Comitant Ocular Deviation in Myasthenia Gravis.

Background: Occurrence of comitant ocular deviation in myasthenia gravis (MG) is not well described.

Methods: A retrospective analysis of patients with ocular or generalized MG evaluated at a neuro-ophthalmology clinic for a 6-year period. Comitant ocular deviation was defined as magnitude of deviations in all planes varying by <20% from the measurement in the primary position.

The Microbiome of Temporal Arteries.

Objective: A role for microorganisms in giant cell arteritis (GCA) has long been suspected. We describe the microbiomes of temporal arteries from patients with GCA and controls.

Methods: Temporal artery biopsies from patients suspected to have GCA were collected under aseptic conditions and snap-frozen.

A Case Report of Drug-Induced Myopathy Involving Extraocular Muscles after Combination Therapy with Tremelimumab and Durvalumab for Non-Small Cell Lung Cancer.

Recently developed anti-tumour therapies targeting immune checkpoints include tremelimumab and durvalumab. These agents have incompletely characterised side effect profiles. The authors report a 68-year-old man treated for non-small cell lung cancer (NSCLC) with a combination of tremelimumab and durvalumab.

Isolated optic nerve sarcoidosis.

To report three cases of sarcoidosis confined to the optic nerve. Chart review of clinical, laboratory, imaging, and optic nerve biopsy findings and a review of the literature. All three cases presented with progressive visual loss and showed enhancement of the intraorbital optic nerve on magnetic resonance imaging.

Optic Neuropathy and Stroke Secondary to Invasive Aspergillus in an Immunocompetent Patient.

Angioinvasive aspergillosis is an aggressive fungal infection that is potentially life threatening without prompt treatment. Optic nerve involvement of Aspergillus can mimic optic neuritis commonly seen in demyelinating and other inflammatory conditions. Treatment of Aspergillus infection with steroids may worsen the clinical course.

A pain in the eye.

A 38-year-old woman presented with chronic left retro-orbital pain and photophobia. Palpation of the left occipital prominence revealed tenderness in the area of the greater occipital nerve and reproduced the eye pain. The diagnosis of cervicogenic headache was confirmed by symptom resolution following left greater occipital nerve blockade.

Idiopathic intracranial hypertension: pseudotumor cerebri.

Background: Idiopathic intracranial hypertension (IIH) is most often diagnosed in young obese females of childbearing years. The diagnosis is made based on the modified Dandy criteria and the exclusion of alternate causes of raised intracranial pressure.

Results: The focus of this review is to provide an overview of the diagnosis and treatment options for patients with IIH.

Chiari type I malformation: a mimicker of myasthenia gravis.

Introduction: Myasthenia gravis is an autoimmune disease, which commonly presents with extraocular muscle weakness, eyelid ptosis, bulbar dysfunction, and proximal limb weakness. We report an unusual differential diagnosis for myasthenia gravis.

Case Report: A 56-year-old woman presented with worsening blurry vision, double vision, eyelid droopiness, slurred speech, and fatigable limb weakness, worsening over a 6-month period.

Acute postoperative endophthalmitis in a patient with Darier's disease.

A 58-year-old man with Darier's disease developed endophthalmitis 3 days following left-sided cataract extraction with intraocular lens implantation. Vitreous cultures were positive for Pseudomonas aeruginosa, similar to previously cultured hyperkeratotic plaques on the patient. Despite emergent vitrectomy and aggressive treatment with systemic, intravitreal, and topical fortified antibiotics, the patient required evisceration 19 days postoperatively.

Granulomatous orbital inflammation associated with intraorbital titanium-impregnated acetate fiber.

Herein we report a 52-year-old man with subacute right-sided proptosis and diffuse intraconal enhancing abnormality on MRI. Orbital biopsy revealed granulomatous inflammation consistent with idiopathic orbital inflammatory syndrome (IOIS), or orbital pseudotumor. However, further examination under polarizing light microscopy also revealed acetate fiber fragments within the orbit.

