RESUMO
INTRODUCTION: The finding of an eyelid ptosis in a manuscript of the xiii century raises the differential diagnosis of injury to the third cranial nerve. This nerve was not differentiated from the other oculomotors until the xvi century and only in the xix century a clinicopathological correlation was established for its paralysis. AIM: Describe the characteristics and differential diagnoses of an eyelid ptosis illustrated in the Book of Divine Works (1173) by Hildegard of Bingen. DEVELOPMENT: In the mentioned work the nun Richardis of Stade is portrayed with her left eyelid drooping. Two conspicuous signs are described, ptosis and corresponding raising of the eyebrow. The deviation of the eye downward and outward is inferred from the shape that adopts the eyelid by the position of the eye and the curvature of the cornea. The picture is consistent with an isolated paralysis of the oculomotor nerve. The causes of ptosis are discussed: aponeurotic due to levator palpebrae dehiscence; myogenic, congenital and acquired; of the neuromuscular junction, and neuropathic, the latter being the most probable in this case and of a compressive mechanism. The nun's unexpected natural death suggests a ruptured brain aneurysm. CONCLUSIONS: Richardis of Stade's portrait shows an oculomotor paralysis centuries before its anatomy, function, and clinicopathological expression were known. Credit for this original description must go to Hildegard, whose medical vocation has long been recognized.
TITLE: Estudio de una ptosis ocular en un manuscrito iluminado del siglo XIII.Introducción. El hallazgo de una ptosis palpebral en un manuscrito del siglo xiii plantea el diagnóstico diferencial de lesión del tercer par craneal. Este nervio no fue diferenciado de los otros oculomotores hasta el s. xvi. En el s. xix se estableció una correlación clinicopatológica con su parálisis. Objetivo. Describir las características y diagnósticos diferenciales de una ptosis palpebral ilustrada en el Libro de las obras divinas (1173) de Hildegarda de Bingen. Desarrollo. En la obra en cuestión se retrata a la monja Richardis de Stade con su párpado izquierdo caído. Se describen dos signos notorios, ptosis y elevación de la ceja correspondiente, y se infiere la desviación del ojo hacia abajo y afuera por la forma que le imprime al párpado la posición del ojo y la curvatura de la córnea. El cuadro es consistente con una parálisis aislada del motor ocular común. Se discuten las causas de ptosis: aponeurótica por dehiscencia del levator palpebrae; miógenas, congénitas y adquiridas; de la unión neuromuscular; y neuropática, que es la más probable en este caso y de mecanismo compresivo. Conclusiones. El retrato de Richardis de Stade muestra una parálisis del motor ocular común siglos antes de que se conocieran su anatomía, función y expresión clinicopatológica. Su inesperada muerte de causa natural hace presumir la ruptura de un aneurisma cerebral. El mérito de esta descripción original debe concedérsele a Hildegarda, cuya vocación médica ha sido largamente reconocida.
Assuntos
Blefaroptose , Oftalmoplegia , Blefaroptose/etiologia , Diagnóstico Diferencial , Pálpebras/patologia , Feminino , Humanos , Músculos Oculomotores/inervaçãoRESUMO
Aberrant regeneration in third nerve palsies, linking medial rectus contraction to the levator palpebrae muscle, is a great opportunity for surgical planning to address both the ptosis and horizontal deviation in a single procedure. We report a case of severe ptosis associated with exotropia that was successfully corrected with a single horizontal strabismus surgery owing to aberrant regeneration and discuss the basis underlying the surgical planning.
