ABSTRACT
Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out.
Subject(s)
Humans , Female , Adult , Middle Aged , Creutzfeldt-Jakob Syndrome/complications , Brain Infarction/complications , Eyelid Diseases/etiology , Muscular Diseases/complications , Oculomotor Muscles , Magnetic Resonance Imaging , Creutzfeldt-Jakob Syndrome/diagnostic imaging , Brain Infarction/diagnostic imaging , Eyelid Diseases/diagnosisABSTRACT
Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating disorder of the central nervous system, characterized by an acute or subacute onset of neurological symptoms and focal signs in association with multifocal demyelinating findings on neuroimaging. Spontaneous resolution has been reported within days of onset, corticosteroids therapy accelerates the resolution time. ADEM has been associated with previous infections, and its relationship with other autoinmune disease is unclear. A case of ADEM is reported, in a patient previously diagnosed with ulcerative pancolitis, whose neurological symptoms resolved after 3 days of hospital admission without evident sequelae after receiving a short empirical treatment with ampicilin, ceftriaxone, acyclovir and intravenous steroids.
La encefalomielitis aguda diseminada (EAD) es un trastorno desmielinizante agudo del Sistema Nervioso Central, caracterizado por la presentación aguda de síntomas y signos neurológicos en asociación con hallazgos multifocales de desmielinización en las neuroimágenes. Se describe en la literatura resolución espontánea a los pocos días de presentación, con secuelas variables. La terapia corticoesteroidal aceleraría este tiempo de resolución. Se ha relacionado con eventos infecciosos previos, y su relación con otras enfermedades autoinmunes no es clara. Se presenta un caso de EAD en paciente con diagnóstico previo de pancolitis ulcerosa cuya sintomatología neurológica se resuelve tras 3 días del ingreso hospitalario, sin secuelas evidentes, tras recibir tratamiento empírico corto con Ampicilina, Ceftriaxona, Aciclovir y corticoides endovenosos en dosis de estrés.