Crossover trial of gabapentin and memantine as treatment for acquired nystagmus.

We conducted a masked, crossover, therapeutic trial of gabapentin (1,200mg/day) versus memantine (40 mg/day) for acquired nystagmus in 10 patients (aged 28-61 years; 7 female; 3 multiple sclerosis [MS]; 6 post-stroke; 1 post-traumatic). Nystagmus was pendular in 6 patients (4 oculopalatal tremor; 2 MS) and jerk upbeat, hemi-seesaw, torsional, or upbeat-diagonal in each of the others. For the group, both drugs reduced median eye speed (p < 0.

Can't hear, can't see, and too sore to play.

A 52-year-old man developed transient, migratory polyarthralgias in the presence of hearing loss. He then developed persistent leukocytosis and thrombocytosis. His initial transient, bilateral visual obscurations happened in context with bilateral disk edema and an enlarged blind spot.

The operation was a success, but the patient cannot see.

A 71-year-old African American woman presented with severe vision loss in her left eye one day following trabeculectomy with mitomycin C and retrobulbar anesthesia. She had a new left relative afferent pupillary defect and macular whitening. The optic disc appeared normal.

Selected lid problems in neurologic practice.

Ptosis is a common clinical finding. The many causes of ptosis include involutional (aging), myopathic, neuropathic, congenital, infectious, tumorous, traumatic, and inflammatory processes. This article reviews recent literature on some causes of ptosis and other lid conditions.

My, what asthenia you have.

A 59-year-old woman noted intermittent ptosis, diplopia, dysphagia, and proximal muscle weakness for several years. She had a strong family history of myasthenia gravis. Chest computed tomography and sternotomy revealed a micronodular spindle cell thymoma.

Nonuniform pressure generation in the optic chiasm may explain bitemporal hemianopsia.

Purpose: To measure the pressure in the temporal and central aspects of the chiasm simultaneously during compression of the optic chiasm from below with an expanding simulated tumor.

Design: Experimental study.

Methods: Craniotomies were performed on 5 unfixed cadaveric specimens ranging in age from 49 to 89 years, and the optic chiasm was exposed.

The fate of patients with retinal artery occlusion and Hollenhorst plaque.

Objective: Ocular symptoms and signs often herald hemispheric neurological events associated with extracranial cerebrovascular disease. However, the presence of a Hollenhorst plaque (HP) or retinal artery occlusion (RAO) and the risk of stroke is unclear. The purpose of this study was to review the outcomes of all patients who presented with a HP or RAO at a single institution.

Retinal manifestations of cerebroretinal vasculopathy.

We report a case of a 42-year-old woman who presented with a slowly progressive decrease in visual acuity and memory loss. Dilated fundus exam showed cotton-wool spots and parafoveal telangiectasias. Fluorescein angiography revealed foveal capillary nonperfusion, which was very similar to that of her father, who passed away from a similar illness.

Conjunctival involvement in Churg-Strauss syndrome.

Purpose: To describe an unusual case of Churg-Strauss syndrome (CSS) that presented with a conjunctival nodule and was successfully treated with oral corticosteroids.

Methods: Case report.

Results: A 30-year-old woman with a history of adult-onset asthma, seasonal allergies, and a lung mass presented with a nodular elevation of the conjunctiva.

Rapamycin for treatment of refractory dysthyroid compressive optic neuropathy.

We report a patient with dysthyroid optic neuropathy refractory to steroids and orbital decompression treated with rapamycin, a fibroblast and T cell inhibitor. Symptoms, visual acuity, color plate testing, and visual fields improved. Aside from hypercholesterolemia, no complication related to this therapy was observed.

Prevalence of optic nerve edema in patients on peripheral hemodialysis.

Purpose: Cerebral venous hypertension with optic nerve edema has been reported in patients with peripheral arteriovenous hemodialysis shunts. This study aimed to estimate the prevalence of optic nerve edema in patients with peripheral arteriovenous accesses and to evaluate the value of ophthalmic examination and surveillance in this study population.

Design: Cross-sectional observation case series.