Dengue fever is an acute febrile disease that is caused by a mosquito-borne flavivirus. It has become a major infectious disease threat in tropical and subtropical areas. In Korea, travel-associated dengue fever is increasing. Thirty-five Koreans went to Sri Lanka to do volunteer activities. Eight of the volunteers developed fever, myalgia, and rash; they were diagnosed with dengue fever. Two patients had macular hemorrhages and edema with no ophthalmic symptoms. The maculopathy caused by the dengue fever improved without specific treatment.
Communicable Diseases ; Dengue* ; Edema ; Exanthema ; Eye Manifestations ; Fever ; Flavivirus ; Hemorrhage ; Humans ; Korea ; Myalgia ; Sri Lanka* ; Volunteers*

PURPOSE: To report a case of a 9-year-old girl who complained of a floater symptom due to preretinal hemorrhage, subdural hemorrhage and arachnoid cyst. CASE SUMMARY: A 9-year-old girl presented to our clinic with floater symptom in her right eye and a headache. Her corrected visual acuities were 20/20 in both eyes. Preretinal hemorrhage around the optic disc in both eyes was observed. Brain MRI revealed subdural hemorrhage on the frontal, temporal, and parietal lobes, and the arachnoid cyst in the right fronto-temporal lobe. One year later, the preretinal hemorrhages were absorbed. CONCLUSIONS: Arare case of concomitant preretinal and spontaneous subdural hemorrhage with arachnoid cyst was presented. The utilization of brain MRI is recommended to determine underlying causes when fundus examination reaveals retinal hemorrhage without trauma, systemic disease and neurologic symptom.
Arachnoid ; Brain ; Child ; Eye ; Headache ; Hematoma, Subdural ; Hemorrhage ; Humans ; Neurologic Manifestations ; Parietal Lobe ; Retinal Hemorrhage ; Visual Acuity

A clinical study was done on 29 cases of spontaneous pontine hemorrhage which were confirmed by brain CT scan at Keimyung university Dongsan hospital from Jan. 1981 to Feb. 1986. The results are summarized as follows. 1. The incidence of pontine hemorrhage was 7.4% of all spontaneous intracranial parenchymal hemorrhage. 2. The most prevalent age group were 40th and 50th decades and male to female ratio was 2.2:1. 3. The most common precipitating factor was hypertension and most of pontine hemorrhage occurred during daily routine or increased activities. 4. Symptoms on onset were headache, altered consciousness, vomiting, dizziness, motor weakness, dysarthria, sensory disturbance and generalized convulsion, in order of frequency. 5. Cardinal neurologic signs on admission were loss of consciousness, ocular signs e.g. Pinpoint or miotic pupil absent horizontal doll's eye movement ocular bobbing skew deviation MLF syndrome, motor weakness e.g. quadriparesis hemiparesis decerebrate rigidity, positive Babinski sign. 6. Mean size of hematoma on CT was 6.8cc and 44% was under 5cc. Hematoma of 4th ventricle was seen in 36% of pontine hemorrhage. 7. 25 cases of pontine hemorrhage were divided into 3 groups according to the location of hematoma on CT-basilar (2 cases), tegmental (15 cases), diffuse (8 cases). 8. All 29 cases of pontine hemorrhage were treated medically, 21% were improved, and 79% hopeless discharge or death. 9. Mild disturbance of consciousness on admission, small size (under 5cc) of hematoma and absence of hematoma in the 4th ventricle seem to be good prognostic indicators.
Brain ; Consciousness ; Decerebrate State ; Dizziness ; Dysarthria ; Eye Movements ; Female ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Hypertension ; Incidence ; Male ; Neurologic Manifestations ; Ocular Motility Disorders ; Paresis ; Precipitating Factors ; Pupil ; Quadriplegia ; Reflex, Babinski ; Seizures ; Tomography, X-Ray Computed ; Unconsciousness ; Vomiting

