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RESUMO Objetivo Identificar as alterações oculares em crianças e adolescentes secundárias ao fator do isolamento social e ao consequente aumento do uso de telas. Métodos Estudo observacional, descritivo e analítico, do tipo transversal realizado no período de julho a agosto de 2021, por meio da aplicação de questionários. Resultados Apresentaram cefaleia associada ao uso excessivo de tela 26,51% dos estudantes e 38,8% relataram suspeita de insuficiência de convergência. Em relação ao questionário de olho seco, 18,8% foram sintomáticos e 7,5% sintomáticos de difícil manejo. O computador foi o dispositivo mais utilizado em atividades escolares (71,5%), e, em segundo lugar, esteve o celular (66,3%). Casos sintomáticos de olho seco foram mais relatados em participantes que não faziam uso de computador (36,4%). Não foi possível identificar relação entre insuficiência de convergência e tempo de uso de dispositivos. Em relação ao olho seco, aqueles que passaram mais tempo em frente a tela relataram maior porcentagem de sintomas de difícil manejo (42,9%). Conclusão Foram mais prevalentes olho seco e sintomas de insuficiência de convergência na população estudada.

ABSTRACT Objective To identify eye conditions associated to social distancing and related increase in screen time exposure on children and teenagers. Methods Observational, descriptive and analytical study, with a cross-section design, carried out between July and August 2021, by questionnaire survey. Results Headaches related to excessive screen time exposure were reported by 26.51% of the students surveyed, while 38.8% reported suspect convergence insufficiency. Regarding the questionnaire about dry eye, 18.8% were symptomatic and 7.5% reported hard-to-manage symptoms. Computers were the devices most used for schoolwork (71.5%), followed by cellphones on second place (66.3%). Symptomatic cases of dry eye were mostly reported by participants that did not make use of computers (36.4%). It was not possible to establish a connection between convergence insufficiency and device usage time. Those participants that reported more screen time exposure also reported an increased percentage of hard-to-manage symptoms (42.9%), regarding dry eye. Conclusion Dry eye and convergence insufficiency symptoms were more prevalent in the surveyed population.

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ABSTRACT We report the case of a previously healthy 48-year-old man who developed an isolated abducens nerve palsy 18 days after presenting with coronavirus disease (COVID-19) confirmed by reverse transcriptase polymerase chain reaction. His main complaint at arrival was double vision. Ocular examination revealed a sixth cranial nerve palsy in the left eye. The incomitant esotropia at arrival was 30 prism diopters. Abduction was markedly limited, while adduction was normal in the left eye. The patient underwent complete clinical, neurological, and neuroimaging investigations, including cerebrospinal fluid sample analysis to rule out infectious causes. A conservative approach with orthoptic therapy and Fresnel prism was opted. Eight months after the onset of COVID-19, regression of the strabismus was observed, and the patient reported complete recovery of the diplopia. This case suggests that isolated abducens nerve palsy caused by severe acute respiratory syndrome coronavirus 2 infection may improve with a conservative approach.

RESUMO Reportamos o caso de homem previamente hígido, 48 anos, com paralisia isolada do nervo abducente 18 dias após infecção pelo novo coronavírus (COVID-19) confirmada por reação cadeia polimerase de transcriptase reversa. A principal queixa do paciente na admissão era diplopia. O exame ocular revelou paralisia do sexto nervo craniano do olho esquerdo. Esotropia incomitante no exame inicial media 30 dioptrias prismáticas. Abdução estava limitada com adução completa no olho esquerdo. O paciente foi submetido a investigação clínica e neurológica com exame de neuroimagem, incluindo análise de amostra do líquido cefalorraquidiano para descartar causas infecciosas. Optou-se por abordagem conservadora com terapia ortóptica e prisma de Fresnel. Oito meses após a infecção pelo COVID-19, o paciente evoluiu com regressão do estrabismo e informou recuperação completa do quadro. Este relato sugere que paralisia isolada do nervo abducente causada por SARS-CoV-2 pode melhorar com abordagem conservadora.

