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2.
Arq. bras. oftalmol ; 83(5): 424-426, Sept.-Oct. 2020. graf
Article in English | LILACS | ID: biblio-1131622

ABSTRACT

ABSTRACT Congenital cranial dysinnervation disorders are a group of complex strabismus syndromes that present as congenital and non-progressive ophthalmoplegia. The genetic defects are associated with aberrant axonal targeting onto the motoneurons, development of motoneurons, and axonal targeting onto the extraocular muscles. We describe here the surgical management of a 16-year-old boy who presented with complex strabismus secondary to hypoplasia of the third cranial nerve and aberrant innervation of the upper ipsilateral eyelid.


RESUMO Os distúrbios de inervação craniana congênita en­globam um grupo de síndromes associadas a estrabismos complexos, que se apresentam como oftalmoplegia congênita e não progressiva e são frequentemente herdadas. Os defeitos dos genes estão associados a erros no desenvolvimento ou direcionamento axonal dos motoneurônios, e erros no direcionamento axonal para os músculos extraoculares. Este caso descreve o caso de um menino que apresenta estrabismo complexo secundário à hipoplasia do terceiro nervo craniano e inervação aberrante da pálpebra superior ipsilateral, bem como o resultado após a correção cirúrgica.


Subject(s)
Humans , Male , Adolescent , Ophthalmoplegia , Strabismus , Cranial Nerves , Strabismus/surgery , Strabismus/etiology , Cranial Nerves/pathology , Oculomotor Muscles/surgery , Oculomotor Nerve
3.
Rev. bras. oftalmol ; 79(1): 59-62, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092665

ABSTRACT

Abstract Tolosa-Hunt syndrome is a painful ophthalmoplegia caused by non-specific granulomatous inflammation, corticoid-sensitive, of the cavernous sinus. The etiology is unknown. Recurrences are common. The diagnosis is made by exclusion, and a variety of other diseases involving the orbital apex, superior orbital fissure and cavernous sinus should be ruled out. This study reports a case of a 29-year-old woman, diagnosed with Tolosa-Hunt Syndrome, who presented ophthalmoparesis and orbital pain. She had poor response to corticotherapy and developed colateral effects, so she was treated with single infliximab dose immunosuppression, evolving total remission of the disease.


Resumo A Síndrome de Tolosa-Hunt é uma oftalmoplegia dolorosa causada por uma inflamação granulomatosa não específica, sensível a corticoides, do seio cavernoso. A etiologia é desconhecida. Recorrências são comuns. O diagnóstico é feito por exclusão, devendo ser descartada uma variedade de outras doenças que envolvem o ápice orbitário, fissura orbitária superior e seio cavernoso. O presente estudo trata-se de um relato de caso de uma paciente de 29 anos, diagnosticada com Síndrome de Tolosa-Hunt, que apresentou paresia e dor em região orbital. Obteve resposta pouco efetiva a corticoterapia e desenvolveu efeitos colaterais, por isso foi tratada com dose única de infliximabe, evoluindo com remissão total da doença.


Subject(s)
Humans , Female , Adult , Tolosa-Hunt Syndrome/drug therapy , Infliximab/administration & dosage , Infliximab/therapeutic use , Pain/drug therapy , Remission Induction , Prednisolone/adverse effects , Prednisone/adverse effects , Single Dose , Ophthalmoplegia/drug therapy , Tolosa-Hunt Syndrome/diagnosis
4.
Article in English | WPRIM | ID: wpr-880602