Assuntos
Blefaroptose , Exotropia , Doenças do Nervo Oculomotor , Estrabismo , Blefaroptose/cirurgia , Exotropia/cirurgia , Humanos , Músculos Oculomotores/inervação , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estrabismo/cirurgiaRESUMO
SUMMARY: The purpose of this study was to reveal the overall distribution pattern of the intramuscular nerves of each extraocular muscle and provide morphological guidance for the selection of the neuromuscular compartment during extraocular muscle transplantation and target localization of the botulinum toxin A injection to correct strabismus. We studied 12 Chinese head specimens that were fixed with formalin. The extraocular muscles from both sides of each head were removed, and a modified Sihler's staining technique was used to reveal the overall distribution pattern of the intramuscular nerves. We observed an intramuscular nerve-dense region formed by the intramuscular arborized branches in the semitransparent superior rectus, inferior rectus, medial rectus, lateral rectus, superior oblique, inferior oblique, and levator palpebrae superioris muscles with Sihler's staining technique. The seven extraocular muscles can each be divided into two neuromuscular compartments. The intramuscular nerve-dense regions of the superior, inferior, medial, and lateral rectus and the superior oblique, inferior oblique, and levator palpebrae superioris muscles were positioned at 33.50 % -72.72 %, 40.21 % - 66.79%, 37.92 % - 64.51 %, 31.69 % - 56.01 %, 26.35 % - 64.98 %, 40.46 % - 73.20 %, and 27.72 % - 66.07 % of the lengths of the muscle bellies, respectively, and the centers of intramuscular nerve dense regions were located at 59.50 %, 54.18 %, 51.68 %, 50.08 %, 48.38 %, 56.49 %, and 50.77 % of the length of each muscle belly, respectively. The aforementioned values are the means of the actual values. These results suggest that when the strabismus is corrected with muscle transplantation, the extraocular muscle should be transplanted based on the neuromuscular compartment, which would benefit the function of both donor and recipient muscles. The localization of these nerve dense regions is recommended as an optimal target for the injection of botulinum toxin A to treat strabismus.
RESUMEN: El objetivo de este estudio fue revelar el patrón de distribución de los nervios intramusculares de cada músculo extraocular y, proporcionar una guía morfológica para la selección del compartimento neuromuscular durante el trasplante de músculo extraocular, y la localización de la inyección de toxina botulínica A para corregir el estrabismo. Estudiamos 12 muestras de cabezas de individuos chinos fijadas en formalina. Se extrajeron los músculos extraoculares de ambos lados de cada cabeza y, se utilizó una técnica de tinción de Sihler modificada para revelar el patrón de distribución general de los nervios intramusculares. Observamos una región densa en nervios intramusculares formada por los ramos intramusculares en los músculos recto superior semitransparente, recto inferior, recto medial, recto lateral, oblicuo superior, oblicuo inferior y elevador del párpado superior con técnica de tinción de Sihler. Los siete músculos extraoculares se pueden dividir cada uno en dos compartimentos neuromusculares. Las regiones intramusculares densamente nerviosas de los músculos recto superior, inferior, medial y lateral y los músculos oblicuo superior, oblicuo inferior y elevador del párpado superior se colocaron en 33,50 % -72,72 %, 40,21 % -66,79 %, 37,92 % -64,51 % , 31,69 % -56,01 %, 26,35 % -64,98 %, 40,46 % -73,20 % y 27,72 % -66,07 % de las longitudes de los vientres musculares, respectivamente, y los centros de las regiones densamente nerviosas intramusculares se ubicaron en 59,50 %, 54,18 % , 51,68 %, 50,08 %, 48,38 %, 56,49 % y 50,77 % de la longitud de cada vientre muscular, respectivamente. Los valores antes mencionados son medios de los valores reales. Estos resultados sugieren que cuando el estrabismo se corrige con trasplante de músculo, el músculo extraocular debe trasplantarse en función del compartimento neuromuscular, lo que beneficiaría la función tanto de los músculos donantes como receptores. Se recomienda la localización de estas regiones densas en nervios, como un objetivo óptimo para la inyección de toxina botulínica A para tratar el estrabismo.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Músculos Oculomotores/inervação , Nervo Oculomotor/anatomia & histologia , Coloração e RotulagemRESUMO
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.
Assuntos
Humanos , Feminino , Criança , Transtornos da Motilidade Ocular/congênito , Nervos Cranianos/anormalidades , Doenças do Nervo Troclear/congênito , Sincinesia/congênito , Músculos Oculomotores/inervação , Transtornos da Motilidade Ocular/classificação , Transtornos da Motilidade Ocular/patologia , Doenças do Nervo Troclear/classificação , Doenças do Nervo Troclear/patologia , Doenças Raras , Sincinesia/classificação , Sincinesia/patologia , Pálpebras/anormalidadesRESUMO
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.
