Visual agnosia with bilateral temporo-occipital brain lesions in a child with autistic disorder: a case study.

A 2-year-old boy meeting the criteria for autistic disorder was diagnosed 2 years later with a visual agnosia characterised by a combination of certain aspects of associative and apperceptive agnosia. MRI then revealed a severe encephalomalacia of the right temporal lobe and bilateral temporo-occipital areas. This association is discussed in terms of a clinical and aetiological relation between autistic disorder and visual agnosia.

A comparative study of Hardy-Rand-Rittler and Ishihara colour plates for the diagnosis of nonglaucomatous optic neuropathy.

OBJECTIVE: To determine the ability of the Hardy-Rand-Rittler (HRR) and Ishihara colour plates to detect acquired colour vision defects in patients with nonglaucomatous optic neuropathy (NGON). DESIGN: Prospective study. SETTING: Neuro-Ophthalmology Unit of the Wilmer Eye Institute, Baltimore. PATIENTS: A total of 178 consecutive patients (349 eyes) referred to the Neuro-Ophthalmology Unit and the General Eye Service of the Wilmer Eye Institute and examined by two of the authors were enrolled from July 1992 to June 1993. OUTCOME MEASURES: Results of testing with HRR and Ishihara plates. RESULTS: Among the 202 eyes that were found to have no ocular disease on neuro-ophthalmologic testing, the HRR plates gave a normal result in 168 (83.2%), compared with 196 (97.0%) with the Ishihara plates (p < 0.0001). The HRR plates detected an acquired colour vision deficit in 48 (87.3%) of the 55 eyes with NGON, compared with 38 (69.1%) for Ishihara plates (p = 0.001). The values for the eyes with NGON with a visual acuity of 20/25 or better were 76.5% (13/17) and 35.3% (6/17) respectively (p = 0.008) and with a visual acuity less than 20/25, 92.1% (35/38) and 84.2% (32/38) respectively. CONCLUSIONS: For patients with unilateral or bilateral NGON, HRR plates are more likely than Ishihara plates to detect a colour vision defect, particularly when the visual acuity is 20/25 or better. However, neither test is sensitive enough to be used as the sole criterion for the diagnosis of NGON. The results of comparison of colour perception of the two eyes may be more useful than absolute colour vision responses, particularly in patients with unilateral disease.

Outcome of sixth nerve palsy or paresis in young children.

This study evaluated the ophthalmological outcome following sixth nerve palsy or paresis in 64 children 7 years of age and younger. The outcomes considered were vision, residual strabismus and the need for strabismus surgery. Etiologies included tumor, hydrocephalus, trauma, infection, malformation, and idiopathic and miscellaneous causes. Strabismus surgery was performed on 24% of the patients, with residual strabismus present in 66% of the patients. Neurologists and ophthalmologists should monitor visual acuity in these young children at frequent intervals be prepared to institute amblyopia therapy early in the course of the ocular misalignment if permanent visual disability is to be avoided.

Glioblastoma multiforme masquerading as pseudotumor cerebri. Case report.

A 16-year-old girl developed headaches and bilateral papilledema while taking minocycline for acne. The initial neuro-ophthalmologic evaluation was normal except for enlarged blind spots OU. An MRI scan demonstrated subtle abnormalities. A lumbar puncture was entirely normal except for an increased opening pressure. A tentative diagnosis of pseudotumor cerebri was made and the patient was treated with Diamox. A second MRI was unchanged, and a lumbar puncture performed while the patient was taking Diamox was entirely normal. The patient subsequently lost vision in both eyes, and a third MRI now revealed a supracellar enhancing mass. Biopsy and subtotal resection of the mass showed it to be a glioblastoma multiforme. This case emphasizes pitfalls in the diagnosis of pseudotumor cerebri. Careful follow-up and a high index of suspicion in pseudotumor cerebri syndromes are essential.

Pupillary areactivity in hydrocephalus of recent onset.

A patient who presented with bilateral loss of all pupillary reactions and normal ocular motor function is reported. Investigation revealed the presence of massive hydrocephalus. The syndrome developed shortly after transsphenoidal surgery for a suprasellar craniopharyngioma. Pupillary function returned to normal following the insertion of a ventriculo-peritoneal shunt. It is suggested that the syndrome was due to compression of the visceral oculomotor nuclei by a dilated sylvian aqueduct.

[Physiopathology and surgical correction of gastroesophageal reflux: review of the issues]. / Physiopathologie et correction chirurgicale du reflux gastro-oesophagien: revue de la question.

The authors review the pathophysiology of gastroesophageal reflux, pointing out the predominant role of the lower esophageal sphincter in antireflux mechanisms. The diagnosis of gastroesophageal reflux must be based on the results of detailed examination and other tests of which endoscopy and esophageal pH monitoring are the most important. The authors describe how to manage operation for gastroesophageal reflux so as to prevent complications. Although the Hill, Belsey and Nissen operations, referred to as valvuloplasties, have proved their effectiveness in curing gastroesophageal reflux, a review of the literature shows that better results are achieved by Nissen total fundoplication.