RESUMO
PURPOSE: To evaluate the efficacy of botulinum toxin type A injection to cause orbicularis eyelid muscle paralysis to improve dry eye signs and symptoms. METHODS: A prospective, randomized, comparative eye-to-eye and interventional study was performed. Patients with dry eye symptoms and positive fluorescein corneal staining were included. Randomly one eyelid received a subcutaneous injection of botulinum toxin in the medial orbicularis muscle portion of the lower eyelid, and the other eye received placebo. The subjective evaluation was achieved with a questionnaire assessing symptoms, quality of vision and ocular comfort level. The objective evaluation included the measurement of the tear film break-up time (TBUT), Schirmer's test and corneal and conjunctival staining. RESULTS: Twenty patients were included with a mean age of 59.5 years. Two weeks after the botulinum toxin injection, all patients showed a decrease in the horizontal movement of the lower eyelid when blinking. The eyes in the active treatment group showed better scores compared with the sham group in four symptoms 4 weeks after the treatment. The TBUT was higher at 1 and 3 months in the active treatment group. The corneal and conjunctival staining were significantly lower in the active treatment group at 1 and 3 months, and the Schirmer's test showed better measurements in the same group at 2 weeks, 1 month and 3 months. There were no adverse events reported. CONCLUSIONS: The injection of botulinum toxin A in the medial part of the lower eyelid is an effective and safe procedure that temporally improves some of the signs and symptoms of patients with dry eye.
Assuntos
Piscadela/fisiologia , Toxinas Botulínicas Tipo A/efeitos adversos , Síndromes do Olho Seco/tratamento farmacológico , Movimentos Oculares/efeitos dos fármacos , Músculos Oculomotores/efeitos dos fármacos , Oftalmoplegia/induzido quimicamente , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Síndromes do Olho Seco/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Fármacos Neuromusculares/efeitos adversos , Músculos Oculomotores/fisiopatologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/fisiopatologia , Estudos ProspectivosRESUMO
A 19-month-old, white, Pennsylvanian boy, with an unremarkable medical history, presented to our hospital with a 3-week history of nonbloody, nonbilious emesis up to 5 times a day and nonbloody diarrhea. Ten days before admission, his gait became progressively unsteady, until he finally refused to walk. A day before admission, he found it difficult to move his eyes. The patient was hypoactive. History, physical and neurologic examination, blood and cerebrospinal (CSF) fluid studies, and neuroimaging studies ruled out the most frequent causes of acute ataxia. The etiology of bilateral, complete ophthalmoplegia was also taken into consideration. Magnetic resonance imaging (MRI) findings of bilateral thalami and mammillary bodies provided diagnostic clues. Additional history and specific tests established the final diagnosis and treatment plan. The patient improved to a normal neurologic state. This case provides important practical information about an unusual malnutrition cause of acute ataxia, particularly in young children of developing countries.
Assuntos
Ataxia/fisiopatologia , Transtornos da Consciência/fisiopatologia , Oftalmoplegia/fisiopatologia , Deficiência de Tiamina/diagnóstico , Deficiência de Tiamina/fisiopatologia , Ataxia/diagnóstico , Ataxia/patologia , Transtornos da Consciência/diagnóstico , Transtornos da Consciência/patologia , Diagnóstico Diferencial , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Oftalmoplegia/diagnóstico , Oftalmoplegia/patologia , Tiamina/administração & dosagem , Deficiência de Tiamina/patologia , Deficiência de Tiamina/terapia , Estados UnidosRESUMO
A twelve-year-old African-American female presented with two week history of progressively worsening headache and fatigue, and vision difficulties for the past week. The physical examination was normal. The neurological evaluation was normal, except for cranial nerves (CN) testing, which showed bilateral restriction of adduction (CN III) and up gaze (CN IV) motions, vertical nystagmus, and left side facial paresis of central origin (CN VII). The bilateral exotropia and ophthalmoplegia are characteristics of WEBINO (Wall-Eyed Bilateral Intranuclear Ophthalmoplegia) syndrome, associated to a brain stem structural lesion. The following causes were evaluated and ruled out: tumor, infection, ischemic stroke, non-infectious inflammation. Pediatric Acquired Demyelinating Syndromes were then considered. Neuromyelitis Optica was ruled out in the absence of neuritis and normal spinal cord MRI. The differential diagnosis between Clinically Isolated Syndrome and Acute Demyelinating Encephalomyelitis, causing an isolated brain stem syndrome, is discussed.