Assuntos
Nervos Cranianos/anormalidades , Transtornos da Motilidade Ocular/congênito , Músculos Oculomotores/inervação , Sincinesia/congênito , Doenças do Nervo Troclear/congênito , Criança , Pálpebras/anormalidades , Feminino , Humanos , Transtornos da Motilidade Ocular/classificação , Transtornos da Motilidade Ocular/patologia , Doenças Raras , Sincinesia/classificação , Sincinesia/patologia , Doenças do Nervo Troclear/classificação , Doenças do Nervo Troclear/patologiaRESUMO
Direct muscle neurotization has been proved to be a feasible technique for facial reanimation microsurgical procedures. Direct muscle neurotization is performed by implanting the interposition nerve graft directly into the substance of the muscle. The authors present the case of a 36-year-old male patient with upper eyelid dysfunction secondary to facial trauma. The levator palpebrae superioris muscle was macroscopically unaffected; however, neurophysiological test proved a selective denervation of the CN III motor branch to the levator palpebrae superioris muscle. Direct muscle neurotization was performed by means of 2 separate nerve procedures. The authors have made follow-up for 3 months after surgery. The authors have noted development of upper eyelid movement meaning adequate function of the neurotized muscle. The authors believe that this procedure could be integrated into the surgical options to treat selective nerve injuries should the right patient is encountered.
Assuntos
Blefaroptose/cirurgia , Traumatismos Faciais/cirurgia , Transferência de Nervo , Músculos Oculomotores/inervação , Músculos Oculomotores/cirurgia , Adulto , Blefaroptose/etiologia , Traumatismos Faciais/complicações , Humanos , Masculino , MovimentoRESUMO
INTRODUÇÃO: A blefaroplastia inferior transconjuntival está cada vez sendo mais utilizada pelos cirurgiões por ser uma técnica reprodutível e com baixo índice de complicações quando comparada à via transcutânea. Esta técnica tem como vantagens em relação à transcutânea a preservação do septo orbital, da lamela média e a manutenção da inervação do músculo orbicular. Este estudo tem o objetivo de analisar os resultados e as complicações da blefaroplastia transconjuntival com ressecção de pele na pálpebra inferior sem descolamento em uma amostra de pacientes. MÉTODO: Foram avaliados 18 pacientes submetidos a esta cirurgia, associada ou não à cantopexia lateral. A técnica cirúrgica é descrita detalhadamente. RESULTADOS: Um total de 16 pacientes femininos e 2 masculinos foram avaliados, com idade média de 52,7 anos. Houve melhora do aspecto do aumento de volume da pálpebra inferior, da flacidez de pele e da flacidez ligamentar lateral em todos os casos. Não foram registradas complicações tardias como retrações palpebrais, ectrópio, cicatrizes inestéticas, diplopia ou bolsas gordurosas remanescentes. Em nenhum caso foi necessária reintervenção cirúrgica. CONCLUSÃO: A blefaroplastia inferior transconjuntival com ressecção cutânea sem descolamento e preservação do músculo orbicular, associada ou não à cantopexia, se mostrou uma excelente técnica, facilmente reprodutível, confiável, segura e com poucas complicações pós-operatórias para o tratamento das alterações senis das pálpebras inferiores.
