Shedding light on walking in the dark: the effects of reduced lighting on the gait of older adults with a higher-level gait disorder and controls

OBJECTIVE: To study the effects of reduced lighting on the gait of older adults with a high level gait disorder (HLGD) and to compare their response to that of healthy elderly controls. METHODS: 22 patients with a HLGD and 20 age-matched healthy controls were studied under usual lighting conditions (1000 lumens) and in near darkness (5 lumens). Gait speed and gait dynamics were measured under both conditions. Cognitive function, co-morbidities, depressive symptoms, and vision were also evaluated. RESULTS: Under usual lighting conditions, patients walked more slowly, with reduced swing times, and increased stride-to-stride variability, compared to controls. When walking under near darkness conditions, both groups slowed their gait. All other measures of gait were not affected by lighting in the controls. In contrast, patients further reduced their swing times and increased their stride-to-stride variability, both stride time variability and swing time variability. The unique response of the patients was not explained by vision, mental status, co-morbidities, or the values of walking under usual lighting conditions. CONCLUSION: Walking with reduced lighting does not affect the gait of healthy elderly subjects, except for a reduction in speed. On the other hand, the gait of older adults with a HLGD becomes more variable and unsteady when they walk in near darkness, despite adapting a slow and cautious gait. Further work is needed to identify the causes of the maladaptive response among patients with a HLGD and the potential connection between this behavior and the increased fall risk observed in these patients

Traumatic Optic Neuropathy and Monocular Blindness following Transnasal Penetrating Optic Canal Injury by a Wooden Foreign Body

Purpose: To report a case of right eye blindness due to a penetrating injury in the contralateral nostril. Methods: This is a case report of a 67-year-old patient who presented to the emergency room complaining of transient blurred vision in his right eye after falling on a small branch with no apparent injury besides minor lacerations. The following day, the patient experienced blindness in the right eye. Physical examination revealed small lacerations on his left forehead and optic neuropathy on the right side with no other obvious discerning physical or imaging abnormalities. Results: After elevated suspicion and reassessment of the neuroimaging findings, a radiolucent track was observed in the nasal cavity, continuing up from the left nostril to the right optic nerve. Transnasal endoscopic surgery was performed and a long wooden branch was removed from the nasal cavity. Conclusion: A nasally penetrating wooden foreign body can cause traumatic optic neuropathy and vision loss on the unaffected side and can be very difficult to locate and image without any clear external evidence as to its presence. This case highlights the importance of maintaining a high level of suspicion in these types of cases

High Sensitivity C-Reactive Protein Measurements in Patients with Non Arteritic Anterior Ischemic Optic Neuropathy, a Clue to the Presence of a Microinflammatory Response

Non arteritic anterior ischemic optic neuropathy is the most common cause for acute optic neuropathy in the elderly. The incidence of atherothrombotic risk factors in these individuals, including diabetes mellitus and hypertension, raises the possibility of common pathological mechanisms that contribute to the development of this ischemic disease

Enlarged Optic Nerve with Central Retinal Artery and Vein Occlusion Due to Inflammation of Optic Nerve in a 4 Year Old Girl

A 4-year-old healthy girl was brought to our clinic with acute loss of vision in her right eye. On examination there was no light perception on her right eye and the fundus revealed a swollen optic disc combined with central retinal artery occlusion and central retinal vein occlusion

The Relation Between Psychological Factors and Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) is a disorder associated with intracranial pressure greater than 250 mm of water, normal neuroimaging (apart from possible small ventricles) and normal cerebrospinal content. Although the accurate diagnosis and treatment of IIH are receiving increasing research attention, the possibility that psychosocial factors contribute toits etiology or the psychosocial impact of this condition have not been studied systematically

Advanced Magnetic Resonance Imaging in Idiopathic Intracranial Hypertension

Idiopathic intracranial hypertension (IIH) is a disorder associated with intracranial pressure greater than 250mm H2O and normal neuroimaging and cerebrospinal fluid content. Earlier studies of IIH have shown reduced cerebral perfusion usingSPECT

Epidemiology of Intracranial Hyptertension in Israel

To determine the incidence, demographic and clinical features of Pseudo Tumor Cerebri ( PTC) / Idiopathic Intracranial Hypertension (IIH), in Israel