Wernekink commissure syndrome is a rare midbrain syndrome with bilateral cerebellar dysfunction,eye movement disorder,and palatal myoclonus.Few cases of this syndrome have been reported in China,let alone those combined with hallucinations and involuntary groping.This paper reports the diagnosis and treatment of a case of Wernekink commissure syndrome with hallucinations and involuntary groping,aiming to enrich the knowledge about this disease for clinicians.
Humans ; Mesencephalon ; Ocular Motility Disorders/diagnosis* ; Spinal Cord ; Syndrome ; Hallucinations

BACKGROUND: Ocular flutter is a rare horizontal eye movement disorder characterized by rapid saccadic oscillations. Excessive discharge of burst neurons, and/or loss of tonic excitation of pause cells cause ocular flutter in several neurologic diseases. Ocular flutter can be easily differentiated from other saccadic oscillations with the aid of electro-oculography (EOG) findings showing an absence of intersaccadic intervals. METHODS: We analyzed EOG findings of ocular flutter in four patients. RESULTS: Ocular flutter, which was shown as rapid, repetitive, horizontal, symmetrical, and sinusoidal movements without intersaccadic intervals on EOG, was confirmed in four patients. The etiology of each patient was olivopontocerebellar atrophy (1 case), meningoencephalitis (2 cases), and lithium intoxication (1 case). CONCLUSIONS: Ocular flutter can be present in numerous neurologic diseases. Characteristic EOG findings are useful in the diagnosis of ocular flutter.
Diagnosis ; Electrooculography ; Humans ; Lithium ; Meningoencephalitis ; Neurons ; Ocular Motility Disorders ; Olivopontocerebellar Atrophies ; Saccades

A 65-year-old man who had been experiencing diplopia in front and down gaze for 15 days visited our hospital. Hypertropia was noted in the patient's left eye, and limitation of depression was found in the adduction, primary gaze, and abduction. Brain magnetic resonance imaging showed no remarkable findings. Two weeks after the first visit, the patient complained of ptosis in the left eye. An ice test was performed and the ptosis was resolved after the test. Then, anti-acetylcholine receptor binding antibody levels were checked and found to be slightly elevated. We prescribed methylprednisolone per os 24 mg for 2 weeks, and his symptoms improved after the 2-week treatment. Five weeks after his first visit, the patient showed an ortho result in the alternate prism cover test and normal ocular movements. This may be the first case in which ocular myasthenia gravis presented as double depressor palsy, and in such cases, the possibility of ocular myasthenia gravis should be considered to rule out double depressor palsy.
Aged ; Diagnosis, Differential ; Diplopia/*diagnosis/*etiology ; Humans ; Male ; Myasthenia Gravis/*complications/*diagnosis ; Ocular Motility Disorders/diagnosis/etiology ; Strabismus/diagnosis/etiology

BACKGROUND: Cavernous malformations consist of dilated vascular spaces separated by fibrous tissues that create a well-defined mass. They are increasingly recognized in the brainstem with the advent of magnetic resonance imaging (MRI). This study was aimed to understand neuro-ophthalmologic findings in the brainstem cavernous malformations. METHODS: Fourteen patients with brainstem cavernous malformations, who presented mainly with neuro-ophthalmologic findings, were asked to participate in this study. The diagnosis was based on the characteristic MRI findings of well-circumscribed lesions with a mottled core of mixed-signal intensity. All patients received full neuro-ophthalmological evaluation, including oculography in some of them. RESULTS: Seven patients mainly presented with ophthalmoplegia, 3 with abducens palsy, 1 with oculomotor palsy, 1 with gaze-evoked nystagmus, and another 2 with internuclear ophthalmoplegia. In the other 7 patients, the main neuro-ophthalmologic findings were ocular dyskinesia with variable degree of ophthalmoplegia. Six of them had oculopalatal tremor and the other patient showed macrosaccadic oscillation. Six of the 14 patients had a history of recurrent ophthalmoplegia from repeated bleedings of the cavernous malformations. CONCLUSIONS: Cavernous malformations in the brainstem can manifest with various ocular motor abnormalities. In patients with recurrent ophthalmoplegia or oculopalatal tremor, cavernous malformation in the brain stem should be considered in the differential diagnosis.
Brain Stem* ; Diagnosis ; Diagnosis, Differential ; Dyskinesias ; Eye Movements* ; Humans ; Magnetic Resonance Imaging ; Ocular Motility Disorders ; Ophthalmoplegia ; Paralysis ; Tremor