ABSTRACT

OBJECTIVES@#Oculomotor nerve palsy is a kind of disease with many causes, showing eye movement disorders, abnormal eyelid position, and/or damage of the pupil. The etiology of oculomotor nerve palsy in different departments is different. The study discussed the etiology, localization of the lesion, and prognosis for oculomotor nerve palsy firstly diagnosed in department of ophthalmology.@*METHODS@#Clinical data of 137 hospitalized patients with oculomotor nerve palsy at the Department of Ophthalmology, the First Medical Center of PLA General Hospital from 2009 to 2018 were retrospectively collected. The etiology and its distribution characteristics in different age groups, the location of the lesion, and the prognosis of patients were analyzed.@*RESULTS@#In 137 patients, the top 3 causes for oculomotor nerve palsy were head trauma (38.69%), cavernous sinus lesions (12.40%), and orbital inflammation (9.49%). Other causes included intracranial aneurysm, the intracranial space-occupying lesion, cerebral vessel diseases, infection, orbital tumors, diabetes, the operation of nasal cavity. Traumatic oculomotor nerve palsy was more common in young adults aged 20-49 years and in the patients with cerebral vascular disease in elderly people aged 60-69 years, while diabetic oculomotor nerve palsy is common in middle-aged and elderly people aged 50-69 years. The age distribution of other etiological types was relatively balanced. Seventy-five cases of orbital apex lesions were due to trauma, inflammation, infection, and tumor; 40 cases of cavernous sinus lesions were due to inflammation, tumor, and thrombosis; 6 cases of subarachnoid lesions were due to aneurysms, tumors, and trauma; 5 cases were oculomotor nucleus lesions were due to infarction; 11 cases could not be allocated because of unknown etiology. After treatment, the corrected visual acuity of oculomotor nerve palsy side was not significantly improved. The patients with oculomotor nerve palsy caused by intracranial aneurysm, cerebrovascular disease, and diabetes mellitus had the highest proportion of partial or complete recovery from ptosis and ocular dyskinesia.@*CONCLUSIONS@#Oculomotor nerve palsy is a common cause of ophthalmoplegia and diplopia. Head trauma, cavernous sinus lesions, and orbital inflammation are the most common causes for oculomotor nerve palsy first diagnosed in ophthalmology department. Traumatic oculomotor nerve palsy is common in adolescents. Oculomotor nerve palsy caused by diabetes and cerebrovascular disease are common in the middle-aged and elderly people. Most of the lesions locate in the orbital apex and cavernous sinus. The prognosis of corrected visual acuity is poor. The prognosis of ptosis and ocular dyskinesia caused by intracranial aneurysm, cerebrovascular disease, and diabetes is good. Figuring out the cause timely and accurately is the basis and key to treat oculomotor nerve palsy.


Subject(s)
Adolescent , Adult , Aged , Cavernous Sinus , Humans , Middle Aged , Oculomotor Nerve Diseases/etiology , Ophthalmoplegia , Prognosis , Retrospective Studies , Young Adult
5.
Rev. bras. oftalmol ; 78(4): 271-273, July-Aug. 2019. graf
Article in Portuguese | LILACS | ID: biblio-1013685

ABSTRACT

Resumo A síndrome de Tolosa-Hunt (STH) é uma doença rara caracterizada por oftalmoplegia dolorosa unilateral de início súbito causada por uma inflamação granulomatosa inespecífica no seio cavernoso ou fissura orbital superior (ou ambos). A oftalmoparesia ocorre quando os nervos cranianos III, IV e VI são acometidos pela inflamação. Disfunções pupilares podem estar presentes e está relacionado com acometimento das fibras simpáticas que passam pelo seio cavernoso na porção da artéria carótida interna ou fibras parassimpáticas ao redor do nervo oculomotor. O acometimento do primeiro ramo do trigêmeo pode provocar parestesia território correspondente à distribuição desde ramo (testa). Raramente, pode haver extensão da inflamação para além do seio cavernoso ou fissura orbital superior podendo acometer também o nervo óptico. Há uma boa resposta com o uso de corticoides e pode haver remissões espontâneas. Recidivas ocorrem em 40% dos casos. A doença é mais comum após a segunda década de vida. Afeta ambos os gêneros de forma igualitária. O presente estudo trata-se de um relato de caso de um paciente que se apresentou com oftalmoplegia dolorosa de início súbito à direita com 4 dias de evolução seguido de amaurose ipslateral após um dia do início da dor.


