Neurological Impact of Wallenberg Syndrome on the Visual-Vestibular Systems

2020 ◽  
pp. 8-14
Keyword(s):  
Case Report ◽  
Left Vertebral Artery ◽  
Clinical Correlation ◽  
Ocular Motor ◽  
Eye Care ◽  
Motor Responses ◽  
Wallenberg Syndrome ◽  
Video Recordings ◽  
Binocular Diplopia ◽  
Skew Deviation

Purpose: This case discusses the neurological impact of Wallenberg syndrome on the visual-vestibular system and provides a clinical pathologic correlation between neuro-anatomic involvements with the manifesting symptoms. Case Report: A 50-year-old male presented for consultation following a left lateral medullary infarct occlusion of the left vertebral artery (Wallenberg syndrome) with complaints of intermittent binocular diplopia, vertigo, and oscillopsia. Assessment revealed an intermittent central nystagmus, a right skew deviation, and a left Horner’s syndrome. Video recordings of the nystagmus and ocular motor responses were documented. Conclusion: Wallenberg syndrome has very defined characteristics which can be used clinically to make a definitive diagnosis.It is important for eye care professionals to understand the neuro-anatomic involvements associated with this condition and make the clinical correlation to aid in the treatment and management of these patients.

scholarly journals Combined anomalous origin of a left inferior thyroid artery and a left vertebral artery: a case report

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
pp. 7400 ◽  
Author(s):  
Konstantinos Natsis ◽  
Matthaios Didagelos ◽  
Georgios Noussios ◽  
Aspasia Adamopoulou ◽  
Elisavet Nikolaidou ◽  
...  
Keyword(s):  
Case Report ◽  
Vertebral Artery ◽  
Inferior Thyroid Artery ◽  
Anomalous Origin ◽  
Left Vertebral Artery

Cerebral Palsy for the Pediatric Eye Care Team—Part II: Diagnosis and Treatment of Ocular Motor Deficits

2006 ◽  
Vol 56 (1) ◽  
pp. 86-96 ◽  
Author(s):  
Jorie Jackson ◽  
Claire Castleberry ◽  
Mario Galli ◽  
Kyle A. Arnoldi
Keyword(s):  
Cerebral Palsy ◽  
Care Team ◽  
Diagnosis And Treatment ◽  
Motor Deficits ◽  
Ocular Motor ◽  
Eye Care

scholarly journals Debunking the viper's strike: harmless snakes kill a common assumption

2016 ◽  
Vol 12 (3) ◽  
pp. 20160011 ◽  
Author(s):  
David A. Penning ◽  
Baxter Sawvel ◽  
Brad R. Moon
Keyword(s):  
High Speed ◽  
Past Century ◽  
Loss Of Consciousness ◽  
Common Assumption ◽  
Motor Responses ◽  
High Speed Video ◽  
The Past ◽  
Venomous Snakes ◽  
Video Recordings ◽  
Very High

To survive, organisms must avoid predation and acquire nutrients and energy. Sensory systems must correctly differentiate between potential predators and prey, and elicit behaviours that adjust distances accordingly. For snakes, strikes can serve both purposes. Vipers are thought to have the fastest strikes among snakes. However, strike performance has been measured in very few species, especially non-vipers. We measured defensive strike performance in harmless Texas ratsnakes and two species of vipers, western cottonmouths and western diamond-backed rattlesnakes, using high-speed video recordings. We show that ratsnake strike performance matches or exceeds that of vipers. In contrast with the literature over the past century, vipers do not represent the pinnacle of strike performance in snakes. Both harmless and venomous snakes can strike with very high accelerations that have two key consequences: the accelerations exceed values that can cause loss of consciousness in other animals, such as the accelerations experienced by jet pilots during extreme manoeuvres, and they make the strikes faster than the sensory and motor responses of mammalian prey and predators. Both harmless and venomous snakes can strike faster than the blink of an eye and often reach a target before it can move.

An unusual variant of the dorsal midbrain syndrome in MS: clinical characteristics and pathophysiologic mechanisms

2004 ◽  
Vol 10 (3) ◽  
pp. 322-325 ◽  
Author(s):  
Elliot M Frohman ◽  
Richard B Dewey ◽  
Teresa C Frohman
Keyword(s):  
Clinical Characteristics ◽  
Ocular Motor ◽  
N Limitation ◽  
Relapsing Remitting ◽  
Midbrain Syndrome ◽  
Unusual Variant ◽  
The Right ◽  
Dorsal Midbrain Syndrome ◽  
Skew Deviation ◽  
Pathophysiologic Mechanisms

Patients with MS exhibit a broad diversity of ocular motor syndromes. We describe a patient with relapsing-remitting MS who developed an unusual variation of the dorsal midbrain syndrome, character ized by monocular convergent-retraction nystagmus in the right eye, accompanied by divergent-retraction nystagmus in the fellow eye upon attempted upward gaze. Examination also revealed a skew deviation with a left hyperdeviation and severe adductio n limitation in the left eye during attempted right gaze. We propose that a left INO accounted for the inability of the left eye to adduct (and result in convergent-retraction) during attempted upward saccades. We consider the patho physiologic mechanisms responsible for our observations and review important details of the dorsal midbrain ocular motor circuitr y.

scholarly journals Acute binocular diplopia: peripheral or central?

2020 ◽  
Vol 267 (S1) ◽  
pp. 136-142
Author(s):  
Olympia Kremmyda ◽  
Claudia Frenzel ◽  
Katharina Hüfner ◽  
Nicolina Goldschagg ◽  
Christian Brem ◽  
...  
Keyword(s):  
Emergency Department ◽  
Motor Nerve ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Screen Test ◽  
Ocular Motor ◽  
Diagnostic Challenge ◽  
Ocular Motor Disorders ◽  
Visual Vertical ◽  
Binocular Diplopia

Abstract Objectives Acute diplopia is a diagnostic challenge for clinicians, in particular in the emergency department. The most common cause of acute diplopia are ocular motor nerve palsies (OMP). In this prospective study, we focused on identifying the most crucial signs and symptoms for differentiating between peripheral and central OMP. Methods We prospectively evaluated 56 non-consecutive patients who presented at our emergency department with acute binocular diplopia (≤ 10 days). The patient history was taken using a standardized questionnaire and patients underwent a neurological, neuro-ophthalmological and neuro-otological examination, including measurement of the subjective visual vertical (SVV), Harms tangent screen test, and cranial MRI. Results Forty-six out of 56 patients were diagnosed with an ocular motor cranial nerve palsy (OMP), 21 of peripheral and 23 of central origin; in two patients, the etiology remained unknown. The following features were different in peripheral and central OMP: (1) the presence of vertigo/dizziness was more frequent in central (43.5%) than in peripheral (9.5%) OMP. (2) Central ocular motor signs, such as saccadic smooth pursuit, additional internuclear ophthalmoplegia, skew deviation, and saccade palsies, were also found more frequently in the central than in the peripheral group (86.7% vs. 33.3%). (3) Further, a pathological SVV deviation by monocular testing of the non-affected eye was also more common in central (77.3%) than in peripheral OMP (38.9%). The presence of all three factors has a positive predictive value of 100% (CI 50–100%) for the presence of a central lesion. Conclusions In acute diplopia due to central OMP, the most important accompanying symptom is vertigo/dizziness, and the most important clinical signs are central ocular motor disorders (which require examination of the non-paretic eye) and an SVV deviation in the non-paretic eye.

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