RESUMEN
Strümpell-Lorrain syndrome, or hereditary spastic paraplegia is a genetic disease of the central nervous system affecting the spinal cord and cerebellum. It represents a clinically heterogenous group of neurodegenerative disorders characterized by progressive spasticity and hyperreflexia of the lower limbs. Ocular abnormalities include keratitis, macular pigmentary abnormalities, juxtafoveolar retinal telangiectasis and choroidal neovascularization. We report the first case of choroidal neovascularization associated with Strüpell-Lorrain syndrome treated successfully with intravitreal ranibizumab injection.
Asunto(s)
Inhibidores de la Angiogénesis/administración & dosificación , Anticuerpos Monoclonales Humanizados/administración & dosificación , Neovascularización Coroidal/tratamiento farmacológico , Paraplejía Espástica Hereditaria/complicaciones , Neovascularización Coroidal/genética , Femenino , Humanos , Inyecciones Intravítreas , Ranibizumab , Adulto JovenRESUMEN
OBJECTIVE: To study visual impairment and the etiology of visual loss in fallers and non-fallers in older patients. PATIENTS AND METHOD: Cross-sectional study including two groups of patients: elderly patients admitted for a fall (group 1) and elderly individuals who did not report a fall during the 6 months before admission (group 2). Visual acuity was measured in both eyes of all participants. Complete ophthalmologic evaluation was performed in the fallers group. RESULTS: The fallers group included 98 patients (mean age, 83.4 ± 6.3) and the non-fallers group included 106 patients (mean age, 79 ± 6.6). The fallers had lower vision than non-fallers (P<0.001). Visual impairment (visual acuity less than 20/40) was more frequent in the fallers (49.5% vs 15.3%, P<0.001). Causes of visual impairment in fallers were cataract (47.4%), association of cataract and age-related macular degeneration (17.5%), age-related macular degeneration without cataract (13.4%), and optic neuropathy (9.3%). Management of fallers was difficult, and only 17 of 48 eyes (35.4%) with cataract had undergone surgery. CONCLUSION: Fallers have a higher prevalence of visual impairment and blindness. Vision may improve with surgery in half of these eyes. This study highlights the need for systematic ophthalmologic evaluation in this high-risk population in order to prevent falls.
Asunto(s)
Accidentes por Caídas/estadística & datos numéricos , Baja Visión/epidemiología , Personas con Daño Visual/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Catarata/complicaciones , Catarata/epidemiología , Estudios Transversales , Retinopatía Diabética/complicaciones , Retinopatía Diabética/epidemiología , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Degeneración Macular/complicaciones , Degeneración Macular/epidemiología , Masculino , Neuropatía Óptica Isquémica/complicaciones , Neuropatía Óptica Isquémica/epidemiología , Baja Visión/etiología , Agudeza Visual/fisiologíaAsunto(s)
Ceguera/etiología , Celulitis (Flemón)/complicaciones , Dermatosis Facial/complicaciones , Oftalmoplejía/etiología , Infecciones Estreptocócicas/complicaciones , Anciano , Antibacterianos/uso terapéutico , Celulitis (Flemón)/tratamiento farmacológico , Dermatosis Facial/tratamiento farmacológico , Dermatosis Facial/microbiología , Humanos , Masculino , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes/aislamiento & purificación , Tomografía Computarizada por Rayos XRESUMEN
UNLABELLED: Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma manifesting in acute headaches, consciousness impairment, endocrine features, and moderate to severe visual loss, with chiasmal syndrome or oculomotor palsies. We present a case report and a review of the literature. CASE-REPORT: We report the case of a 31-year-old man who neglected bitemporal visual loss (less than 1/10 OD and 2/10 OS). Emergency cerebral tomodensitometry found a pituitary apoplexy. Visual field loss was nearly complete at OD and temporal hemianopia was present at OS. These ocular complications led to a neurosurgical transsphenoidal resection of the necrotic adenoma. Follow-up was satisfactory with complete recovery of visual acuity and visual field. DISCUSSION: In the literature, headaches are present in 76% of the patients, visual loss in 62%, and ocular motor nerve palsy in 40%. Third cranial nerve palsies are predominant. CONCLUSION: The clinical picture of pituitary apoplexy is characterized by the sudden onset of oculomotor palsy or blindness with acute headaches and even consciousness impairment. A functional and vital risk is present because of acute hypopituitarism. This emergency diagnosis is confirmed by tomodensitometry or magnetic resonance imaging. The association of hormone substitution and tumor transsphenoidal resection commonly leads to a positive outcome and visual improvement.