Norman G. Brunner

Ophthalmoplegia, ptosis, and miosis in temporal arteritis

Ophthalmoplegia occurred in 7 of 14 patients with biopsy proved temporal arteritis. Only one patient had diplopia. In six of the seven patients, the pattern of ophthalmoplegia did not conform to the distribution of one of the ocular motor nerves. Impairment of upward gaze was most common. In five patients the ophthalmoplegia was accompanied by ptosis, and in five it was accompanied by a miotic pupil. Ophthalmoplegia and ptosis were the major manifestations of temporal arteritis in one patient. Oculomotor signs and symptoms responded to corticosteroid therapy in all seven patients, but in two patients prolonged therapy was necessary. Ophthalmoplegia or ptosis may be early manifestations and may precede visual loss, so that frequent examination is recommended in patients suspected of temporal arteritis, with prompt administration of adequate doses of corticosteroid as soon as any ocular manifestations of temporal arteritis are noted.

Corticotrophin therapy in myasthenia gravis: Effects, indications, and limitations

SINCE THE FIRST DESCRIPTION IN 1948,1 the therapeutic effect of corticotropin in patients with myasthenia gravis has been investigated extensively.2-5z Although improvement in muscle strength occurred in some patients following termination of the therapy, corticotropin had not been widely accepted for treatment of myasthenia gravis following studies in the 1940s and 1950~2--25 because in many patients muscle strength decreased during this therapy, leading to death in at least two patient~.~*%15 Recently, improvement in the management of patients with respiratory impairment has permitted more intensive therapeutic trials of corticotropin, generally as “short intensive courses” in doses of 100 to 200 units daily intravenously or intramuscularly for ten to twenty days, and encouraging results have been obtained.37-51 This report evaluates the value of corticotropin in the management of myasthenia gravis by summarizing the authors’ experience in 64 courses in 22 inyasthenic patients and the experiences recorded by others in 251 courses in 166 patients.l-10,21-30,3”-41.43-4~,~;1