Abstract Tolosa-Hunt syndrome (STH) is a rare disease characterized by sudden onset unilateral painful ophthalmoplegia caused by non-specific granulomatous inflammation in the cavernous sinus or superior orbital fissure (or both). Ophthalmoparesis occurs when the cranial nerves III, IV and VI are affected by inflammation. Pupillary dysfunctions may be present and is related to involvement of the sympathetic fibers that pass through the cavernous sinus in the portion of the internal carotid artery or parasympathetic fibers around the oculomotor nerve. The involvement of the first branch of the trigeminal can cause paresthesia corresponding to the distribution from the first branch (forehead). Rarely, there may be extension of inflammation beyond the cavernous sinus or superior orbital fissure and may also affect the optic nerve. There is a good response with the use of corticosteroids and there may be spontaneous remissions. Relapses occur in 40% of cases. The disease is most common after the second decade of life. It affects both genders equally. The present study is a case report of a patient who presented with painful ophthalmoplegia of sudden onset on the right with 4 days of evolution followed by ipsilateral amaurosis after one day of onset of pain.


Subject(s)
Humans , Male , Middle Aged , Pain , Ophthalmoplegia/diagnosis , Tolosa-Hunt Syndrome/diagnosis , Tolosa-Hunt Syndrome/therapy , Prednisone/therapeutic use , Magnetic Resonance Imaging , Cavernous Sinus/pathology , Cavernous Sinus/diagnostic imaging , International Classification of Diseases , Cranial Nerves/diagnostic imaging , Tolosa-Hunt Syndrome/classification , Diagnosis, Differential , Headache
6.
Rev. cir. traumatol. buco-maxilo-fac ; 19(4): 34-37, out.-dez. 2019. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1253637

ABSTRACT

Introdução: A Síndrome da Fissura Orbital Superior (SFOS) é uma condição de ocorrência rara, inicialmente descrita por Hirchfield em 1858. Caracterizada pela presença de oftalmoplegia, ptose da pálpebra superior e midríase, podendo ocorrer parestesia da pálpebra superior e da região frontal, associada à lesão dos pares de nervos cranianos: oculomotor, troclear, abducente (III, IV e VI) e, por vezes, o nervo trigêmeo (V). A identificação da SFOS é importante, visto que sua incidência é rara no trauma, e sua identificação pode ajudar a direcionar o tratamento de forma mais adequada. Relato de caso: O presente trabalho descreve dois casos da SFOS associados a traumas craniofaciais, cita as possíveis etiologias relacionadas a essa síndrome e descreve a situação de trauma agudo. Considerações Finais: A avaliação das condições sistêmicas do paciente e de exames complementares, como tomografias computadorizadas, auxilia o diagnóstico diferencial entre patologias que acometem a região orbital e a base de crânio, fraturas e traumas craniofaciais. A identificação da SFOS no trauma agudo orienta a abordagem imediata ou precoce quando indicada, como nos casos de hematomas retrobulbares ou em grandes deslocamentos ósseos maxilofaciais com necessidade de redução cirúrgica. Nos casos com indicação de abordagem tardia, as fraturas craniofaciais são tratadas de forma conservadora, e o paciente é encaminhado para atendimento especializado... (AU)


Introduction: The superior orbital fissure syndrome (SOFS) is a rare condition and initially described by Hirchfield in 1858. Characterized by the presence of ophthalmoplegia, upper eyelid ptosis and mydriasis, and there may be paresthesia of the upper eyelid and forehead associated by the injury of the cranial nerves like: oculomotor, trochlear, abducens (III, IV and VI) and sometimes the trigeminal nerve (V). The identification of SOFS is important, since its incidence is rare in trauma, and its identification may help to target the treatment more adequately. Case report: The present study describes two cases of SFOS associated with craniofacial trauma, cites the possible etiologies related to this syndrome and describes the situation of acute trauma. Final considerations: The evaluation of the patient's systemic conditions and complementary exams, such as computed tomography, help the differential diagnosis between pathologies that affect the orbital region and the skull base, and fractures and traumatic head injuries. The identification of SFOS in acute trauma guides the immediate or early approach when indicated, as in cases of retrobulbar hematomas or large maxillofacial bone dislocations requiring surgical reduction. In cases with indication for late approach, craniofacial fractures are treated conservatively and the patient is referred for specialized care... (AU)