Assuntos
Encefalomielite Aguda Disseminada/diagnóstico , Oftalmoplegia/diagnóstico , Negro ou Afro-Americano , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Criança , Diagnóstico Diferencial , Encefalomielite Aguda Disseminada/tratamento farmacológico , Encefalomielite Aguda Disseminada/patologia , Encefalomielite Aguda Disseminada/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/patologia , Oftalmoplegia/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To investigate the veracity of Jampolsky's statement that Bielschowsky's head tilt test is inverted if performed with the patient in the upside-down position and to interpret its neuromuscular mechanism. METHODS: We present a series of 10 patients selected from a referred sample who were diagnosed with superior oblique paresis. Hypertropia was measured in the primary position, with the head erect and tilted toward both shoulders with the patient in the erect, supine, and upside-down positions. The last position was achieved by hanging the patient upside-down. RESULTS: As expected, our results showed the veracity of Jampolsky's statement. The forced head tilt difference was inverted or significantly decreased when the test was performed in the upside-down position. Moreover, in all patients, Bielschowsky's phenomenon was neutralized in the supine body position, in which hypertropia with the head erect tended to vanish. In 3 patients, it disappeared completely. CONCLUSIONS: This study showed that, in patients with superior oblique paresis, differences in the extent of hypertropia in Bielschowsky's test tended to vanish when the test was performed with the patient in the supine position and invert when it was performed with the patient in the upside-down position.
Assuntos
Movimentos da Cabeça/fisiologia , Oftalmoplegia/fisiopatologia , Postura/fisiologia , Estrabismo/fisiopatologia , Adulto , Técnicas de Diagnóstico Oftalmológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
Purpose: To investigate the veracity of Jampolsky's statement that Bielschowsky's head tilt test is inverted if performed with the patient in the upside-down position and to interpret its neuromuscular mechanism. Methods: We present a series of 10 patients selected from a referred sample who were diagnosed with superior oblique paresis. Hypertropia was measured in the primary position, with the head erect and tilted toward both shoulders with the patient in the erect, supine, and upside-down positions. The last position was achieved by hanging the patient upside-down. Results: As expected, our results showed the veracity of Jampolsky's statement. The forced head tilt difference was inverted or significantly decreased when the test was performed in the upside-down position. Moreover, in all patients, Bielschowsky's phenomenon was neutralized in the supine body position, in which hypertropia with the head erect tended to vanish. In 3 patients, it disappeared completely. Conclusions: This study showed that, in patients with superior oblique paresis, differences in the extent of hypertropia in Bielschowsky's test tended to vanish when the test was performed with the patient in the supine position and invert when it was performed with the patient in the upside-down position. .
Objetivo: Investigar a veracidade da suposição de Jampolsky de que o teste de inclinação da cabeça de Bielschowsky invertese caso seja realizado com o paciente de cabeça para baixo, e tentar interpretar o mecanismo neuromuscular envolvido. Métodos: Apresentamos uma série de 10 pacientes portadores de paresia do oblíquo superior. Foi medida a hipertropia dos pacientes na posição primária do olhar e com a cabeça inclinada para cada um dos lados nas posições ereta, supina e de cabeça para baixo. Resultados: Como esperado, nossos resultados confirmaram a suposição de Jampolsky; além disso, e em todos os pacientes, o fenômeno de Bielschowsky foi neutralizado em posição supina. As diferenças da magnitude da hipertropia ao teste de Bielschowsky diminuiram significativamente ou inverteramse quando o paciente foi testado de cabeça para baixo. Conclusões: Este estudo demonstrou que, nos pacientes com paresia do oblíquo superior, a hipertropia evidenciada pelo teste de Bielschowsky tende a desaparecer com o paciente na posição supina e a se inverter quando o teste é realizado com o paciente de cabeça para baixo. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Movimentos da Cabeça/fisiologia , Oftalmoplegia/fisiopatologia , Postura/fisiologia , Estrabismo/fisiopatologia , Técnicas de Diagnóstico Oftalmológico , Reprodutibilidade dos TestesRESUMO