INTRODUCTION: Transconjunctival lower blepharoplasty is increasingly used by surgeons, since it is reproducible and has a low rate of complications compared to transcutaneous technique. The advantage of the transconjunctival technique is the preservation of the orbital septum, middle lamella, and orbicularis muscle innervation. This study aims to assess the results and complications of transconjunctival blepharoplasty with skin resection in the lower eyelid without detachment. METHOD: Eighteen patients who underwent this surgery with or without lateral canthopexy were analyzed. The surgical technique is described in detail. RESULTS: A total of 16 female and 2 male patients were assessed, with an average age of 52.7 years. There was improvement in all cases in the appearance of increased volume in the lower eyelid, and a decrease in skin and lateral ligament laxity. Late complications such as eyelid retraction, ectropion, unaesthetic scars, diplopia, or remnant fat bags were not observed. Surgical reintervention was not required in any cases. CONCLUSION: Transconjunctival lower blepharoplasty with skin resection without detachment and with preservation of the orbicularis muscle, with or without canthopexy, is an excellent technique, and is easily reproducible, reliable, and safe, with few postoperative complications in treatment of age-related changes in the lower eyelids.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , História do Século XXI , Estudos Retrospectivos , Blefaroplastia , Procedimentos de Cirurgia Plástica , Estudo de Avaliação , Pálpebras , Músculos Oculomotores , Blefaroplastia/métodos , Procedimentos de Cirurgia Plástica/métodos , Pálpebras/cirurgia , Pálpebras/patologia , Músculos Oculomotores/cirurgia , Músculos Oculomotores/inervaçãoRESUMO
OBJECTIVE: This study aimed to evaluate the benefit and specifically the feasibility of using ultrasound in ophthalmologic periconal block, and the occurrence of complications. STUDY DESIGN: Prospective experimental study. ANIMALS: Ten healthy New Zealand White rabbits (6-8 months of age), weighing 2.0-3.5 kg. METHODS: Rabbits were anesthetized by intramuscular injection of acepromazine (1 mg kg(-1)), ketamine (30 mg kg(-1)) and xylazine (3 mg kg(-1)). Ultrasound-assisted periconal block with lidocaine was performed on 18 eyes. Intraocular pressure was measured by applanation tonometry whereas corneal sensitivity was assessed using an esthesiometer, before and after each periconal anesthesia. RESULTS: In all 18 eyes, it was possible to adequately visualize the needle shaft within the periconal space, as well as muscular cone, optic nerve and local anesthetic solution spread. Lidocaine 2% without epinephrine (0.79 ± 0.19 mL) was injected into the periconal space. There was no statistical difference between the intraocular pressure (mean ± SD) measured before (10.9 ± 2.9 mmHg) and after (11.9 ± 3.8 mmHg) the periconal anesthesia (p = 0.38). The effectiveness of the ultrasound-assisted technique was shown according to the values for corneal sensitivity, assessed before and after periconal anesthesia (p < 0.0001). Complications were not observed in this study. CONCLUSIONS: Eye ultrasonography allowed visualization of all anatomic structures necessary to perform a periconal block, as well as the needle insertion and anesthetic spread in real time. Further studies are required to prove the real potential of ultrasound for reducing the incidence of complications associated with ophthalmic blocks, especially when anatomic disorders of the eye could potentially increase the risk. CLINICAL RELEVANCE: Ultrasonography is a painless, noninvasive tool that may improve safety of ophthalmic regional blocks, potentially by reducing the prevalence of globe perforation or penetration of the optic nerve associated with the needle-based techniques.
Assuntos
Anestésicos Locais/administração & dosagem , Olho/inervação , Lidocaína/administração & dosagem , Bloqueio Nervoso/veterinária , Ultrassonografia de Intervenção/veterinária , Anestesia/veterinária , Animais , Olho/diagnóstico por imagem , Injeções Intraoculares/veterinária , Músculos Oculomotores/inervação , Oftalmodinamometria/veterinária , Estudos Prospectivos , CoelhosRESUMO
BACKGROUND: The neurorehabilitation of the patient with cerebral damage implies the reestablishment of the visual functions. Botulinum toxin can be considerate as a less invasive alternative for treatment. OBJECTIVE: to demonstrate the answer to the treatment using botulinum toxin of the visual motor alterations in patients with cerebral damage. METHODS: Descriptive study of patients with visual alterations associated to cerebral damage. The visual treatment included three areas: sensorial, refracting and motor under quimiodenervation with botulinum toxin, of May 2009 to May 2010. RESULTS: 48 patients were studied, age 22,4 years ± 23. The strabismus were: esotropia 52%, exotropia 39,5%, vertical 8%, nystagmus 4%. 50% of the patients had psychomotor delay. Some of the most important causes of cerebral damage were: Down syndrome, epilepsy, tumor, hydrocephalus, neuroinfection, infantile cerebral paralysis, multiple sclerosis, metabolic syndrome, cranial trauma, congenital cardiopathy, ventricular hemorrhage, cerebrovascular stroke. The dose of botulinum toxin was 8,1 UI ± 3. We registered good results in 56.5%, regular 23,9% and bad 19,5%. The global percentage of rehabilitation was 69% of correction with a r of Pearson of 0,5. DISCUSSION: Patients with cerebral damage have diverse types of visuomotor alterations, strabismus and nystagmus.Use of botulinum toxin as a paralytic muscle agent is a good alternative in these cases. CONCLUSION: The botulinum toxin is an effective option for the visual rehabilitation in patients with cerebral damage and prevents the progression of more cerebral changes secondary to strabismus.
