As soon as you boot up the device, you will be greeted by a 2,160 by 1,000 OLED panel, which generates a 1,080 by 1,2000 picture for each eye. These two sensors work together to obtain the best tracking possible and to cover as much space as necessary. The second sensor has a whole different role, namely tracking the Oculus Touch Controllers. You can adjust the elevation of the sensor by tilting it up and down, but you will have to make sure it is positioned in such a way that it maintains a clear view of the headset. The Oculus rift comes with a single external sensor, a black, cylinder-shaped device that is mounted on a metal desktop stand. The headset is connected to a PC or XBOX One directly via a lengthy cable that is split at the end into two connectors: a USB 3.0 and a HDMI jack. However, if you are a console player (more specifically, an Xbox One user), you can easily coonect the oculus rift to it. Additionally, you will need an HDMI 1.3 output, three USB 3.0 ports, and one USB 2.0 port. Costing between $300 and $400 on Amazon, you will need an Intel i5-4590, and Nvidia 960 and at east 8 GB of RAM to use the VR headset. Since launch, due to consumer demand, both the price and the specs have been lowered. The official requirements for the Oculus Rift are similar to the requirements for the HTC Vive. Furthermore, you can wear glasses with the headset without experiencing any discomforts whatsoever. Compared to other VR headsets, such as the HTC Vive or PlayStation VR, the Rift is extremely lightweight and compact. Admittedly, users have reported instances of slight condensation – but most of those cases occurred in rooms with high amounts of humidity.īut the fabric is not the only design element that provides users with comfort and ease of gaming. Unlike other VR headsets, which force you to take occasional breaks to catch your breath, the Rift supports successive hours of uninterrupted playing. However, with the Oculus Rift, you will never deal with this issue even after long gaming sessions. This design decision starts making even more sense when you consider the fact that most VR sweats tend to become very hot, sweaty and uncomfortable, especially in more demanding video games. This might seem like an unnecessary addition, but according to the company, the fabric prevents the goggles from becoming foggy due to condensation. The headset is wrapped in a soft black material that hides the plastic exterior beneath it. Compared to other virtual reality headsets, such as the HTC Vive and PlayStation VR, the Rift has an elegant, played down look that roughly resembles a pair of ski goggles. While nowadays the selection of vr for xbox one is as wide as it will ever get, the Oculus Rift still has not been surpassed in terms of design and aesthetics. Even though it fell short in some respects back when it was released, it had the chance to evolve in the last two years and become one of the best VR headsets for the Xbox One. However, things have drastically changed since then, with VR gradually transitioning from a niche technology reserved to gamers and tech geeks to being advertised on virtually (no pun intended) every corner. It started the VR wave with its successful Kickstarter campaign in 2012, back when this technology was considered merely a retro curiosity, more fitting to 90’s cyberpunk films such as Hacker than our own reality. The Oculus Rift is arguably the most famous VR headset, even more so than the HTC Vive and other devices released to date. As hard as it is to believe, Oculus Rift is already two years old.
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Set up your scene and in your project make sure you have more than one slide with content.The Lightform layout in TouchOSC can be easily used to control slide management and playback in a project. Now when you use that control, the parameter will change in realtime on your Lightform device.Touch one of the buttons in the app or move one of the sliders to associate that control with the parameter that your Lightform device is learning.Click Learn next to the parameter that you’d like to connect to a control in the TouchOSC app.Switch to the Control Page and open the OSC Mappings Window.Publish your project with at least one Live effect on.The same surface can have a different Live effect on a different slide. Make sure you have Labs enabled and Live turned on (refer to the beginning of this tutorial for more details).