Valérie Biousse

Isolated acquired unilateral horizontal gaze paresis from a putative lesion of the abducens nucleus

In three patients, acute horizontal gaze pareses developed that could not be overcome with the oculocephalic maneuver, indicating a putative lesion of the ipsilateral abducens nerve nucleus. None of the patients had a facial nerve paresis or evidence of a trigeminal sensory neuropathy. Although most lesions that affect the abducens nerve nucleus also damage the ipsilateral fasciculus of the facial nerve, small lesions in this region can produce an isolated horizontal gaze paresis.

Retinal and optic nerve ischemia.

Purpose of Review:This review focuses on aspects of retinal and optic nerve ischemia that may be encountered by neurologists. Recent Findings:Recent guidelines have emphasized the similarities between cerebral and retinal ischemia in terms of etiologic workup, acute management, and subsequent stroke risk. However, although ischemic optic neuropathies reflect optic nerve ischemia, they result from local small vessel disease and are not associated with a higher risk of cerebral infarction. Their management is therefore very different from acute cerebral ischemia. It is essential to rule out giant cell arteritis in all patients with acute retinal or optic nerve ischemia. Summary:Because the eye is vascularized by branches of the internal carotid artery, retinal ischemic symptoms are common in patients with anterior circulation ischemic strokes. Patients with central retinal artery occlusion, whether permanent or transient (responsible for transient visual loss), need to be evaluated and managed emergently similar to patients with cerebral ischemia, while anterior and posterior ischemic optic neuropathy are more concerning for giant cell arteritis.

Hemodialysis graft-induced intracranial hypertension.

Intracranial hypertension is rarely associated with peripheral hemodialysis shunts, presumably in association with central venous stenosis.1,2 Hemodialysis Reliable Outflow (HeRO) grafts (CryoLife, Inc., Kennesaw, GA) are designed to bypass preexisting central venous stenosis by connecting the brachial artery with the venous circulation through the ipsilateral internal jugular vein (IJV) (figure, C and D).3 We report a case of intracranial hypertension immediately after placement of a HeRO graft, review similar cases in the medical literature, and discuss possible pathophysiology.

Nonmydriatic retinal photography in the evaluation of acute neurologic conditionsAuthors Respond

Ocular fundus examination is a fundamental component of the neurologic examination. Finding papilledema in headache patients or retinal arterial emboli in stroke patients can be extremely useful. Although examination of the ocular fundus with a direct ophthalmoscope is an important skill for all neurologists, it is rarely and unreliably performed. Nonmydriatic ocular fundus photography, which allows direct visualization of high-quality photographs of the ocular fundus, has been recently proposed for screening neurologic patients in urgent care settings such as emergency departments. This new technology has many potential applications in neurology, including e-transmission of images for remote interpretation.The article by Bidot et al.1 is worth appreciation. I would like to share my additional views on this important clinical device. Ophthalmoscopy is an important bedside test by which a clinician can diagnose, offer a differential diagnosis in an undiagnosed patient, and—once diagnosed—contribute to prognosis in various infectious and noninfectious diseases. These tests are well-described in certain noncommunicable diseases, but need validation by randomized double-blind trials in infectious diseases such as malaria and dengue.2,–,4 When a patient in critical condition presents to the emergency department, ophthalmoscopy without pupillary dilatation (time sparing) may be a useful clinical tool for diagnosis. Furthermore, pupillary dilation may at times bias …