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PURPOSE: The purpose of this study was to evaluate the effects of amblyopia on children's reading performance after the successful patching treatment with 20/20 visual acuity (VA) in the treated eye. METHODS: The treated amblyopes group included 10 children with strabismic amblyopia diagnosed on the first visit presenting VA equal or better than 0.0 logMAR (20/20 Snellen) in the better vision eye and VA worse than 0.2 logMAR (20/32 Snellen) in the worse eye that underwent patching treatment of amblyopia reaching a final VA equal to 0.0 logMAR in the treated eye. The control group comprised 10 children matched by age, gender and school-grade with no visual disorders. Reading performance was evaluated according to reading acuity (RA), critical print size (CPS), reading speed (RS) at 0.7 logMAR, and maximum reading speed (MRS) using the MNREAD chart. RESULTS: Binocular reading performance was compared between groups and no statistically significant differences were found on RA, CPS, RS, or MRS (p > 0.05). When analyzing monocular reading performances of treated amblyopes, a worse RA (p = 0.04) and CPS (p = 0.04) were observed on the previously amblyopic eye when compared to the fellow eye. When comparing the fellow eye from treated amblyopes and a randomly selected eye from controls, no statistically significant differences on RA, CPS, RS, or MRS were found (p > 0.05). CONCLUSIONS: The results suggest that even patients who reached 20/20 VA in the treated eye after patching treatment for amblyopia may present persistent impaired reading performance. These findings reinforce the importance of reading performance testing as a tool when evaluating the visual function development in amblyopic patients.

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The authors describe a rare case of abducens nerve schwannoma, manifested with headache and diplopia, associated to right side cerebellar syndrome. During surgery, the authors identified that the origin of the tumor was from the abducens nerve, and the histopathological diagnosis confirmed that it was a schwannoma. A gross total tumor resection was performed, and the patient recovered from her symptoms 1 month after surgery. The authors followed the Case Report guidelines (CARE) guideline and the patient authorized the authors to publish the present case report by signing an informed consent form.

Os autores descrevem um raro caso de Schwannoma do nervo abducente, cuja manifestaçao clínica foi com cefaleia e diplopia, associadas à síndrome cerebelar hemisférica direita. Durante a cirurgia, os autores identificaram que o tumor tinha sua origem junto ao nervo abducente, e o diagnóstico histopatológico confirmou schwannoma. Realizou-se uma ressecção completa do tumor e o paciente apresentou melhora total dos sintomas em um mês após a cirurgia. Os autores seguiram as diretrizes do CARE para produzir este relato e o paciente assinou o termo de consentimento livre e esclarecido, autorizando a publicação deste caso.

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ABSTRACT Purpose: Synkinesis results from nerve miswirings and causes aberrant movements of the affected muscles. We present a series of cases of rare congenital ocular synkinesis involving the extraocular muscles and the levator palpebrae superioris and speculate the possibility of classifying these entities in the spectrum of congenital cranial dysinnervation disorder. Methods: Records of patients with the diagnosis of congenital ocular synkinesis were analyzed retrospectively. We analyzed the sex, laterality, and complete features of the ocular motility of each patient. Results: Nine patients with congenital ocular synkinesis were included. A slight predominance of women was noted. In terms of laterality, four patients had only the right eye involved, four had only the left eye, and one had both eyes involved. Notably, 55.5% were orthotropic in the primary position. The third, fourth, and sixth cranial nerves were involved in the miswiring in 100%, 44.4%, and 11.1% of the cases, respectively. Conclusions: Congenital synkinesis might present in a very eclectic and uncommon fashion. The aberrant innervation in these cases classifies them into the group of congenital cranial dysinnervation disorders.

