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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We compared surgical results of superior oblique tenotomy to the superior oblique silicone expander for the treatment of superior oblique overaction and Brown syndrome. Of 24 patients with bilateral superior oblique overaction, 13 underwent tenotomy and 11 had the silicone expander procedure. Reduction of A-pattern to within 10 prism diopters was achieved in 12/13 (92.3%) tenotomy patients and in 10/11 (90.9%) patients undergoing silicone expander (P greater than .05). Correction of superior oblique overaction on versions to within +/- 1 dysfunction was achieved in 22/26 (84.6%) of the tenotomies, and 21/22 (95.5%) silicone expander procedures (P greater than .05). Zero superior oblique dysfunction was found after 14/26 (53.8%) tenotomy procedures versus 18/22 (81.8%) silicone expander operations (P = .041). Superior oblique paresis occurred postoperatively in 4/13 (30.8%) tenotomy patients, whereas none of the 11 patients in the silicone expander group had superior oblique paresis (P = .044). Six patients who underwent superior oblique tenotomy for superior oblique overaction had preoperative stereopsis; following surgery, only two maintained the same level of stereopsis, and three patients totally lost all stereo acuity. All patients in the silicone expander group either maintained or had improved stereo acuity postoperatively. Seven patients with true Brown syndrome were operated on: three underwent the silicone expander procedure and four had a superior oblique tenotomy with an ipsilateral inferior oblique recession. The combination of superior oblique tenotomy with simultaneous ipsilateral inferior oblique recession resulted in an undercorrection in two of the four patients, whereas all three patients in the silicone expander group showed excellent ocular motility postoperatively, with two having normal versions and one a -1 residual limitation.(ABSTRACT TRUNCATED AT 250 WORDS)
J Pediatr Ophthalmol Strabismus
PMID:Comparison of superior oblique tendon expander to superior oblique tenotomy for the management of superior oblique overaction and Brown syndrome. 158 83

A surgical case of bilateral chronic subdural hematoma presenting with divergence palsy is reported. A 75-year-old female was admitted to hospital for investigation of 2-week history of diplopia. The initial neurological examination demonstrated no abnormal findings except Hess chart suggesting bilateral concomitant strabismus or paresis of lateral rectus on both eyes. Because of the homonymous diplopia disappeared when the object of fixation in brought closer and the patient showed no impairment of gaze movements and following movements, the patient was diagnosed as divergence palsy and referred to the Neurosurgical Service. The physical examination revealed a 75-year-old, alert, fully oriented with diplopia at distant gaze. A computerized tomographic (CT) scan showed bilateral subdural hematoma. Emergency burrhole evacuation was performed and total amount bilateral hematoma was 220ml. Diplopia disappeared postoperatively. Hess chart examined two months after the operation shows no impairment of divergence function. This is the first reported case of divergence palsy associated with bilateral chronic subdural hematoma in CT era.
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PMID:[A case of divergence palsy associated with bilateral chronic subdural hematoma]. 187 87

Twenty-one individuals, aged 28 to 29 years, with documented thalidomide embryopathy were examined in Sweden. The most noteworthy ophthalmologic finding was the high prevalence of incomitant horizontal strabismus, primarily of the Duane syndrome type. Less frequently seen were cases of both marked abduction and adduction limitation similar to a gaze paresis with no observable fissure changes, as well as a few cases of isolated abduction weakness or inferior oblique under-action. There were many examples of aberrant lacrimation, facial nerve palsy, and ear anomalies combined with horizontal incomitant forms of strabismus. Ear and facial nerve palsies are known to occur with ingestion of thalidomide early in the sensitive period (approximately days 21 to 26 after conception).
J Pediatr Ophthalmol Strabismus
PMID:Ocular motility in thalidomide embryopathy. 201 59

Examination of 21 children with unilateral congenital paresis of superior oblique muscle and of 50 children with unilateral hyperfunction of inferior oblique muscle has shown that both forms of early squint have a picture of the same syndrome of oblique muscles disfunction as a primary congenital defect of muscular balance. A constant sign of the syndrome is unilateral hypertropia of adduction, disappearing or sharply reducing in abduction of the upward deviated eye, as well as horizontal squint of a convergent type, more frequently esotropia, nonaccommodative or partially accommodative, accompanied by a V-sign. It is proposed to name this syndrome as "syndrome of congenital unilateral hyperfunction of inferior oblique muscle".
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PMID:[The syndrome of congenital unilateral hyperfunction of the inferior oblique muscle: clinico-pathogenetic variants]. 225 96

The paper deals with principles of surgical treatment of vertical squint caused by paresis of muscles of vertical action. The authors consider to be optimal one-stage surgical intervention consisting of enhancing the paretic muscle and weakening the antagonist of the same eye, i. e. the rectus and oblique muscles. The dosage of the surgery was calculated considering the angle of squint. A new method is proposed for calculating the position, on the sclera, of the point of fixation of inferior oblique muscle at its recession. Results of 73 operations are analysed. Orthotropia was achieved in 72.6% of patients. The authors recommend the operation to be widely used in clinical practice.
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PMID:[The surgical treatment of vertical strabismus in children]. 225 98

