RESUMO
Introduction The incidence of intracranial aneurysms in the pediatric population is low, and endovascular treatment is becoming a safe and minimally invasive treatment option. In the present study, the occurrence of special features of cerebral aneurysm in children, in comparison to adults, is also described. Case Report A 3-month-old female infant presented with progressive proptosis and divergent strabismus at the right eye, in addition to inconsolable crying. Cerebral resonance, angiotomography and angiography exams demonstrated angiodysplasia in the right internal carotid artery with two large paraclinoid dissecting aneurysms with wide neck. The right internal carotid artery was occluded with coils by endovascular approach, without detriment to the perfusion of the ipsilateral hemisphere and without neurological deficits. The patient achieved good recovery, and a late control angiotomography confirmed the exclusion of the aneurysms. Conclusion Parent artery sacrifice via endovascular approach is an effective therapeutic option, but a long-termfollow-up is necessary to avoid recurrence and bleeding.
Assuntos
Humanos , Feminino , Lactente , Artéria Carótida Interna/cirurgia , Aneurisma Intracraniano/cirurgia , Procedimentos Endovasculares/métodos , Dissecção Aórtica/cirurgia , Exoftalmia/complicações , Exotropia/complicações , Angiografia por Tomografia ComputadorizadaRESUMO
BACKGROUND: In psychomotor retardation there is an abnormal development of mental, sensory and motor skills associated with ocular manifestations. There are biological and psychosocial risk factors that predispose an individual to neurological damage. From 50% to 80% of patients with strabismus retardation have special features that differentiate it from the rest of strabismus in healthy patients. OBJECTIVE: To determine the most common type of strabismus in patients with psychomotor retardation and their clinical features. MATERIAL AND METHODS: Patients with psychomotor retardation and strabismus were included. An ophthalmological examination was performed, as well as an evaluation of the characteristics of strabismus, including perinatal and post-natal history. RESULTS: Esotropia was the most frequent squint with 65.3%, followed by exotropia with 32.7%. The variability in the squint magnitude was 60% in both types, and 6 patients had dissociated vertical deviation. Most of the patients started to present strabismus since they were born. The most frequent perinatal risk factors were threatened miscarriage, pre-eclampsia, foetal distress, and hypoxia. CONCLUSIONS: Esotropia is the most common type of strabismus in psychomotor retardation. The variability of squint magnitude is a characteristic in these patients. The moderate variability is the most frequent in both esotropia and exotropia. The most common refractive error is hyperopic astigmatism in esotropia and the myopic kind in exotropia.
Assuntos
Esotropia/complicações , Exotropia/complicações , Deficiência Intelectual/complicações , Transtornos Psicomotores/complicações , Ameaça de Aborto/epidemiologia , Adolescente , Asfixia Neonatal/epidemiologia , Astigmatismo/complicações , Causalidade , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Feminino , Sofrimento Fetal/epidemiologia , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Idade Materna , Nistagmo Patológico/complicações , Pré-Eclâmpsia/epidemiologia , Gravidez , Gravidez na Adolescência , Efeitos Tardios da Exposição Pré-Natal , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
UNLABELLED: Permanent exotropia (XT) occurs in 1 to 2% of the pediatric population. Its management involves careful assessment of patient, treatment of amblyopia, refractive errors and surgery. The aim of the surgery is to straighten the eyes in the primary gaze position, giving a better cosmetic outcome. The factors reported to affect surgical outcome after exotropia surgery vary widely in reports and success rates for strabismus surgery have been reported to range from 60% to 80%. There are few reports to determine the relation between amblyopia and surgical outcome in exotropic patients. PURPOSE: To compare the surgical outcome of permanent exotropia surgery in amblyopic and non-amblyopic patients. METHODS: This is a retrospective study of 37 clinical records from amblyopic patients (Group A) and non-amblyopic patients (Group B) who underwent recess-resect in one eye for XT. Postoperative deviation was analyzed in one month (immediate) and in six months (final) in both groups and in between. Age: group A 24.7 ± 14.2 years, group B 22.6 ± 18.6 years; Preoperative deviation: group A 29.1 ± 7.2(Δ), group B 28.4 ± 6.8(Δ). RESULTS: The success rate in the immediate postoperative period was 60% (Group A) and 100% (Group B) (p<0.05); 50% (Group A) and 82.3% (Group B) (p=0.082) in the final postoperative period. There was a statistical difference in the immediate postoperative deviation, but the final deviation and the variation of the deviation were similar in both groups. CONCLUSION: There is a better outcome in patients of group B and no diference in the surgical outcome between these amblyopic and non-amblyopic patients in the final postoperative period.