Īt the moment Lightform Creator only supports one Live effect per slide. Step 4 Map OSC Controls in Lightform Creator However, something like color parameters are 2D or 4D controls, and you will need to define multiple sliders with indexed commands (see OSC Controls). With TouchOSC, you can use a fader (or most other controls) to control 1D parameters such as 'Line Width' or 'Zoom'. This means that not all of our OSC controllable parameters will work with Touch OSC. If you don't do this, pressing and then releasing a button will generate 2 events ( e.g., pressing a button for "next slide" would actually advance you 2 slides instead of 1).Īnother thing to keep in mind is that TouchOSC only lets you define 1D and 2D sliders and toggle/momentary buttons. Please note: When creating your own TouchOSC layout, if using buttons ( e.g., for play/stop/next slide/etc), you must turn off "Send on Release" - see this article. Refer to the TouchOSC documentation for layouts to learn more. You can create custom layouts to have more control over your projects by downloading the TouchOSC Editor. Tap < TouchOSC to return to the main menu and tap Done. Once the file is on your device, you need to set it as the current layout by tapping the line under Layout and selecting Lightform-0.9.6. Install this file directly by downloading it on your phone.ĭownload the file to your computer, then use iTunes to copy the file to your phone. You can start by using the Lightform layout which can be downloaded here: The Lightform device will not show up in 'Found Hosts' but if the information has been entered correctly, it will work Step 3 Choose Layout You should now be connected to your Lightform via OSC! Press Hostname: (You can find your device's IP address in Lightform Creator on the Control Page, or by looking on the projected Testcard.) In the TouchOSC app, tap the OSC line under CONNECTIONS and enter the following information:.Connect your mobile device to the same WiFi network that your Lightform device and computer are connected to.Once you have the TouchOSC app downloaded and installed on your mobile device To learn more about TouchOSC visit their website. To control your Lightform device via a mobile device, you can use the TouchOSC app available for both iOS and Android. Using the TouchOSC Mobile App Step 1 Download the TouchOSC Mobile App Learn more about Editing OSC Mappings in Lightform Creator. Now the effect/generator will be computed in real-time during project playback by the Lightform device and you can adjust the effect's parameters using OSC messages simultaneously during playback. when an effect or generator has been applied to a surface, in its properties enable Live.go to the Help menu and enable Labs in Lightform Creator.To get Lightform Creator ready for OSC messages: Each effect has various exposed parameters that you can adjust ( e.g., speed and size). You can communicate with the Lightform device using OSC messages. How does TouchOSC work with Lightform Creator? Bringing the benefits of modern networking technology to the world of electronic musical instruments, OSC's advantages include interoperability, accuracy, flexibility, and enhanced organization and documentation." Read more here. "Open Sound Control (OSC) is a protocol for communication among computers, sound synthesizers, and other multimedia devices that is optimized for modern networking technology. These features are experimental and unsupported, but we welcome bug reports and feedback to continue improving Lightform Creator. We do not recommend using Labs for installations or productions where dependability is required. (Paper read to 4th International Harbour Conf., Antwerp, June). Spreading and evaporation of petroleum products on water. Petroleum products survey no.46 : Burner fuel oils. The microbial deterioration of hydrocarbons and the related deterioration of equipment used for the storage, distribution and handling of petroleum products. Identification of crude oils by paper chromatography. Institute of Petroleum, London.īeynon, L. Scientific aspects of pollution of the sea by oil (pp. The migrating populations of the longtailed duck (Clangula hyemalis) and the common scoter (Melanitta nigra) in the spring, 1960 (in Finnish). Some effects of pollution from the “Torrey Canyon” disaster on littoral and sublittoral ecosystems dominated by attached macrophytes. The attempted rehabilitation of oiled sea birds. Post-mortem findings in oiled auks dying during attempted rehabilitation. Mode of Action and Toxicity of Solvont- emulsifiersīeer, J. Bacterial Degradation and Other Biological Processesī. Pacific Northwest Laboratories, Richland, Washington, D.C.Beaumont, F. Oil spillage study : research report to U.S.Coast Guard. Detergents: effects on the chemical senses of the fish Ictalurus natalis (le Sueur). Oil Pollution Research Unit, 1968, B1-B11. Mode of Action and Toxicity of Oilsīaker, J. The biological problems of littoral pollution by oil and emulsifiers -a summing up. Shredded polyurethane absorbs oil spilled on oceans. Public Amenity and the Tourist IndustryĪnon. Standard methods for the examination of waterĪnon. Washington, D.C.