RESUMEN
PURPOSE: To report visual, clinical and radiological outcomes of three patients with fibromuscular dysplasia (FMD) that presented different ocular ischemic events, supported by different multimodal imaging. METHODS: A retrospective study including patients who attended a tertiary referral hospital from July 2016 to June 2019 referring acute visual loss and later diagnosed of FMD. Ophthalmological examination included best corrected visual acuity (BCVA), biomicroscopy, fundoscopy, fluorescein angiography (FA), and macular and retinal nerve fiber layer spectral domain optic coherence tomography (SD-OCT). Patients were admitted by the Neurology service, completing the study with blood and cerebrospinal fluid (CSF) test, serology and cultures, cerebral magnetic resonance angiography (angioMRI), and arteriography. RESULTS: Three patients were included; one male and second females. All referred unilateral acute visual loss, with BCVA of counting fingers or hand-motion. Relative afferent pupilar defect was present in all patients. Two patients associated neurological focal signs and one had chronic hypertension. Fundoscopy revealed hemorrhages and exudates in all patients, and the typical sign of "string-of-beads" in one. FA showed dye filling delay and macular and peripheral hypofluorescence. SD-OCT revealed acute and chronic retinal ischemic signs. Blood and CSF tests, serologies and cultures resulted negative. All presented cerebral vascular involvement, objectified in the cerebral angioMRI or arteriography. CONCLUSIONS: FMD should be considered in cases with unilateral sudden visual loss associated to neurological focal deficits in young patients. The typical "string-of-beads" image is rare in small arteries such as the retinal vasculature. When suspected, a complete ophthalmological examination and cerebral vascular imaging is essential to confirm the diagnosis.
Asunto(s)
Displasia Fibromuscular , Femenino , Displasia Fibromuscular/complicaciones , Displasia Fibromuscular/diagnóstico , Angiografía con Fluoresceína/métodos , Humanos , Masculino , Oftalmoscopía , Estudios Retrospectivos , Tomografía de Coherencia Óptica/métodos , Trastornos de la Visión/complicaciones , Agudeza VisualRESUMEN
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Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Trombocitopenia/complicaciones , Disartria/diagnóstico , Accidente Cerebrovascular/diagnóstico por imagen , Plasmaféresis , Corticoesteroides/uso terapéutico , Diagnóstico Precoz , Accidente Cerebrovascular/complicaciones , Pronación , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/etiología , Diagnóstico DiferencialRESUMEN
El Burgo de Osma (Soria, Spain) offers one of the best preserved medieval structures in Spain. The interior of the building conserves abundant samples of Romanesque art, and the tomb in polychromatic stone of the founder, San Pedro de Osma. We have classified those pieces of art that could represent descriptions of movement disorders. In the main façade of the Cathedral, several statues representing prophets can be seen one of them is clearly different to the rest. This statue represents a man with abnormal cervical posture characterized by right rotation, head tilt and elevation of right shoulder. The tomb includes several statues representing fragments of the life of San Pedro de Osma. Some of these figures show movement disorders. First, a woman with a baby in her arms who has marked head tilt to the left. Second a peasant without hands, perhaps amputated, this man has a head tilt to the right. We suggest that in the latter case ergotism can explain both manifestations: peripheral vascular disease leading to amputation, and cervical dystonia.Finally, a statue of polychromatic wood represents a priest with stooped posture, half open mouth, staring expression and a very notorious anterocollis. The author probably depicted a man with parkinsonism.