RESUMEN
Over the last 10 years from 1982-1992, we have diagnosed 29 cases of multiple sclerosis at our centre. In this hospital based retrospective study, 22 cases were definite (including 4 cases of Neuromyelitis optica) and the remaining 7 were probable cases of multiple sclerosis according to Poser's criteria (Poser et al 1983). There was no sex preponderence. Striking clinical presentations included high incidence of optic nerve, brain stem and spinal cord involvement. Sympathetic disturbance in the form of Horner's syndrome was seen in two patients. Major depressive psychosis was an associated disease in 2 cases. One patient developed multiple sclerosis after receiving anti rabies vaccine.
RESUMEN
A 47 year old man with episodes of attacks of pain, redness and mild blurring of vision was investigated for narrow angle glaucoma in view of shallow anterior chambers and a cupped optic disc. The history was reviewed following a spontaneous attack in hospital, which had features other than acute glaucoma. A diagnosis of cluster headache was made on the basis of tests. Cluster headache has been defined as unilateral intense pain, involving the eye and head on one side, usually associated with flushing, nasal congestion and lacrimation; the attacks recurring one or more times daily and lasting 20 - 120 minutes. Such attacks commonly continue for weeks or months and are separated by an asymptomatic period of months to years. This episodic nature, together with unilaterality and tendency to occur at night, closely mimics narrow angle glaucoma. Further, if patients have shallow anterior chambers and disc cupping, the differentiation becomes more difficult yet critical. Resource to provocative tests is often the only answer as the following case report demonstrates.