Īmerican Public Health Association (1960). Manual for the prevention of water pollution during marine oil terminal transfer operations. Manual on disposal of refinery wastes.Īmerican Petroleum Institute (1963). Sampling and analysis of waste water.New York (2nd edn.). and Pacific American Tankship Ass.)American Petroleum Institute (1957). Petroleum Institute, Pacific American Steamship Ass. Behaviour of Spilt Oil on Sea and ShoreĪmerican Merchant Marine Institute (1953). On the behaviour and filtering ability of the Black Sea Mytilus galloprovincialis in oil-polluted waters(in Russian). A recent oil pollution and its effects on the waterbirds in the San Francisco Bay area. Report to Council, Royal Society, London. The pollution of the sea and shore by oil. Containing oil spills with a pneumatic barrier. Biological and oceanographic effects of oil spillage in the Santa Barbara Channel following the 1969 blowout. Tanker Operation and General-cargo ShippingĪbbott, B. Histopathologic and biochemical responses in Arctic marine bivalve molluscs exposed to experimentally spilled oil. Neff, J.M., R.E.Hillman, R.S.Carr, R.L.Buhl, and J.I.Lahey Neff JM, Bence AE, Parker KR, Page DS, Brown JS, Boehm PD.īioavailability of polycyclic aromatic hydrocarbons from buried shoreline oil residues thirteen years after the Exxon Valdez oil spill: a multispecies assessment. The Prestige oil spill: a laboratory study about the toxicity of the water-sobule fraction of the fuel oil. Navas JM, Babin M, Casado S, Fernandez C, Tarazona JV. Nutritional Autopsy of a Short-tailed Albatross (Diomedea albatyus)Weakened by Fishhook, Washed Ashore in Central Honshu,Japan Gas chromatographic analysis of external oil and blackish liquid contents of digestive organs of rhinoceros auklets (Cerorhinca monocerata) in the Japan Sea. San Mateo Mystery Spill-Longest Response in OWCN History Mollusc communities of tropical rubble shores of Curacao: Long-term (7+ years) impacts of oil pollution.Įffect of Prudhoe Bay (Alaska, USA) crude oil on the homing of coho salmon in marine waters. Operational Pollution Prevention Programs for Loaded Tankers Transiting Coastal Waters Sailing with a strong wind blowing from behind sereĪ state without motion or development taiga The quality of being or acting lenient mawkishĪn area of soggy ground a situation that impedes or prevents progress, that is hard to get through muskegĪn area of swamp or boggy land covered in moss, leaves and dead plant matter opprobriumĪ large cactus found in the American Southwest that can grow to be sixty feet tall scudding Vagabonds without a vehicle, who thus have to hitchhike or walk lenity Traveling from place to place leather tramps Steep ridges or cliffs forming the boundary of a plateau area garrulous Though comforted by the surrounding landscape’s beauty, Walt and Billie leave still nursing heavy hearts.Resistant to authority flagrantly disobedient or rebellious coppice Having solved the mystery of McCandless’s death, Krakauer accompanies Chris’ parents’, Walt and Billie, to pay their respects at the bus where Chris died. Investigating the potato seeds further, Krakauer theorizes that McCandless died of swainsonine poisoning after consuming wild potato seeds laced with a toxic mold. Too weak to hunt or gather, McCandless dies soon thereafter, having spent his last days discovering that the greatest happinesses in life must be shared with others. On July 30, Chris frantically writes in his journal that he is very weak and in grave danger, but also mentions potato seeds. However, the thawing summer floodwaters of the Teklanika River prevent Chris from crossing, so he returns to the bus to regroup. Butchering the moose’s messy carcass to preserve its meat fills Chris with regret, but through reading, journaling and self-reflection, McCandless comes to terms with his kill and decides to return to civilization. Throughout the summer, Chris hunts and forages, eventually shooting down a moose. Off the Sushana River, Chris discovers an abandoned city bus, where he makes camp. Hitchhiking north, Chris arrives in Alaska on Apand crosses the Teklanika River onto the Stampede Trail ten days later. On March 14, 1992, Chris returns to Carthage to work for Wayne Westerberg, but leaves at the end of the month, having gathered just enough money and supplies to pursue his dream of living out in the Alaskan wilderness. Along the way, he camps with drifters Jan Burres and her boyfriend Bob, flips burgers at McDonald’s in Bullhead City, canoes the Colorado River to Mexico, and befriends eighty-one-year-old Ronald Franz. Through his research, Krakauer figures out that after a flash flood dampened the Datsun’s engine, Chris abandoned the malfunctioning car to conceal his predicament from his parents and the authorities.