Two cases of papilledema associated with typical albumino cytologic dissociation in spinal fluids

The purpose of this paper is to call attention to the occasional occurrence of papilledema associated with typical albuminoytologic dissociation in spinal fluids. In view of the possible allergic etiology of the syndrome by Reitman, ACTH and corticosteroids have been tried. These drugs have yielded encouraging results when treatment was initiated early in the course of the illness, when nerve-root edema had caused only functional paralysis but the syndromes of my cases hadn't responded to prednisolone. It can be deduced that the illness is thought to be too advanced and the nerve-root had had organic destructions already. our cases revealed prolonged typical albuminocytologic dissociation in spinal fluids, increased intracranial pressure throughout the whole hospital course and papilledema. This condition is really a very common one but there is so much confusion about the criteria necessary for the diagnosis and so many different names are employed to designate it that its incidence is thought to be underestimated. A review of the literature dealing with Guillain-Barre syndrome reveals few references to papilledema. Occasional notes of "optic neuritis" are found but the descriptions are not sufficient to enadle one to dete mine whether there was papilledema or not. In the author's cases, the optic nerVe heads showed papilledema of 3 diopters or more with tortuosities of the veins and filling of the cups. There were no hemorrhages or exudates. Although not essential, the demonstration of an increased protein in cerebrospinal fluids with little or no elevation of cells is an appreciable aid in diagnosis on the Guillain-Barr'e syndrome. Certainly this patient, with a protein content of from 243 mg% to 1,200 mg% in 8 successive lumbar punctures with cell counts ranging from zero to 29 lymphocytes per cubic millimeter demonstrates typical albuminocytologic dissociation. Walsh postulated one more element to this syndrome and pointed out that increased intracranial pressure may occur in cases otherwise typical of the Guillain-Barre syndrome. It is scarecely necessary to add the cause of this condition, if indeed there is one cause and not many cases, is quite unknown. In the author's cases, the intracranial pressure revealed from 110 mm H2O to 520 mm H20 in 8 successive lumbar punctures.

Dye Test for 24 Cases of Uveitis

Toxoplasma gondii preferred for this test was "Anyang strain" from Veterinary Research Laboratory, Anyang, Korea. Sabin and Feldman's Methylene Blue Dye Test for toxoplasmosis was carried out upon 24 cases, of whom 14 outpatients in this clinic from June to August in 1966 had uveal lesions and 10 blinds were thought to be resulted from uveitis. The results were as follows: 1. 3 out of 24 cases were positive in each titers of 1:4, 1:16 and 1:64 respectively. 2. One rabbit was positive in titer 1:64, which rabbit was 30 days after intraocular innoculation of the Toxoplasma gondii.

Dye Test for Toxoplasmosis to normal population in Pusan

Serological survey, using methylene blue dye test for toxoplasmosis was carried out upon 395 normal population, 21 cases of uveal lesions, and 95 cases of acute febrile and chronic systemic diseases. Toxoplasma gondii preferred for this test was "Anyang straio" from Veterinary Researh Anynag, Korea in March 1968. The results were as follows: 1. In normal population 9.62 per cent of the sera examined showed positive titers of 1:16 or above in adult and 1:8 or above in children. 2. The positive in serologic survey was prevalent 3rd to 5th decades of both sex. 3. 4 out of 21 cases of uveal lesions were positive of which titers showed 1:64 or above in adults and 1:32 in a girl. 4. In 95 cases of acute febrile and chronic systemic diseases 4.2 per cent of the sera examined showed positive titers of 1:16 or above.