Locked in syndrome (LIS) is a state of tetraplegia and lower cranial nerve palsies in which vertical eye movement and blinking are the only means of communication, but consciousness is preserved. LIS is most frequently a sequelae of a basilar artery thrombosis lesion and may be caused by trauma, hemorrhage, a tumor, infection, etc., which results in a ventral pontine lesion or bilateral midbrain lesion. Early diagnosis and treatment must be a priority because the recovery of patients with locked in syndrome caused by a basilar artery occlusion is exceptional, with a 65~75% mortality. Although an improved clinical outcome can be achieved in patients with a basilar artery occlusion by early recanalization after the use of thrombolytic therapy or angioplasty, early diagnosis and treatment of this state is difficult, for the neurologic deficits develope gradually. The diagnosis of LIS in patients who present with hypoxia, metabolic disorder, endocrine disorder, central nerve system disorder, acute alcohol intoxication, acute drug intoxication, etc may be missed. At the emergency department, closer attention and frequent neurologic examinations must be given to patients who complain of altered mental state. We report a case of LIS which was misdiagnosised as hypoglycemic encephalopathy and review the literature.
Angioplasty ; Anoxia ; Basilar Artery ; Blinking ; Consciousness ; Cranial Nerve Diseases ; Diagnosis ; Diagnostic Errors ; Early Diagnosis ; Emergency Service, Hospital ; Eye Movements ; Hemorrhage ; Humans ; Hypoglycemia* ; Mesencephalon ; Mortality ; Neurologic Examination ; Neurologic Manifestations ; Quadriplegia* ; Thrombolytic Therapy ; Thrombosis

Akinetic mutism (AM) is a rare complication of spontaneous subarachnoid hemorrhage (SAH). It is characterized by mutism and general hypokinesis in a patient superficially fully awake in that the eyes remain open and follow objects. Most common cause of AM in patients with SAH is secondary infarction in the distal anterior cerebral artery (DACA) territory. Sometimes post-SAH hydrocephalus has also been implicated in a delayed form of AM because of disruption of dopaminergic pathway. We report a case of 64-year-old woman who presented with sudden bursting headache without neurologic deficit. She was referred from the other hospital with a diagnosis of spontaneous SAH on head computed tomography (CT) which showed high density on sylvian, interhemispheric fissures and basal cistern. We performed computed tomographic cerebral angiography (CTA) and trans-femoral catheter cerebral angiography (TFCA), that revealed no definitive intracranial aneurysm, arterial dissection, or other vascular abnormality of the SAH. During admission period, she developed mutism and motor weakness of all limbs without spontaneous movement. We performed brain magnetic resonance (MR) image and RI cisternography. Also we prescribed levodopa. On the 33th hospital day, she had neurological recovery with drowsy mentality and grade 4 weakness of all limbs, but she was observed to suddenly develop general weakness and became cardiac arrest on the 55th hospital day. Efforts to resuscitate her failed, no more treatment could not be applied. In our case, we couldn't find infarction in the DACA terriority, midbrain or cerebellum except communicating hydrocephalus. This case may alert neurosurgeon to recognize the possibility of such rare complication after spontaneous SAH.
Akinetic Mutism ; Anterior Cerebral Artery ; Brain ; Catheters ; Cerebellum ; Cerebral Angiography ; Extremities ; Eye ; Female ; Head ; Headache ; Heart Arrest ; Humans ; Hydrocephalus ; Infarction ; Intracranial Aneurysm ; Levodopa ; Magnetic Resonance Spectroscopy ; Mesencephalon ; Middle Aged ; Mutism ; Neurologic Manifestations ; Subarachnoid Hemorrhage

PURPOSE: Recently syncope can be recored on video during head-up tilting table test (HUT). We assess the eye signs during the syncope to characterize eye signs of syncope.METHODS: We tried HUT based on the SMC protocol. The protocol includes video setting for eye observation. We included the subjects who had HUT at Samsung Medical Center, Seoul, Korea between October 2010 and June 2011. We investigated the video of the patients with positive results and syncope during HUT, especially focusing on the eye signs including eye opening and eyeball position. We analyzed the differences of hemodynamic parameters between eye-open and eye-close groups.RESULTS: Of 380 patients with positive HUT, 53 (13.9%) patients experienced syncope during the test. Among the syncope patients, 31 (58.5%) patients showed eye opening during the syncopal attack and 22 (41.5%) patients revealed eye closure. When the syncopal patient had eye open, the eyeball position was fixed in 22 patients. Upward deviation was most common position. Eye opening group showed significant decrease of systolic blood pressure and heart rate during syncopal attack compared with eye closing group (p=0.044, p=0.041).CONCLUSIONS: We concluded that eye opening state during syncopal attack can be the sign of more severe degree of cardiohemodynamic dysfunction.
Blood Pressure ; Eye ; Eye Manifestations ; Eye Movements ; Heart Rate ; Hemodynamics ; Humans ; Korea ; Seizures ; Syncope ; Tilt-Table Test