Ĭhris then hitchhikes throughout the west. Going back to October 1990, McCandless’ yellow Datsun is found abandoned in the Lake Mead National Recreation Area. Yet Wayne is arrested for stealing satellite TV codes, forcing Chris to hit the road in search of work. Chris works so hard on Westerberg’s grain elevator crew that Wayne offers him a job. Two months after the discovery of McCandless’ body, Krakauer interviews grain elevator operator Wayne Westerberg, who recounts the day he picked up Chris, (going by “Alex” at the time), on his way back to Carthage, South Dakota. Alaska State troopers recover the corpse, taking it to a crime lab, which determines the cause of death to be starvation. Later that year, in September, a trio of moose hunters, a couple from Anchorage and an ATV driver, happen upon an abandoned bus in Denali National Park, where they discover Chris’ decomposing body. Gallien figures that the boy will reemerge out of the forest when he becomes hungry. Chris reluctantly accepts these gifts and walks onto the snowy Stampede Trail. But Chris refuses Gallien’s advice, so Gallien insists that the young man take his lunch and boots with him. Gallien, noticing that Chris’s backpack is far too light to be carrying enough supplies for an extended camping trip, tries to dissuade from hiking alone into the woods. The young man is Christopher McCandless, but he introduces himself as “ Alex” and says that he intends to “live off the land for a few months” in Denali National Park. The young man turns out to be the runaway son of a well-to-do East Coast family, Christopher (Chris) McCandless, who after graduating from Emory University in May 1990, gave away his savings to charity, abandoned his car, burned all his cash, and hitchhiked across the country “to live off the land” in the Alaskan wilderness.įive months earlier, on April 28, 1992, Jim Gallien, driving on the outskirts of Fairbanks, Alaska, spots a young hitchhiker and offers him a ride. When the body of a young male hiker is discovered in Alaska’s Denali National Park, Outside magazine assigns journalist Jon Krakauer to cover the story. Without giving away too many spoilers, we can confirm that the final episode of Age of Resistance does *not* line up exactly with the film, with many plot threads still dangling and the state of Thra still vastly different than what we were introduced to in 1982.Ĭertain parts of the ending definitely also suggest new storylines to be resolved in a potential second season, which could mean it’s at least a few years before the events of the Dark Crystal movie – though other clues suggest that it might not be long before the Skeksis’ rule is supreme once more. “If you remember the opening shot of the movie, the world is quite darkened and when we see our Thra and the castle here, it's green and lush. (Avoid the sequels.) - Return to Oz is a terrifying dark fantasy kids horror film which truly goes there like the Dark Crystal did - Legend good fantasy 80s film again - The Company of Wolves is a beautiful dark fantasy horror film, its dreamlike and haunting, uses puppets. However, fellow executive producer Halle Stanford did hint that there could be more of a gap between the series and the film than fans are expecting. The Neverending Story, dark atmospheric fantasy with puppets. The Hobbit: The Desolation of Smaug (2013) 6. “The Skeksis are almost immortal and Aughra is immortal, and the Gelfling have short lives like humans do and so we don't know where on the timeline this is exactly.” The Chronicles of Narnia: The Lion, the Witch and the Wardrobe (2005) 3. “We're keeping it a little vague how far in advance of the film it is,” Henson said. In the drama it’s unclear (it also largely seems to ignore previous spin-off books and media, so we’re not including them here), and according to Henson that was the intention. Yes, it’s before the Gelfling genocide by the Skeksis – but is it one year before, or 50, or a thousand? However, the series doesn’t make entirely clear exactly how long before the events of the film the new series takes place, or exactly where the new episodes fit into Thra’s general timeline. Is The Dark Crystal: Age of Resistance too scary for kids?