Assuntos
Ambliopia/complicações , Exotropia/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Exotropia/complicações , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
A exotropia permanente (XT) acomete cerca de 1 a 2 por cento da população. Seu tratamento é clínico: antiambliogênico e correção dos erros refrativos, e cirúrgico. O objetivo do tratamento cirúrgico é alinhar os olhos na posição primária do olhar, proporcionando melhor resultado estético. Há muito tempo diversos autores estudam os fatores pré, per e pós-operatórios relacionados ao resultado cirúrgico, uma vez que a taxa de sucesso varia de 60 a 80 por cento. Ainda são poucos os estudos que comparam a presença de ambliopia como fator de influência no resultado final. OBJETIVO: Comparar o resultado cirúrgico dos pacientes amblíopes e não-amblíopes submetidos à cirurgia de correção de XT. MÉTODOS: Análise retrospectiva de 37 prontuários de pacientes amblíopes (Grupo A) e não-amblíopes (Grupo B) submetidos à correção cirúrgica de XT por retrocessoressecção monocular, sendo avaliados os registros pós-operatórios imediatos e tardios. Idade: grupo A 24,7 ± 14,2 anos, grupo B 22,6 ±18,6 anos; Desvio pré-operatório: grupo A 29,1± 7,2Δ, grupo B 28,4 ± 6,8Δ. RESULTADOS: A taxa de sucesso foi de 60 por cento e 100 por cento (p<0,05), no pós-operatório imediato e 50 por cento e 82,3 por cento (p=0,082), no pós-operatório final, nos grupos A e B, respectivamente. Não houve diferença significante quanto aos desvios pós-operatórios imediatos, tardios e variação do desvio. CONCLUSÃO: Pode-se concluir que o grupo B mostrou melhor resultado no pós-operatório imediato; porém não houve diferença no resultado cirúrgico de correção de exotropia permanente entre pacientes amblíopes e não-amblíopes no período pós-operatório de seis meses.
Permanent exotropia (XT) occurs in 1 to 2 percent of the pediatric population. Its management involves careful assessment of patient, treatment of amblyopia, refractive errors and surgery. The aim of the surgery is to straighten the eyes in the primary gaze position, giving a better cosmetic outcome. The factors reported to affect surgical outcome after exotropia surgery vary widely in reports and success rates for strabismus surgery have been reported to range from 60 percent to 80 percent. There are few reports to determine the relation between amblyopia and surgical outcome in exotropic patients. PURPOSE: To compare the surgical outcome of permanent exotropia surgery in amblyopic and non-amblyopic patients. METHODS: This is a retrospective study of 37 clinical records from amblyopic patients (Group A) and non-amblyopic patients (Group B) who underwent recess-resect in one eye for XT. Postoperative deviation was analyzed in one month (immediate) and insixmonths (final) in both groups and in between. Age: group A 24.7 ± 14.2 years, group B 22.6 ± 18.6 years; Preoperative deviation: group A 29.1 ± 7.2Δ, group B 28.4 ± 6.8Δ. RESULTS: The success rate in the imediate postoperative period was 60 percent (Group A) and 100 percent (Group B) (p<0.05); 50 percent (Group A) and 82.3 percent (Group B) (p=0.082) in the final postoperative period. There was a statistical difference in the imediate postoperative deviation, but the final deviation and the variation of the deviation were similar in both groups. CONCLUSION: There is a better outcome in patients of group B and no diference in the surgical outcome between these amblyopic and non-amblyopic patients in the final postoperative period.