In recent years the immunocompromised population has increased rapidly to include people with acquired immune deficiency syndrome (AIDS), drug abusers, and transplant patients. Accordingly, the incidence of intracranial fungal infection has increased. Our institution experienced 2 cases of internal carotid artery (ICA) occlusion due to invasion of the cavernous sinus by an intracranial fungal infection. The first case was a 60-year-old man who presented with headache, eye pain, conjunctival injection, right-sided diplopia, and blurred vision. Infected tissues within the frontal and ethmoid sinuses were removed via bifrontal craniotomy and endoscopic sinus surgery through the Caldwell Luc approach. The second case was a 63-year-old woman who developed right-sided facial pain after a tooth extraction. The infection was not controlled despite continuous use of antifungal agents, resulting in death from sepsis. We believe that when intracranial fungal infection is suspected in a patient with orbital symptoms and a focal neurologic deficit, immediate angiographic investigation of possible ICA occlusion is warranted. Aggressive treatment with antifungal agents is the only way to improve prognosis.
Acquired Immunodeficiency Syndrome ; Antifungal Agents ; Carotid Artery, Internal ; Cavernous Sinus ; Craniotomy ; Diplopia ; Drug Users ; Ethmoid Sinus ; Eye Pain ; Facial Pain ; Female ; Headache ; Humans ; Incidence ; Middle Aged ; Neurologic Manifestations ; Orbit ; Prognosis ; Sepsis ; Tooth Extraction ; Transplants ; Vision, Ocular

There are several diseases characterized by neurologic abnormalities and renal disease. Joubert syndrome is one of them. Joubert syndrome is a relatively rare autosomal recessive syndrome. The most significant and constant neurologic finding is hypoplasia of the cerebellar vermis. Joubert syndrome is associated with hypotonia, retinal dystrophy, abnormal eye movement, delayed development, abnormal respiratory pattern (neonatal episodic tachypnea or apnea) and nephronophthisis. We report a boy with Joubert syndrome associated with nephrocalcinosis and agenesis of the cerebellar vermis. This patient had also abnormal eye movement, hypotonia, abnormal respiratory pattern, delayed development and chronic renal failure.
Eye Movements ; Humans ; Kidney Failure, Chronic ; Male ; Muscle Hypotonia ; Nephrocalcinosis* ; Neurologic Manifestations ; Retinal Dystrophies ; Tachypnea

BACKGROUND AND PURPOSE: Guillain-Barre syndrome (GBS) is an acute demyelinating polyneuropathy with various clinical features. Optic neuritis occurs in rare cases. In this study we determined the incidence and patterns of visual evoked potential (VEP) abnormality in GBS in association with ophthalmologic findings. METHODS: Thirty-two patients with a diagnosis of GBS were included in the study. The correlation between pathologic VEPs and categories of neurologic deficit and electrophysiological findings were examined statistically. RESULTS: The patients ranged in age from 19 to 77 years. Five cases (16%) had abnormal VEPs. All five of these patients exhibited increased P100 latency differences between the two eyes. Other abnormalities were prolonged p100 latency, increased interocular amplitude difference, and distorted p100 configuration. Pathologic signs on ophthalmologic examination were observed in 80% of patients with abnormal VEPs. VEP abnormality was never present in pure axonal forms. There was no significant correlation between pathologic VEP and cerebrospinal fluid protein level or categories of neurologic deficits. CONCLUSIONS: Involvement of the optic pathways is not a frequent finding in GBS. When present it is always asymmetric and generally accompanied with pathologic findings on ophthalmologic examination. VEPs may be abnormal in different clinical variants of GBS, and especially in demyelinating forms.
Axons ; Evoked Potentials, Visual ; Eye ; Guillain-Barre Syndrome ; Humans ; Incidence ; Neurologic Manifestations ; Optic Neuritis ; Polyneuropathies

Ocular rosacea is the eye manifestations of rosacea, which involves the lids, conjunctiva, and cornea. A recent study revealed that all patients with cutaneous rosacea had some degree of ocular involvement which is often undiagnosed. It is difficult to make a diagnosis of ocular rosacea because it lacks clinical or pathological hallmarks. However, early diagnosis and treatment are emphasized to decrease morbidity and prevent potential blindness. We report a case of ocular rosacea in a 49 year-old man who showed blepharoconjunctivitis, keratitis, and cutaneous manifestations of persistent erythema, telangiectasia, and papules. The ocular symptoms and signs had improved significantly with tetracycline therapy.
Blindness ; Conjunctiva ; Cornea ; Diagnosis ; Early Diagnosis ; Erythema ; Eye Manifestations ; Humans ; Keratitis ; Middle Aged ; Rosacea* ; Telangiectasis ; Tetracycline