OCR Text |
Show lounlal of Clillieal Ncuro- ol'hthalmology 11( 1): 74- 77. 1991 Letters to the Editor To the Editor: I read with interest your article in the Journal of Clinical Neuro- ophthalmology Volume 10, No. 2, entitled, " Post Myelographic Nerve Palsy in Association With Contrast Agent lopanidol." A few years ago I wrote you a letter, for which I never got an answer, concerning an interesting case of mine involving something similar to the case that the authors Bell et at described in volume 10, No. 2 of the Journal. A few hours after iohexol myelography my patient developed a sixth nerve palsy which resolved in about 10 days. About a month later he underwent lumbar laminectomy and fusion at which time inadvertent dural puncture with a significant outpouring of spinal fluid occurred; this was treated with surgical repair. My frightful anticipation of another, possibly more prolonged, sixth nerve palsy was dampened by no ill effects suffered by the patient. It is possible that Dr. Bell and his colleagues are correct in stating that when something is put into the subarachnoid space during lumbar puncture, the risk of sixth nerve palsy is heightened, since, in our particular case, every bit as much ( if not more) spinal fluid was allowed to leave the spinal canal with a much larger rent in the dura at the time of surgery. But, of course, at that time nothing was put back in, as it was during myelography. It was an interesting paper. We used iohexol instead of iopanidol, but I suspect that similarities do exist with the nonionic contrast materials. I hope this is of some interest. I think it may lend some credence to Dr. Bell's notations on the possible etiology of sixth nerve palsies. Vincent L. Ferrara, M. D. 1010 Fox Chase Road Rockledge, Pennsylvania To the Editor: How transient are the glories that the world bestows upon us! I am referring to the letter to the editor bv Dr. Beckman and Dr. Hartman describ' L rl,-, ppler flow meter to identify 74 co 1991 Raven Press, Ltd., New York the course of the temporal artery. In 1984 I wrote precisely the same letter to the American Journal of Ophthalmology. The reference is Bienfang, D. C. " Use of the Doppler Probe to Detect the Course of the Superficial Temporal Artery," American JournalofOphthalmology, Volume 97, no. 4, pages 526527, 1984. Sincerely yours and best wishes for a joyous Christmas and a happy New Year! Don C. Bienfang, M. D. 75 Francis Street Boston, Massachusetts Ed. Note: Please forgive the lack of response to your letter a few years ago. Happy New Year, too! ( Ed.) Frame with Spirit Level for Evaluating Visual Tilt To the Editor: Tilt in visual perception of verticality is both a frequent neuro- ophthalmological finding and an important clinical clue. It is often associated with ocular tilt reaction, which consists of ipsilateral head tilt, conjugate eye torsion and skew deviation, and occurs in a number of vestibular disorders ( 1,2). Ocular torsion can be measured either objectively by fundus photography or subjectively by various psychophysical methods ( 3). We found that a Maddox rod in a trial frame was useful for evaluating changes in visual perception of verticality. To make such an evaluation, the patient's head should be vertical and the frame horizontal. Minimal tilts of head and/ or frame, although often passing unnoticed, can cause significant changes in measured values. We therefore fixed a small spirit level to the transverse bar of a trial frame to ensure that it was horizontal ( Fig. 1). When the frame was placed carefully on the patient's face / |