ABSTRACT
La polirradiculoneuropatía desmielinizante inflamatoria crónica, es un grupo de neuro-patías periféricas inmunomediadas clínicamente heterogéneas que comparten manifes-taciones neurofisiológicas de desmielinización y disociación albuminocitológica. Se distinguen una forma típica y variantes atípicas, algunas asociadas a anticuerpos con-tra proteínas del nodo de Ranvier, como la neurofascina- 155. Presentamos el caso de un varón de 38 años, que acudió por cuadro de ocho meses de evolución, caracterizado por parestesias y debilidad progresiva de cuatro extremidades, asociado a diplopía y disfagia. El paciente estaba despierto, con cuadriparesia flácida simétrica de predominio distal, hipotrofia en dorso y palma de ambas manos, arreflexia generalizada, temblor postural de baja frecuencia y alta amplitud en miembros superiores de predominio izquierdo, dismetría apendicular, adiadococinesia, oftalmoparesia a la dextroversión en ojo dere-cho, reflejo nauseoso ausente, marcha atáxica con aumento de base de sustentación y signo de Romberg positivo. El líquido cefalorraquideo mostró disociación albuminocitológica y la electromiografía fue compatible con polineuropatía sensitivo- motora primariamente desmielinizante. Por la sospecha clínica, solicitamos anticuerpos antineurofascina- 155, que resultaron positivos. Recibió tratamiento con metilprednisolona a dosis de un gramo al día durante cinco días, seguido de un miligramo por kilogramo durante tres meses de prednisona, con disminución progresiva con lo que mejoró la diplopía y la disfagia, sin mejoría de la fuerza en extremidades e incluso empeoramiento de la funcionabilidad. Por esta razón se inició tratamiento con rituximab en dosis de dos gramos presentando una notable mejoría en la fuerza muscular distal, el temblor, la estabilidad de la marcha, coordinación y de su funcionabilidad medida con la escala de Rankin modificado.
Chronic inflammatory demyelinating polyradiculoneuropathy is a clinically heterogeneous group of immune- mediated peripheral neuropathies that share neurophysiological manifesta-tions of demyelination and albuminocytologic dissociation. There are typical and atypical variants of this disease, some associated with antibodies against proteins of the node of Ranvier, such as neurofascin- 155. We present the case of a 38- year- old male who presented with an eight- month history of par-esthesia and progressive weakness of four limbs associated with diplopia and dysphagia. The patient was conscious, with symmetric flaccid quadriparesis of distal predominance, hyp-otrophy in the dorsum and palm of both hands, generalized areflexia, postural low frequency, and high amplitude tremor in upper limbs of left predominance, appendicular dysmetria, dys-diadochokinesia, ophthalmoparesis to dextroversion in the right eye, absent gag reflex, ataxic gait with an increased base of support and positive Romberg's sign. Cerebrospinal fluid showed albuminocytologic dissociation, and electromyography was com-patible with primarily demyelinating sensory- motor polyneuropathy. Due to clinical suspicion, we requested anti- neurofascin- 155 antibodies, which tested positive. The patient was treated with methylprednisolone at a dose of one gram per day for five days, followed by one milligram per kilogram for three months of prednisone, with progressive de-crease, which improved diplopia and dysphagia, with no effect on limb strength and even worsening of function. For this reason, treatment with rituximab was started in doses of two grams, presenting a substantial improvement in distal muscle strength, tremor, gait stability, coordination, and functionality measured with the modified Rankin scale.
Subject(s)
Humans , Male , Adult , Deglutition Disorders/complications , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/diagnosis , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/drug therapy , Peru , Tremor/complications , Diplopia/complicationsABSTRACT
El síndrome de Tolosa-Hunt es una entidad poco frecuente cuya etiopatogenia y mecanismos fi- siopatológicos son controversiales, se caracteri- za por cefalea asociada a parálisis de uno o más nervios craneales, diplopía, estrabismo y ptosis palpebral, ocasionados por el compromiso del seno cavernoso o la fisura orbitaria superior. Su diagnóstico es un reto y se aborda dentro de los diagnósticos diferenciales de las oftalmoplejías dolorosas. Con el objetivo de describir y actua- lizar el conocimiento sobre esta enfermedad se presenta el caso de una paciente de 14 años que acudió a consulta por cefalea intensa, dolor ocu- lar y afección de nervios craneales. Los hallazgos clínicos y la resonancia magnética confirmaron el diagnóstico del síndrome de Tolosa Hunt...(AU)
Subject(s)
Humans , Female , Adolescent , Cavernous Sinus , Tolosa-Hunt Syndrome/diagnosis , Ophthalmology , Diplopia/complications , Eye PainABSTRACT
La parálisis de convergencia se caracteriza por la imposibilidad de la convergencia en la mirada próxima, con diplopía horizontal cruzada a partir de 1 metro, con aducción normal. La parálisis de la convergencia es una condición distinta de la insuficiencia de la convergencia y normalmente secundaria a una lesión intracraneal. Acude paciente de 12 años de edad por presentar diplopía horizontal de cerca ± 1 metro de 3 meses de evolución, cefalea, lagrimeo y fotofobia. La impresión diagnóstica fue parálisis de convergencia. En los estudios neurológicos solo se encontró implantación baja de las amígdalas cerebrales. Aún no se precisa la etiología aunque se recoge el antecedente de un traumatismo craneal sin relevancia por la familia
The convergence paralysis is characterized by impossible convergence in the near sight, with crossed horizontal diplopia at one meter distance and normal adduction. The convergence paralysis is a condition different from the inadequate convergence and usually secondary to intracranial lesion. A 12-years old patient went to the hospital because he had suffered horizontal diplopia in near sight (± 1 meter) for 3 months, migraine, watering and photophobia. The definitive diagnosis was convergence paralysis. In the neurological studies, the low placing of the tonsils of cerebellum was the only finding. The etiology of this disorder is not determined yet; although there is some history of head trauma to which the family did not pay enough attention
Subject(s)
Humans , Female , Child , Convergence, Ocular/physiology , Diplopia/complications , Case ReportsABSTRACT
Acquired disruption of motor fusion is a rare condition characterized by intractable diplopia. Management of these patients is extremely difficult. Prisms in any combination or even surgery may not help relieve their symptoms. We describe a longstanding case of acquired motor fusion disruption which was managed successfully with botulinum toxin injection.