RESUMO Objetivo: Sincinesias são resultado de inervações anômalas e ocasionam movimentos aberrantes dos músculos envolvidos. Apresentamos uma série com casos raros de sincinesias oculares congênitas dos músculos extraoculares e do levantador da pálpebra superior e especulamos a possibilidade de classificá-las dentro do espectro das desordens congênitas da desnervação cranianana. Métodos: Prontuários de pacientes com diagnóstico de sincinesia ocular congênita foram estudados retrospectivamente. Analisamos sexo, lateralidade e as características completas do exame de motilidade de cada paciente. Resultados: Nove pacientes com sincinesias oculares congênitas foram incluídos. Houve discreta predominância no sexo feminino. Em termos de lateralidade, o olho direito foi o único envolvido em 4 casos, o olho esquerdo também em 4 casos e 1 caso apresentou acometimento bilateral. 55,5% dos pacientes eram ortotrópicos na posição primária. Os III, VI e IV nervos participaram da sincinesia em 100%, 44,4% e 11,1% dos casos, respectivamente. Conclusões: Sincinesias oculares congênitas podem se apresentar de modo bastante eclético e incomum. A inervação aberrante presente em cada um desses casos os coloca na lista de candidatos a integrar o grupo das desordens congênitas da desenervação craniana.

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The bedside examination associated with their clinical history remains the most critical means to accurately diagnose the cause for most of the signs and symptoms related to pathology of the cerebellum and vestibular system in patients presenting with dizziness and imbalance. This paper focuses on those critical bedside examinations, suggests when laboratory testing might be useful to confirm the clinical suspicion, and considers the shared neural circuitry within the visual and vestibular systems to offer an algorithmic approach in conducting the clinical bedside examination.

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Spinocerebellar ataxias (SCAs) represent a large group of heredodegenerative diseases, with great phenotypic and genotypic heterogeneity. However, in the clinical neurological practice, some symptoms and signs might help differentiate the SCAs. This study's aims were to evaluate the frequency of upward gaze palsy (UGP) and investigate its role in assisting in the clinical differentiation of SCAs. We included 419 patients with SCAs (248 with SCA3, 95 with SCA10, 38 with SCA2, 22 with SCA1, 12 with SCA7, and 4 with SCA6). This study compared UGP with other known markers of disease severity-age of onset, disease duration, SARA score, and size of CAG expansion, and also other semiologic features, as bulging eyes. This sign was significantly more prevalent in SCA3 (64.11%), compared with SCA10 (3.16%; p < 0.001) and other SCAs (SCA1, SCA2, SCA7-11.84%; p < 0.001). UGP showed very high sensibility ins SCA3 (92.9), although lacking of specificity (64.1%). The odds ratio (OR) of UGP were also very high, 23.52 (95% CI 12.38-44.69), and was significantly correlated with larger CAG expansions, age, and disease duration in SCA3 patients, but not with age of onset or severity of the ataxic syndrome. This study showed that UGP is highly suggestive of SCA3 and has high sensitivity for the differential diagnosis among SCAs, and it could be of great value for bedside semiologic tool.

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OBJETIVO: Descrever um quadro clínico subagudo pós-infeccioso caracterizado por ataxia de tronco e flutter ocular. RELATO DE CASO: Um homem de 37 anos previamente hígido, pouco após um quadro sistêmico inespecífico que se resolveu espontaneamente, deu início a movimentos involuntários hipercinéticos dos olhos, da cabeça e desequilíbrio importante. Os sintomas evoluíram em poucos dias. Ao exame, apresentava ataxia de tronco e presença de flutter ocular. O líquor mostrou pleocitose discreta. Ressonância magnética (RM) de crânio e exames laboratoriais normais. Houve melhora espontânea e total dos sintomas em cerca de três semanas. CONCLUSÃO: A síndrome de flutter ocular e ataxia de tronco é rara e é destacado a benignidade do quadro.

