ABSTRACT
Resumo A paralisia do terceiro nervo craniano representa o estrabismo paralítico de tratamento mais complexo e desafiador. Os casos de paralisia completa III par incitam o uso de certas técnicas de cirurgia de estrabismo destinadas a manter o olho voltado para a posição primária do olhar (PPO). Entretanto, as possibilidades terapêuticas são limitadas e complexas e o tratamento cirúrgico tende a hipocorreção e recorrências frequentes a longo prazo.O envolvimento completo e congênito do terceiro nervo craniano requer cirurgias para a exotropia, hipotropia e ptose.Dentre as técnicas cirúrgicas já descritas, optou-se pela realização de uma modificação da técnica cirúrgica de recuo-ressecção, que deu-se em único tempo cirúrgico, sendo suficiente para alcançar o objetivo estético. Este trabalho relata o resultado positivoda manutenção de sutura de tração à carúncula para tratamento cirúrgico de estrabismo paralítico congênito de nervo oculomotor de longa data.
Abstract Paralysis of the third cranial nerve represents the most complex and challenging paralytic squint. The cases of complete III nerve paralysis encourages the use of certain strabismus surgery techniques in order to keep eye in primary position of gaze. However, the therapeutic possibilities are limited and complex and the surgical treatment tends to hypocorrection and frequent recurrences in the long term. Complete and congenital involvement of the third cranial nerve requires surgeries for exotropia, hypotropia and ptosis. Among the surgical techniques already described, we choose a modification of the surgical technique of recession-resection, which occurred in a single surgical time, being suffice to achieve aesthetic objective. This paper reports the positive result of the maintenance of caruncle traction suture as surgical treatment of congenital III nerve paralysis.
Subject(s)
Humans , Female , Adult , Oculomotor Nerve Diseases/surgery , Strabismus/surgery , Suture Techniques , Oculomotor Muscles/surgery , Ophthalmologic Surgical Procedures/methods , Blepharoptosis , Mydriasis , Oculomotor Nerve Diseases/complications , Oculomotor Nerve Diseases/congenital , Strabismus/congenital , Strabismus/etiologyABSTRACT
A presença de paralisia do nervo oculomotor (NOM) sem outro déficit neurológico é considerada rara como forma de apresentação em hematoma subdural crônico (HSDC). Geralmente apresenta sintomas de déficit neurológico focal, cefaleia e alterações do nível de consciência, havendo múltiplos diagnósticos diferenciais. RTA, 79 anos, masculino. Paciente com demência senil, hipertensão arterial sistêmica e diabetes mellitus. Estado geral: moderado. Exame físico: sonolento, eupneico. Exame neurológico: disfásico e anisocoria esquerda. Tomografia computadorizada (TC) de crânio sem contraste revelou lesão com densidade heterogênea na região frontoparietotemporal esquerda com efeito de massa e hipodensa na região frontoparietal direita. Submetido a trépano-punção frontal anterior e parietal posterior esquerda e drenagem do hematoma. Evoluiu com melhora da paralisia do NOM à esquerda. Em caso de HSDC volumoso, pode-se comprimir o mesencéfalo e apresentar-se herniação do uncus do hipocampo, podendo causar paralisia do NOM. Seu diagnóstico precoce e tratamento correto apresentam bons resultados...
The presence of complete paralysis of the oculomotor nerve (OMN) with no other neurological deficit is rare as the presentation of chronic subdural hematoma (CSDH). Usually there are symptoms of focal neurologic deficit, headache and changing consciousness level, so there are multiple differential diagnoses. RTA, 79-year-old man. Patient who has senile dementia, hypertension and diabetes mellitus. General condition: moderate. Physical examination: sleepy, eupneic. Neurological examination: dysphasia and anisocoria left eye. Computed tomography (CT) scan without contrast revealed a lesion with heterogeneous density in the left frontoparietotemporal region, with mass effect and hipodense region right parietofrontal. The patient was submited to trepano-punction at left anterior frontal and posterior parietal and drainage of the hematoma. He evolved with neurological improvement of the paralysis of OMN on the left eye. The CSDH when it was large, can compress the midbrain and provide herniation of hippocampus? uncus may cause paralysis of the OMN. Early diagnosis and correct treatment has shown good results...