Assuntos
Toxinas Botulínicas Tipo A , Dano Encefálico Crônico/complicações , Bloqueio Nervoso , Nistagmo Patológico/reabilitação , Oftalmoplegia/reabilitação , Estrabismo/reabilitação , Adulto , Idoso , Dano Encefálico Crônico/fisiopatologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Nistagmo Patológico/tratamento farmacológico , Nistagmo Patológico/etiologia , Nistagmo Patológico/fisiopatologia , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiopatologia , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/etiologia , Oftalmoplegia/fisiopatologia , Estudos Prospectivos , Transtornos Psicomotores/complicações , Transtornos Psicomotores/fisiopatologia , Estrabismo/tratamento farmacológico , Estrabismo/etiologia , Estrabismo/fisiopatologia , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: A characteristic feature of spinocerebellar ataxia type 2 (SCA2) is saccadic slowing at early disease stages. We sought to determine whether this sign is detectable before clinical manifestation and quantifies the disease progression throughout life in linear fashion. METHODS: In a specialized ataxia clinic, 54 presymptomatic carriers of SCA2 polyglutamine expansions and 56 relatives without mutation were documented with regard to their maximal saccade velocity (MSV). RESULTS: Among the control individuals, a significant effect of aging on MSV was observed. After elimination of this age influence through a matched-pair approach, a presymptomatic decrease of MSV could be shown. The MSV reduction was stronger in carriers of large expansions. In the years before calculated disease manifestation, the MSV impairment advanced insidiously. CONCLUSION: Saccade velocity is a sensitive SCA2 endophenotype that reflects early pontine degeneration and may be a useful diagnostic parameter before the onset of ataxia. SIGNIFICANCE: Future neuroprotective therapies of polyglutamine neurodegeneration may be assessed by MSV from earliest to prefinal disease stages.
Assuntos
Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/fisiopatologia , Movimentos Sacádicos/fisiologia , Ataxias Espinocerebelares/complicações , Ataxias Espinocerebelares/fisiopatologia , Adolescente , Adulto , Idoso , Ataxinas , Cerebelo/fisiopatologia , Progressão da Doença , Diagnóstico Precoce , Feminino , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas do Tecido Nervoso/genética , Vias Neurais/fisiopatologia , Transtornos da Motilidade Ocular/diagnóstico , Músculos Oculomotores/inervação , Valor Preditivo dos Testes , Prognóstico , Ataxias Espinocerebelares/diagnóstico , Adulto JovemRESUMO
PURPOSE: To describe the incidence, etiologies and follow-up of patients with paralytic strabismus. METHODS: Retrospective study of 519 strabismic patients with isolated III, IV or VI cranial nerve palsy of 11,000 charts of the Ocular Motility Section of the Department of Ophthalmology of "Faculdade de Ciências Médicas Santa Casa de São Paulo", Brazil, between January 1980 and October 2004. This study analyzed: the injured cranial nerve, affected eye, sex distribution, etiology and follow-up. RESULTS: It was found that 17.1% of the cases were congenital and 82.9% acquired. The VI cranial nerve was the most frequently affected (49.7%). The incidence was higher in males (58.1%). Traumatism was the most common cause of III (43.0%), IV (52.4%) and VI (48.8%) nerve palsy. Surgery was performed in the three groups: third nerve (42.9%), fourth nerve (73.2%) and sixth nerve (43.2%). CONCLUSIONS: The sixth cranial nerve was the most frequently affected and the most common cause was traumatism, the same as observed in the literature.
