No abstract

A 16-year-old girl with a history of T-cell lymphoblastic lymphoma and stem cell transplant presented with blurry vision in the left eye. One day prior, she developed a new-onset right facial palsy in addition to bilateral eyelid, lip, and feet swelling. Ophthalmologic evaluation revealed visual acuities of 20/20 OD and 20/800 OS. The left eye showed a relative afferent pupillary defect and decreased color vision. Extraocular movements, confrontation visual fields, and intraocular pressures were within normal limits. Anterior segment examination was unremarkable in both eyes. Dilated fundus examination revealed optic nerve head edema and peripapillary hemorrhages bilaterally, greater in the left eye than in the right eye (Figure 1). Scattered peripheral hemorrhages were present, consistent with thrombocytopenia at the time.

Clinical trials in children with Attention Deficit Hyperactivity Disorder (ADHD) show variability in behavioral responses to the selective norepinephrine reuptake inhibitor atomoxetine (ATX). The objective of this study was to determine whether Transcranial Magnetic Stimulation (TMS)-evoked Short Interval Cortical Inhibition (SICI) might be a biomarker predicting, or correlating with, clinical ATX response. At baseline and after 4 weeks of ATX treatment in 7–12 year old children with ADHD, TMS-SICI was measured, blinded to clinical improvement. Primary analysis was by multivariate ANCOVA. Baseline SICI did not predict clinical responses. However, paradoxically, after 4 weeks of ATX, mean SICI was reduced 31.9% in responders and increased 6.1% in non-responders (ANCOVA t41=2.88; p = .0063). Percent reductions in SICI correlated with reductions in ADHD-Rating Scale (ADHDRS) (r = .50; p = .0005). In children ages 7–12 years with ADHD treated with ATX, improvements in clinical symptoms are correlated with reductions in motor cortex SICI.

No abstract

A 63-year-old healthy woman presented with a 3-week history of fluctuating left eye swelling and redness. She also reported a 1-week history of left eye discomfort and left-sided tinnitus and a 1-day history of binocular horizontal diplopia. She denied any history of recent trauma. Ophthalmologic examination at the time revealed visual acuities of 20/30 OD and 20/40 OS. Intraocular pressures were 15 mm Hg OD and 21 mm Hg OS, with a widened pulse pressure of the left eye. Extraocular motility revealed a left eye abduction deficit. Pupils and confrontational visual fields were unremarkable. Hertel measured 16 mm and 17 mm, respectively. Slitlamp examination of the right eye was unremarkable, but examination of the left eye revealed a large subconjunctival hemorrhage and engorged episcleral veins (Figure 1). Fundus examination of both eyes was unremarkable.