PURPOSE: To evaluate the differences of wavefront aberrations under cycloplegic, scotopic and photopic conditions. METHODS: A total of 174 eyes of 105 patients were measured using the wavefront sensor (WaveScan® 3.62) under different pupil conditions: cycloplegic 8.58 ± 0.54 mm (6.4 mm - 9.5 mm), scotopic 7.53 ± 0.69 mm (5.7 mm - 9.1 mm) and photopic 6.08 ± 1.14 mm (4.1 mm - 8.8 mm). The pupil diameter, standard Zernike coefficients, root mean square of higher-order aberrations and dominant aberrations were compared between cycloplegic and scotopic conditions, and between scotopic and photopic conditions. RESULTS: The pupil diameter was 7.53 ± 0.69 mm under the scotopic condition, which reached the requirement of about 6.5 mm optical zone design in the wavefront-guided surgery and prevented measurement error due to the pupil centroid shift caused by mydriatics. Pharmacological pupil dilation induced increase of standard Zernike coefficients Z(3)(-3), Z(4)(0) and Z(5)(-5). The higher-order aberrations, third-order aberration, fourth-order aberration, fifth-order aberration, sixth-order aberration, and spherical aberration increased statistically significantly, compared to the scotopic condition (P<0.010). When the scotopic condition shifted to the photopic condition, the standard Zernike coefficients Z(4)(0), Z(4)(2), Z(6)(-4), Z(6)(-2), Z(6)(2) decreased and all the higher-order aberrations decreased statistically significantly (P<0.010), demonstrating that accommodative miosis can significantly improve vision under the photopic condition. Under the three conditions, the vertical coma aberration appears the most frequently within the dominant aberrations without significant effect by pupil size variance, and the proportion of spherical aberrations decreased with the decrease of the pupil size. CONCLUSIONS: The wavefront aberrations are significantly different under cycloplegic, scotopic and photopic conditions. Using the wavefront sensor (VISX WaveScan) to measure scotopic wavefront aberrations is feasible for the wavefront-guided refractive surgery.
Assuntos
Acomodação Ocular/fisiologia , Sensibilidades de Contraste/fisiologia , Aberrações de Frente de Onda da Córnea/diagnóstico , Oftalmoplegia/fisiopatologia , Adolescente , Adulto , Topografia da Córnea , Aberrações de Frente de Onda da Córnea/fisiopatologia , Humanos , Adulto JovemRESUMO
PURPOSE: To evaluate the differences of wavefront aberrations under cycloplegic, scotopic and photopic conditions. METHODS: A total of 174 eyes of 105 patients were measured using the wavefront sensor (WaveScan® 3.62) under different pupil conditions: cycloplegic 8.58 ± 0.54 mm (6.4 mm - 9.5 mm), scotopic 7.53 ± 0.69 mm (5.7 mm - 9.1 mm) and photopic 6.08 ± 1.14 mm (4.1 mm - 8.8 mm). The pupil diameter, standard Zernike coefficients, root mean square of higher-order aberrations and dominant aberrations were compared between cycloplegic and scotopic conditions, and between scotopic and photopic conditions. RESULTS: The pupil diameter was 7.53 ± 0.69 mm under the scotopic condition, which reached the requirement of about 6.5 mm optical zone design in the wavefront-guided surgery and prevented measurement error due to the pupil centroid shift caused by mydriatics. Pharmacological pupil dilation induced increase of standard Zernike coefficients Z3-3, Z4(0) and Z5-5. The higher-order aberrations, third-order aberration, fourth-order aberration, fifth-order aberration, sixth-order aberration, and spherical aberration increased statistically significantly, compared to the scotopic condition (P<0.010). When the scotopic condition shifted to the photopic condition, the standard Zernike coefficients Z4(0), Z4², Z6-4, Z6-2, Z6² decreased and all the higher-order aberrations decreased statistically significantly (P<0.010), demonstrating that accommodative miosis can significantly improve vision under the photopic condition. Under the three conditions, the vertical coma aberration appears the most frequently within the dominant aberrations without significant effect by pupil size variance, and the proportion of spherical aberrations decreased with the decrease of the pupil size. CONCLUSIONS: The wavefront aberrations are significantly different under cycloplegic, scotopic and photopic conditions. Using the wavefront sensor (VISX WaveScan) to measure scotopic wavefront aberrations is feasible for the wavefront-guided refractive surgery.