OBJECTIVE: To describe a post-infectious subacute clinical picture characterized by truncal ataxia and ocular flutter. CASE REPORT: A healthy 37-year-old man, a few days after spontaneously resolved nonspecific systemic disease, initiated involuntary hyperkinetic movements of the eyes, head, and major imbalance. The symptoms progressed within a few days. He presented ataxia of the trunk and presence of ocular flutter. CSF showed pleocytosis. Magnetic resonance of the skull and laboratory tests were normal. There was spontaneous and total improvement of symptoms in about three weeks. CONCLUSION: The ocular flutter syndrome and truncal ataxia is rare and the benignity of the condition is highlighted.

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Resumo A esporotricose humana e animal é uma infecção subaguda a crônica causada pelo fungo dimórfico Sporothrix schenckii. A esporotricose ocular tem ganhado destaque em função da epidemia de esporotricose urbana enfrentada pelo estado do Rio de Janeiro na última década e se apresenta classicamente como conjuntivite granulomatosa, mas formas atípicas podem ocorrer. Este artigo tem por objetivo relatar 2 casos atípicos de esporotricose ocular em pacientes imunocompetentes, ambos apresentando quadro clínico compatível com a síndrome oculoglandular de Parinaud associada à dacriocistite em um caso e presumivelmente à coroidite no outro caso.

Abstract Human and animal sporotrichosis is an infection caused by the dimorphic fungus Sporothrix schenckii, which is classified from subacute to chronic. Ocular sporotrichosis has been highlighted due to the epidemic of urban sporotrichosis faced by the state of Rio de Janeiro in the last decade and presents classically as granulomatous conjunctivitis, but atypical forms may occur. This article aims to report two atypical cases of ocular sporotrichosis in immunocompetent patients, both presenting a clinical picture compatible with Parinaud oculoglandular syndrome associated with dacryocystitis in one case and presumably to choroiditis in the other case.

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ABSTRACT This report documents an unusual phenomenon. A 6-year-old girl with trochlear-oculomotor synkinesis presented with superior oblique and palpebral levator co-contraction. The literature was reviewed and the possibility of classifying this entity as a congenital cranial dysinnervation disorder was speculated.

RESUMO Este relato descreve um fenômeno incomum. Uma menina de 6 anos com sincinesia troclear-oculomotora apresentou co-contração do oblíquo superior e do levantador da pálpebra. A literatura foi revisada e especulou-se a possibilidade de classificar essa desordem como um distúrbio da congenital cranial dysinnervation disorder.

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Resumo Objetivo: Investigar a prevalência de desconforto visual e insuficiência de convergência (IC) em docentes universitários. Métodos: Tratar-se de um estudo transversal, com 60 docentes de ambos os sexos, tendo sido utilizado o questionário Convergence Insufficiency Symptom Survey, validado para a população brasileira. Resultados: Dos docentes entrevistados 55,0% eram do sexo feminino. 48,3% responderam dedicar menos que duas horas por dia à leitura, sendo que 40,0% dos entrevistados disseram que fazem pausas de 30 minutos à uma hora durante a leitura e 63,3% afirmaram passar entre 2 a 5 horas por dia em frente ao computador. Em relação à investigação sobre as doenças do sistema visual, 25,0% relataram apresentar miopia, sendo que 55,0% dos indivíduos usam óculos e destes 41,7% o usam com frequência. Quanto à investigação da prevalência de insuficiência de convergência, obteve-se frequência de (1,8) %. Conclusão: Constatou-se que a maioria dos entrevistados se apresentou com desconforto visual e uma pequena porcentagem foram acometidos pela IC.

Abstract Objective: To investigate the prevalence of visual discomfort and convergence failure in professors. Methods: A cross-sectional study was done, consisting of 60 teachers of both sexes, of the Centro Universitário FAG, which used the Convergence Insufficiency Symptom Survey, validated for the Brazilian population. Results: Of those surveyed 55.0% are female. 48.3% respondents spend less than two hours a day reading, with 40.0% of respondents said they do 30-minute breaks for one hour during reading and 63.3% said they spend between 2-5 hours a day in front of the computer. With regard to research on diseases of the visual system, 25.0% reported having myopia, with 55.0% of individuals use these glasses and 41.7% use it frequently. The research of the prevalence of convergence insufficiency, gave an average of 12.4(1.8) %. Conclusion: It was found that most respondents presented with visual discomfort and small percentages were affected by CI.

