RESUMEN
Diplopia is one of the most vexing problems to confront a physician. When diplopia is binocular, it commonly results from dysfunction of one or more of the ocular motor nerves. Ocular motor dysfunction may result from injury anywhere along the neuraxis, from the ocular motor nucleus to the myoneural junction. Identifying the location of the lesion is important for determining the etiology and prognosis of third-, fourth-, and sixth-nerve injuries. In this article, an anatomic approach is presented for the diagnosis and treatment of ocular motor nerve lesions. Emphasis is placed on the identification of associated neurologic and ophthalmologic findings that are critical for management of patients with acquired and congenital ocular motor palsies.
Asunto(s)
Enfermedades del Nervio Abducens , Enfermedades del Nervio Oculomotor , Enfermedades del Nervio Troclear , Enfermedades del Nervio Abducens/complicaciones , Enfermedades del Nervio Abducens/diagnóstico , Enfermedades del Nervio Abducens/terapia , Diplopía/diagnóstico , Diplopía/etiología , Diplopía/terapia , Humanos , Enfermedades del Nervio Oculomotor/complicaciones , Enfermedades del Nervio Oculomotor/diagnóstico , Enfermedades del Nervio Oculomotor/terapia , Estrabismo/diagnóstico , Estrabismo/etiología , Estrabismo/terapia , Enfermedades del Nervio Troclear/complicaciones , Enfermedades del Nervio Troclear/diagnóstico , Enfermedades del Nervio Troclear/terapiaRESUMEN
The authors studied six patients with brainstem ocular motility deficits with 4.0 Tesla (T) magnetic resonance imaging to investigate whether a higher field strength would produce superior images compared with 1.5T. In four patients whose lesions were evident on 1.5T, the increased signal-to-noise achieved with 4.0T allowed for better resolution at 1-mm slice thickness than was achieved at the standard 5-mm slice thickness with 1.5T. In the two patients with unremarkable 1.5T scan results, 4.0T also failed to demonstrate a lesion. Therefore, 4.0T imaging has superior resolution to 1.5T imaging and can provide more detailed images of lesions identified by 1.5T.
Asunto(s)
Encefalopatías/diagnóstico , Tronco Encefálico/patología , Imagen por Resonancia Magnética/métodos , Trastornos de la Motilidad Ocular/diagnóstico , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The quantitative assessment of visual function in multiple sclerosis (MS) clinical trials has been limited to Snellen visual acuity. The purpose of this study was to examine the inter-rater reliability and test characteristics of a new visual outcome measure, the Low-Contrast Sloan Letter Charts, in patients with MS and visually-asymptomatic volunteers. Contrast letter acuity scores (letter scores) were measured at each of four contrast levels (100, 5, 1.25 and 0.6%) by two independent raters. Inter-rater agreement was described with the intraclass correlation coefficient (ICC) and comparison of mean scores. Excellent inter-rater agreement (ICC=0.86 - 0.95) was demonstrated at each contrast level among MS patients (n=100) and visually-asymptomatic volunteers (n=33). Average letter scores at the lowest contrast level (0.6%) were highly variable in the MS group, even among patients with visual acuities of 20/20 or better, and among those who required no assistance for ambulation. Low-Contrast Sloan Letter Chart testing is a highly reliable method of visual assessment, and provides information on an aspect of neurologic impairment in MS which is not captured by Snellen visual acuity or ambulation status. This new method demonstrates excellent potential as a visual function outcome measure for future MS clinical trials.
Asunto(s)
Esclerosis Múltiple/fisiopatología , Pruebas de Visión/instrumentación , Visión Ocular , Adolescente , Adulto , Sensibilidad de Contraste , Humanos , Esclerosis Múltiple/complicaciones , Variaciones Dependientes del Observador , Neuritis Óptica/complicaciones , Valores de Referencia , Pruebas de Visión/normas , Agudeza Visual , CaminataRESUMEN
A 36-year-old man presented with spinal myoclonus, ataxia, hearing loss, and unilateral pupillary dilation. MRI demonstrated hemosiderin deposition along the superficial surfaces of the brain, brainstem, cerebellum, and spine. The pupillary changes were localized to the preganglionic oculomotor nerve. In contrast to vasculopathic oculomotor nerve palsies, superficial siderosis may cause selective involvement of the superficially located pupillary fibers.
Asunto(s)
Fibras Autónomas Preganglionares/patología , Pupila/fisiología , Siderosis/patología , Adulto , Fibras Autónomas Preganglionares/fisiopatología , Humanos , Imagen por Resonancia Magnética , Masculino , Siderosis/fisiopatologíaRESUMEN
In this study we analysed the potential of highly purified polyclonal TcR alpha beta+, TcR gamma delta + and CD3- NK cells, to produce lymphokines in response to mitogenic stimulation. RNA hybridizations were performed to detect with high sensitivity the induction of multiple lymphokine genes. Upon stimulation with lectin and phorbol ester TcR gamma delta + lymphocytes expressed the same set of lymphokine genes as the TcR alpha beta + lymphocytes expressed the same set of lymphokine genes as the TcR alpha beta + lymphocytes, which included IL-2, -3, -4, -5, GM-CSF, TNF alpha and beta, IFN gamma. In contrast, a more limited set of lymphokine genes (GM-CSF, TNF alpha and beta, IFN gamma) was induced in activated CD3- NK cells, thus indicating that this subpopulation of cells may display different regulatory functions, with respect to CD3+ T lymphocytes.
Asunto(s)
Células Asesinas Naturales/metabolismo , Activación de Linfocitos/efectos de los fármacos , Linfocinas/genética , Receptores de Antígenos de Linfocitos T/metabolismo , Subgrupos de Linfocitos T/metabolismo , Antígenos de Diferenciación/metabolismo , Antígenos de Diferenciación de Linfocitos T/metabolismo , Secuencia de Bases , Northern Blotting , Complejo CD3 , Expresión Génica , Humanos , Datos de Secuencia Molecular , ARN/genética , Receptores de Antígenos de Linfocitos T alfa-beta , Receptores de Antígenos de Linfocitos T gamma-delta , Receptores Fc/metabolismo , Receptores de IgGRESUMEN
In five rhesus monkeys (Macaca mulatta) we used anterograde and retrograde tracing techniques to investigate the projection from the inferior temporal cortex (area TE) to the prefrontal cortex as well as the course of the projecting fibers. The results showed that TE projects to both the inferior convexity and orbital surface of prefrontal cortex and that these projections course almost exclusively via the uncinate fascicle. Transection of the uncinate fascicle deprives the prefrontal cortex of virtually all input from TE, but leaves intact inputs from prestriate and parietal visual areas as well as the amygdala. Such transection also leaves intact many projections from TE to targets other than the prefrontal cortex, including the amygdala, ventral putamen, tail of the caudate nucleus, and pulvinar.