OBJETIVO: Avaliar as diferenças de aberrações de frente de onda, em diferentes condições pupilares: sob cicloplegia, escotópica e fotópica. MÉTODOS: Um total de 174 olhos de 105 pacientes foram avaliados utilizando o sensor de frente de onda (WaveScan® 3.62) em diferentes condições pupilares: sob cicloplegia 8,58 ± 0,54 mm (6.4 mm-9.5 mm), escotópica 7,53 ± 0,69 mm (5,7 mm - 9,1 mm) e fotópica 6,08 ± 1,14 mm (4,1 mm - 8,8 mm). Diâmetro da pupila, coeficientes de Zernike, RMS ("Root Mean Square") das aberrações de alta ordem e as aberrações dominantes foram comparados entre as condições sob cicloplegia e escotópica, e entre as condições escotópica e fotópica. RESULTADOS: O diâmetro da pupila foi 7,53 ± 0.69 mm sob a condição escotópica e atingiu a exigência de cerca de 6,5 mm de zona óptica na cirurgia baseada em análise de frentes de ondas, evitando erros de medição consequentes à mudança de centroide pupilar provocada por midriáticos. A dilatação farmacológica da pupila induziu aumento dos coeficientes de Zernike Z3-3, Z4(0) e Z5-5. As aberrações de mais alta ordem (terceira, quarta, quinta e sexta ordem) e a aberração esférica aumentaram de forma estatisticamente significativa, em comparação com a condição escotópica (P<0,010). Quando a condição escotópica se mudou para a condição fotópica, os coeficientes de Zernike Z4(0), Z4², Z6-4, Z6-2, Z6² e todas as aberrações de alta ordem diminuíram de forma estatisticamente significativa (P<0,010), demonstrando que a miose acomodativa pode significativamente melhorar a visão sob a condição fotópica. Sob as três condições, a aberração coma vertical apareceu mais frequentemente dentro das aberrações dominantes, sem influência significativa da variação do tamanho da pupila, e a proporção de aberração esférica diminuiu com a diminuição do tamanho da pupila. CONCLUSÕES: As aberrações de frente de onda são significativamente diferentes sob cicloplegia, condições escotópica e fotópica. O uso do sensor de frentes de onda (VISX WaveScan) para medir as aberrações de frente de onda escotópicas é uma opção viável para a cirurgia refrativa baseada em análise de frentes de onda.
Assuntos
Adolescente , Adulto , Humanos , Adulto Jovem , Acomodação Ocular/fisiologia , Sensibilidades de Contraste/fisiologia , Aberrações de Frente de Onda da Córnea/diagnóstico , Oftalmoplegia/fisiopatologia , Topografia da Córnea , Aberrações de Frente de Onda da Córnea/fisiopatologiaRESUMO
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
Around 3% of the individuals with painful ophthalmoplegia have bilateral complaints. In the vast majority of these cases, appropriate investigation demonstrates a secondary etiology, and we are not aware of idiopathic cases reported. Herein we report a case of bilateral ophthalmoplegia where extensive investigation did not suggest a secondary cause.
Assuntos
Oftalmoplegia/etiologia , Síndrome de Tolosa-Hunt/complicações , Adulto , Anti-Inflamatórios/administração & dosagem , Blefaroptose/tratamento farmacológico , Blefaroptose/etiologia , Blefaroptose/fisiopatologia , Dexametasona/administração & dosagem , Feminino , Lateralidade Funcional , Humanos , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/fisiopatologia , Indução de Remissão , Síndrome de Tolosa-Hunt/fisiopatologiaRESUMO
PURPOSE: To evaluate the MRI cross sectional greater area of the unilateral superior oblique (SO) muscle in patients with congenital or acquired superior oblique palsy to detect asymmetries and to determine if there is any relationship between the degree of vertical deviation and the muscle size determined by imaging. METHODS: Magnetic Resonance Imaging coronal images were obtained in primary position, supraversion and infraversion. Interocular differences and intergroup differences were compared in 17 patients with unilateral acquired or congenital SO palsy and 15 orthotropic control subjects. RESULTS: Mean maximal difference was 3.56 +/-0.83 mm(2) (p 0.01) between healthy and paretic eye in the paretic group, and 1.08 +/-0.40 mm(2) (p 0.02) in the control group. Statistical Intergroup comparison was p 0.02 (conventionally statistically significant). In 9 patients the maximal interocular difference was detected in 44.4% in infraversion, 33.3% indistinctly in supra- and infraversion and 22.2% in primary position. The correlation coefficient between vertical deviation and interocular asymmetry was not conventionally statistically significant at p>0.05. CONCLUSIONS: Patients with unilateral superior oblique palsy showed significant MRI asymmetry, which was represented by a relatively greater healthy SO muscle size, in the paretic congenital group. We found no association between the SO muscle size and the degree of any vertical deviation present.