Īccordingly, in the new series we meet the Gelflings at the pinnacle of their power, as they first begin to distrust their Skeksis overlords.place in a dangerous otherworld where dark forces have taken over, and human-like. And they realise they know nothing about where they came from, and they realise this was their civilisation.” Enjoy incredible footage from the Henson archives in The Dark Crystal. “And our jumping-off point for the prequel world is the scene in the original Dark Crystal film where Jen and Kira are in the forest, and they discover these ruins. By entering your details, you are agreeing to our terms and conditions and privacy policy. Some cards have special abilities like diving underwater to avoid a hit, or being able to attack from different directions. His Bullfrog, sitting opposite, has two health… On your next turn, you’ll draw a card and keep going.” The player needs to do enough damage in order to tip a scale against your opponent, every hit you deal adds a stone to the opponents side, and vice versa. A reviewer stated, “Your Raven will do three damage. Each card has a health number and a damage number on it. The player then rings a bell on the corner of the table to end their turn. The player plays wildlife cards, like stumps or wolves against your opponent on a board with four lanes. The game starts in a cabin, where the player plays cards against a being shrouded in darkness. In each case though both gameplay and story are perfectly in step, as the plot opens up at the same time as the card game gains new rules, that add additional depth, and you get to explore more of the cabin. The more you will experience when you enter the game and accept the challenges. Moreover, the game includes lots of thrills such as ominous horror and fascinating experience. It provides you unique experience that hits all the notes with replayability and addicting core. Inscryption is an old game that has been recreated in a new version with several twists and climaxes. Therefore, you should spend the most time checking out new cards and figuring out ways to earn rewards. The aim of the game is earning rewards for causing more damage. If you delete an image from the page by mistake, you will need to upload it to the page a second time to add it back. The tile with the grey background is what users will see tiles can't be resized. Alt text can be helpful in adding more context and meaning to the image and can be very effective in assisting users of all types to understand the image better.Īfter a file is inserted, it will appear on the page as a tile. Link - Add a link to a Confluence page or to an external URL so that page viewers can click the image to navigate to the page you added.Īlt text - Add supplemental text that accompanies an image for all users. Text wrapping - Let text flow around your images by selecting an image and clicking Wrap left or Wrap right from the floating toolbar. Image alignment - Determine how the image is aligned on the page The text size and alignment can't be changed, but you can apply other formatting. Selecting the image brings up the floating toolbar that offers you the following controls:Īdd a caption - Add more information about the image. Type /files or /images, choose Files & images, and upload a file or image.Īfter an image is inserted, select the image and use the handles on either side to resize it. There are a few ways to insert a file or image into your page while editing:ĭrag the file directly onto the page to insert and upload it in a single step. Inserting a file or image into the page also adds it as an attachment. 198–205.This section provides the details for displaying files and images using the new editor. Sear (eds.), Proceedings of CHI2001 Conference on Human Factors in Computing Systems, CHI Letters 3(1), ACM Press, pp. (2001), Using Thumbnails to Search the Web, in J. Woodruff, A., Faulring, A., Rosenholtz, R., Morrison, J. Wixon (eds.), Proceedings of CHI2002 Conference on Human Factors in Computing Systems, CHI Letters 4(1), ACM Press, pp.251–8. (2002), Popout Prism: Adding Perceptual Principles to Overview+Detail Document Interfaces, in L. Beaudouin-Lafon (ed.), Proceedings of the 11th Annual ACM Symposium on User Interface Software and Technology, UIST’98, ACM Press, pp. (1998), Data Mountain: Using Spatial Memory for Document Management, in M. Robertson, G., Czerwinski, M., Larson, K., Robbins, D., Thiel, D. Sears (eds.), Companion Proceedings of CHI200I: Human Factors in Computing Systems (CHI200I Conference Companion), ACM Press, pp.379–80. (2001), Integrating Back, History and Bookmarks in Web browsers, in J. (2001), Designing an Integrated History/Bookmark System for Web Browsing, MSc Thesis, Department of Computer Science, University of Calgary. Shipman (eds.), Proceedings of the 9th ACM Conference on Hypertext - Hypertext’98, ACM Press, pp.58–65. (1998), Graphical Multiscale Web Histories: A Study of PadPrints, in K. Hightower, R., Ring, L., Helfman, J., Bederson, B. Johnson (eds.), Human-Computer Interaction - INTERACT’ 99: Proceedings of the Seventh IFIP Conference on Human-Computer Interaction, Vol. (1999), The Contribution of Thumbnail Image, Mouse-over Text and Spatial Location Memory to Web Page Retrieval in 3D, in A. Scott (ed.), Proceedings of OzCHT99 The Ninth Australian Conference on Computer-Human Interaction, IEEE Computer Society Press.