The authors compared and analyzed the correlated meridians in Internal Classic and Study on the Eight Extra-Channels and Vessels by clinical observation on acupuncture for treatment of oculomotor paralysis and reorganization research on ancient related literature, and course of meridians and collaterals, manifestations of disease and function were used as indexes. The present symptoms of oculomotor paralysis (paralytic strabismus) are well consistent with the delineation in Internal Classic such as inability to open eyes, blurring of vision and pain of outer canthus. The results indicate that it is important to regulate the Qiao Meridian function for acupuncture treatment of oculomotor paralysis; the method of the twelve regular meridians and the eight extra-meridians is different for treatment of this disease, for the twelve regular meridians treating the superficiality and the eight extra-meridians treating the origin, and the combinativue use of the two methods can display the TCM theory thought and the characteristic of simultaneous treatment of principal and subordinate symptoms; there is closely relation between musculature diseases and pathological change of oculomotor paralysis and it is helpful in perfecting therapeutic principles and research methods.
Acupuncture Therapy ; methods ; Diagnosis, Differential ; Humans ; Meridians ; Ophthalmoplegia ; diagnosis ; therapy

PURPOSE: To report upon several cases of rhino-orbito-cerebral mucormycosis with variable clinical manifestations including ocular symptoms. METHODS: We documented three patients with rhino-orbital-cerebral mucormycosis and uncontrolled diabetes. RESULTS: The patients presented variable ophthalmic symptoms including blepharoptosis, ophthalmoplegia, visual disturbance, visual field defect and ocular pain. Despite administration of an antifungal agent within two days, all of the patients died. CONCLUSIONS: We reported the cases of three patients with rhino-orbito-cerebral mucormycosis presenting ophthalmic symptoms with a literature review. Variable initial symptoms were emphasized in making diagnosis of rhino-orbito-cerebral mucormycosis.
Blepharoptosis ; Diagnosis ; Humans ; Mucormycosis* ; Ophthalmoplegia ; Orbital Cellulitis ; Visual Fields

Alternating recurrent painful ophthalmoplegia is caused by various neurological conditions including Tolosa-Hunt syndrome, sellar mass, and parasagittal meningioma. We experienced a rare case of recurrent painful ophthalmoplegia occurring on the contralateral side as a manifestation of idiopathic hypertrophic tentorial pachymeningitis. We propose that idiopathic hypertrophic pachymeningitis should be considered in the differential diagnosis of alternating recurrent painful ophthalmoplegia.
Diagnosis, Differential ; Meningioma ; Meningitis* ; Ophthalmoplegia* ; Tolosa-Hunt Syndrome

Aged ; Animals ; Diabetes Complications ; Diagnosis, Differential ; Female ; Humans ; Ophthalmoplegia ; diagnosis ; etiology ; Tolosa-Hunt Syndrome ; diagnosis

To the best of our knowledge, isolated bilateral oculomotor nuclear palsy has not yet been reported in the literature, while bilateral oculomotor nuclear palsy with more widespread rostral brainstem infarction has often been reported. We present a patient having top of the basilar syndrome with midbrain infarction selectively involving the bilateral oculomotor nucleus. A 61-year-old woman with two episodes of vertebrobasilar infarction presented with sudden onset of bilateral ptosis. Examination revealed pronounced bilateral ptosis. In the primary position, fixation of either eye produced an approximately 50 prism diopter exotropia. Adduction of the right eye was restricted to the midline. There was moderately decreased adduction of the left eye, severe limitation of depression, and moderately decreased elevation of both eyes. Abduction of both eyes was normal. The pupils were equal, round, and reactive to light. Bilateral ptosis is suggestive of oculomotor nuclear palsy. On the basis of clinical findings alone, we could not establish whether the precise location of the lesion was all the subdivisions of the oculomotor nucleus except the Edinger-Westphal nucleus or the central caudal nucleus and bilateral fascicles. However, because axial MRI showed a small midbrain infarct in the oculomotor nucleus region, we concluded that she had an isolated, pupil-sparing, bilateral oculomotor nuclear palsy caused by midbrain infarct.
Cerebral Infarction/*complications/diagnosis ; Female ; Human ; Magnetic Resonance Imaging ; *Mesencephalon ; Middle Aged ; Ophthalmoplegia/diagnosis/*etiology/physiopathology