PURPOSE: To determine the degree of control-grade of exotropia and related clinical factors in patients diagnosed with intermittent exotropia. METHODS: One hundred seventy-six patients with a diagnosis of intermittent exotropia were evaluated for control of their deviation. The relationship to age at onset and diagnosis, time interval between the onset and diagnosis, refractive error, visual acuity, near stereopsis, angle of deviation, type of exotropia, accompanied hypertropia, oblique overaction and AV pattern were investigated. RESULTS: Mean control grade is 2.76+/-1.56 point and 114 (65%) were within range of grades from excellent to fair. Poor control of exotropia was significantly correlated with poor near stereopsis (p=0.000), long time interval (p=0.033), binocular amblyopia (p=0.000), large angle of exodeviation (p=0.028), convergence insufficiency type (p=0.017), accompanied hypertropia (p=0.008), AV pattern (p=0.003), and oblique overaction (p=0.000). Among these factors, the influences of stereopsis, hypertropia, oblique overaction, convergence insufficiency type were statistically significant when multiple linear regression analysis was performed (p=0.000, 0.026, 0.044, 0.011 respectively). CONCLUSIONS: The factors of near stereopsis, accompanied hypertropia, oblique overaction and convergence insufficiency type correlated significantly with control of exotropia which may interfere with fusion and contribute to the prognosis of intermittent exotropia.
Amblyopia ; Depth Perception ; Diagnosis ; Exotropia* ; Humans ; Linear Models ; Ocular Motility Disorders ; Prognosis ; Refractive Errors ; Strabismus ; Telescopes ; Visual Acuity

Internuclear ophthalmoplegia(INO) is characterized by the adduction deficit on lateral gaze associated with dissociated nystagmus of an abducting eye and caused by the lesion in the medial longitudinal fasciculus(MLF). It occurs unilaterally or bilaterally in infarction of brain stem and multiple sclerosis. Ocular myasthenia is a localized form of myasthenia involving extraocular, levator palpebrae perioris, and/or orbicularis oculi muscles. It is frequently confused with a variety of ocular mortility disorders including INO. We experienced 2 patients who had bilateral wall-eyes and diplopia. One was a true bilateral INO due to hypertensive brain stem infarction(Wall-eyed bilateral INO) and the other was a myasthenic bilateral pseudo-INO. Diagnosis was made by Tensilon test, repetitive nerve stimulation test of orbicularis oculi muscles, and serum antibody assay in latter case.
Brain Stem ; Diagnosis ; Diplopia ; Edrophonium ; Exotropia* ; Humans ; Infarction ; Multiple Sclerosis ; Muscles ; Nystagmus, Pathologic ; Ocular Motility Disorders ; Ophthalmoplegia*

Behçet's disease is a systemic chronic disease that occurs in tissues such as eyes, joints, organs and nerves, and it has been noted that symptoms may be observed in a variety of tissues. In previous studies, reports of blepharoptosis observed in patients with Behçet's disease have been rare. We would like to report a case where a patient among those who visited our hospital with blepharoptosis had a history of Behçet's disease. This patient had been diagnosed with Behçet's disease, and complained of bilateral blepharoptosis even at the time of diagnosis. He complained of dysfunctions in vision and hearing, and upon eye examination, an eye movement disorder was found in his left eye. From the symptoms, neuro-Behçet's disease was diagnosed. The oculomotor and levator palpebrae superioris muscles are both controlled by cranial nerve III, which may suggest that Behçet's disease in this patient occurred in cranial nerve III. The patient received an oral steroid, and the symptoms have improved without surgery. Since we could identify the correlation between Behçet's disease and blepharoptosis, we considered that sharing this case and its outcome would be helpful for plastic surgeons who treat eyelids.
Behcet Syndrome ; Blepharoptosis* ; Chronic Disease ; Diagnosis ; Eyelids ; Hearing ; Humans ; Joints ; Muscles ; Ocular Motility Disorders ; Oculomotor Nerve ; Plastics ; Surgeons

