Biomedical subjects
Publications and source records attributed to R I Kellen.
We examined a middle-aged man with a prominent yellow forelock who complained of loss of vision in both eyes. He smoked his pipe avidly and drank a little Bourbon whisky daily. The nicotine content of the forelock (21.7 ng/mg) was 10 times that of the hair on his occiput (2.23 ng/mg). A yellow forelock when associated with isolated painless visual loss suggests tobacco amblyopia.
Four patients with progressive visual deterioration were found to have sarcoidosis involving the anterior visual pathway. They all developed chiasmal dysfunction and bilateral optic neuropathy, which responded to megadose corticosteroid therapy. When an attempt was made to withdraw the corticosteroids, the patients experienced a recrudescence of visual dysfunction and were subsequently unable to tolerate the corticosteroid dose levels necessary to maximise their visual potential. Each patient was treated with high-voltage radiation therapy, totalling up to 4500 rads. The beneficial response obtained was temporary, and immunosuppressive therapy with azathioprine or chlorambucil was instituted, preventing further deterioration.
Unilateral peripheral sixth nerve palsy associated with an ipsilateral postganglionic Horner's syndrome has previously been described. Isolated bilateral sixth nerve palsy due to a pontine hemorrhagic lesion, however, is a rare occurrence. We describe such a case whose only other neurological finding was a unilateral preganglionic Horner's syndrome.