Assuntos
Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Ambliopia/complicações , Exotropia/cirurgia , Exotropia/complicações , Seguimentos , Procedimentos Cirúrgicos Oftalmológicos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Brown's syndrome is characterized by a limitation of elevation in adduction, slight or normal limitation of elevation in abduction, divergence in straight upgaze (V-pattern), intorsion in upgaze and positive forced duction. It is caused by a tight or inelastic superior oblique tendon. Benign joint hypermobility is a hereditary disease of the connective tissue characterized by an increase of mobility in diverse joints. Its prevalence is very changeable regarding age range, sex and ethnicity, varying from 2 to 35% in men and 5 to 57% in women. In this case the authors describe a case of Brown's syndrome associated with Benign joint hipermobility and call attention to a little described association in the literature. J.C.S, male, 6 years old, mulatto, student, was referred to the University of Santo Amaro with complaint of exotropia for 2 years that it increased in supraversion. The patient with the diagnosis of bilateral Brown's syndrome, was diagnosed as having benign joint hipermobility by the reumatologist. The patient with benign joint hipermobility can develop symptoms such as arthralgia caused by a joint inflammation. We believe in the possibility that Brown syndrome has occurred, caused by an inflammatory process in the trochlea that started because of the benign joint hypermobility.
Assuntos
Instabilidade Articular/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Criança , Exotropia/complicações , Movimentos Oculares , Humanos , Masculino , Síndrome , Tomografia Computadorizada por Raios X , Acuidade VisualRESUMO
Aicardi syndrome is a triad of abnormalities that includes total or partial agenesis of the corpus callosum, chorioretinal lacunae, and infantile spasms. This syndrome was first described in 1965. A female infant with Aicardi syndrome associated with a nasoethmoidal cephalocele is described in this report. She presented with a history of unilateral nasal discharge since birth and seizures since age 1 week. She was microcephalic and there was visual impairment. A fleshy mass of the left nostril was noted. Ophthalmological evaluation revealed left exotropia, dysplastic optic discs and retina, 'morning glory' appearance of the left optic disc, and bilateral chorioretinal lacunae. Magnetic resonance imaging of the brain showed absence of the corpus callosum, dysmorphic changes of the lateral ventricles, a superiorly located third ventricle, heterotopic grey matter of the frontal lobes, a left nasoethmoidal cephalocele, and closed lip schizencephaly of the left frontal lobe. This female infant developed asymmetric infantile spasms at age 8 weeks. Surgical correction of the cephalocele was declined. She developed recurrent pneumonias secondary to aspiration of feeds and died at age 8 months during one of these events.