Assuntos
Nervos Cranianos , Traumatismos Oculares/complicações , Paralisia/etiologia , Estrabismo/etiologia , Brasil/epidemiologia , Feminino , Humanos , Incidência , Masculino , Músculos Oculomotores/lesões , Músculos Oculomotores/inervação , Paralisia/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Estrabismo/congênito , Estrabismo/cirurgiaRESUMO
OBJETIVO: Avaliar a incidência, etiologia e evolução dos estrabismos paralíticos ou paréticos. MÉTODOS: Foram selecionados retrospectivamente 519 prontuários de pacientes com paresia ou paralisia isolada dos músculos inervados pelos III, IV ou VI nervos cranianos, a partir de 11.000 prontuários da Seção de Motilidade Extrínseca Ocular do Departamento de Oftalmologia da Santa Casa de São Paulo de janeiro de 1980 a outubro de 2004. Foram estudados: o nervo craniano acometido, o olho acometido, o sexo, os fatores etiológicos e a evolução desses pacientes. RESULTADOS: Dos 519 pacientes, 17,1 por cento foram casos congênitos e 82,9 por cento foram adquiridos. O nervo craniano mais afetado foi o VI (49,7 por cento). Os pacientes do sexo masculino foram mais acometidos, com 58,1 por cento dos casos. A etiologia traumática foi a mais freqüente nos casos de paresia ou paralisia de III (43,0 por cento), IV (52,4 por cento) e VI (48,8 por cento) nervos cranianos. Os pacientes evoluíram mais freqüentemente para cirurgia nos três grupos: III nervo (42,9 por cento), IV nervo (73,2 por cento) e VI nervo (43,2 por cento). CONCLUSÃO: O VI nervo craniano foi o mais freqüentemente acometido e o fator etiológico mais importante foi o traumatismo, dados esses que coincidem com os encontrados na literatura.
PURPOSE: To describe the incidence, etiologies and follow-up of patients with paralytic strabismus. METHODS: Retrospective study of 519 strabismic patients with isolated III, IV or VI cranial nerve palsy of 11,000 charts of the Ocular Motility Section of the Department of Ophthalmology of "Faculdade de Ciências Médicas Santa Casa de São Paulo", Brazil, between January 1980 and October 2004. This study analyzed: the injured cranial nerve, affected eye, sex distribution, etiology and follow-up. RESULTS: It was found that 17.1 percent of the cases were congenital and 82.9 percent acquired. The VI cranial nerve was the most frequently affected (49.7 percent). The incidence was higher in males (58.1 percent). Traumatism was the most common cause of III (43.0 percent), IV (52.4 percent) and VI (48.8 percent) nerve palsy. Surgery was performed in the three groups: third nerve (42.9 percent), fourth nerve (73.2 percent) and sixth nerve (43.2 percent). CONCLUSIONS:The sixth cranial nerve was the most frequently affected and the most common cause was traumatism, the same as observed in the literature.
Assuntos
Feminino , Humanos , Masculino , Nervos Cranianos , Traumatismos Oculares/complicações , Paralisia/etiologia , Estrabismo/etiologia , Brasil/epidemiologia , Incidência , Músculos Oculomotores/lesões , Músculos Oculomotores/inervação , Paralisia/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Estrabismo/congênito , Estrabismo/cirurgiaRESUMO
BACKGROUND: To review the preoperative signs of bilateral superior oblique paresis and to analyze their presence. METHODS: The proposed preoperative signs of bilateral superior oblique (SO) muscle paresis were separated into "certain signs" and "suspicious signs." The signs were analyzed for accuracy using case examples and statistics. RESULTS: A strong preoperative sign of bilateral SO muscle paresis was reversal of the hypertropia in the ipsilateral (and/or ipsi-supralateral) position and/or in the contralateral head tilt position. In such cases, the addition of a light contralateral weakening procedure to the operation aimed at the elimination of the hypertropia caused by the more affected SO muscle prevented development of the clinical picture of a contralateral SO muscle paresis. A suggestive preoperative sign of bilateral SO muscle weakness was marked reduction of the hypertropia in the ipsilateral (and ipsi-supralateral) position, as well as in the contralateral head tilt position. In these cases, a contralateral inferior oblique muscle weakening was deferred until after motility could be reassessed postoperatively. An additional sign of possible bilateral SO muscle weakness was the presence of a large V pattern. CONCLUSIONS: When planning surgery for apparent unilateral SO muscle paresis, the surgeon should be aware of the often subtle preoperative signs of bilateral SO muscle paresis. Early diagnosis allows the surgeon to avoid the reversal of the clinical picture or to advise the patient of the possibility of a bilateral problem.
