Analysis of descriptive electrophysiological parameters in contralateral interlimb reflexes on tetraplegic patients.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: The present study aims to analyze and correlate the interlimb reflexes (ILRs), through a standard methodology, in tetraplegic and healthy subjects. The study of the connectivity between the injured spinal cord and the ILR transmission empowers new rehabilitation pathways for tetraplegic patients. SETTING: University Hospital-UNICAMP, Campinas, Brazil. METHODS: A total of 15 chronic tetraplegic patients and 10 healthy subjects were analyzed with the same methodology. Two tests were performed: (i) In test 1, the stimulus was applied to the right-arm radial nerve and the electromyography (EMG) signal collected in contralateral left tibial muscle. (ii) In test 2, the stimulus was applied to the left-leg fibular nerve and EMG collected in contralateral limb biceps, exploring the opposite direction of the pathway. In both tests, the subjects were stimulated with intensities from 5 to 30 mA (5 mA step) and 40 × 500 µs current modulated pulses. Reflexes were detected from the averaging of the 40 EMG sweeps. RESULTS: Each group was analyzed with regard to the reflexes' incidence, amplitude and latency. ILRs were found with similar prominence in both groups. A correlation between the ILR amplitude and the subject injury level was verified. Significant differences were found in the correlation of ILR latency with stimulation charge between healthy and tetraplegic subjects. CONCLUSION: The ILR transmission parameters of healthy and tetraplegic subjects were studied. The results obtained strongly suggest a different ILR transmission between healthy and tetraplegic subjects, reinforcing the hypothesis of nerve regeneration after injury.

[Intermittent sea-saw nystagmus successfully treated with clonazepam]. / Abolition par le clonazépam d'un nystagmus en bascule intermittent.

See-saw nystagmus is a pendular nystagmus with two distinct components: a conjugate torsional component and a disjonctive vertical component. The acquired form of nystagmus is usually seen with parasellar mass and less frequently in head injury or brainstem infarction. Almost all patients with parasellar mass or head injury have associated bitemporal hemianopia. We report the case of a 27-year-old man who developed intermittent daily oscillopsia five years after a severe head injury. On neurological examination, the patient showed a congenital left eye divergence with left eye convergence paresis, an anosmia, a right optic atrophy and a bitemporal hemianopia. Visual acuity was 7/10 and 3/10 for the right and left eyes. The rest of the neurological examination was unremarkable. Electroencephalogram during oscillopsia was normal. MRI revealed bilateral orbito-frontal low signal intensity on T1 weighted images. The brainstem, the diencephalon and the ventricular system appeared to be intact. Eye movement recordings exhibited intermittent see-saw nystagmus. Clonazepam treatment resolved the see-saw nystagmus. Slowly withdrawal of clonazepam was done without return of the see-saw nystagmus.

[Retinal toxicity caused by intravitreous injection of an aminoglycoside. Apropos of a case]. / Toxicité rétinienne secondaire à l'injection intravitréenne d'un aminoside. A propos d'un cas.

The authors present a case of severe retinal ischemia associated with Dibekacin intraocular injection. This aminoglycoside was used, at an inadvertent dose, for the treatment of a postoperative endophthalmitis. The prominent finding at ocular ophthalmoscopy was oedematous retina with hemorrhages in the macular area. Fluorescein angiography revealed severe retinal vascular non perfusion. The eye subsequently developed neovascular glaucoma. Precautions are necessary to prevent such a catastrophic event; the injectable solution must be prepared on the surgical field, the injection should be performed slowly in the anterior vitreous without exceeding 0.2 mg when Gentamicin is used.

[Lens complication during panphotocoagulation using a panfundoscope]. / Complication cristallinienne au cours d'une panphotocoagulation avec le panfundoscope.

We report one case of lens opacities, secondary to retinal panphotocoagulation using the panfunduscope. Cataract can be attributable to nuclear sclerosis, optical features of the panfunduscope and blue-green laser.

[Retinal photocoagulation without corneal contact using the 90 diopter lens]. / Photocoagulation rétinienne sans contact cornéen au moyen de la loupe 90 D.

The authors used the hand held 90 diopter lens for practice of non contact retinal photocoagulation in 8 cases when ocular conditions make undesirable the use of a contact lens. The excellent visualisation of the retina, patients comfort, his utilisation immediately after surgery and in gaz filled, are among its more interesting uses. The movements of the eye and the impossibility to go further than the mid periphery of the retina are its principals disadvantages.

[Retinal detachment with vitreoretinal proliferation treated by temporary silicone oil tamponade. Long-term results]. / Décollement de rétine avec prolifération vitréorétinienne traité par tamponnement provisoire d'huile de silicone. Résultats à long terme.

We have analyzed the long-term complications of 14 retinal detachments successfully reattached six months after silicone oil removal. Corneal decompensation and cataract were the most frequent causes of loss of vision between six months and two years.

[Listeria endophthalmitis: an uncommon etiology]. / Endophtalmie à Listéria: une étiologie exceptionnelle.

Listeria monocytogenes is an uncommon cause infections: to our knowledge this is the seventh case of human endophthalmitis isoleted. An early diagnosis and therapy allowed an excellent functional recovery when compared to the reported cases of the literature.

[Eye perforation caused by retrobulbar injection]. / Perforation du globe oculaire par injection rétrobulbaire.

The authors present a case of scleral perforation following a retrobulbar injection of anesthetic. Predisposing factors are reminded and ways to avoid such complications are expanded.

Tratamiento del desprendimiento de retina causado por roturas del polo posterior / Treatment of retinal detachment caused by posterior break

El desprendimiento de retina por dehiscencia posterior es una entidad rara. Veintidós casos de DR por rotura del polo posterior han sido operados en el Centro Hospitalario de Rowen, Francia, entre 1979 y 1989. Se utilizaron solamente técnicas de tamponamiento interno con aire, gas (SF6) y silicona. Siempre se practicó una vitrectomía. Una retinopexia (láser argón) se realizó en primera intención, sólo en los casos de roturas extramaculares o utilización de silicona. El éxito anatómico con vitrectomía + SF6 alcanza 73%, y es inferior a otras series debido al alto número de roturas parapapilares y en borde de estafiloma de difícil retinopexia. Cincuenta por ciento de nuestras observaciones obtienen una agudeza visual calculable en postop. Esto se explica por la existencia de un número importante de roturas extramaculares. Los nuevos métodos de examen del cuerpo vítreo y sus relaciones con la retina, nos permiten separar las roturas del polo posterior en dos tipos. Aquellas con DPV completo, sin REM y que habitualmente son los agujeros maculares. En este caso una simple punción-aspiración del líquido retrohialoidio + SF6 bastaría. El otro grupo lo forman las roturas con DPV incompleto y que habitualmente son las roturas extramaculares. En estos casos una vitrectomía se impone

[Amaurosis during surgery of strabismus. Apropos of a case]. / Amaurose lors de la chirurgie du strabisme. A propos d'un cas.

The authors report one case of blindness occurrence after surgery of strabismus. The clinical description is a posterior ischemic optic neuropathy. We expose the different proceeds of blindness occurrence after ophthalmologic surgery.