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Myasthenia gravis is a disease characterized by muscular weakness and fatigability which afflicts 2-10 patients per 100,000 with 20% of cases presenting in childhood. Muscles innervated by cranial nerves are frequently involved with ptosis and diplopia being the most frequent presenting complaints. We review the literature and report a case of a 20-month-old infant presenting with inspiratory stridor and cyanosis, resembling foreign body aspiration.
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PMID:Juvenile myasthenia gravis: an unusual presentation. 221 Sep 54

A 13-year-old boy, with no past medical history, was admitted after a car accident on October 29, 1989. On admission, he was alert. Physical examination revealed a bruise on the left frontal region, a fracture of right clavicula and right hemopneumothorax. He was treated with respirator due to dyspnea. On November 1, 1989, he was removed from respirator and expressed diplopia. Neurological examination showed bilateral ptosis, mild anisocoria, normal light reflex and horizontal gaze nystagmus in lateral gaze. Both eyes were deviated outward slightly in the primary position and showed inability to converge. The external ocular movements of both eyes were mildly limited in elevation and adduction. Ataxia was observed in bilateral upper extremities. Deep reflexes were normal and no pathological reflexes were observed. Brain CT scans showed no abnormality. On November 6, 1989, his ptosis and diplopia improved. On November 8, he was completely recovered. A magnetic resonance imaging on November 10 revealed no abnormality. We suggested that transient dysfunction of midbrain associated with head injury might cause transient bilateral primary oculomotor nerve paresis, nystagmus and ataxia.
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PMID:[A case of transient bilateral primary oculomotor nerve paresis associated with head injury]. 224 37

We reported a patient with a brainstem ptosis (midbrain ptosis) associated with mesencephalic hemorrhage. A 57-year-old woman had the sudden onset of bilateral blepharoptosis and diplopia. On admission, computed tomography of the brain and magnetic resonance imaging disclosed a small hematoma in the left tegmentum of midbrain. She had no past history of hypertension of head trauma. Cerebral angiography gave no additional informations. The lesion involving the central caudal subnucleus of IIIrd nerve nucleus may be responsible for the bilateral ptosis, since this finding is consistent with current models of oculomotor organization in monkeys (Warwick 1953).
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PMID:[Brainstem ptosis (midbrain ptosis) associated with mesencephalic hemorrhage]. 224 38

Disorders of ocular motility usually present with double vision which may be accompanied by ptosis and pupillary changes. The differential diagnosis comprises supranuclear, nuclear and infranuclear palsies and diseases of the myoneural junction. Accurate assessment is important, since the aetiological possibilities include neurosurgical emergencies such as intracranial aneurysm and systemic problems such as diabetes mellitus.
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PMID:Disorders of ocular motility. 202 91

To test the hypothesis that visual disturbances are more common during intravenous magnesium sulfate administration than at 1 to 4 days after discontinuation of the drug, 13 women underwent bedside neuroophthalmologic examinations during intravenous magnesium sulfate tocolysis at 2.0 to 3.0 gm hr and again at 1 to 4 days after cessation of therapy. Visual symptoms were common during intravenous magnesium sulfate administration. Blurred vision was present in 12 of 13 patients and diplopia was present in 10 of 13 patients. Abnormal findings during neuroophthalmologic examination occurred in all patients during intravenous magnesium sulfate administration. Findings included ptosis, accommodative and convergence insufficiency, and abnormal pupillary responsiveness to light and near. All patients were symptom-free and had normal examinations after magnesium sulfate was discontinued. These findings suggest that visual disturbances with therapeutic magnesium sulfate are common.
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PMID:Neuroophthalmologic effects of intravenous magnesium sulfate. 225 94

The authors use injections of botulinum A toxin in treatment of facial spasms. 105 patients (70 patients with blepharospasm, 35 patients with hemispasm) were treated during 4 years. The toxin Wisconsin relieved spasms for an average of 10 weeks. Local complications such as ptosis and diplopia appeared in less than 1/5 of the cases. No general complications were observed. Repeated treatments are necessary. The authors noted a decrease of lacrimal secretion on the treated side in hemifacial spasm and concluded that botulinum A toxin injections could be used as a treatment of epiphora.
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PMID:[Treatment of facial spasm with botulin A toxin]. 225 49