Assuntos
Músculos Oculomotores/inervação , Doenças do Nervo Oculomotor/fisiopatologia , Movimentos Oculares , Humanos , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/cirurgia , PrognósticoRESUMO
INTRODUCTION: These two eye movements have not been previously studied in this condition by this method. METHODS: Five cases were studied. Both visual acuity and eye examination of anterior and posterior segments were normal. A Nicolet Nystar Plus system with chloride silver electrodes was used to record the EOG. RESULTS: Of the two systems under study, the smooth pursuit system showed the most relevant anomalies, both in the Duane's eye and in the apparently healthy eye. No correlation was found between the pursuit and optokinetic nystagmus disorders. In some cases, more significant abnormalities were observed in the clinically normal eye. CONCLUSIONS: The results clearly demonstrated a significant impairment of the pursuit system. This suggests that this motor disorder is not exclusively caused by hypoplasia or aplasia of the nucleus of the abducens nerve (VIth cranial nerve). These abnormalities might be related to a poor development of the rhombencephalon since both supramotor nuclei as well as the pathways of this system arise from this region of the embryonic brain. In the particular case of OKN, the supramotor nuclei have a different origin. Therefore, these systems might be affected differently.
Assuntos
Síndrome da Retração Ocular/fisiopatologia , Nistagmo Optocinético/fisiologia , Acompanhamento Ocular Uniforme/fisiologia , Nervo Abducente/fisiologia , Adolescente , Criança , Eletroculografia , Feminino , Humanos , Masculino , Músculos Oculomotores/inervação , Nervo Oculomotor/fisiologia , Rombencéfalo/fisiologiaRESUMO
OBJECTIVE: The aim of this paper is to review existing literature on the subject and to report on and discuss a case of Marcus Gunn Phenomenon. DESCRIPTION: A five year-old female, otherwise a healthy patient, while still a few months old, was seen by a pediatrician who detected a disorder of the right eye, initially believed to be strabismus, at a follow-up childcare consultation. Several ophthalmologists failed to establish a precise diagnosis. After a pediatric ophthalmologist had examined the child at four years of age, a diagnosis of Marcus Gunn Phenomenon, otherwise known as jaw-winking phenomenon, was confirmed. Apart from this anomaly, physical, ophthalmological, and neurological examinations were normal. Since ptosis was mild and no association with strabismus, amblyopia or other conditions was established, no surgical procedures were necessary. COMMENTS: This report is an alert to pediatricians regarding the presence of this largely unknown phenomenon, making it possible for pediatricians to identify the phenomenon, refer the patient to an ophthalmologist, and establish differential diagnosis from other, more severe forms of ptosis, requiring more aggressive treatment.
Assuntos
Blefaroptose/diagnóstico , Piscadela , Pálpebras/inervação , Distúrbios Pupilares/diagnóstico , Ambliopia/etiologia , Blefaroptose/congênito , Criança , Diagnóstico Diferencial , Pálpebras/fisiopatologia , Feminino , Humanos , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiopatologia , Estrabismo/etiologia , Nervo Trigêmeo/fisiopatologiaRESUMO
OBJETIVO: Este trabalho teve por objetivo fazer uma revisão bibliográfica, relatar e discutir o caso clínico de um paciente com fenômeno de Marcus Gunn. DESCRIÇAO: Criança de 5 anos de idade, sexo feminino, hígida. Nos primeiros meses de vida, em consulta de puericultura, foi detectada alteração no olho direito, que, a princípio, parecia tratar-se de estrabismo. Após consultas com vários oftalmologistas, não se alcançou um diagnóstico preciso. Já aos 4 anos de idade, após exame realizado por oftalmologista pediátrico, confirmou-se o diagnóstico do fenômeno de Marcus Gunn. O restante do exame físico, incluindo exame neurológico, estava normal. Por se tratar de ptose palpebral leve, sem outras patologias associadas, optou-se por uma conduta conservadora. COMENTARIOS: Este relato visa alertar os pediatras com relação ao fenômeno de Marcus Gunn, que ainda é pouco conhecido. A partir deste conhecimento, o pediatra poderá identificar o fenômeno, possibilitando o encaminhamento precoce para a abordagem de complicações ou condições associadas, além de diagnóstico diferencial com outros tipos de ptose palpebral.
