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

Fractures, Bone ; Humans ; Ocular Motility Disorders ; Orbit ; Retrospective Studies

A 49-year-old male presented with horizontal binocular diplopia without facial pain or skin lesion. Limitation of medial gaze in the left eye was revealed on neurological examination, which is accompanied by peripheral facial nerve palsy ipsilaterally. The diagnosis had been made based on the diffusion restriction lesion of left pontine tegmentum. We may denominate a “seven-and-a-half syndrome” and clinician should maintain a high level of awareness of the various syndromes associated with pontine lesions.
Diagnosis ; Diffusion ; Diplopia ; Facial Nerve ; Facial Pain ; Facial Paralysis ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Ocular Motility Disorders ; Paralysis ; Pontine Tegmentum ; Skin ; Telescopes

PURPOSE: To investigate the types and clinical features of neurological diseases after head trauma. METHODS: From March 2010 to December 2018, a total of 177 patients were enrolled in this study. We retrospectively reviewed the clinical features of neurological ophthalmic diagnoses and frequencies, the types of head injuries, and the prognoses. RESULTS: Cranial nerve palsy was the most common (n = 63, 35.6%), followed by traumatic optic neuropathy (n = 45, 25.4%), followed by optic disc deficiency, ipsilateral visual field defect, Nystagmus, skewing, ocular muscle paralysis between nuclei, and Terson syndrome. Neuro-ophthalmic deficits occurred in relatively strong traumas accompanied by intracranial hemorrhage or skull fracture. However, convergence insufficiency and decompensated phoria occurred in relatively weak trauma such as concussion. The prognoses of the diseases were poor (p < 0.05) for traumatic optic neuropathies and visual field defects. The prognoses of neurological diseases were poor if accompanied by intracranial hemorrhages or skull fractures (p < 0.05). CONCLUSIONS: After head trauma, various neuro-ophthalmic diseases can occur. The prognosis may differ depending on the type of the disease, and the strength of the trauma may affect the prognosis.
Cranial Nerve Diseases ; Craniocerebral Trauma ; Diagnosis ; Head ; Humans ; Intracranial Hemorrhages ; Ocular Motility Disorders ; Optic Nerve Injuries ; Paralysis ; Prognosis ; Retrospective Studies ; Skull Fractures ; Strabismus ; Visual Fields

PURPOSE: To evaluate the long-term efficacy of slanted lateral rectus recession in children for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency. METHODS: The medical records of 53 patients with convergence insufficiency intermittent exotropia who underwent slanted bilateral lateral rectus recession performed by a single surgeon and received follow-up for more than 12 months were retrospectively analyzed. Deviation angles at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively and on the last visit were reviewed. Surgical success was defined as postoperative residual distance and near deviation angles ≤8 prism diopters and a difference between the near and distance angles ≤8 prism diopters. RESULTS: The mean duration of follow-up was 24 months (range, 12 to 61 months). On the last visit, the residual deviation angles were ≤8 prism diopters in 75.5% for distance, 62.3% for near, and 81.1% for the near-distance difference. Surgical success was achieved in 31 (58.5%) patients, and none of them manifested limitations in eye movements or diplopia at the last follow-up visit. CONCLUSIONS: Slanted lateral rectus recession is an effective surgical method for reducing distance and near exodeviation and near-distance deviation difference in intermittent exotropia with convergence insufficiency.
Child ; Diplopia ; Exotropia ; Eye Movements ; Follow-Up Studies ; Humans ; Medical Records ; Methods ; Ocular Motility Disorders ; Retrospective Studies

