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Show LETTERS TO THE EDITOR 69 TABLE 1. Clinical characteristics of eight cases of uveitis observed among a population of 50 TSP/ HAM in Martinique Case no. 1 2 3 4 5 6 7 8 Age 43 47 42 36 50 52 49 54 Sex F F F F F M F F Anterior uveitis R Yes Yes - - Yes Yes - Yes L Yes Yes Yes - Yes Yes - Yes Vitreous opacity R L Yes Yes - Yes - Yes - - Yes Yes Yes - - Yes Yes - Hyperhemia of optic R Yes - - Yes - - - - disk L Yes Yes Yes - - - Yes - Evolution Recurrent form since 5 years old Recurrent form since 15 years old Recurrent form since 1 year old Routine examination Routine examination Recurrent form since 1 year old Routine examination Recurrent form since 1 year old TSP/ HAM, tropical spastic paraparesis/ human T- lymphotropic virus type l- associated myelopathy. REFERENCES Vernant JC, Gessain A, Gout O, et al. Parapareses spas-tiques tropicales en Martinique: haute prevalence d'anti-corps HTLV- I. Presse Med 1986; 15: 419- 22. Ohba N, Matsumoto M, Sameshima M, et al. Ocular manifestations in patients infected with human T- lymphotropic virus type I. Jpn J Ophthalmol 1989; 33: 1- 12. Nakao K, Ohba N, Matsumoto M. Non infectious anterior uveitis in patients infected with human T- lymphotropic virus type I. Jpn J Ophthalmol 1989; 33: 472- 81. Mochizuki M, Watanabe T, Yamaguchi K, et al. Uveitis associated with human T- cell lymphotropic virus type I. Am J Ophthalmol 1992; 114: 123- 9. Yoshimura K, Mochizuki M, Araki S, et al. Clinical and immunologic features of human T- cell lymphotropic virus type- I uveitis. Am J Ophthalmol 1993; 116: 156- 63. Comment on " Isolated Trochlear Nerve Palsy Secondary to Dural Carotid- Cavernous Sinus Fistula" by Aki K. Selky and Valerie A. Purvin ( JNO 14( 1): 52- 54, 1994) Dear Editors: I read with great interest and pleasure the report of Drs. Selky and Purvin. It recalled a case of mine ( unfortunately not reported in the printed medical literature). I first examined the patient, a 60- year-old woman on March 23, 1970. She complained of a 5- week history of double vision, worse when looking down and to her left, as well as a pounding headache. Examination revealed mild redness of the conjunctiva, gross paresis of the right superior oblique muscle with 10 prism diopter ( p. d.) of right hypertropia on forward gaze, increasing to 17 p. d. on right head tilt. Among my initial diagnostic impressions were diabetic mononeuropathy, temporal arteritis, myasthenia gravis, episcleritis, and dysthyroid ophthalmopathy. Initially there was no exophthalmos or asymmetry in intraocular pressures. Five months later, the diplopia had resolved, but 8 months later right exophthalmos developed with maximum relative proptosis of 5 mm. At 11 months after onset, intraocular pressure had risen to 25 mm O. D. ( 15 mm O. S.). A B- scan performed by Dr. Jackson Coleman 12 months after onset revealed an abnormal optic nerve pattern consistent with " vascular anomaly" such as " carotid- cavernous sinus fistula." An orbital venogram 16 months after onset of symptoms showed obstruction of the superior ophthalmic vein on the right, with a large collateral proceeding laterally and posteriorly. The left superior ophthalmic vein was normal. A bilateral carotid arteriogram done 20 months after onset revealed a right dural carotid- cavernous fistula. Feeding vessels were from small meningeal branches of the right internal carotid system and by ascending pharyngeal, nasopharyngeal, and middle meningeal branches of the right external carotid artery. Venous drainage was shown to be exclusively on the right side, anteriorly, through the superior ophthalmic vein and facial vein. Clinical course: 6 months after the arteriogram, the proptosis, redness, and asymmetric pressures resolved. Over the next 22 years, a relentless drop of acuity secondary to cataract occurred, along with recurrence of redness, and dilation of fundus veins. At no time during the entire 24- year course has there ever been objective or subjective bruits. At the time of diagnosis ( 1971), the only therapeutic option offered her by Dr. Charles Wilson was electrothrombosis of the right cavernous sinus, which the patient respectfully declined. Although this case obviously would have taken precedence had it been reported, I can hardly fault Drs. Selky and Purvin for not citing it. Congratulations to them! Richard L. Sogg, M. D. Clinical Professor of Neuro- Ophthalmology / Neuro- Ophthalmol, Vol. 16, No. 1, 1996 |