Assuntos
Humanos , Feminino , Criança , Piscadela , Blefaroptose/diagnóstico , Pálpebras/inervação , Distúrbios Pupilares/diagnóstico , Ambliopia/etiologia , Blefaroptose/congênito , Diagnóstico Diferencial , Pálpebras/fisiopatologia , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiopatologia , Estrabismo/etiologia , Nervo Trigêmeo/fisiopatologiaRESUMO
Se describen las alteraciones de las ducciones en cuatro grupos: por parálisis: III par, IV par, VI par; por hipofunción: agenesia muscular, sección traumática del músculo, debilitamiento quirúrgico excesivo, músculo suelto; por alteraciones inervacionales: síndrome de Duane, parálisis monocular de elevadores, síndrome de Moebius; por restricción: síndrome de Brown, estrabismo fijo, fibrosis del recto inferior, estrabismo tiroideo, fractura blow-out de órbita, adhesión post-quirúrgica
Assuntos
Nervo Abducente/fisiopatologia , Músculos Oculomotores/fisiopatologia , Nervo Oftálmico/fisiopatologia , Nervo Oculomotor/fisiopatologia , Oftalmoplegia/diagnóstico , Nervo Abducente/lesões , Músculos Oculomotores/inervação , Músculos Oculomotores/lesões , Nervo Oftálmico/lesões , Nervo Oculomotor/lesões , Oftalmoplegia/etiologiaRESUMO
Three hundred eight patients with strabismus were treated with botulinum A toxin (Oculinum) chemodenervation; 153 were followed by the authors for at least 6 months. In this study group, 97 received botulinum A toxin injections as the primary method of treatment of their ocular deviation. Fifty-six received injections after traditional extraocular muscle surgery. Botulinum A toxin was useful for management of patients with recent surgical overcorrections and for management of some patients with sixth cranial nerve palsy. Chemodenervation of an extraocular muscle was not as successful as traditional strabismus surgery for treatment of infantile esotropia and other comitant deviations. Botulinum A toxin injection was ineffective in patients who had restrictive strabismus. This drug has limited application in the management of patients with strabismus.
Assuntos
Toxinas Botulínicas/uso terapêutico , Estrabismo/terapia , Nervo Abducente , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Esotropia/terapia , Feminino , Seguimentos , Humanos , Lactente , Injeções , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/inervação , Músculos Oculomotores/cirurgia , Estrabismo/cirurgia , Acuidade VisualRESUMO
Eighty-two children aged 13 years or younger were given injections of botulinum toxin for horizontal strabismus. Improvement was achieved in all but one patient. Children younger than 1 year or older than 6 years of age received only topical drop anesthesia and no sedation. Young children generally required low-dose ketamine sedation. The technique typically undercorrects, so reinjection was necessary in 85% of the patients. There were no systemic complications. Side effects, lasting up to a few weeks, included transient ptosis and hypertropia caused by involvement of other extraocular muscles.
Assuntos
Toxinas Botulínicas , Músculos Oculomotores/inervação , Estrabismo/terapia , Criança , Pré-Escolar , Denervação/métodos , Eletromiografia , Humanos , Lactente , KetaminaRESUMO
Extraocular muscle motoneurones were localised in the oculomotor nucleus (ON), trochlear nucleus (TN) and abducens nucleus (AN) in the marmoset brain using the horseradish peroxidase (HRP) retrograde labelling technique. HRP pellets injected into individual extraocular muscles revealed one or more groups of labelled neurones occupying discrete loci within these nuclei. Relatively little overlap of motoneurone pools was observed, except in the case of the inferior oblique and superior rectus muscles. Injections of HRP into the medial rectus muscle revealed three separate populations of labelled cells in the ipsilateral ON. Motoneurones innervating the inferior rectus muscle were mainly localised in the lateral somatic cell column of the ipsilateral ON. A second smaller grouping was observed in the medial longitudinal fasciculus. The inferior oblique muscle motoneurones were localised in the ipsilateral medial somatic cell column intermingled with motoneurones supplying the superior rectus muscle of the opposite eye. The superior oblique muscle motoneurones occupied the entire TN and the lateral rectus muscle motoneurones the AN. It was concluded that the organisation of nuclei and subnuclei responsible for controlling the extraocular muscles in the marmoset is broadly similar to that of other primates.