Ĭzerwinski, M. (1999), WebView: A Graphical Aid for Revisiting Web Pages, in J. (2000), “What Do Web Users Do? An Empirical Analysis of Web Use”, International Journal of Human-Computer Studies 54(6), 903–22.Ĭockburn, A., Greenberg, S., McKenzie, B., Smith, M. Scott (ed.), Proceedings of OzCHI’99 The Ninth Australian Conference on Computer-Human Interaction, IEEE Computer Society Press.Ĭockburn, A. (1999), Issues of Page Representation and Organisation in Web Browser’s Revisitation Tools, in J. Vezza (eds.), Proceedings of the 4th International World Wide Web Conference.Ĭockburn, A. (1995), Using Graphical History in Browsing the World Wide Web, in I. Continued abuse of our services will cause your IP address to be blocked indefinitely. Please fill out the CAPTCHA below and then click the button to indicate that you agree to these terms. If you wish to be unblocked, you must agree that you will take immediate steps to rectify this issue. If you do not understand what is causing this behavior, please contact us here. If you promise to stop (by clicking the Agree button below), we'll unblock your connection for now, but we will immediately re-block it if we detect additional bad behavior. Overusing our search engine with a very large number of searches in a very short amount of time.Using a badly configured (or badly written) browser add-on for blocking content.Running a "scraper" or "downloader" program that either does not identify itself or uses fake headers to elude detection.Using a script or add-on that scans GameFAQs for box and screen images (such as an emulator front-end), while overloading our search engine.There is no official GameFAQs app, and we do not support nor have any contact with the makers of these unofficial apps. Continued use of these apps may cause your IP to be blocked indefinitely. This triggers our anti-spambot measures, which are designed to stop automated systems from flooding the site with traffic. Some unofficial phone apps appear to be using GameFAQs as a back-end, but they do not behave like a real web browser does.Using GameFAQs regularly with these browsers can cause temporary and even permanent IP blocks due to these additional requests. If you are using Maxthon or Brave as a browser, or have installed the Ghostery add-on, you should know that these programs send extra traffic to our servers for every page on the site that you browse.Attach the rope to the grappling hook and then pick it up. Also, if you talk to Beatrice, she calls herself the Red Shark. Notice the name of the ship is The Golden Eagle. The most common causes of this issue are: You can watch my video for Chapter 2 here or continue below for my step-by-step guide: 1. Three pieces of the same color cannot be next to each other.” You can copy my solution below.Īnd that’s the end of Chapter 3! Click here to continue to Chapter 4 or choose a chapter below.Your IP address has been temporarily blocked due to a large number of HTTP requests. AE Mysteries Pirates Treasure Walkthrough & Guide Paradise Painted Worlds Dark Ruins Puzzle Pack Picture Perfect Legend of the Sacred Stones Psychic. Each row and column must have the same number of gold and silver squares. Time to solve another puzzle! The carving reads: “Fill the grid with squares. Head back to the other side of the beach and place them on the door. Now you have all three missing door pieces. Count the number of sides on each and then put them together to get the safe code 4854. Tap on the locked safe and notice the four shapes on it. Also, notice the name of the ship is EL RELAMPAGO. Thank you for watching my video and please don't forget to subscribe to get latest walkthrough guides update for ios and android game.SUBSCRIBE https://www. Place the idol with the other three and then turn all four so that the suns face East. First, pick up the coconut and the paper strips. Go back to the other side of the beach and enter the water. It’s a puzzle! You need to copy the pattern from the pyramid - eyes, tears, diamonds, hearts. Head back to the other side of the beach and use the torch to burn all the vines. After some dialogue, Conroy will put on the Breath of