Assuntos
Imageamento por Ressonância Magnética , Músculos Oculomotores/fisiopatologia , Oftalmoplegia/fisiopatologia , Estrabismo/fisiopatologia , Doenças do Nervo Troclear/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Movimentos Oculares , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Contração Muscular , Órbita/patologia , Estudos Prospectivos , Doenças do Nervo Troclear/congênito , Visão BinocularRESUMO
Objetivo: Describir en una serie de pacientes con parálisis unilateral del cuarto nervio craneal, la diferencia de la desviación vertical en posición erecta y supina. Material y método: Se incluyeron pacientes con diagnóstico de parálisis del cuarto nervio craneal unilateral, realizando exploración oftalmológica completa así como medición de la desviación con prismas y oclusión alterna en posición erecta y en posición supina realizando la maniobra de Bielschowsky. Resultados: Se exploraron 13 pacientes con el diagnóstico antes mencionado; la mayor parte de ellos presentaron menor desviación vertical en posición supina; así mismo al realizar la maniobra de Bielschowsky, la respuesta en posición supina fue menor que la presentada en posición erecta. Conclusiones: Los reflejos vestíbulo oculares, responsable de la mayor desviación vertical al inclinar la cabeza hacia el lado parético en casos de parálisis del nervio troclear, se atenúan en posición supina. La explicación fisiológica se basa en el control de los movimientos oculares por parte de los otolitos, los cuales reciben estimulación de a cuerdo a su posición en relación a la gravedad; esta observación clínica apoya la explicación propuesta por Bielschowsky sobre la participación del aparato vestibular en uno de los principales signos clínicos de esta entidad.
Purpose. To describe vertical deviation differences in a group of patients with unilateral fourth cranial nerve palsy in erect versus supine position. Methods. We included patients with unilateral fourth cranial nerve palsy who underwent full ophthalmologic exploration and measurement of the vertical deviation with prisms and alternate occlusion in erect and supine position performing Bielschowsky´s test. Results. Thirteen patients were explored; most of them showed less vertical deviation in the supine position, the response to the Bielschowsky´s test was smaller in the supine position than in the erect patient. Conclusion. The vestibulo-ocular reflexes responsible for the larger vertical deviation when tilting the head to the paretic side, are attenuated in the supine position; the physiologic explanation of this phenomenon is based on the otholits role in the control of ocular movements; these receptors are stimulated according to their position in relation to gravity. This clinical observation supports the explanation proposed by Bielschowsky about the role of the vestibular system in one of the main clinical sings of this entity.
Assuntos
Feminino , Criança , Adulto Jovem , Pessoa de Meia-Idade , Doenças do Nervo Troclear/fisiopatologia , Movimentos Oculares/fisiologia , Oftalmoplegia/fisiopatologia , Reflexo Vestíbulo-Ocular/fisiologia , Nervo Troclear/fisiopatologia , Membrana dos Otólitos , PosturaRESUMO
Se presenta un caso de parálisis de la mirada conjugada horizontal. Se describen las estructuras anatómicas involucradas en el control de la movilidad conjugada. Se analizan los mecanismos etiopatogénicos, factores etiológicos y se discuten las posibilidades terapéuticas
Assuntos
Humanos , Masculino , Adulto , Infarto Cerebral/diagnóstico , Esotropia , Diplopia , Oftalmoplegia/etiologia , Oftalmoplegia/fisiopatologia , Oftalmoplegia/terapia , Toxinas Botulínicas/uso terapêutico , Lúpus Eritematoso SistêmicoRESUMO
Se estima que la neuropatía diabética se presenta en 8 por ciento de los individuos con diagnóstico reciente de diabetes y hasta en 50 por ciento de aquéllos con más de 20 años de enfermedad. La mononeuropatía de los pares craneanos suele aparecer en pacientes con control metabólico deficiente o como la primera manifestación de la diabetes. La parálisis de los nervios oculomotores tiene una frecuencia de 0.5 a 5 por ciento y afecta principalmente a las personas mayores de 50 años. En general son de aparición súbita, unilaterales y asociadas con dolor ocular, cefalea y diplopía. El motor oculara común y el motor ocular externo son los que se ven afectados con mayor frecuencia. El pronóstico es favorable cuando se establece control metabólico estricto
Assuntos
Humanos , Diabetes Mellitus/complicações , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/fisiopatologia , Diabetes Mellitus/metabolismo , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/fisiopatologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/fisiopatologia , Oftalmoplegia/metabolismoRESUMO
The author reports the case of a 54-year-old male patient with a pontine hematoma and with the one-and-a-half syndrome, cerebellar ataxia and no signs of pyramidal tract involvement. The absence of involvement of the pyramidal tract in the case reported herein is likely due to variation in the vascular anatomy of the pons. The pathophysiologic mechanisms of the one-and-a-half syndrome and of the clinical findings recorded are discussed.