Assuntos
Agenesia do Corpo Caloso , Corioide/anormalidades , Encefalocele/complicações , Encefalocele/fisiopatologia , Seio Etmoidal/anormalidades , Retina/anormalidades , Espasmos Infantis/complicações , Ventrículos Cerebrais/patologia , Exotropia/complicações , Evolução Fatal , Feminino , Lateralidade Funcional/fisiologia , Humanos , Recém-Nascido , Imageamento por Ressonância Magnética , SíndromeRESUMO
A síndrome de Brown é caracterizada por grande limitação de elevação em adução, elevação ligeiramente diminuída ou normal na abdução, anisotropia em "Y" ou "V", intorção do olho em supraversão e ducção forçada positiva. Sua causa se deve à inelastibilidade do músculo oblíquo superior ou por sua contenção em sua própria bainha. A hipermobilidade articular benigna é doença hereditária do tecido conectivo caracterizada por aumento da mobilidade em diversas articulações. Sua prevalência é muito variável em relação à idade, sexo e etnia, variando de 2 a 35 por cento em homens e de 5 a 57 por cento e mulheres. Neste relato os autores descrevem um caso de síndrome de Brown associada com hipermobilidade articular benigna e atentam para a associação pouco referida na literatura. J.C.S, masculino, 6 anos de idade, pardo, estudante, foi encaminhado à Universidade de Santo Amaro com queixa de exotropia há dois anos que aumentava na supraversão. Paciente com o diagnóstico de síndrome de Brown bilateral teve o diagnóstico de hipermobilidade articular benigna pelo Reumatologista. O paciente com hipermobilidade articular benigna pode desenvolver sintomas articulares como artralgia devido a uma inflamação articular. Acreditamos na possibilidade de que síndrome de Brown possa ter ocorrido devido a processo inflamatório na tróclea que teve início devido a hipermobilidade articular benigna.
Brown's syndrome is characterized by a limitation of elevation in adduction, slight or normal limitation of elevation in abduction, divergence in straight upgaze (V-pattern), intorsion in upgaze and positive forced duction. It is caused by a tight or inelastic superior oblique tendon. Benign joint hypermobility is a hereditary disease of the connective tissue characterized by an increase of mobility in diverse joints. Its prevalence is very changeable regarding age range, sex and ethnicity, varying from 2 to 35 percent in men and 5 to 57 percent in women. In this case the authors describe a case of Brown's syndrome associated with Benign joint hipermobility and call attention to a little described association in the literature. J.C.S, male, 6 years old, mulatto, student, was referred to the University of Santo Amaro with complaint of exotropia for 2 years that it increased in supraversion. The patient with the diagnosis of bilateral Brown's syndrome, was diagnosed as having benign joint hipermobility by the reumatologist. The patient with benign joint hipermobility can develop symptoms such as arthralgia caused by a joint inflammation. We believe in the possibility that Brown syndrome has occurred, caused by an inflammatory process in the trochlea that started because of the benign joint hypermobility.
Assuntos
Humanos , Masculino , Criança , Instabilidade Articular/complicações , Transtornos da Motilidade Ocular/etiologia , Movimentos Oculares , Exotropia/complicações , Transtornos da Motilidade Ocular/diagnóstico , Músculos Oculomotores/fisiopatologia , Síndrome , Tomografia Computadorizada por Raios X , Acuidade VisualRESUMO
BACKGROUND: A homonymous hemianopia can be compensated for by an exotropia in the direction of the visual field defect. CASE REPORTS (AND LITERATURE REVIEW): Two young males with visual field defects and exotropia are reported. Both refused surgery when they were advised of the risk of reduction of their binocular visual field with the alignment of their eyes. CONCLUSION: Mapping of the binocular visual field is mandatory in patients with exotropia and neurological involvement to search for this rare combination which could produce a disappointing surgical outcome.
Assuntos
Exotropia/complicações , Exotropia/terapia , Hemianopsia/complicações , Recusa do Paciente ao Tratamento , Transtornos da Visão/etiologia , Campos Visuais , Adulto , Angiografia , Angiografia Cerebral , Hemianopsia/diagnóstico , Hemianopsia/fisiopatologia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Transtornos da Visão/diagnósticoRESUMO
Se presentan 9 casos de exodesviación intermitente con desviación vertical disociada, cuyas características clínicas, registros EOG y resultados quirúrgicos las diferencian de las X(T) verdaderas. Por las implicancias terapéuticas se hace hincapíe en la necesidad de realizar un diagnóstico correcto. Esto se basa en los registros EOG, en el comportamiento del ojo fijador cuando se compensa la exodesviación mediante prismas de base interna delante del ojo desviado, en el comportamiento del ojo desviado cuando se coloca un filtro delante del ojo fijador y por la presencia de DVD