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Show LlTERATLI/\L /\HST/\I\CTS 263 to be cit ,rninant. Age at onset varied from a few months to 55 years; the patients experienced a reduction in vision starting generally during adolescence and reached blindness afkr J-JH yl',US (average 14 years). At an e,uly st,lge, cl'ntraOI scotoma and d~'schromatopsia could be demonstrated, although only minimal ophthalmoscopic changes were seen, and fluorl'scein angiography and ERG results were !wrmal. At the final stage, a large area of chl)ril)rdin,ll ,1trophY was observed, optic discs were p,l1l', fluorescein angiography showed absence llf eMly choroidal flush, and ERG disappeared. E~'l' movements Wt'rt' abnormal in 21 reported cases, with ddectiye upward or lateral gaze or slow saccades, or even total ophthalmoplegia. ~!L)tl)r sYmptoms usually followed changes in vision by 1-5 vears. When the disorder starts before the age of 3 years, prognosis is serious. Seven of 11 children died within a year from onset, the longest survival being 4.5 years. Al'illoam B. Safrall, M.D. Anterior Ischaemic Optic Neuropathy Secondary to Cluster Headache. Toshniwal P. Acta NClIro/ Sc,md 1986;73:213-8 (Feb). [Reprint requests to Pradip Toshniwal, M.Do, Division of Neurology, Cook County Hospital, Mo 3128, 1835 W. Harrison St., Chicago, IL 60612.) A patient with cluster headache developed anterior ischemic optic neuropathy during an attack of headache. Although a variety of vascular disturbances have been reported in the context of headache syndromes, anterior ischemic neuropathies have ~pparently not previously been described with cluster headache. During headache, intraocular pressure on the side of the headache was raised significantly in patients with cluster headache, but not in patients with migraine. Therdore, mechanisms of anterior ischemic optic neuropathy in cluster and migraine headaches were presumed to be different, the primary event possibly being vasodilatation in the former, and vasoconstriction in the latter. Avilloam B. Safrall, M.D. Infarcts of Both Inferior Parietal Lobules with Impairment of Visually Guided Eye Movements, Peripheral Visual Inattention and Optic Ataxia. Pi, rot-DeseiIIigny Ch, Gray F, Brunet P. Bmill 1l)t)6;1Ol):81-l)7 (Feb). [Reprint requests to Dr. Ch. Pierrot-Deseilligny, H6pital de la Salpetriere, 47, Boulevard de I'H6pital, 75651 Paris, Cedex 13, France.] It had been shown in the monkey that the dorsal part of the inferior parietal lobule (Broadmann's area 7) is involved both in visual attention and in different visually guided eye movements. However, in humans, clinicopathological cases have so far been rarely described, and lesions have not been limited to the inferior parietal lobule. Therefore, the case reported by Pierrot-Deseilligny, Gray, and Brunet contains substantial information on the role in humans of this small part of the parietal lobe for the control of guided eye movements, peripheral visual inattention, and optic ataxia. It is suggested that two corbe' ,fugal pathways are implicated in visually guided <lecades, the first arising from the frontal eye fields and projecting directly onto premotor structures of the brainstem, the second arising from the posterior part of the parietal cortex and reaching the premotor structures after having had a relay in the superior colliculus; finally, the findings support the idea that optic ataxia can result from interruption of direct and/or crossed occipitofrontal pathways running in the deep white matter of the parietal lobe. A"iIlIJa/1I B. 5,ltnl/l. ,\1. O. Oral Vitamin E Supplements Can Prevent the Retinopathy of Abetalipoproteinaemia. Runge P, Muller DPR, McAllister J, Calver 0, lloYd JK, Taylor D. Br I Oplltllll/1110/ 1986;70:166-73 (Feb). [Reprint requests to D. Taylor. Dep<1ftment of Ophthalmology, Hospital fl)r Sick Children, Great Ormond Strl'et, London WCIN 3jH, Engl'lI1d.] Progressive rdinop,lthy l)bserved in untreated abetalipoproteinaemi,l (B,lssen KI)rnZ\\l'i~ 5\ndrome) was subst'1l1ti,11Iy nwdifit'd by large oral doses of vitamin E (,lpproxim,llL'h' lllLl mg kg,daY). administr,ltl'd during pl'rillds r.1I1,lC,lI1g frl)!l1 12 tl' It) years, in .1ddition tLl .1 ILlw~t.1t dll'l .1nd O>U~Tkments of the Llther f,lt SLllubk \·ll.1I1lins. This was shown in six atfeckd subject::;, in WI1l1111 the Iwrmally prugressive retinal changes that tvpicallv lead to blindness bv e,lrlv .1dult lift' wcre avoided. Treatment with vitamin i\ .)ll1l1l' ((luld nl)t pre\Oent or arrest progression ot rl'lin,ll ksiLln5 ..1"111(1(1111 I:. :--ill! i", Illl" |