PURPOSE: To report two patients with positive ice tests who had diplopia and blepharoptosis caused by something other than ocular myasthenia gravis. CASE SUMMARY: A 35-year-old female presented with a one-week history of inability to adduct the left eye and left blepharoptosis. Although the ice test was positive, serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Brain angiography showed an aneurysm of the left posterior communicating artery, leading to the diagnosis of left pupil-sparing oculomotor nerve palsy. A 25-year-old female presented with an 8-month history of intermittent horizontal diplopia and blepharoptosis in the right eye. The ice test was positive, however serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Anti-nuclear antibody was positive (titer 1:160). CONCLUSIONS: The ice test is a useful screening test for myasthenia gravis. However, a series of differential diagnoses including blepharoptosis and ocular motility disorder should be considered because these conditions also show a positive result in the ice test.
Adult ; Aneurysm ; Angiography ; Arteries ; Blepharoptosis ; Brain ; Diagnosis ; Diagnosis, Differential ; Diplopia ; Female ; Humans ; Ice* ; Mass Screening ; Myasthenia Gravis* ; Ocular Motility Disorders ; Oculomotor Nerve Diseases

The patient with complaints of seizure, headache and upward gaze paralysis underwent V-P shunt under the impression of pinealoma. The diagnosis of cerebral paragonimiasis was eventually made by the aid of brain CT scan and PW skin test. The case showed a positive intradermal test with relevant histories of eating rare crayfishes and the characteristic CT findings. Plain skull X-ray showed the round calcifications around the pineal region. Brain CT demonstrated multiple round calcifications in the left fronto-occipital region and dilation of the left lateral ventricle with cortical atrophy.
Astacoidea ; Atrophy ; Brain ; Diagnosis ; Eating ; Headache ; Humans ; Intradermal Tests ; Lateral Ventricles ; Ocular Motility Disorders* ; Paragonimiasis* ; Paralysis ; Pinealoma ; Seizures ; Skin Tests ; Skull ; Tomography, X-Ray Computed

PURPOSE: To describe the neuro-ophthalmic findings in a group of patients with head trauma. METHODS: A retrospective chart review of all patients who were given a diagnosis code of cerebral concussion and cerebral contusion in a hospital between 1995 and 2003. A total of 1284 consecutive patients were reviewed (972 [76%] men and 312 [24%] women). The mean age was 40.36 years. Motor vehicle accident was the most common cause of head trauma, occurring in 944 (74%) patients. RESULTS: Ophthalmological examination was undertaken in 308 (24%) head trauma patients and an abnormal neuro-ophthalmic examination result was noted in 122 patients (9.5% of total patients, 40% of ophthalmologically examined patients). Traumatic optic neuropathy was the most common manifestation, followed by oculomotor, abducens, trochlear, facial nerve palsy, Terson syndrome and internuclear ophthalmoplegia. Loss of consciousness and cerebral concussion were not associated with any outcomes, but the presence of neuroimaging (computed tomography, magnetic resonance imaging) abnormality, particularly intracranial hemorrhage and skull fracture, was significantly associated with neuro-ophthalmic deficits. CONCLUSIONS: Head trauma causes a number of neuro-ophthalmic manifestations. Intracranial hemorrhage and skull fracture may be a reliable predictor of specific neuro-ophthalmic outcomes.
Brain Concussion ; Contusions ; Craniocerebral Trauma* ; Diagnosis ; Facial Nerve ; Head* ; Humans ; Intracranial Hemorrhages ; Male ; Motor Vehicles ; Neuroimaging ; Ocular Motility Disorders ; Optic Nerve Injuries ; Paralysis ; Retrospective Studies ; Skull Fractures ; Unconsciousness