Subject(s)
Humans , Male , Female , Child , Adult , Trigeminal Nerve , Ophthalmoplegia , Cranial Nerves , Diagnosis, Differential , Craniocerebral Trauma , Orbital Diseases , Skull Base
7.
Article in English | WPRIM | ID: wpr-762775

ABSTRACT

Orbital tuberculosis is a rare form of extrapulmonary tuberculosis, even in endemic areas. It may involve the soft tissue, lacrimal gland, periosteum, or bones of the orbital wall. We present a case of orbital tuberculosis on the lower eyelid. An 18-year-old woman with no underlying disease visited our clinic for evaluation of an oval nodule (1.5× 1.2 cm) on the right lower eyelid. Incision and drainage without biopsy was performed 2 months ago in ophthalmology department, but the periorbital mass had deteriorated, as the patient had erythematous swelling, tenderness, and cervical lymphadenopathy. Visual acuity was normal; there were no signs of proptosis, diplopia, or ophthalmoplegia. Computed tomography revealed a small abscess cavity without bony involvement. We performed an excision and biopsy through a percutaneous incision under local anesthesia. Histological examination revealed a granuloma and was diagnosed as orbital tuberculosis. The patient was additionally treated with anti-tuberculosis therapy for 6 months and recovered without complication or recurrence by 7 months. Orbital tuberculosis occurs in patients with or without associated pulmonary tuberculosis, and should be considered as a differential diagnosis in patients with inflammatory orbital disease and an orbital mass. If recurrence occurs despite adequate initial treatment, we recommend an additional examination and excisional biopsy.


Subject(s)
Abscess , Adolescent , Anesthesia, Local , Biopsy , Diagnosis, Differential , Diplopia , Drainage , Exophthalmos , Eyelids , Female , Granuloma , Humans , Lacrimal Apparatus , Lymphatic Diseases , Ophthalmology , Ophthalmoplegia , Orbit , Orbital Diseases , Periosteum , Recurrence , Tuberculosis , Tuberculosis, Pulmonary , Visual Acuity
8.
Article in English | WPRIM | ID: wpr-764344

ABSTRACT

BACKGROUND AND PURPOSE: The most-common initial manifestation of Miller Fisher syndrome (MFS) is diplopia due to acute ophthalmoplegia. However, few studies have focused on ocular motility findings in MFS. This study aimed to determine the pattern of extraocular muscle (EOM) paresis in MFS patients. METHODS: We consecutively recruited MFS patients who presented with ophthalmoplegia between 2010 and 2015. The involved EOMs and the strabismus pattern in the primary position were analyzed. Antecedent infections, other involved cranial nerves, and laboratory findings were also reviewed. We compared the characteristics of the patients according to the severity of ophthalmoplegia between complete ophthalmoplegia (CO) and incomplete ophthalmoplegia (IO). RESULTS: Twenty-five patients (15 males and 10 females) with bilateral ophthalmoplegia were included in the study. The most-involved and last-to-recover EOM was the lateral rectus muscle. CO and IO were observed in 11 and 14 patients, respectively. The patients were aged 59.0±18.4 years (mean±SD) in the CO group and 24.9±7.4 years in the IO group (p<0.01), and comprised 63.6% and 21.4% females, respectively (p=0.049). Elevated cerebrospinal fluid protein was identified in 60.0% of patients with CO and 7.7% of patients with IO (p=0.019) for a mean follow-up time from the initial symptom onset of 3.7 days. CONCLUSIONS: The lateral rectus muscle is the most-involved and last-to-recover EOM in ophthalmoplegia. The CO patients were much older and were more likely to be female and have an elevation of cerebrospinal fluid protein than the IO patients.


