Ischemic optic neuropathy associated with internal carotid artery dissection.

BACKGROUND: Ischemic optic neuropathy (ION) is an infarction of the anterior or, less frequently, posterior part of the optic nerve, usually due to a disease of small arteries supplying the optic nerve. Carotid stenosis or occlusions are rare causes, and among them, carotid dissections have been so far reported in only 5 cases. METHODS: We describe 4 patients with ION (2 anterior and 2 posterior) due to internal carotid artery dissection of a consecutive series of 110 patients with internal carotid artery dissection (3.6%). RESULTS: None of the patients had signs of central retinal artery occlusion or ischemic ocular syndrome. Ischemic optic neuropathy occurred after a mean of 5.3 days (range, 3-8 days) following the first symptom, which was headache in 1 patient, transient monocular blindness in 2, and hemispheric transient ischemic attack in 1. One patient had associated Homer syndrome, and 2 had severe ipsilateral headache and orbital pain. None of the patients developed a cerebral infarction. These features differ from those observed in "classic" nonarteritic anterior ION and might therefore point to carotid dissection. CONCLUSION: Ischemic optic neuropathy may occur as an early sign of carotid dissection: young age, previous transient monocular blindness, an association with pain, Horner syndrome, or hemispheric transient ischemic attacks are suggestive of this cause and should prompt confirmatory investigations.

Ophthalmologic manifestations of internal carotid artery dissection.

PURPOSE: To report the ophthalmologic symptoms and signs associated with extracranial internal carotid artery dissection. METHODS: One hundred forty-six consecutive patients with extracranial internal carotid artery dissection were evaluted; 29 were studied retrospectively from 1972 to 1984 and 117 prospectively from 1985 to 1997. RESULTS: Sixty-two percent of patients (91/146) with extracranial internal carotid artery dissection had ophthalmologic symptoms or signs that were the presenting symptoms or signs of dissection in 52% (76/146). Forty-four percent (65/146) had painful Horner syndrome, which remained isolated in half the cases (32/65). Twenty-eight percent (41/146) had transient monocular visual loss, which was painful in 31 cases, associated with Horner syndrome in 13 cases, and described as "scintillations" or "flashing lights"-often related to postural changes or exposure to bright lights-suggesting acute choroidal hypoperfusion in 23 cases. Four patients had ischemic optic neuropathy; one had diplopia. Among the 76 patients with ophthalmologic symptoms or signs as the presenting features of carotid dissection, a nonreversible ocular or hemispheric stroke later occurred in 27, within a mean of 6.2 days (range, 1 hour to 31 days). Eighteen patients had a stroke within the first week after the onset of neuro-ophthalmic symptoms and signs, and 24 had a stroke within the first 2 weeks. CONCLUSION: Ophthalmologic symptoms or signs are frequently associated with and are often the presenting features in internal carotid artery dissection. Painful Horner syndrome or transient monocular visual loss should prompt investigations to diagnose carotid artery dissection and begin early treatment to prevent a devastating ocular or hemispheric stroke.

[Oculomotor nerve nucleus syndrome: report of two clinical cases (author's transl)]. / Syndrome nucléaire du nerf moteur oculaire commun: A propos de deux observations cliniques.

Two clinical cases are reported of similar oculomotor disorders presenting as a paralysis of the oculomotor nerve (III) on one side and isolated paralysis of the superior rectus on the other side. Previous reports of this clinical picture have not been found. Recent experimental studies have established that all the superior rectus motoneurons decussate and pass through the opposite II nucleus before entering the radicular portion. Therefore it is suggested that the reported syndrome results from an unilateral lesion in the III nucleus.

[Opthalomoplegic migraine]. / Migraine ophtalmoplégique.

We report the case of a 24 year old man with a 22 year history of attacks of migraine without aura and attacks of ophthalmoplegic migraine. A persistent right 3rd nerve palsy appeared after the 17th attack. Although its existence has been debated, ophthalmoplegic migraine is recognized as such in the International Headache Society (IHS) classification. A review of published cases satisfying the IHS diagnostic criteria for ophthalmoplegic migraine is presented.

[Dysarthria-clumsy hand syndrome caused by cerebellar infarction]. / Syndrome dysarthrie-main malhabile par infarctus cérébelleux.

A 80 year old woman suddenly complained of dysarthria and clumsiness of the right hand. CT scan showed an infarct in the territory of the lateral branch of the right superior cerebellar artery. This dysarthria-clumsy hand syndrome in a patient with paroxysmal atrial fibrillation suggests that the likely cause was an embolus from the heart.

