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Show LlT[f~ATUI~L 11HS'['f,!\CTS /95 Relapsing Fisher's Syndrome. VilKl'nt FM, Vincent T. 1NCllrol NClIro~lIrs p~.llc"il1lrlf IlJH6;4LJ:6114-5 (May). [Reprint rt'quests to Dr. F. Vincent, M,lssachusetts General Hospital, Boston, Mi\ 1121l4.1 A 58-vear-L1ld WL1lllan W,lS first l'V,llu,lll'd in November 1977 fL1r tlw COlllpl,lints of di;zinl'ss ,1Ild unsteadil1t'ss. She h,ld ,1 flu-Iikl' illIll'sS 4 weeks previL1usl~·. On'r tlw ensuing kw d,lVS, the p,ltient devell)ped ophthalllloplegi,l, .nefll'xia, ,1Ild ataxia. Within a fL-'w wel'ks, sill' h,ld rl'lurned to her pre-illness stalL'. She rl'lll,lined ,1SVIllptOIll,ltiC until 19HJ, whl'n a silllil,H illIll'ss occurrl'd. This again de.ned up in ,1 fL-'w \\'l'l'ks. Fisher s~'ndwlllt' is ch.n,KlL'rized bv tlll' triad of ophthalmL1plegia. areflexia, and ,1taxia. It is thought tl) be a vari,1I1t L1f tlw Landrv-CuillainBarre svndwllle, in which as high as 10'1, L1f the patients may suffer a relapse. Only two other cases L1f relapsing Fisher's syndrome have been reported. Recurrence appears much less commL1n with the Fisher variant. Waller M. 1011, M.D. Pseudotumor Cerebri with Amiodarone. Fikkers BC, Bogousslavsky L Regli F, ClassL1n S. 1NClirol Neuro~urg Psycllialry 1986;49:606 (May). [Reprint requests to Dr. J. Bogousslavsky, Service de neurologie, CHUV, 1011 Lausanne, Switzerland.] A 58-year-old man had been treated for 6 months with amiodarone for supraventricular arrhythmias on exercise. He also had received pindolol, allopurinol, and clofibrate for several months prior to amiodarone. The patient developed bilateral papilledema. A computerized tomography scan was normal and cerebrospinal fluid (CSF) pressure was 300 mm H20. CSF pressure remained elevated on follow-up 2, 5, and 12 months later. At 12 months, ophthalmoscopic examination revealed bilateral papilledema with developing disc atrophy. Because of possible drug toxicity, amiodarone and other medications were discontinued. During the following months, the papilledema resolved. Amiodarone is a cardiac drug valuab1l' in the treatment of angina and ventricular arrythmias. i\ high percentage of patients receiving amiodarone develop a vortex-like epithelial keratopathy. [n this case report, amiodarone is implicall'd in causing pseudotumor cerebri. Besides amiodarone, the patient described was taking three other medications. Paitents receiving amiodarone should be followed with both slit-lamp and ophthalmoscopic examinations. Waller M. lill!, M.D. Treatment of Kearns-Sayre Syndrome with Coenzyme QIO' Ogasahara S, Nishikawa Y, Yorifuji S, Soga F, Nakamura Y, Takahashi M, Hashimoto S, Kono N, Tarui S. Ncurology 1986;36:45-53 (Jan). [Reprint requests to S. Ogasahara, M.D., The Second Department of Internal Medicine, Osaka University Medical School, Fukushima 1-1-50, Fukushima- ku, Osaka 553, Japan.] Kearns-Sayre syndrome is characterized by the triad of ophthalmoplegia, retinal degeneration, and cardiac conduction defects. Morphologic abnormalities of mitochondria in many organs and elevated lactate and pyruvate concentrations in serum or cerebrospinal tluid suggest abnormal mitochondrial function. The authors treated five patients with Kearns-Sayre syndrome with coenzyme Q IO for more than a year. They noted some improvement in electrocardiogram abnormalities and neurologic symptoms. However, there was only slight improvement, barely noted by the patients themselves, in ocular movement and ptosis. The authors raise the possibility of biochemical replacement therapy for Kearns-Sa~'fe syndrome. Unfortunately, there was little, if any, improvement noted in ptosis or ophthalmoplegia. Enzyme replacement ultimately may be the treatment of choice for this condition. At present, however, much more research is necessary before this type of therapy can be recommended for patients with Kearns-Sayre syndrome. Walter A1. la~I. M.D. Trihexyphenidyl Treatment of Vertical Pendular Nystagmus. Herishanu Y, Lauzoun Z. NCllrology 1986;36:82-4 (Jan). A 34-year-old WL1lllan developed vertical pendular nystagmus (ocular myoclonus) 4 months after a brainstl'm hemorrhage due to eclampsia. No palatal myoclonus was observed. Treatment with trihexyphenidyl, 5 mg three times daily, resulted in marked reduction in the amplitude of the nystagmus. UpL1n stopping the medication, I 01/1 Nl'lIro-ol'hthallllol. Vol. 6. No.3. 1986 |