Assuntos
Hemorragia Cerebral/fisiopatologia , Hematoma/fisiopatologia , Ponte/irrigação sanguínea , Hemorragia Cerebral/diagnóstico , Movimentos Oculares/fisiologia , Hematoma/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Oftalmoplegia/diagnóstico , Oftalmoplegia/fisiopatologia , Síndrome , Tomografia Computadorizada por Raios XRESUMO
O autor relata o caso de um paciente de sexo masculino de 54 anos com hematoma pontino que se manifestou por síndrome "one-and-a-half" e ataxia cerebelar mas sem sinais de acometimento do trato piramidal. A ausência de acometimento do trato piramidal é decorrente possivelmente de uma variaçäo da anatomia vascular do segmento pontino do tronco cerebral. Os achados clínicos do caso e os mecanismos fisiopatológicos da síndrome "one-and-a-half" säo discutidos
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Movimentos Oculares/fisiologia , Hematoma/fisiopatologia , Oftalmoplegia/fisiopatologia , Ponte/irrigação sanguínea , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/fisiopatologia , Hematoma/diagnóstico , Hematoma/etiologia , Imageamento por Ressonância Magnética , Oftalmoplegia/diagnóstico , Síndrome , Tomografia Computadorizada por Raios XRESUMO
Se propone un modelo de investigación para comprobar la fisiología de la interacción neurológica de músculos de acción vertical a través del concepto de cuircuitos. El concepto de estaciones correspondientes y no correspondientes en un solo circuito o en circuitos cruzados es indispensable en la valoración de resultados de potencialización, suma o neutralización cuando se interviene quirúrgicamente en dos ó más músculos extraoculares.
Assuntos
Oftalmologia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia , Fenômenos Fisiológicos Musculoesqueléticos e Neurais , Músculos Oculomotores/cirurgia , Oftalmoplegia/fisiopatologiaRESUMO
For those ophthalmologists who have not already discovered ocular torsion, the assessment of fundus torsion as well as subjective torsion will literally reveal a new dimension in strabismus diagnosis and surgical management. I strongly recommend thinking of fundus torsion in terms of the indirect ophthalmoscope view, and the use of the Lancaster red-green test to plot subjective torsion in the nine diagnostic position of gaze
Assuntos
Humanos , Músculos Oculomotores/fisiopatologia , Estrabismo/cirurgia , Oftalmoplegia/cirurgia , Oftalmoplegia/fisiopatologia , OftalmoscopiaRESUMO
Relato de um paciente de 65 anos, sexo masculino, com síndrome de Tolosa-Hunt que apresentou oftalmoplegia dolorosa unilateral e perda visual bilateral. A tomografia computadorizada mostrou uma lesäo hipercaptante na fissura orbitária superior e no canal óptico que à biopsia revelou-se tratar de processo inflamatório crônico inespecífico. Tratamento com corticosteróides resultou em melhora acentuada do quadro embora um olho tenha permanecido sem percepçäo luminosa. O processo inflamatório envolvia a fissura orbitária superior e o nervo óptico à direita e presumivelmente se extendia através da base do crânio para envolver o nervo óptico contralateral