Subject(s)
Humans , Male , Aged , Oculomotor Nerve Diseases/complications , Oculomotor Nerve Diseases/diagnosis , Oculomotor Nerve Diseases/therapy , Hematoma, Subdural, Chronic/etiologyABSTRACT
Aims: To derive a reliable estimate of the frequency of pupillary involvement and to study the patterns and course of anisocoria in conjunction with ophthalmoplegia in diabetes-associated oculomotor nerve palsy. Materials and Methods: In this prospective analytical study, standardized enrolment criteria were employed to identify 35 consecutive patients with diabetes-associated oculomotor nerve palsy who were subjected to a comprehensive ocular examination. Standardized methods were used to evaluate pupil size, shape, and reflexes. The degree of anisocoria, if present and the degree of ophthalmoplegia was recorded at each visit. Results: Pupillary involvement was found to be present in 25.7% of the total number of subjects with diabetic oculomotor nerve palsy. The measure of anisocoria was < 2 mm, and pupil was variably reactive at least to some extent in all cases with pupillary involvement. Majority of patients in both the pupil-involved and pupil-spared group showed a regressive pattern of ophthalmoplegia. Ophthalmoplegia reversed much earlier and more significantly when compared to anisocoria. Conclusions: Pupillary involvement in diabetes-associated oculomotor nerve palsy occurs in about 1/4th of all cases. Certain characteristics of the pupil help us to differentiate an ischemic insult from an aneurysmal injury to the 3rd nerve. Ophthalmoplegia resolves much earlier than anisocoria in diabetic oculomotor nerve palsies.
Subject(s)
Anisocoria/epidemiology , Anisocoria/etiology , Carotid Artery Injuries/etiology , Diabetes Mellitus , Humans , Oculomotor Nerve Diseases/complications , Ophthalmoplegia/complications , Patients , Pupil/abnormalities , Pupil/anatomy & histology , Pupil/ultrastructureABSTRACT
Joubert syndrome is a very rare autosomal recessive disorder with only 200 cases reported worldwide.Here we report 4 cases of this rare disorder with MRI findings.
Subject(s)
Ataxia/complications , Ataxia/genetics , Cerebellum/abnormalities , Child, Preschool , Chromosome Disorders/genetics , Developmental Disabilities/complications , Developmental Disabilities/genetics , Humans , Infant , Intellectual Disability/complications , Intellectual Disability/genetics , Magnetic Resonance Imaging , Male , Muscle Hypotonia/complications , Muscle Hypotonia/genetics , Oculomotor Nerve Diseases/complications , Oculomotor Nerve Diseases/genetics , Respiration Disorders/complications , Respiration Disorders/genetics , SyndromeABSTRACT
A "esotropia fixa progressiva" se apresenta como um quadro de esotropia progressiva, em adultos altos míopes, que aumenta até que os olhos fiquem fixos numa esotropia de grande ângulo, geralmente associada a hipotropia, e que tem fracos resultados cirúrgicos. O objetivo deste trabalho é descrever a abordagem cirúrgica de 2 pacientes com "esotropia fixa adquirida progressiva" que foram operados segundo a técnica de Yamada (hemitransposição dos retos lateral e superior), e obtiveram bom resultado pós-operatório.
Subject(s)
Humans , Male , Female , Middle Aged , Esotropia/surgery , Myopia/surgery , Oculomotor Nerve Diseases/complications , Esotropia/etiology , Myopia/complications , Ophthalmologic Surgical Procedures/methods , Treatment OutcomeABSTRACT
As alteraçöes neuro-oftalmologicas em pacientes HIV positivo säo achados infreqüêntes. As principais alteraçöes säo: papiledema, neuropatia óptica e distúrbios da motilidade. O objetivo do nosso trabalho é apresentar um caso em que o paciente apresentava retraçäo palpebral associada à paralisia de movimentos verticais conjugados. Fizemos o diagnóstico de Síndrome de Parinaud, o que ainda näo foi descrito em nosso meio em associaçäo à Síndrome da imunodeficiência Adquirida
Subject(s)
Humans , Oculomotor Nerve Diseases/complications , Acquired Immunodeficiency Syndrome/complicationsABSTRACT
Se estudiaron 120 pacientes con posición viciosa de cabeza (PVC) de causa ocular. Se determinó que los estrabismos incomitantes fue el grupo que más frecuentemente presentó PVC. La paresia del oblicuo superior aportó 36 (30 por ciento) de las PVC, siendo la entidad mas frecuente. Se operaron 66 casos, obteniéndose eliminación o disminución de la PVC en 51 (77 por ciento) de ellos
Subject(s)
Humans , Head-Down Tilt , Oculomotor Nerve Diseases/complications , Posture , Strabismus/complications , Eye Diseases/complicationsABSTRACT
Five cases of tetanus with local palsy are reported. They presented with palatal palsy, pseudohernia, paralysis of both lower limbs, 3rd and 7th cranial nerve palsies and only 7th nerve palsy. Except the last tetanus became generalised in all.