The Effect of Cytochrome C in Ophthalmic Diseases

Cytochrome compounds which act as electron transfer agents in oxidation-reduction reactions. An important example is cytochrome c, which has a molecular weight of about 13,000 and contains one atom of iron per mol. Our attempt is to evaluate clinically the therapeutic effect of cytochrome c on the healing wound of the lesions which supposed to be oxygen concentration is lowered than in normal tissues in tissue respiration, and it used in neuropathy, muscle paralysis, retinopathy, vitreous hemorrhage, corneal chemical burns in ophthalmology. The patients included in the following series: They were five cases of retrobulbar optic neuritis, two cases of optic neuritis, one case of axial optic atrophy, two cases of simple optic atrophy, two cases of muscle paralysis, one case of central retinopathy, one case of chorio-retinal atrophy, one case of maculra degeneration, one case of diabetic retinopathy, one case of pigmentary degeneration of the retina, one case of vitreous hemorrhage, four cases of corneal chemical burn, and one case of corneal dystrophy. After intra-dermal injection with cytochrome c, evaluated the allergic character and it was given intra-venous injection. The results were as follows: 1) In total 23 cases, had excellent therapeutic effects on neuropathy, muscle paralysis, and corneal chemical burns. 2) In general, we found that it did not respond to central retinopathy and diabetic retinopathy. 3) We experienced that it have response to the old lesions. 4) It was interested that the night blindness could be disappeared by cytochrome c use in pigmentary degeneration of the retina. Yet there remain certain problems so far unsolved.

A Case of Orbital Injury by a Plastic Chopstick

A case of orbital injury with a plastic chopstick accompanied by meningeal irritation signs was presented. A 34-year-old house-wife was admitted to our clinic complaining of vision loss, proptosis and dull ocular pain in right eye on March 11, 1976. 17 days before admission she was stabbed on the right orbital region with a plastic chopstick. The clinical finical findings Were recorded normal in left eye. The right eye showed zero in vision, proptosis, fixed eyeball with total ophthalmoplegia and exposure Keratitis. On the 2nd hospital day a broken plastic chopstick, 9.5 cm in length, was carefully removed from injured site by exploratory eperation. In that afternoon meningeal irritation signs, vomiting and neck stiffness was abruptly developed. The laboratory findings of the cerebrospinalfluid revealed inflammatory signs. After having been administered massive antibiotics (crystalline penicillin, bayrena, and chloramphenicol) systemi-cally for 17 days, she was recovered from meningeal irritation signs containing remission of inflammatory findings of cerebro spinal fluid examination. On the 21st hospital day, 39 days after injury, the optic disc was seen totally pale. On the 25th hospital day she was discharged, at which right eye showed clear in cornea, totally pale disc, and total ophthalmoplegia with ptosis. When she returned about 5 months after discharge, the right eye revealed much regressed ptosis, superficial corneal opacity with loss of corneal sense, ocular motility limited in superolateral direction, fixed and dilated pupil and still pale disc. Authors attempt to evalurate this case throlgh the related literatues.

A Case of Orbital Cavernous Hemangioma

A 47-years old korean farmer was first visited our department in Nov. 19, 1969 with complaining of proptosis, lateral deviation of eye ball and visual disturbance of 5 years duration. The onset was insidious. Past and family history were not contributory. On examination, right eye was within normal limit. The left eye was markedly proptotic (aoout 10 mm of exophthalmos) and displaced out-and downward. The vision of the left eye was L.P.. The ocular motility was slightly limited to all direction. Pupil was normal size and poorly reacted to light. Funduscopic examination revealed pale and slightly excavated in disc. X-ray of chest, skull and optic foramen showed normal. On Nov. 22. 1969 author adopted the Kronlein's approach and exceed well capsulated oval mass situated within the muscle cone, which attached to optic nerve. The tumor mass showed soft, dark reddish color of surface measuring 2 X 2 X 15 cm and its cut surface disclosed sponge like appearance. Histologically the section from tumorous mass showed many large cavernous spaces separated by connective tissue. The newly formed cavernouus space was for the most part lined by a single layer of endothelium and in part contained with red cell. We confirmed adiagnosis of cavernous hemangioma of the orbit in pathologic study. It was suggested that early loss of vision was caused by optic atrophy due to direct pressure of optic nerve by the tumor mass. A review of literature of recent years related to cavernous hemangioma of orbit was added.