[Chiasmatic radionecrosis after multifractionated radiotherapy of a temporal glioma]. / Radionécrose chiasmatique après radiothérapie multifractionnée d'un gliome temporal.

A 45-year-old male received split course multiple daily fractionated radiotherapy for an anaplastic left parieto-temporal astrocytoma. A total dose of 60 grays was delivered by 15 fractions of 2 grays given in 5 days and repeated after a rest period of 15 days. Forty grays were delivered to the whole brain and 20 grays to the tumor area. No surgery or radiosensitizer or chemotherapy were used at any time. The patient noted progressive loss of vision in both eyes and became blind 9 months after irradiation. Post-mortem study revealed 2 areas of radionecrosis in the chiasma and corpus callosum, corresponding to the dose of 57-60 grays. The necrotic area were at a distance of the tumor remnants. The high Daily Dose Multifractionation schedule may be responsible for the radionecrosis.

[2 rare neuro-ophthalmologic complications of long-term treatment with lithium salts]. / Deux complications neuro-ophtalmologiques rares d'un traitement au long cours par les sels de lithium.

We describe two patients with unusual neuro-ophthalmologic complications during long-term therapy with lithium carbonate given for bipolar affective disorder, "benign" intracranial hypertension in one, and downbeat nystagmus, with oscillopsia in the other. A review of the literature is proposed. Though rare, such neuro-ophthalmologic manifestations are worth being recognised since they usually disappear with cessation--when possible--of lithium therapy.

[Ocular symptoms in pituitary adenomas (author's transl)]. / Manifestations ophtalmologiques des adénomes hypophysaires.

The study of 85 patients suffering from pituitary adenoma, amongst which 56 with a visual failure, allowed to show: 1) The importance of the functional loss a revealing sign of the disease (50% cases). 2) The importance of the ophthalmological examination as a diagnostic argument. The latter, however, needs an extremely methodical examination of the visual fields. The combinated use of the Goldman Perimeter, and the Amsler schemes gave us satisfactory results: 87.5% of patent bitemporal hemianopsiae. It has been useful, in several cases to enhance these methodes by using coloured indexes. All of the patients underwent surgery, with complementary radiotherapy. The functional recovery quality has been shown, in the majority of the cases, to be proportionnal to the operation precocity in relation to the first functional symptoms.

Visual toxicity following intra-arterial chemotherapy with hydroxyethyl-CNU in patients with malignant gliomas. A prospective study with statistical analysis.

We studied the effects of intra-arterial chemotherapy (IAC) with a new nitrosourea (hydroxyethyl-chloroethyl nitrosourea: HeCNU) on the visual system of 68 patients with malignant gliomas. The intra-arterial chemotherapy was given as a complementary treatment of glioma after surgery (19 patients), after tumor recurrence (28 patients) and as the preliminary treatment before radiotherapy (21 patients). Eleven patients (16%) suffered a visual complication after two or more courses of chemotherapy. The main visual symptoms included mild to major decrease of visual acuity and in some cases ocular pain, palpebral edema and conjunctival injection. The delay in onset of ocular symptoms from the last course of IAC varied from 1 week to 9 months. From ophthalmoscopic findings, visual field testing and fluorescein angiography, the visual symptoms presented by our patients could be related to ischemic optic neuropathy or retinal vasculopathy. None of the patients had hypertension, diabetes, cardiopathy or hematological disease. Statistical analysis failed to demonstrate a relationship between the occurrence of visual toxicity and patient age, number of courses of HeCNU, the vascular axis treated, total systemic dose or dose by carotid artery, suggesting a possible specific sensitivity of some patients to chemotherapy. The pathophysiology and the therapeutic implications of this visual toxicity are discussed.

[Oedematous optic neuropathy from Perhexilline maleate associated with peripheral polyneuropathy (author's transl)]. / Neuropathie optique oedémateuse au maléate de Perhexiline associée à une polyneuropathie périphérique.

The authors report on a polyradiculoneuropathy related to long-term treatment with Perhexiline maleate (a drug used in France since 1973 for coronary insufficiency) whose presenting sign is a bilateral aedematous optic neuropathy. The mechanism of this effect on the optic nerves and on papilloedema is discussed; it seems not to be caused by a direct toxic action on the optic fibres but by the existence of chronic intracranial hypertension.