Subject(s)
Cerebrospinal Fluid , Cranial Nerves , Diplopia , Female , Follow-Up Studies , Guillain-Barre Syndrome , Humans , Jupiter , Male , Miller Fisher Syndrome , Ophthalmoplegia , Paresis , Strabismus
10.
Article in English | WPRIM | ID: wpr-764164

ABSTRACT

Upon review, it is noted that recurrent painful ophthalmoplegic neuropathy (RPON) is a rare neurological syndrome characterized by recurrent unilateral headaches and painful ophthalmoplegia of the ipsilateral oculomotor nerve. As seen on brain MRI, thickening and enhancement of the oculomotor cranial nerve can be observed in these cases. We experienced a case of RPON in an adult patient who showed thickening and enhancement of the oculomotor nerve on gadolinium-enhanced 3D-FLAIR image. The authors report a case of RPON with a review of the literature.


Subject(s)
Adult , Brain , Cranial Nerves , Headache , Humans , Magnetic Resonance Imaging , Oculomotor Nerve , Oculomotor Nerve Diseases , Ophthalmoplegia , Paralysis
11.
Article in Korean | WPRIM | ID: wpr-766873

ABSTRACT

PURPOSE: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery. CASE SUMMARY: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered. CONCLUSIONS: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.


Subject(s)
Aged , Angiography , Brain , Carotid Artery, Internal , Collateral Circulation , Eyelids , Humans , Injections, Intravenous , Intraocular Pressure , Magnetic Resonance Imaging , Methylprednisolone , Ophthalmology , Ophthalmoplegia , Oral Medicine , Prone Position , Pupil Disorders , Retina , Retinal Artery Occlusion , Spine , Visual Acuity
12.
Yonsei Medical Journal ; : 230-231, 2019.
Article in English | WPRIM | ID: wpr-742514

ABSTRACT

No abstract available.


Subject(s)
DNA, Mitochondrial , Ophthalmoplegia
13.
Yonsei Medical Journal ; : 232-233, 2019.
Article in English | WPRIM | ID: wpr-742513

ABSTRACT

No abstract available.


Subject(s)
DNA, Mitochondrial , Ophthalmoplegia
14.
Rev. nefrol. diál. traspl ; 38(2): 134-138, jun. 2018. ilus
Article in English | LILACS | ID: biblio-1006777

ABSTRACT

Shiga toxin-producing Escherichia coli (STEC) that causes a prodromal hemorrhagic enteritis is the main cause of hemolytic uremic syndrome (HUS) particularly in pediatric patients. It is characterized by acute kidney injury with microangiopathic hemolytic anemia and thrombocytopenia. The kidney and brain are the two major target organs, and neurological involvement is the most frequent cause of mortality. The time delay between bloody diarrhea and neurological symptoms ranges from few days to a month. Neurological disorders include disturbances in cognitive functions, focal neurological signs, epileptic seizures, myoclonus and neuropsychiatric symptoms. Cerebral magnetic resonance imaging reveals various patterns of hyperintensities distributed through cerebral matter or may be totally normal even the patient has severe neurological involvement. Electroencephalography usually show generalized or focal slowing of the background activity, spikes or sharp waves despite being normal in around 20% of patients. We present here an adult male patient referred to our center with requirement of hemodialysis due to diarrhea-associated HUS complicated by acute kidney injury. Later during the course of plasma exchange therapy the patient developed an isolated abducens nerve palsy. Complete renal recovery was achieved by plasma exchange therapy but abducens palsy remedied rescue introduction of immunoglobulin G (IgG) depletion by immunoadsorption


