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Show Literature Abstracts which seems only "possibly effective" in identifying malingering patients-and then only in the han?s of very good electrophysiologists. The actual tracmgs, however, are so variable that they may be unconvincing to the clinician. Lyn A. Sedwick, M.D. • • • 10. Referencl': Friedman, J. R., Kosmorsky, G. S., and Burde, R. M.: Stereoacuity in patients with optic nerve disease. Arch. Ophtha/mo/. 103: 37-38, 1985. Reprints: R. M. Burde, M.D., Department of Ophthalmology, Box 8096, 660 South Euclid Avenue, St. Louis, MO 63110. Thirteen patients with various optic nerve diseases and 11 patients with other ocular diseases were tested for near stereoacuity using the Titmus stereo acuity test. Visual acuity ranged from 20/20 in both eyes to asymmetry of 20/20 in one eye and 20/200 in the other. Stereoacuity scores were predicted based on visual acuity in each eye (the authors cite a previous study which set "normograms" for stereoacuity achieved by normal subjects with artificially degraded subnormal visual acuity, monocular and binocular). More than twice as many patients with optic nerve disease (76%) as other ocular diseases (27%) failed to achieve predicted stereoacuity scores. Data were not given regarding color vision, visual field, or details of motility examination, and quite variable optic nerve diseases were included. Most patients had good visual acuity. The authors concluded that good stereoacuity predicts good visual acuity, but that poor stereoacuity is not necessarily indicative of poor visual acuity (implicitly in patients with optic nerve disease); moreover, good stereoacuity with poor claimed visual acuity is probably indicative of malingering. Although these conclusions are probably valid, the patients tested seem too few with pathology too diverse to support them. Lyn A. Sedwick, M.D. • • • 11. Reference: Simonsz, D. M., Harting, F., de Waal, B. J., and Verbeeten, B. W. J. M.: Sideways displacement and curved path of recti eye muscles. Arch. Ophtha/mol. 103: 124-128, 1985. Reprints: D. M. Simonsz, Department of Ophthalmology, Academisch Ziekenhuis der Vrije Universiteit, De Boeleaan 1117, 1007 MB Amsterdam, Holland. The sideways displacement of the rectus eye muscles was examined by CT scanning of normal volunteers. The relaxed muscles assumed a curved path but straightened when contracted. The pictures of the scans themselves are very nice axial and coronal views of the orbits. One wonders why normal volunteers were subjected to radiation, as the prac- 202 tical application of this information is not readily apparent. Lyn A. Sedwick, M.D. • • • 12. Reference: rmes, R. K., Schatz, H., Hoyt, W..F., Monteiro, M. L. R., and Narahara, M.: Evolution of optociliary veins in optic nerve sheath meningioma. Arch. Ophtha/mo/. 103: 59-60, 1985. Reprints: W. F. Hoyt, M.D., Neuro-ophthalmology Unit, Room M-876, University of California Medical Center, San Francisco, CA 94143. A patient with a clinical course and CT s~an.consistent WIth optiC nerve sheath menmglOma was studied with serial fundus photographs over 8 years. These photographs docu,:,ent~d the onset of optociliary shunt vessels followmg dISC edema and the regression of these vessels with the development of optic atrophy. Very nice black and white disc photographs are included in the article. Lyn A. Sedwick, M.D. • • • 13. Reference: Zasorin, N. L., Yee, R. D., and Baloh, R. W.: Eye-movement abnormalities in ophthalmoplegia, ataxia, and areflexia (Fisher's syndrome). Arch. Ophtha/mol. 103: 55-58, 1985. Reprints: R. D. Yee, M.D., Jules Stein Eye Institute, 800 Westwood Plaza, Los Angeles, CA 90024. Three patients with the clinical diagnosis of Fisher's syndrome were studied, three by CT scan and two by eye movement recordings. The authors found that the ophthalmoplegia of these patients is consistent with a combination of supranuclear and peripheral cranial nerve palsies. Support for this view was provided by several pieces of evidence. The first was an abnormal computerized tomographic scan showing a right midbrain lucency in a patient with an up-gaze palsy, bilateral internuclear ophthalmoplegia, and bilateral ptosis. Eye movement recordings supplied information suggesting supranuclear and nuclearlinfranuclear patterns in the other two patients, which fit the clinical presentation. The authors reviewed 65 reported cases of Fisher's syndrome and 25 of brainstem encephalitis and found combinations of peripheral cranial neuropathy and supranuclear palsy in each group. Moreover, they postulated that the ataxia in Fisher's syndrome, as distinct from that of brainstem encephali'tis, is probably not due to long tract involvement but rather to cerebellar dysfunction, a conclusion that is suggested by eye movement abnormalities characteristic of lesions in the midline structures of the cerebellum, Le., impaired smooth pursuit, etc. This is an interesting article and a thoughtful addition to the literature about this unusual disorder. Lyn A. Sedwick, M.D. • • • Journal of Clinical Neuro-ophthalmology |