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Objetivo: Describir un caso raro de una paciente previamente diagnosticada con cáncer de mama que evolucionó después de algunos años con metástasis intraorbitaria. Métodos: Relato del caso y revisión de literatura. Resultados: La correlación del diagnóstico previo de neoplasia de mama y la presencia de múltiples lesiones en la órbita y regiones adjacentes ha permitido concluir que la paciente presentaba enfermedad metastásica. Las metástasis se presentan como manifestaciones cada vez más frecuentes en enfermos oncológicos. La órbita y estruturas próximas constituyen topografías poco usuales de diseminaciónde células neoplásicas y manifestaciones iniciales pueden mimetizar otras condiciones, retrasando el diagnóstico. Como se trataban de pequeñas lesiones, se ha optado por radioterapia como tratamiento único. Después del término la paciente evolucionó con regresión de sintomatología. Conclusiones: Aunque infrecuentes, manifestaciones oculares pueden ocurrir en enfermos oncológicos y la investigación de enfermedad metastático de la órbita es esencial para el seguimiento adecuado.

Objective: Description a rare case of a patient with previous diagnosis of breast cancer that evolved years after with orbital metastasis. Method: Case report and literature review. Results: The relation between the previous diagnosis of breast cancer and the presence of multiple orbital and adjacent lesions allowed concluding that the patient presented metastatic disease. Metastasis presented as a common manifestation in oncological patients. Orbit and neighboring structures constitute unusualsite of neoplastic cells dissemination and initial manifestations could mimic other conditions, which can slow diagnosis. As they were small lesions that are close to noble structures, it was opted by performing exclusive radiotherapy. After the end of treatment, the patient referred improvement of her symptoms. Conclusions: Although unusual, ocular manifestations could occur in oncological patients and orbit metastatic disease investigation is essential to the proper follow.

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ABSTRACT A 48-year-old patient with blunt periorbital trauma presented with vertical strabismus and diplopia secondary to inferior rectus muscle avulsion. After ophthalmologic and CT scan evaluation, early surgical treatment with anatomical restoration led to improvement in motility deficits with resolution of diplopia.

RESUMO Paciente de 48 anos com história de trauma periorbitário contuso apresentou estrabismo vertical e diplopia secundários à avulsão de músculo reto inferior. Após avaliação oftalmológica e tomográfica, o tratamento precoce cirúrgico das lesões com reparo anatômico permitiu melhora nos deficits de motilidade com resolução da diplopia.

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Introducción. El cuestionario Convergence Insufficiency Symptoms Survey, (CISS-V15) es una herramienta para el diagnóstico y seguimiento del tratamiento de pacientes con insuficiencia de convergencia. Objetivo. Determinar la validez del cuestionario CISS-V15 para el diagnóstico de la insuficiencia de convergencia, frente a las pruebas clínicas con que se evalúa el estado motor ocular de los pacientes atendidos en consulta optométrica, en las ciudades de Recife y Salvador, Brasil. Métodos. Se llevó a cabo un estudio con enfoque cuantitativo, de tipo transversal y descriptivo, con 50 pacientes de dos instituciones educativas en Brasil. Se seleccionaron aquellos que cumplían con los criterios de inclusión para aplicar el cuestionario, y se identificaron los pacientes con insuficiencia de convergencia y aquellos con visión binocular normal. Se analizaron los resultados del cuestionario y las pruebas de motilidad ocular, para estimar medidas de tendencia central, y analizar los valores de sensibilidad y especificidad del cuestionario. Resultados. La prueba alcanzó una sensibilidad de 0,83 y una especificidad de 0,81. Conclusiones. Frente a las pruebas clínicas, el cuestionario CISS-V15 demostró tener validez diag-nóstica para las personas con insuficiencia de convergencia y aquellas con visión binocular normal, lo que lo convierte en una herramienta valiosa para el diagnóstico y seguimiento del tratamiento de los pacientes con insuficiencia de convergencia