Cavernous sinus syndrome (CSS) is defined as the involvement of two or more of the third, fourth, fifth (V1, V2) or sixth cranial nerves or involvement of only one of them in combination with a neuroimaging-confirmed lesion in the cavernous sinus. Some cases of CSS are attributed to Tolosa-Hunt syndrome (THS), an idiopathic inflammatory disease of the cavernous sinus. THS is characterized by painful ophthalmoplegia due to granulomatous inflammation in the cavernous sinus. THS is a diagnosis of exclusion that requires a vigorous series of differential diagnoses, and corticosteroid therapy is known to dramatically resolve clinical findings of THS. We report a case of a patient with painful ophthalmoplegia associated with vision loss, which was suspected to be THS. This patient followed a relatively typical clinical course of THS on steroid pulse therapy. We emphasize the differential diagnosis of THS, its presentation, and treatment.
Abducens Nerve ; Cavernous Sinus ; Diagnosis ; Diagnosis, Differential ; Headache* ; Humans ; Inflammation ; Ophthalmoplegia ; Tolosa-Hunt Syndrome*

Of the anxiety disorders which may be identified in a clinical setting, generalized anxiety disorder (GAD) has often been overlooked for several reasons : 1) its unremarkable place in the diagnostic hierarchy, 2) relationship to excessive anxiety and worry, and 3) comorbidity with other mental disorders which may take clinical precedence. However, clinicians should be attentive to the clinical signs leading to a diagnosis of GAD. This paper reviewed the availability of reliable assessment tools to help clinicians diagnose and assess GAD. First, diagnostic interview tools targeting GAD were introduced. Then, the tools for assessing worry (intensity/frequency/topic), factors associated with its maintenance (cognitive avoidance, intolerance of uncertainty), and tools for assessing generalized anxiety (severity/aspects), comorbid condition and differential diagnosis were reviewed. Lastly, cultural and developmental aspects related to GAD were addressed. The considerations included in this report were summarized in a flow chart and table that are practically useful in the diagnoses and assessment of GAD. Thus, this review provided guidelines for clinicians in the Korean psychiatric setting to enable appropriate diagnosis, assessment, and treatment of GAD.
Anxiety ; Anxiety Disorders ; Comorbidity ; Diagnosis, Differential ; Hypogonadism ; Mental Disorders ; Mitochondrial Diseases ; Ophthalmoplegia

PURPOSE: We report the clinical findings and surgical results of congenital fibrosis of extraocular muscles in a 5-year-old boy. METHODS: For a 5-year-old boy diagnosed with congenital fibrosis of extraocular muscles, we performed myectomy with disinsertion of both lateral rectus muscles and inferior rectus muscles and the conjunctival recession. We checked the position and motility of the eyeball before and after the operation, computerized tomography(CT) preoperatively, and the muscle biopsy postoperatively. RESULTS: In a 5-year-old boy complaining of blepharoptosis and ophthalmoplegia of both eyes from birth, and gaze limitation in all direction except abduction, atrophy of the extraocular muscles was found in CT. After myectomy with disinsertion of both lateral rectus muscles and inferior rectus muscles and conjunctival recession, the eyeball position improved but lower eyelid retraction occurred. The biopsy of the inferior rectus muscle confirmed the diagnosis of fibrosis of extraocular muscles. CONCLUSIONS: Congenital fibrosis of extraocular muscles shows ophthalmoplegia and blepharoptosis from birth. With clinical findings, extraocular muscle atrophy in CT is a useful finding in diagnosis. In treatment, extraocular muscle recession or disinsertion can be done but the treatment of postoperative lower lid retraction is required. Treatment of combined blepharoptosis can also be required.
Atrophy ; Biopsy ; Blepharoptosis ; Child, Preschool ; Diagnosis ; Eyelids ; Fibrosis* ; Humans ; Male ; Muscles* ; Muscular Atrophy ; Ophthalmoplegia ; Parturition

A classic triad of acute external ophthalmoplegia, areflexia and ataxia characterizes Miller Fisher syndrome(MFS). Diagnosis is based on clinical findings and supported by two laboratory findings; CSF albuminocytological dissociation and serum anti-GQ1b IgG antibody testing. Anti-GQ1b antibody is a key factor in the pathogenesis of Miller Fisher syndrome and a useful marker in laboratory diagnosis. Here we report 2 cases with Miller Fisher syndrome without ataxia, whose major symptom was acute external ophthalmoplegia. Case 1 was associated with preceding Epstein-Barr virus infection and negative anti- GQ1b antibody. Case 2 was positive for the anti-GQ1b antibody. Both received intravenous immunoglobulin and fully recovered within 2 months after the onset of disease.
Ataxia* ; Clinical Laboratory Techniques ; Diagnosis ; Herpesvirus 4, Human ; Immunoglobulin G ; Immunoglobulins ; Miller Fisher Syndrome* ; Ophthalmoplegia

A 67-year-old woman with brainstem abscess was cured by nonsurgical treatment. The clinical features and MRI findings allowed the presumptive diagnosis to be made. The abscess was located in the left midbrain part of brainstem; left ptosis and partial ophthalmoplegia with ellipticaI pupil. Massive antibiotic therapy was provided and clinical improvement was resulted. The authors reviewed reported cases and discussion was presented.
Abscess* ; Aged ; Brain Stem* ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Ophthalmoplegia ; Pupil