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Marc P. Cruciger, MD; Brian Brown, PhD; Elbert Magoon, MD
Smith Kettlewell Institute of Visual Sciences San Francisco

Nancy M. Newman, MD; Eric H. Denys, MD
Institute of Medical Sciences San Francisco

JAMA. 1981;246(20):2324.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

Convergent nystagmus, paresis of upward gaze, and pupillary abnormalities are signs of the Sylvian aqueduct syndrome.¹ We wish to report an unusual case of myasthenic syndrome (Eaton-Lambert) demonstrating convergent nystagmus and pupillary abnormalities. Similar findings have been previously described in diseases affecting the dorsal midbrain.

Our patient (who is a subject of a previous report²) is a 48-year-old man whose symptoms of lower extremity weakness and ptosis began in 1971. He was initially treated for myasthenia gravis. Because weakness persisted, electromyography was performed and the myasthenic syndrome was diagnosed. He began receiving guanidine, but chronic renal failure developed, necessitating long-term hemodialysis. At the present time he is receiving an experimental protocol of plasmapheresis, prednisone, azathioprine, and anticholinesterase medication. At the time of neuro-ophthalmologic examination, no anticholinesterase medication had been used for 12 hours.

The examination showed no paresis of upward gaze. The pupils were sluggish . . . [Full Text PDF of this Article]

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