Introduction: The Convergence Insufficiency Symptom Survey Questionnaire (CISS-V15) is a tool for diagnosis and monitoring of treatment of patients with convergence insufficiency. Objective: To determine the validity of the questionnaire CISS-V15 for the diagnosis of convergence insufficiency against clinical tests assessing the oculomotor state in optometric patients seen in con-sultation in the cities of Recife and Salvador, Brazil. Methods: A descriptive transversal study with a quantitative approach was conducted with 50 patients from two educational institutions in Brazil. Patients were selected from those that met the inclusion criteria for applying the questionnaire. Patients with convergence insufficiency and those with normal binocular vision were identified. The results of the questionnaire and ocular motility tests were analyzed to estimate central tendency measures and to analyze the sensitivity and specificity of the questionnaire. Results: The test had a sensitivity of 0.83 and a specificity of 0.81. Conclusions: Given the clinical test, the CISS-V15 questionnaire proved to be valid to classify individuals with convergence insufficiency, and those with normal binocular vision, which makes it a valuable tool for the diagnosis and monitoring of the treatment of patients with convergence insufficiency.

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Presentamos el caso de un paciente de 31 años con el síndrome de opsoclonus-mioclonus, entidad poco frecuente caracterizada por movimientos oculares multidireccionales (opsoclonus) y mioclonías, el cual puede estar asociado a ataxia, temblor y alteración del estado de conciencia. Es una entidad descrita como manifestación infecciosa secundaria, paraneoplásica o idiopática, siendo las etiologías más frecuentes en la población adulta. Existe evidencia de un mecanismo inmunológico en su patogénesis por lo que el tratamiento con esteroides y/o drogas inmunomoduladoras es ampliamente empleado aunque no existen estudios que soporten su uso prolongado en la evolución favorable del cuadro. Nuestro paciente recibió tratamiento esteroideo precoz y se observó mejoría y recuperación temprana. Es importante el reconocimiento de este cuadro por la posibilidad de estar relacionado a neoplasias subyacentes.

We report a case of 31 a year old male patient with opsoclonus-myoclonus syndrome, a rare entity which is characterized by multidirectional eye movements (opsoclonus) and myoclonus. It can be associated with ataxia, tremor and altered level of consciousness. This entity is reported as secondary manifestation of infectious, paraneoplastic or idiopathic disease, the more common etiologies in adult population. There is evidence of an immunological mechanism involved in its pathogenesis. The treatment with steroids and/or immunomodulator drugs is widely used although there are no trials supporting its long term use in clinical improvement. Our patient received early steroid treatment with a prompt improvement and recovery. It is important to recognize this entity for the possibility of being related with underlying malignancies.

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According to the World Health Organization, cataract is the leading cause of blindness and visual impairment throughout the world. However, the etiology of cataracts often remains unknown. This report describes the development of cortical cataract in a patient after Parinaud's oculoglandular syndrome caused by the fungus Sporothrix schenckii.

De acordo com a Organização Mundial de Saúde, a catarata é a principal causa de cegueira e deficiência visual em todo o mundo. No entanto, a etiologia das cataratas frequentemente permanece desconhecida. Este relato descreve o desenvolvimento de catarata cortical em um paciente após Síndrome oculoglandular de Parinaud causada pelo fungo Sporothrix schenckii.