The dizziness associated with paraneoplastic neurologic syndrome is hard to diagnose clinically because the prevalence of disease is rare, and radiologic and serologic examination result may come out normal. Opsoclonus-myoclonus symdrome is a representative of classical paraneoplastic neurologic syndromes. In this paper, we report 2 cases of paraneoplastic neurologic syndromes with negative serologic auto-antibody test and no brain lesion on MRI. Both cases were eventually diagnosed through PET. Patients with opsoclonus-myoclonus type nystagmus should be evaluated for paraneoplastic neurologic syndrome even if their radiologic and serologic findings are normal.
Brain ; Dizziness ; Humans ; Magnetic Resonance Imaging ; Myoclonus ; Ocular Motility Disorders ; Opsoclonus-Myoclonus Syndrome ; Paraneoplastic Syndromes, Nervous System ; Prevalence

PURPOSE: To compare the surgical outcomes between modified bilateral lateral rectus muscle (BLR) recession and augmented unilateral recession-resection (R&R) for the convergence insufficiency intermittent exotropia (IXT). METHODS: 37 patients with convergence insufficiency IXT were divided into two groups: 13 patients (underwent BLR recession) and 24 patients (underwent unilateral R&R). Success was defined as within 10 prism diopters (PD) at distance and near, and within 10 PD of the difference between them at postoperative 12 months. RESULTS: After the patch test, the preoperative distance deviation angle in the BLR group was 29.9 ± 8.4 PD, and the near deviation angle was 42.3 ± 9.7 PD; the difference between them was 12.5 ± 3.2 PD. In the R&R group, the preoperative distance deviation angle was 26.7 ± 5.8 PD, and the near deviation angle was 41.5 ± 7.4 PD; the difference between them was 14.8 ± 4.3 PD (p = 0.235, p = 0.987, and p = 0.123). At the 12-month follow-up in the BLR group, the distance angle was 3.8 ± 5.1 PD, and the near deviation angle was 4.9 ± 6.1 PD; the difference between them was 2.9 ± 5.9 PD. In the R&R group, the postoperative distance deviation angle was 4.7 ± 6.1 PD, and the near deviation angle was 7.9 ± 6.6 PD; the difference between them was 3.65 ± 5.1 PD (p = 0.708, p = 0.162, and p = 0.632, respectively). The surgical success rate did not differ significantly between groups at 12 months postoperatively (76.9%: BLR group and 70.8%: R&R group; p = 0.690). CONCLUSIONS: Modified BLR recession showed a similar surgical success rate to augmented unilateral R&R, and was effective in reducing both distance and near exodeviation, and in decreasing the difference between distance and near deviation in convergence insufficiency IXT.
Exotropia ; Follow-Up Studies ; Humans ; Ocular Motility Disorders ; Patch Tests

PURPOSE: To report a case of isolated abducens nerve palsy caused by the ophthalmic segment of an internal carotid artery (ICA) aneurysm which improved after endovascular coil trapping. CASE SUMMARY: A 59-year-old female visited the ophthalmology department for a sudden onset of horizontal diplopia for 10 days. The best corrected visual acuity was 20/20 in both eyes. The pupils showed normal response to light and near stimulation in both eyes. The extraocular examination showed 35 prism diopters left esotropia at primary gaze and −4 abduction limitation of the left eye. The patient suffered intermittent headaches in the left temporal area and left retrobulbar pain for 1 month. Magnetic resonance imaging with magnetic resonance angiography of the brain was performed. A focal protruding lesion of the left ICA suggested an aneurysm. The patient consulted with the neurosurgery department. The left ophthalmic segment of the ICA aneurysm was confirmed by transfemoral cerebral angiography and treated with coil placement and the patient showed gradual improvement after the procedure. Three months after the procedure there was no diplopia. The patient showed orthotropia at primary gaze without abduction limitation. CONCLUSIONS: Isolated abducens nerve palsy can be caused by the ophthalmic segment of an ICA aneurysm, which should be considered in the differential diagnosis of ocular motility disorders. The disorder improved with coil replacement treatment. Differential diagnosis as a cause of abducens nerve palsy is important for prompt and appropriate treatment. Neuroimaging should be considered in patients with isolated abducens nerve palsy with a non-ischemic origin.
Abducens Nerve Diseases ; Abducens Nerve ; Aneurysm ; Brain ; Carotid Artery, Internal ; Cerebral Angiography ; Diagnosis, Differential ; Diplopia ; Esotropia ; Female ; Headache ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Middle Aged ; Neuroimaging ; Neurosurgery ; Ocular Motility Disorders ; Ophthalmology ; Pupil ; Visual Acuity