Fire. ATLAS is a Survival Pirate MMO video game developed by Instinct Games GameSpot delivers the best and most comprehensive video game and entertainment coverage, including news, reviews, trailers, walkthroughs, and guides for PS4, Xbox One, Nintendo Switch, PC, and Pearson education group is the worlds leading learning company Pearson education. Add the palm leaves to the pile of driftwood and use the rock and coin to start a fire. Place the driftwood down and then pick up the palm leaves and the rock. It’s a puzzle! Place the ball in the hole and then solve the maze to get the ball to the other hole. Also, move the shell and grab the gold coin. If you know other secrets, hints, glitches or level guides, then please Submit your Stuff and share your insights with other players. Use the shovel to dig on the X and reveal a buried chest. Please Submit a Problem for any incomplete, non-working or fake code listed above. The affected pupil can be distinguished from these other causes by testing the tonicity of the constriction. However, this finding is not specific to Adie tonic pupil and can also be found in patients with bilateral anterior afferent visual pathway disease, Argyll Robertson pupil, diabetes, or dorsal midbrain lesions (UpToDate, Lee, 5). Upon initial exam, patients with Adie tonic pupil will demonstrate increased pupillary constriction to accommodation compared to light, also known as the light-near dissociation. Examination reveals anisocoria greater in the light compared to in the dark indicating dysfunction of the parasympathetically innervated iris sphincter muscle in the affected eye ( large pupil is abnormal). To correctly form a diagnosis, it is important to examine the degree of anisocoria in the light and in the dark and to examine the pupillary reaction to light and to accommodation. Slit lamp examination of the pupil often shows sectoral palsy of the iris sphincter, with vermiform movements of the pupillary margin (AAO, 4). However, it is important to note that the affected pupil tends to become smaller over time in the chronic Adie tonic pupil. Initially, the tonic pupil appears larger than the unaffected eye. Typical patients with Adie tonic pupil present with incidental finding of anisocoria. The ciliary ganglion can also be affected in other systemic autonomic or peripheral neuropathies to result in the tonic pupil such as Ross syndrome and Harlequin syndrome (Shin, 1841) Diagnosis Exam However, a tonic pupil can also be caused by viral infection, trauma, vasospasm due to migraine, ocular surgery, and tumors, among other potential causes. Most cases of the tonic pupil are idiopathic and referred to as the Adie tonic pupil. Roughly 80% of cases are unilateral but can become bilateral (4% chance per year). The tonic reaction is the result of the iris sphincter supersensitivity to acetylcholine. As a result, patients develop Light-Near dissociation of the pupil by which the near accommodation produces more miosis compared to response to light, the reaction which is tonic. However, the reinnervation process is often aberrant and fibers intended for the ciliary body may end up targeted to the pupil, a process known as aberrant regeneration (McGee, 171). After damage to the ciliary ganglion occurs, a process known as denervation supersensitivity occurs by which postsynaptic receptors are upregulated to facilitate reinnervation. Typically, there are 30 times the number of axons supplying the ciliary body compared to those for the iris. The parasympathetic fibers of the eye travel with the third cranial nerve to synapse at the ciliary ganglion before innervating the iris and the ciliary body. (Thompson 618) General Pathologyĭamage to the parasympathetic ciliary ganglion may result in a tonic pupil. While 80 percent of Adie tonic pupils are unilateral, bilateral involvement typically has an incidence of 4 percent per year. However, it may be noted that the tonic pupil was initially described in 1931 nearly synchronously by Adie, Morgan, Symonds, and Holmes in (2-4) EpidemiologyĪdie tonic pupil has a prevalence of population and occurs in a 2.6:1 female to male ratio with an average age of onset of 32 years (Thompson, 590). The entity is named after William John Adie, an Australian neurologist who extensively described the features. Patients may also present with decreased deep tendon reflexes in the full Holmes-Adie Syndrome. Constriction is typically more notable with the near reaction and typically remains tonically constricted with slow re-dilation with segmental paralysis of the iris sphincter. The affected pupil, either unilateral or bilateral typically initially appears abnormally dilated at rest and has poor or sluggish pupillary constriction in bright light. Tonic Pupil ICD-10: H57.051 (right), H57.052 (left), H57.053 (bilateral)Īdie tonic pupil, also known as Adie’s Syndrome or Holmes-Adie Syndrome, is a disorder in which there is parasympathetic denervation of the afflicted pupil resulting in a poor light but better and tonic near constriction. 