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Purpose: Evaluate the relationship between the postural alignment of the head and possible interference in the view of children. Methods: We evaluated 11 children between 2 and 7 years of age of both sexes, with the visually impaired, who had nystagmus and head lock position. The test Lea Grating Acuity Test® was used to collect measurements of visual acuity. This applied on two occasions: with and without postural alignment of the head. For reliability of the postural alignment of the head, the slopes were measured by Fisiologic® software. Results: The children had a poorer performance after physiological postural alignment. This poor performance is possible due to loss of position lock nystagmus to gain postural alignment, said to be ideal. Postural compensations were observed, and sharply increased eyestrain. Conclusion: The pursuit of traditional postural alignment affect the visual response of children with visual impairments. .

Objetivo: Avaliar a relação entre o alinhamento postural da cabeça e a possível interferência na visão de crianças. Métodos: Foram avaliadas 11 crianças, entre 2 e 7 anos de idade de ambos os sexos, com o diagnóstico de deficiência visual, que apresentavam nistagmo e posição de bloqueio de cabeça. O teste Lea Grating Acuity Test® foi utilizado para coletar medidas de acuidade visual. Este aplicado em dois momentos: sem e com o alinhamento postural da cabeça. Para confiabilidade do alinhamento postural da cabeça, as inclinações foram medidas pelo software Fisiologic®. Resultados: As crianças apresentaram pior desempenho após o alinhamento postural fisiológico. Este pior desempenho é possível devido à perda da posição de bloqueio do nistagmo para ganho do alinhamento postural, dito como ideal. Foram observadas compensações posturais e maior esforço visual. Conclusão: A busca do alinhamento postural tradicional prejudica a resposta visual de criança com deficiência visual. .

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É relatado aqui o caso de uma mulher de 38 anos com AIDS que desenvolveu a síndrome de opsoclonia-mioclonia-ataxia em um período diferente dos outros casos já relatados na literatura. A síndrome de opsoclonia-mioclonia-ataxia já tinha sido relatada como manifestação inicial de AIDS, assim como no momento da soroconversão de HIV e na síndrome de reconstituição imune. Este caso é único, uma vez que a paciente tinha contagem elevada de CD4 e carga viral negativa no momento em que a síndrome de opsoclonia-mioclonia-ataxia ocorreu.

We report the case of a 38-year-old woman with AIDS who developed opsoclonus-myoclonus-ataxia syndrome during a period different from other cases reported in literature. Opsoclonus-myoclonus-ataxia syndrome had already been reported as the initial neurological presentation of AIDS, as well as at the time of HIV-seroconversion and immune reconstitution syndrome. Our case is unique since the patient had an elevated CD4 count and negative viral load in the period when the opsoclonus-myoclonus-ataxia syndrome occurred.

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OBJETIVOS: Identificar a frequência de ocorrência de desvios oculares e as características dos portadores em uma amostra populacional. MÉTODOS: Estudo transversal, observacional e probabilístico, entre os anos de 2004 e 2005, envolvendo 11 cidades da região centro-oeste do estado de São Paulo. Foram examinados 10.994 indivíduos, sendo utilizada para este estudo uma subamostra desta população, identificada pelo diagnóstico de estrabismo. A população foi abordada por uma equipe treinada e padronizada para os procedimentos da pesquisa. Os dados foram analisados estatisticamente por meio de análise descritiva, frequência de ocorrência, análise de contingência e testes de associação (p<0,05). RESULTADOS: A frequência de ocorrência de estrabismo na população estudada foi de 1,4% (148 portadores de estrabismo), sem diferença entre sexos. Portadores de esodesvios (ET) eram 46,3%, 38,2% casos de exodesvio (XT) e 15,4% de desvios verticais associados a horizontais ou síndromes. A análise de contingência mostrou que 3 indivíduos (2,3%) estrábicos apresentavam cegueira e 7 (5,43%) apresentavam baixa visão em um dos olhos. Tanto a ET, quanto a XT estiveram presentes em indivíduos com graus variáveis de miopia (até -5,75 para XT e -2,50 para ET) e de hipermetropia (até +9,00 para XT e +8,00 para ET). A associação entre estrabismo e o equivalente esférico obtido na refração estática não mostrou diferença significativa (p>0,05). CONCLUSÃO: A frequência de ocorrência de estrabismo em uma amostra populacional foi de 1,4%, sem diferença entre sexos ou tipo de desvio ocular. A presença de cegueira e de baixa visão associadas aos desvios oculares reforçam a necessidade de tratamento precoce.

