RESUMEN
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.
RESUMEN
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.
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Ethambutol is a widely used drug to treat tuberculosis that may cause visual disturbance including ethambutol toxic optic neuropathy (ETON). The disease disrupts bodily tissues' energy production, including the retinal ganglion cells (RGC). Many have proposed treatment with coenzyme Q10 (coQ10) due to its antioxidant and facilitative effects that can improve mitochondrial electron transport. The present study hence assessed whether coQ10 could protect against ETON through a parallel triple-blinded randomised controlled trial in 18 mice using computer-generated tables for treatment allocation. All of the mice received 25 mg/kg ethambutol daily, while only nine in the treated group also received 100 mg/kg coQ10. After 30 days, blinded pathologists counted RGC numbers in enucleated and dyed orbital tissue. The treated group had significantly denser RGCs at 47.2 (standard deviation [SD] 10.6) cells per 500 µm microscope field vs 33.5 (SD 6.3) in the control group (t = 3.34, p = .004). CoQ10 therefore protected RGCs from ETON. Clinical trials of coQ10 in human subjects treated with ethambutol should be considered.
RESUMEN
This report describes a 44-year-old male with a rare case of idiopathic chronic hydrocephalus who came with complaints of intermittent lower urinary tract symptoms (LUTS), erectile dysfunction, gait disturbance, mental disorder, and papilledema. A detailed assessment of voiding dysfunction in the clinical presentation should be explored to find a surgically correctable cause.