2.4 Differential diagnosis and additional tests. We chose a segment slightly longer than the length of the fusiform aneurysm in order to avoid pre- and post-wrap-clipping stenosis. While the firm attachment between the inferior falx and the fusiform aneurysm was maintained, a section of the lower thinner part of the falx cerebri firmly attached to the aneurysm was dissected and wrapped around the fusiform aneurysm, stabilized with a fenestrated clip. We present a review of the literature with an illustrative case, with a ruptured fusiform pericallosal artery aneurysm firmly attached to the lower edge of the falx cerebri and not amenable to endovascular intervention. However, there is no available literature on use of the falx cerebri for wrap-clipping. Various techniques have been used for wrap-clipping a ruptured, fusiform intracranial aneurysm. Their availability makes them first-line options for low-income settings. Conclusion: Microsurgical options achieved good outcomes in the management of ruptured aneurysms in our series. The good outcome was higher among microsurgery groups (73.7%) compared to the coiling group (63.6%) but this difference did not achieve statistical significance (χ 2 = 0.46 P = 0.4976). Overall, 72.7% of those treated had a good outcome (Glasgow Outcome Score of 4 and 5). Ictus-intervention interval (χ 2 = 10.034, P = 0.007) and multiple surgical procedures (χ 2 = 8.9341, P = 0.003) were the significant outcome determinants. ACOM was the most common site for ruptured aneurysm. Coiling was performed for 11 (10%) patients. Microsurgical options such as wrapping, bypass, and excision were performed for 9 (8.2%) patients. Ninety (81.8%) patients received microsurgical clipping. The mean age was 50.8 years (standard deviation ☑3.5) for females and 50.2 (SD ± 12.4) for males (P = 0.8112, t-test). Results: One hundred and ten patients were studied. Data analysis was performed with SPSS for Windows, version 21. It was performed on patients with aneurysmal rupture managed from June 2010 to October 2016. Materials and Methods: This was a single institution questionnaire-based retrospective study from West Bengal India. For locations with limited capacity or evolving endovascular service, however, microsurgical treatment offers not only cost-effective and durable options but also oftentimes the only option available for most patients. However, recent advances in endovascular techniques have broadened their application stimulating much debate regarding the usefulness of microsurgical options. It can prevent rebleeding and represents an improvement when compared with the natural history.īackground: Microsurgical clipping and endovascular coiling have remained over the past half-century, the main options for definitive treatment of ruptured intracranial aneurysms. One patient deceased due to pulmonary tromboembolism.Ĭlip-wrap techniques for the treatment of fusiform and otherwise unclippable aneurysms seem to be safe and it can be associated with a low rate of acute or delayed postoperative complications. No early or late rebleeding was observed after 2 years mean follow-up. Three were dolichoectatic, 4 were unsuitable to complete surgical clipping because parent or efferent vessels arises from the aneurysm sac (1 MCA, 1 AcomA, 1 CO, 1 PICA aneurysms) and two, although ruptured aneurysms, were too small (<2mm) to be directly clipped. The aneurysms were located at middle cerebral artery (2), anterior choroidal artery (1), anterior communicating artery (1), carotid ophthalmic (3), posterior cerebral artery (1) and posterior-inferior cerebellar artery (1). In the last four years, 9 cases of ruptured aneurysms treated by the clip-wrap techniques were identified in the Division of Neurological Surgery, University of São Paulo, School of Medicine. To report a series of nine cases of otherwise untreatable aneurysms managed using the clip-wrap technique and discuss its surgical nuances. Nonetheless, these alternatives methods of treatment have been underused and frequently overlooked. Treatment of these aneurysms often requires alternative surgical strategies, including extracranial-intracranial bypass, wrapping, or clip-wrap techniques. Fusiform and dolichoectatic aneurysms are challenging lesions to treat with direct clipping. |
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