In Bach Mai Hospital from May 1998 to June 2002, 23 children aged 10-15 (15 girls and 8 boys) with malformation of brain vessel were diagnosed definitely. Most of under 11-year-old children have swelling vessel, 30.4% of above 11-year-old children have AVM malformation - 52.1%. The main manifestations of brain vessel malformation are hemorrhage of brain lobe 65.2%, subarachroid hemorrhage 39.1%, brain ischemia 30.4%, epilepxy or epileptic conditions 21.7%, head pain of migraine type 17.4%. Unilateral palsy of III nerve is specific sign for diagnosis of swelling of prosterior communicating artery with a rate of 8.7%. Dysphasia is temporary, while the visual dysfunction is more persistent
Child ; Pupil Disorders ; Nervous System Malformations

The pupillary size and movement are controlled dynamically by the autonomic nervous system; the parasympathetic system constricts the iris, while the sympathetic system dilates the iris. Under normal conditions, these constrictions and dilations occur identically in both eyes. Asymmetry in the pupillomotor neural input or output leads to impaired pupillary movement on one side and an unequal pupil size between both eyes. Anisocoria is one of the most common signs in neuro-ophthalmology, and the neurological disorders that frequently cause anisocoria include serious diseases, such as vascular dissection, fistula, and aneurysm. A careful history and examination can identify and localize pupillary disorders and provide a guide for appropriate evaluations.
Aneurysm ; Anisocoria ; Autonomic Nervous System ; Constriction ; Fistula ; Horner Syndrome ; Iris ; Nervous System Diseases ; Pupil ; Pupil Disorders ; Tonic Pupil

A Dilated pupil with a loss of reactions to light and accommodation convergence exhibit these defects in varying degree, and occur under a variety of circumstances. These conditions include unilateral dilatation and fixity of the pupil as a result of injury to the eye and as the result of ipsilateral cerebral compression and bilaterally dilated and fixed pupils seen commonly in juvenile paresis and tabo-paresis. There are another unknown circumstances as tonic pupil. The authors presented a case of 22 years old Korean female under the diagnosis of dilated and fixed pupil which possibly originated from syphilis in as much as she was strongly positive reaction in serum S.T.S. and her abnormal pupil was recovered after anti-syphilitic therapy. The authors reviewed the literatures concerning these conditions and discussed about the possibility of early involvement of syphilis in the nervous system and the possible site of lesion which interefere pupillary reflex to light and accommodation-convergence. Finally authors commented the possible site of lesion is efferent pupilloconstrictor fibers which pass through the tentorial gap. In this region para-sympathetic pupilloconstrictor fibers, concentrated over the superior are of the oculomotor nerve, may be compressed upon its superior surface by inflammatory swelling of syphilitic involvement of adjacent structures.
Diagnosis ; Dilatation ; Female ; Humans ; Nervous System ; Neurosyphilis ; Oculomotor Nerve ; Pupil ; Pupil Disorders* ; Reflex, Pupillary ; Syphilis ; Tonic Pupil ; Young Adult

The pupillary size and movement are controlled dynamically by the autonomic nervous system; the parasympathetic system constricts the iris, while the sympathetic system dilates the iris. Under normal conditions, these constrictions and dilations occur identically in both eyes. Asymmetry in the pupillomotor neural input or output leads to impaired pupillary movement on one side and an unequal pupil size between both eyes. Anisocoria is one of the most common signs in neuro-ophthalmology, and the neurological disorders that frequently cause anisocoria include serious diseases, such as vascular dissection, fistula, and aneurysm. A careful history and examination can identify and localize pupillary disorders and provide a guide for appropriate evaluations.
Aneurysm ; Anisocoria ; Autonomic Nervous System ; Constriction ; Fistula ; Horner Syndrome ; Iris ; Nervous System Diseases ; Pupil ; Pupil Disorders ; Tonic Pupil

Rieger's anomaly refers to a dysgenesis that features bilateral hypoplasia of the iris stroma, posterior embryotoxon and the associated angle anomalies, pupillary distortion, polycoria, and a high likelihood of glaucoma. In addition to glaucoma, other defects, usually dental, may be present in Rieger's anomaly. When glaucoma occurs, it usually develops during the first to third decades but infrequently occurs in infancy. Frequently mesodermal dysgenesis accompanies ectopia of the pupil and polycoria. In these anomalies no new synechias are formed such as occur in essential iris atrophy. Cataracts are occasionally part of the picture. The anomaly is extremely variable in its expression with the full-blown disease in one member of a family and only minimun signs in another. The authors experienced a case of Rieger's anomaly which occurred in both eyes of 18 year old male who had above characteristic ocular findings and associated juvenile onset glaucoma.
Adolescent ; Atrophy ; Cataract ; Glaucoma ; Humans ; Iris ; Male ; Mesoderm ; Pupil ; Pupil Disorders

A unilated cataract had been reported to cause a relative afferent pupillary defect (RAPD) in the contralateral eye. After extraction of the cataract, the RAPD disappeared in every case. The ability of cataracts to induce an RAPD in the opposite eye is presumed to increased intraocular scatter of light by the cataract, stimulating more peripheral photoreceptors. This observation has not been reported in Korea. The authors have also observed RAPD in the contralateral eye to the unilateral cataract in six patients, disappearing after cataract surgery. Thus, when an RAPD is seen in an eye with a cataract, a visual pathway defect in that eye should definitely be suspected. In addition, it would be better to hold the brain imaging study when an RAPD is noticed in the contralateral eye to the unilateral cataract and to confirm the normal pupillary reflex in both eyes after the cataract surgery.
Cataract* ; Humans ; Korea ; Neuroimaging ; Pupil Disorders* ; Reflex, Pupillary ; Visual Pathways

