Oculomotor Synkinesis (Aberrant Reinnervation of the Third Cranial Nerve) Associated with Atypical Tolosa-Hunt Syndrome.

A 70-year-old woman with systemic lupus erythematosus developed a painful pupil-involving right third nerve palsy, ipsilateral fourth nerve palsy, and periorbital paraesthesia. Magnetic resonance imaging demonstrated enhancement and thickening of the right third nerve, and she was diagnosed with presumed Tolosa-Hunt syndrome. Repeated imaging seven months later showed resolution of the enhancing thickened oculomotor nerve, but the patient developed signs of oculomotor synkinesis. This presentation demonstrates a rare case of oculomotor synkinesis secondary to inflammation.

Nutritional Optic Neuropathy Caused by Copper Deficiency After Bariatric Surgery.

A 47-year-old woman developed severe bilateral visual loss 4 years after a Roux-en-Y gastric bypass and 24 years after vertical banded gastroplasty. Her serum copper level was 35 µg/dL (normal, 80-155 µg/dL). She was prescribed elemental copper tablets. Because her methylmalonic acid was slightly elevated, she received vitamin B12 injections as well. Five weeks later, she reported that her vision had improved and, at 10 months, her vision had recovered from 20/400 bilaterally to 20/25 in each eye. This case highlights the importance of checking copper levels in addition to the "more routine" vitamin levels, such as B1, B6, B12, E, and serum folate in patients with suspected nutritional optic neuropathy after bariatric surgery, particularly if it involved a bypass procedure.

"Ophthalmoplegic migraine" with reversible MRI enhancement of the cisternal sixth cranial nerve.

A 45-year-old woman reported multiple episodes of reversible left eye pain and diplopia stretching over 12 years. Ophthalmic examinations had repeatedly disclosed a left sixth cranial nerve palsy. Postcontrast brain MRI performed 3 weeks after clinical onset of the most recent episode demonstrated enhancement of the cisternal segment of the left sixth cranial nerve. Five months later, when symptoms and signs had largely abated, postcontrast brain MRI was normal. The clinical diagnosis satisfies the criteria for "ophthalmoplegic migraine." Although reversible cisternal enhancement of the third cranial nerve has been often described in this condition, this is the first report of cisternal enhancement of the sixth cranial nerve.

Posterior cortical atrophy: a brief review.

Posterior cortical atrophy is a striking clinical syndrome in which a dementing illness begins with visual symptoms. Initially, the problem may seem to be loss of elementary vision, but over time the patient develops features of visual agnosia, topographical difficulty, optic ataxia, simultanagnosia, ocular apraxia (Balint's syndrome), alexia, acalculia, right-left confusion, and agraphia (Gerstmann's syndrome), and later a more generalized dementia. Occasional patients have visual hallucinations and signs of Parkinson's disease or Lewy body dementia. A number of different neuropathologic disorders are associated with posterior cortical atrophy.

Hyperglycemic hemianopia: a reversible complication of non-ketotic hyperglycemia.

Four patients each developed a reversible homonymous hemianopia caused by non-ketotic hyperglycemia. In two patients the homonymous hemianopia was the first manifestation of diabetes mellitus type 2. All four patients had abnormal MRI scans; in the three patients who had late follow-up scans the abnormalities resolved completely. In one patient the progressive visual field defect and unusual MRI findings initially caused concern for a tumor.