This report describes the use of superior oblique traction testing in the evaluation of superior oblique palsy. Four consecutive children presenting with signs and symptoms of superior oblique palsy were found to have markedly abnormal tendon laxity with traction testing. Surgical exploration revealed anomalies including three with elongated lax tendons, one of which had an anomalous insertion, and one absent tendon. This tendon laxity is not typically found in acquired superior oblique palsy. It is proposed that, in addition to the well known neurogenic paresis/paralysis, a second type of "palsy" due to anatomic abnormalities of the tendon may exist and be responsible for a number of congenital superior oblique palsies. The mechanical disadvantage of these markedly long tendons may explain why inferior oblique weakening procedures alone frequently fail to correct head tilts due to superior oblique palsy in infancy.
J Pediatr Ophthalmol Strabismus
PMID:Traction testing in superior oblique palsy. 236 24

Injections of botulinum toxin type A (BoTox) in one extraocular muscle (EOM) induce long lasting paretic lengthening of the muscle permitting realignment to occur in strabismus, while eye movements appear to be unaffected after the transitory period of induced paresis. It has been hypothesized a BoTox-induced change in the spindle discharge of EOMs to explain the effect in EOM length. In decerebrate lambs and goats, first order neurons of eye muscle spindles were identified in a cellular pool located in the medial dorsolateral portion of the semilunar ganglion. The belly of the muscle to which the recorded unit belonged was infiltrated with BoTox. A decrease in afferent discharge of the spindle and in its stretch sensitivity was observed. This effect began 10-15 minutes after the injection. There was no corresponding decrease in muscle tension during the first 45 minutes. This finding suggests that the block of release of acetylcholine at motor endings is earlier and more efficacious in gamma- than in alpha-motoneurons. As a result of the proprioceptive input reduction, an unbalance between the agonist and antagonist muscles should occur favouring the ocular realignment.
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PMID:Effect of botulinum toxin on extraocular muscle proprioception. 258

The Parks three-step test is the standard for diagnosing which isolated cyclovertical muscle is palsied. It does not, however, tell the examiner if in fact one is dealing with a palsy of one cyclovertical muscle. Numerous other causes of vertical strabismus may have a positive Bielschowsky head tilt test. The use of the three-step test in these clinical situations may lead to incorrect diagnosis and treatment. These clinical conditions include contracture of the vertical recti, paresis of more than one vertical muscle, dissociated vertical divergence, previous vertical muscle surgery, skew deviation, myasthenia gravis, and small nonparalytic vertical deviations associated with horizontal strabismus. Several diagnostic steps in addition to the three-step test are necessary to tell if one is in fact dealing with a palsy of a single cyclovertical muscle.
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PMID:Errors in the three-step test in the diagnosis of vertical strabismus. 278 11

Fourteen patients with ventricular cerebrospinal fluid shunts in place for chronic hydrocephalus presented with a history and neurological deficits usually associated with high intracranial pressure (ICP) caused by an obstructed shunt system. However, the symptoms were characteristically present when the patient was upright and active, and were usually relieved by lying down. The symptoms of intermittent headache, nausea, emesis, lethargy, and diplopia were associated with paresis of upward gaze or minimal strabismus. Measurement of ICP showed unexpected dramatically low levels with a marked drop in pressure when the patient was in the upright position, whereas ICP was near normal when the patient was supine. The low ICP was corrected by insertion of a high-pressure Flo-Control valve into the shunt system already in place. Postoperatively, the immediate clinical improvement and more normal ICP measurements were striking. The important clinical finding in this group of patients was the presence of disabling symptoms which occurred when the patients were up and active and which were relieved by lying down. Measurements of ICP with the patient in the supine and then in the upright position were critical in establishing an accurate diagnosis of symptomatic low ICP in these hydrocephalic patients with indwelling shunts. With the patient in the Trendelenburg position, ICP showed a marked increase, as expected; in some patients this position was prescribed as treatment for several days before surgery.
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PMID:Symptomatic low intracranial pressure in shunted hydrocephalus. 334 12

Both tenotomy and tenectomy of the homolateral superior oblique muscle have been advocated as surgical treatment for isolated paresis of the inferior oblique muscle. An iatrogenic superior oblique palsy has been reported to be a frequent complication of superior oblique tenectomy. This complication appears to be less frequent following superior oblique tenotomy. Of 16 consecutive patients with isolated inferior oblique paresis treated by homolateral superior oblique tenotomy and followed an average of 5.0 years (range six months to 11.6 years), only two patients demonstrated a superior oblique palsy postoperatively. Large vertical deviations with spread of comitance, however, required a superior rectus recession of the fellow eye in addition to superior oblique tenotomy.
J Pediatr Ophthalmol Strabismus
PMID:Superior oblique tenotomy in the treatment of isolated inferior oblique paresis. 355 52


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