A thirty-eight-year-old man developed gradually progressing right retro-orbital pain, diplopia on the left lateral gaze, and left ptosis. On examination paresthesia was present on the first division of right trigeminal nerve. Orbital venography revealed obstruction of right superior orbital vein on the entering portion to the cavernous sinus. A daily administration of 30 mg of prednisolone resulted in a rapid improvement of the symptoms. Diagnosis of Tolosa-Hunt syndrome was made on the basis of neurological symptoms, roentgenographic findings and responsiveness to prednisolone. One year later, weakness of right leg accompanied with left cervical and axillary lymphadenopathy was developed. A biopsy specimen of cervical lymph node was identical with the Hodgkin's disease, lymphocyte predominance type. He was treated with COPP regimen; lymphadenopathy decreased in size. We reported a rare case of Hodgkin's disease preceded by Tolosa-hunt syndrome which might be caused by the extranodal lesions.
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PMID:[Hodgkin's disease associated with Tolosa-Hunt syndrome]. 232 80

From April 1983 to April 1988, 381 botulinum toxin injections for lid spasms were administered to 106 patients. Sixty-nine had bilateral blepharospasm and 37 had hemifacial spasm. Of the 381 injections, 308 had been given to patients who returned for follow-up examinations. No systemic effects were noted at any of these visits; all side effects were temporary; there were no serious complications. Ptosis, the most frequently encountered problem, occurred after 26 (8.4%) of the injections. Other complications included: corneal exposure (after eight injections, 2.59%); face droop (after 11 injections, 3.57%); diplopia (after five injections, 1.62%); and subtle visual blurring (after eight injections, 2.59%). One patient noted jaw tenseness, another mentioned tearing, one reported brow droop, and another complained of crossed eyes. Ten injections had minimal effect; in these cases a repeat injection usually was effective. Only four patients chose surgery after beginning injections. We conclude that botulinum toxin injections are a safe, effective means of treating lid spasms.
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PMID:Side effects of the use of botulinum toxin for treatment of benign essential blepharospasm and hemifacial spasm. 238 55

We evaluated and presented here, the features of the eleven cases of food-borne botulism who admitted to the Infectious Diseases Department of Ibni Sina Hospital of Ankara University. Three of the cases admitted in 1984 and eight of them admitted in 1987. All of the cases were caused by home-prepared foods which had been eaten without cooking; the types of the food were green beans and pepper with sauce. In these cases the main symptoms and signs were generalized muscular weakness, dry mouth, dysphagia, diplopia, ptosis of the eyelids; besides these the other clinical symptoms and signs were seen in some patients. Although toxin couldn't be detected in the patients' sera by mouse-toxin neutralization, the EMG findings supported our diagnoses. To the three patients in the first group, botulinal anti-toxin was not given and two of them died. Anti-toxin was administered to the seven patients in the second group, none of them died.
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PMID:[Food-borne botulism and its epidemiological features as seen in our country during the last few years]. 248 35

A 63-year-old white male with a 25-year history of hypertension experienced the onset of intermittent diplopia and gait disturbance 24 hours after a change in antihypertensive medication from atenolol 50 mg/d to enalapril 5 mg bid. Three weeks later, the patient was admitted with a worsening of symptoms. Cerebral arteriography revealed significant bilateral vertebral artery stenosis. Symptoms continued to progress in the hospital, and at the time of posterior circulation revascularization the patient had a persistent bilateral internuclear ophthalmoplegia and right ptosis. The need for a neurovascular workup and adjustment of therapy in patients with antihypertensive-associated cerebral ischemia is discussed.
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PMID:Hemodynamic vertebrobasilar insufficiency as an adverse effect of antihypertensive therapy. 254 68


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