PURPOSE: To investigate the incidence, associated factors, and the prognostic significance of relative afferent papillary defect (RAPD) in the eyes with less severe cataract and determine which mechanism of 'scattering' or 'dark adaptation' is more applicable, we evaluated 40 patients with asymmetric cataract (AC). METHODS: Forty patients of AC with the differences of three lines or more of visual acuity by Han's visual acuity chart underwent ophthalmic examinations including the 'swinging flashlight test' and electroretinogram before and after cataract surgery. RESULTS: There were nineteen patients who showed definite RAPD in the eyes with less severe cataract. The differences of log MAR between the two eyes were more than 1.55 or less than 0.73 in 17 patients (89.5%) with RAPD. Degree of posterior subcapsular opacity was marginally associated with RAPD in the eyes with less than 1.06 of log MAR differences. There was no association between the presence of RAPD and postoperative visual acuities. In the eyes with RAPD, b wave amplitudes tended to be smaller in the eyes with more severe cataract than those with less severe cataract before dark adaptation. However, after dark adaptation, b wave amplitudes tended to be larger in eyes with more severe cataract than those in the eyes with less severe cataract, and preoperatively than postoperatively. CONCLUSIONS: The incidence of RAPD of less severe cataract eye was significant (48%) but RAPD was not associated with visual acuity prognosis. The results of electroretinogram more favored 'scattering ' than 'dark adaptation' as the mechanism of RAPD phenomenon.
Cataract* ; Dark Adaptation ; Humans ; Incidence ; Prognosis ; Pupil Disorders* ; Visual Acuity

It has been reported that pupillary paralysis is rare findings in typical Guillain-Barre syndrome(GBS). We experienced a 56-year-old male with fulminant GBS who pupillary paralysis. He showed quadriplegia, total paresis of motor cranial nerves including bilateral ptosis and complete opthalmoplegia. Pupils were dilated up to 8mm and fixed. After a one year follow up, his pupil slowly constricted to light. The instillation of 0.1% pilocarpin caused both pupillary constriction. These results pointed to postganglionic involvement of pupillary parasympathetic nerves.
Constriction ; Cranial Nerves ; Follow-Up Studies ; Guillain-Barre Syndrome* ; Humans ; Male ; Middle Aged ; Paresis ; Pilocarpine ; Pupil ; Pupil Disorders* ; Quadriplegia

OBJECTIVE: The aim of this study was to identify the prognostic factors for recovery from oculomotor nerve palsy in patients with a posterior communicating artery aneurysm after surgical intervention. METHODS: We retrospectively reviewed 16 patients with a ruptured or unruptured posterior communicating artery aneurysm that was associated with oculomotor nerve palsy and these patients were treated in our hospital between 2002 and 2006. Fifteen of the 16 patients were women, and the patients' ages ranged between 38 and 75 years (mean age: 52.6 years), and the follow up period was from 0.5 to 36 months (mean: 8.75 months). RESULTS: The total number of aneurysmal cases treated over the 5-year study period was 1135, and there were 223 patients (19.6%) with posterior communicating artery aneurysms. Among these 223 patients, 16 (7.2%) presented with third cranial nerve palsy (4 ruptured, 12 unruptured). Ptosis was presented in all cases (100.0%). Extraocular muscle palsy was presented to some degree by 10 cases (62.5%). The affected pupils were dilated and fixed in all patients (100.0%). The ptosis improved completely in 13 patients (81.3%), and incompletely in 3 patients (18.7%) within 6 months. The dilated and fixed pupils were improved in 10 of the 16 patients (62.5%). The extraocular muscle palsies recovered completely in 15 cases within 6 months. The mean interval between palsy onset and the time of surgery was 6.2 days for the complete recovery cases, and 22 days for the incomplete recovery cases. However, recovery of papillary function was unpredictable. CONCLUSIONS: The duration of symptoms and the degree of preoperative deficits are considered as prognostic factors for the postoperative recovery from third nerve palsy in patients with a posterior communicating artery aneurysm.
Aneurysm* ; Female ; Follow-Up Studies ; Humans ; Intracranial Aneurysm ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Paralysis ; Pupil ; Pupil Disorders ; Retrospective Studies

PURPOSE: We report a case of Urrets-Zavalia syndrome with a fixed dilated pupil after an uneventful trabeculectomy.CASE SUMMARY: Trabeculectomy was performed on a 51-year-old male who had a history of recurrent uveitis in the left eye, with uncontrolled intraocular pressure despite maximally-tolerated medial therapy. There was no unexpected event during surgery. Topical 1% atropine was used for only 2 days after surgery. In the early postoperative period, 1% prednisolone and 0.3% ofloxacin were given four times a day, then gradually reduced. One month later, only 1% prednisolone was given once a day. Intraocular pressure in his left eye was well controlled from 8–14 mmHg after surgery. One month after surgery, the pupils remained dilated. There was no reaction to topical 2% pilocarpine and no relative afferent pupillary defect or posterior synechia.CONCLUSIONS: Our case, although rare, suggests that Urrets-Zavalia syndrome should be considered in patients with well-controlled intraocular pressure after uneventful trabeculectomy.
Atropine ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Ofloxacin ; Pilocarpine ; Postoperative Period ; Prednisolone ; Pupil ; Pupil Disorders ; Trabeculectomy ; Uveitis