Case 2) in their mid-20s with gait disturbance and psychosis. For the Case 1, neurological examination revealed dystonia, ataxia, vertical supranuclear-gaze palsy (VSGP), and global cognitive impairment. Case 2 showed milder, but similar symptoms, with cortical atrophy. Abdominal computed tomography showed hepatosplenomegaly in both cases. NPC1 gene sequencing revealed compound heterozygote for exon 9 (c.1552C>T [R518W]) and exon 18 (c.2780C>T [A927V]). Filipin-staining tests were also positive. When a young patient with ataxia or dystonia shows VSGP, NP-C should be considered.

Two Siblings with Adolescent/Adult Onset Niemann-Pick Disease Type C in Korea

Niemann-Pick disease, type C (NP-C), is caused by NPC1 or NPC2 gene mutations. Progressive neurological, psychiatric, and visceral symptoms are characteristic. Here, we present cases of a brother (Case 1) and sister (Case 2) in their mid-20s with gait disturbance and psychosis. For the Case 1, neurological examination revealed dystonia, ataxia, vertical supranuclear-gaze palsy (VSGP), and global cognitive impairment. Case 2 showed milder, but similar symptoms, with cortical atrophy. Abdominal computed tomography showed hepatosplenomegaly in both cases. NPC1 gene sequencing revealed compound heterozygote for exon 9 (c.1552C>T [R518W]) and exon 18 (c.2780C>T [A927V]). Filipin-staining tests were also positive. When a young patient with ataxia or dystonia shows VSGP, NP-C should be considered.

Application of phase-contrast cine magnetic resonance imaging in endoscopic aqueductoplasty.

The aim of this study was to evaluate the application of phase-contrast cine magnetic resonance imaging (MRI) in endoscopic aqueductoplasty (EA) for patients with obstructive hydrocephalus. The clinical diagnosis of hydrocephalus caused by aqueduct obstruction in 23 patients was confirmed by phase-contrast cine MRI examination. The patients were treated with EA and MRI was repeated during the follow-up. The cerebrospinal fluid (CSF) flow velocity in the aqueduct was measured to determine whether the aqueduct was obstructed. The results of phase-contrast cine MRI examinations indicated that there was no CSF flow in the aqueduct for all patients prior to surgery. Aqueductoplasty was successfully performed in all patients. The results of phase-contrast cine MRI examinations performed a week after surgery demonstrated an average CSF flow velocity of 4.74±1.77 cm/sec. During the follow-up, intracranial hypertension recurred in two patients in whom CSF flow was not observed in the aqueduct by the phase-contrast cine MRI scan. Aqueduct re-occlusion was revealed by an endoscopic exploration. By measuring the CSF flow velocity, phase-contrast cine MRI accurately identifies aqueduct obstruction. Cine MRI is a nontraumatic, simple and reliable method for determining whether the aqueduct is successfully opened following aqueductoplasty.

Determinación de la prevalencia y etiología de las parálisis oculomotoras en un consultorio particular de ortoptica en la ciudad de Bogotá entre los años 2004 y 2006 / Determination of the prevalence and etiology of the oculomotor paralysis in a private doctor’s office of orthoptic in Bogota between 2004 and 2006

Las parálisis oculomotoras son una perdida total de la función de un músculo ocular. El objetivo del presente trabajo fue establecer la prevalencia de las parálisis oculomotoras en la consulta ortóptica, definir los signos y síntomas de las mismas y su etiología. Metodología: el estudio fue retrospectivo, se revisaron todas las historias clínicas de los pacientes remitidos a ortóptica atendidos en un consultorio particular, entre los años 2004 y 2006, seleccionando los casos de parálisis diagnosticadas, el análisis se realizó empleando el programa excel y se estableció la prevalencia de las parálisis oculomotoras según su etiología, signos y síntomas; así como también género, edad y asociación sistémica. Resultados. la población estudiada fue en total 3808 historias de las cuales, se obtuvo 30 casos positivos de parálisis oculomotoras lo cual representó el 0.78 por ciento de la muestra analizada.

Oculomotor paralysis is a total loss of the ocular musclefunction. The objective of this work was to establishthe prevalence of oculomotor paralysis in orthopticconsultation, to define the signs and symptoms as wellas their etiology. Methods: this was a retrospectivestudy. All the clinical records between 2004 and2006 whose patients were remitted to orthopticconsultation in a private doctor’s office were checked.Cases diagnosed with paralysis were chosen. Theanalysis was done through Excel and the prevalence ofoculomotor paralysis was established according to theiretiology, signs and symptoms. It also took into accountage, gender and systemic association. Results: a totalof 3808 clinical records were studied, out of which 30cases had oculomotor paralysis, which represented0.78 percent of the analyzed sample.

Study of evidence-based acupuncture and moxibustion treatment program for oculomotor paralysis / 中华中医药杂志

bjective To induce a treatment program of evidence-based acupuncture and moxibustion for oculomotor paralysis by retrieving and analyzing the current literature for improving clinic technology.MethodsOne case was used as example and it was introduced how to raise clinical questions,retrieve relative literature,evaluate the retrieval literature and at last,stipulate treatment program based on the retrieval evidences.ResultsThe acupuncture and moxibustion treatment program for oculomotor paralysis established by evidence-based medicine was adopted to treat the patient for 10 times,as a result the patient got much better.Conclusion: Through clinically raising questions,searching for evidence,analyzing evidence,making a strategy decision,practicing evidence-based course,the patient could attain satisfactory therapeutic effect,and the physician could raise theoretical level and clinical ability.