PURPOSES: To identify the frequency of occurrence of ocular deviation and the carriers characteristics in a population sample. METHODS: Observational cross-sectional study, evolving a probabilistic sampling, between the years 2004 and 2005, including 11 cities of the São Paulo state. 10,994 individuals were examined. A sub-sample of this population identified as strabismus clinical diagnosis was the subject of the present study. The population was addressed by a trained team and standardized to the research procedures. The results were submitted to statistical tests through descriptive analysis, frequency of occurrence evaluation, contingency analysis and association tests (P<0.05). RESULTS: Strabismus frequency of occurrence in the population studied was on average 1.4% (148 strabismus carriers), with no difference between gender. Depending on the type of strabismus detected, 46.3% presented ET, 38.2% cases of XT and 15.4% of deviations were associated with vertical or horizontal syndromes. Contingency analysis showed three ocular deviation carriers (2.3%) with blindness (both eyes affected) and seven (5.4%) had low vision in only one eye. According to the association of the ocular deviation and refractive error, ET and also XT can be present in individuals with varying degrees of myopia (up to -5.75 for XT and -2.50 for ET) or hyperopia (up to +9.00 for XT and +8.00 for ET). The association between strabismus and static spherical equivalent showed no significant difference between the types of eye deviation (P>0.05). CONCLUSION: The frequency of occurrence of strabismus in the population studied was 1,4%, with no difference between gender or ocular deviation type. The presence of blindness and low vision associated to ocular deviation reinforce the need for early treatment.

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OBJETIVO: Descrever um caso de síndrome de Kinsbourne manifestando-se com quadro de encefalite pós-viral e rever a da literatura. DESCRIÇÃO DO CASO: Criança do sexo feminino, dois anos e seis meses, encaminhada de outro serviço com história de ataxia, irritabilidade e dificuldades articulatórias na fala após episódio prodrômico de febre, lesões de pele e mucosa. Com hipótese de encefalite pós-viral, a avaliação clínica evidenciou quadro de síndrome opsoclônus-mioclonia-ataxia ou síndrome de Kinsbourne. Foi afastada a associação de neuroðblastoma oculto e iniciada terapêutica com corticosteroide. Durante internação e acompanhamento ambulatorial, houve regressão progressiva e normalização do quadro clínico e neurológico inicial. COMENTÁRIOS: Apesar de se tratar de uma doença rara, o diagnóstico de síndrome de Kinsbourne deve ser reconhecido pelos pediatras e intensivistas, com objetivo de instituir traðtamento específico precoce, embora com resultados variáveis, sendo fundamental a exclusão de neuroblastoma oculto.

OBJECTIVE: To describe a case of Kinsbourne syndrome manifesting with signs of post-viral encephalitis, and to review the literature. CASE DESCRIPTION: Female child, aged two years and six months. She was referred from another hospital with a history of ataxia, irritability, and dysphasia after a prodromal episode of fever, skin and mucosa lesions. Referred with suspected post-viral encephalitis, the child was diagnosed with the opsoclonus-myoclonus-ataxia syndrome (Kinsbourne syndrome). The association of occult neuroblastoma was dismissed and therapy with corticosteroids was initiated. During hospitalization and outpatient treatment, there was a progressive regression and normalization of the clinical and neurological original condition. COMMENTS: Albeit a rare disease, the diagnosis of Kinsðbourne syndrome should be recognized by pediatricians and intensivists in order to start an early specific treatment, being important to exclude occult neuroblastomas. The results of the treatment are variable.

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