PURPOSE: To investigate the surgical outcomes of augmented bilateral medial rectus (BMR) recession in patients with low accommodative convergence/accommodation (AC/A) ratio tonic convergence excess esotropia (ET) compared to high AC/A ratio convergence excess ET. METHODS: This study included patients with esodeviation ≥10 prism diopter at near than at distance fixation who underwent BMR recession. The medical records of all esotropic patients with convergence excess who underwent strabismus surgery were reviewed. Six patients with tonic convergence excess and 10 patients with a high AC/A ratio met the study inclusion criteria. A successful outcome was defined as a near or distance angle of deviation ≤8 prism diopter and a ≤10 prism diopter difference between the two at the final recorded visit. RESULTS: The mean age at surgery was 5.9 ± 1.6 years in the tonic convergence excess ET group and 7.3 ± 2.9 years in the high AC/A ET group (p = 0.301). The average length of the postoperative follow-up was 2.7 years (range, 0.6–8.4 years) in the tonic convergence excess ET group and 4.0 years (range, 0.6–8.4 years) in the high AC/A ET group (p = 0.426). Near-distance disparities were reduced in all patients with tonic convergence excess ET within 10 prism diopter postoperatively, but in only 6 of 10 patients in the high AC/A ET group. Five of 6 patients (83.3%) had successful outcomes in tonic convergence excess ET group; 5 of 10 patients (50%) had successful outcomes in the high AC/A ET group. CONCLUSIONS: In our series, five patients (83%) obtained successful results in the tonic convergence excess ET group compared with 50% in the high AC/A ET group. Augmented BMR recession can be safely performed in esotropic patients with tonic convergence excess.
Esotropia ; Follow-Up Studies ; Humans ; Medical Records ; Ocular Motility Disorders ; Strabismus

PURPOSE: To report the surgical outcomes and changes in types of recurrent exotropia after surgical correction of basic type intermittent exotropia. METHODS: We retrospectively analyzed the medical records of 91 patients who underwent reoperations for recurrent exotropia after primary surgical correction, and who visited our hospital for a period of at least one year after the reoperation. When distant deviation was >30 prism diopters (PD), we defined convergence insufficiency type (CI type) if the difference of the deviation angle was >10 PD and basic type exotropia if the difference was <10 PD. When distant deviation was <30 PD, we defined basic type exotropia if the difference of the deviation angle between at distant and near was <33% of the distant deviation angle, and CI type exotropia if the difference was >33% of the distant deviation angle. RESULTS: The types of recurrent exotropia were similar to those of the preoperative condition in 68 patients (74.7%), and newly emergent CI type was observed in 23 patients (25.3%). With regard to the incidence of CI type, bilateral lateral rectus recession was more common than unilateral lateral rectus recession after primary surgery and medial rectus resection and unilateral lateral rectus recession, but the difference was not significant (p = 0.615). Recurrent CI type exotropia was observed 6 months after primary surgery (p < 0.001), but there was no significant difference in the timing of the reoperation between the two groups (p > 0.05). There was no significant difference in the success of reoperations between the two groups (p > 0.05). CONCLUSIONS: The types of recurrent exotropia after surgical correction of primary basic type intermittent exotropia differed from those of preoperative exotropia, which was not related to various factors before surgery. Recurrent exotropia was successfully treated by appropriately selected reoperations, regardless of the type of exotropia.
Exotropia ; Humans ; Incidence ; Medical Records ; Ocular Motility Disorders ; Reoperation ; Retrospective Studies