Subject(s)
Adult , Botulinum Toxins, Type A/administration & dosage , Depth Perception/physiology , Diplopia/complications , Diplopia/drug therapy , Diplopia/physiopathology , Electromyography , Eye Movements/drug effects , Eye Movements/physiology , Female , Humans , Injections, Intramuscular , Neuromuscular Agents/administration & dosage , Ocular Motility Disorders/complications , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/physiopathology , Oculomotor Muscles , Strabismus/complications , Strabismus/drug therapy , Strabismus/physiopathology , Visual AcuityABSTRACT
The objective of this study was to determine factors associated with pyridostigmine therapy in patients with ocular myasthenia gravis (OMG). This retrospective study included eighty-five patients with OMG who have been treated with pyridostigmine. Patients were excluded if they were diagnosed as generalized myasthenia gravis within a month after diagnosis or were treated with other medications. Forty-two patients responded to pyridostigmine and 43 patients did not. There were no significant differences in gender, age, the duration of symptoms before treatment, the dosage of pyridostigmine, and the initial presentations of ptosis or diplopia between the two groups. However, an initial presentation of concurrent ptosis and diplopia and the presence of systemic involvement after follow up were significant factors associated with an insensitivity to pyridostigmine in patients with OMG (p = 0.001 and p = 0.01, respectively). Determining these factors could help predict the pyridostigmine response in patients with OMG.
Subject(s)
Adolescent , Adult , Blepharoptosis/complications , Child , Diplopia/complications , Female , Humans , Male , Middle Aged , Myasthenia Gravis/complications , Ocular Motility Disorders/drug therapy , Pyridostigmine Bromide/immunology , Retrospective Studies , ThailandABSTRACT
Os autores relatam o caso de uma paciente que apresentou quadro reincidente de esotropia aguda e diplopia durante o período gestacional. Não havia história de trauma ou qualquer alteração sistêmica, excetuando-se a gravidez. Tratamento oclusivo alternado foi instituído, e após o parto houve remissão espontânea dos sinais e sintomas.
The authors report a case of a female patient who presented, for the second time, diplopia and acute esotropia during pregnancy. There was no trauma involved neither was systemic disease. The patient was treated with conventional occlusion, and, soon after delivery, the squint was resolved.
Subject(s)
Humans , Female , Pregnancy , Adult , Diplopia/complications , Esotropia/complications , Pregnancy Complications , Acute Disease , Diplopia/diagnosis , Esotropia/diagnosis , Recurrence , Remission, SpontaneousABSTRACT
Hypoaccommodative convergence insufficiency is a relatively uncommon binocular vision abnormality characterized by low amplitude of accommodation and convergence, reduced AC/A ratio, blurred near vision, fatigue around the eyes, intermittent diplopia for near fixation, and frontal headaches. Hypoaccommodative convergence insufficiency is not amenable to orthoptic therapy and, consequently, an early differential diagnosis is clinically important. This report a case of hypoaccommodative convergence insufficiency associated with a peculiar symptom is presented. The physiological bases of the symptoms and the therapy are described
Subject(s)
Male , Diplopia/complications , Vision Disorders/etiology , Eye Infections/etiologyABSTRACT
We evaluated and treated a patient whose superior rectus muscle was severed at the time of retinal detachment surgery resulting in hypotropia and diplopia. By use of adjustable sutures and other techniques for correcting strabismus, single binocular vision was restored in the primary gaze position. To our knowledge this is the first case of superior rectus avulsion during retinal surgery to be reported
Subject(s)
Humans , Female , Scleral Buckling/methods , Diplopia/complications , Strabismus/complications , Postoperative ComplicationsABSTRACT
Un paciente varón de 54 de edad con la variante de CREST de esclerosis sistémica progresiva (escleroderma) se presentó con diplopia vertical diagnosticada como parálisis del músculo superior oblicuo izquierdo. Aunque en escleroderma se han reportado anormalidades de los nervios craneales, creemos que este es el primer informe de la variante de CREST en asociación a una parálisis del IV nervio la cual no se pudo explicar por otra etiología