[Wilhelm Uhthoff (1853-1927)--important contributor of world neuro-ophthalmology]. / Wilhelm Uhthoff (1853-1927)--wazny wspóltwórca swiatowej neurookulistyki.

The reversible blurred vision occurring in patients with multiple sclerosis after a strenuous physical exercise is known as Uhthoff's phenomenon. Wilhelm Uhthoff was a German ophthalmologist, especially interested in neurology. He was a clinician and a devoted researcher--he observed many ophthalmic and neurological symptoms in his numerous patient cohorts, which he reported in many published research papers. His research contributed significantly to the development of neuro-ophthalmology.

Early observations on optic neuritis and Uhthoff's sign.

For much of the 19th century, even after the discovery of the ophthalmoscope, the diagnostic clinical signs and the identity of primary optic nerve disease were confused and inaccurate. Amongst many contributions aimed at clarifying this muddle, those of Wilhelm Uhthoff and Edward Nettleship were of outstanding importance and are outlined here.

[Epidemic neuropathy: proposal and arguments to rename Strachan disease as Strachan and Madan disease]. / Neuropatía epidémica: proposición y argumentacion para renombrar a la enfermedad de Strachan, como de Strachan y Madan.

INTRODUCTION: Strachan's disease is a condition which mainly affects the nervous system. It is characterized by optic, auditory and peripheral neuropathies and lesions of the skin and mucous membranes. In 1955 Miller Fisher gave it this name, since the clinical condition described by Henry Strachan in Jamaica during the nineteenth century was similar to that seen in Canadian prisoners-of-war in Japanese concentration camps during the Second World War. DEVELOPMENT: Since there are similarities between these clinical disorders and the major neuropathic epidemic seen recently in Cuba, we have reviewed and compared the endemic and epidemic conditions of similar characteristics seen in Cuba during the nineteenth and twentieth centuries. We also make a detailed review of a similar condition described in 1898-1900 by Doctors Madan, López and Santos Fernández, during the last Cuban War of Independence. This seems to be one of the earliest descriptions of the disorder. We also consider the so-called Strachan's syndrome or disease, and descriptions from the same period of tobacco-alcohol amblyopia and beriberi. These conditions seem to have been very similar to the so-called optical and peripheral forms of the current Cuban epidemic. It is concluded that the clinical characteristics of the recent Cuban neuropathic epidemic, at least in the optical form, were seen to be endemic during the nineteenth century. In many cases this was considered to be alcoholic amblyopia or some other obscure neuropathy which became epidemic during periods of severe economic depression. CONCLUSION: Madan gave a full description of the disorder at the same time as Strachan did. In 1898 he also suggested its true cause and died trying to relieve it. We therefore consider that Strachan's syndrome should be renamed the Strachan-Madan syndrome.

Optic neuritis: historical aspects.

Optic nerve disorders were not reliably diagnosed until the late nineteenth century when ophthalmoscopy became part of the ophthalmic examination. By the early 1900's, all of the salient clinical features of optic neuritis and its relationship to "systemic sclerosis" were recognized, but there was much controversy and misunderstanding about its differential diagnosis, pathogenesis, and possible treatment. During the twentieth century, physicians began to distinguish optic neuritis from infectious, hereditary, toxic, nutritional, and ischemic optic neuropathies. The development of magnetic resonance imaging and the results from recent clinical trials have enhanced our understanding of the relationship between optic neuritis and multiple sclerosis. The next decade holds the promise of further elaborating the pathogenesis and treatment of optic neuritis.

Uhthoff and his symptom.

At the turn of the last century, Wilhelm Uhthoff was a renowned clinical neuro-ophthalmologist, and probably the first clinician whose entire career was devoted to this discipline. His achievements are among those that mark the commencement of contemporary neuro-ophthalmology. Uhthoff's symptom of visual loss with exercise is most frequently associated with optic neuritis. The symptom carries a major risk for recurrence of optic neuritis and development of multiple sclerosis. This study and its companion in the publication show that, independently, a metabolic byproduct of exercise or increases in body temperature cause a reversible conduction block in demyelinated optic nerves and result in temporary loss of vision [corrected].