Escherichia coli, productor de toxina Shiga (STEC), que causa una enteritis hemorrágica en fase prodrómica, es la principal causa del síndrome urémico hemolítico (SUH), particularmente, en pacientes pediátricos. Se caracteriza por una lesión renal aguda con anemia hemolítica microangiopática y trombocitopenia. El riñón y el cerebro son los dos órganos principales a los que ataca, y la afectación neurológica es la causa más frecuente de mortalidad. El tiempo que transcurre entre la aparición de diarrea sanguinolenta y los síntomas neurológicos varía entre pocos días y un mes. Los trastornos neurológicos incluyen alteraciones en las funciones cognitivas, signos neurológicos focales, ataques epilépticos, mioclonías y síntomas neuropsiquiátricos. La resonancia magnética de cerebro revela varios patrones de hiperintensidades distribuidas a través de la materia cerebral o puede ser totalmente normal incluso si el paciente tiene un compromiso neurológico severo. El electroencefalograma generalmente muestra una disminución generalizada o focal de la actividad de fondo, picos u ondas agudas, a pesar de ser normal en alrededor del 20% de los pacientes. Presentamos un paciente adulto de sexo masculino, derivado a nuestro centro para ser tratado con hemodiálisis debido a SUH asociado a diarrea, complicado por insuficiencia renal aguda. Luego, durante el transcurso de la terapia de intercambio de plasma, el paciente desarrolló una parálisis ocular aislada del sexto par craneal. Se logró una recuperación renal completa por medio de la terapia de intercambio plasmático; no obstante, la parálisis del nervio motor ocular externo remedió la disminución de la inmunoglobulina G (IgG) mediante el tratamiento de rescate de inmunoadsorción


Subject(s)
Humans , Male , Adult , Ophthalmoplegia , Shiga Toxin/adverse effects , Shiga Toxin/toxicity , Renal Insufficiency , Shiga-Toxigenic Escherichia coli , Hemolytic-Uremic Syndrome , Nervous System Diseases
17.
Article in Korean | WPRIM | ID: wpr-738574

ABSTRACT

PURPOSE: To report two cases of orbital apex syndrome caused by blunt orbital trauma without structural damage of the orbit. CASE SUMMARY: (Case 1) A 50-year-old male came to our clinic complaining of visual loss after blunt orbital trauma by a metal bar. The best-corrected visual acuity was no light perception and light reflex was not observed in the affected eye. He also presented with complete ptosis and ophthalmoplegia with relative sparing of adduction and depression. High signal intensity of the orbital soft tissue including the optic nerve sheath was revealed using a T2-weighted image in magnetic resonance imaging. After starting steroid pulse therapy, his visual acuity improved to counting fingers on the third day. Ocular movement and levator function recovered to the normal range while visual acuity remained counting fingers. (Case 2) A 64-year-old female presented with complete ptosis after trauma to her right eyeball. The best-corrected visual acuity was 20/25 in the right eye. Complete ptosis and ophthalmoplegia with relative sparing of abduction and depression in the right eye were observed at the initial presentation. Magnetic resonance images showed enhancement of the right periphery optic nerve and distal rectus muscle. Two months after undergoing steroid pulse therapy, levator function and ocular movement recovered completely, and visual acuity improved to 20/20. CONCLUSIONS: The orbital apex syndrome caused by blunt orbital trauma showed good response to steroid pulse therapy. Steroid treatments may therefore be considered for the treatment of traumatic orbital apex syndrome.


Subject(s)
Depression , Female , Fingers , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Ophthalmoplegia , Optic Nerve , Orbit , Reference Values , Reflex , Visual Acuity
18.
Article in Korean | WPRIM | ID: wpr-738514

ABSTRACT

PURPOSE: To report a case of orbital apex syndrome (OAS) combined with central retinal artery occlusion (CRAO) and central retinal vein occlusion (CRVO) following blunt trauma. CASE SUMMARY: A 4-year-old female visited the hospital following a traffic accident. She was admitted because of multiple fractures of the skull and pneumocephalus. On day 5, she was referred to us with decreased visual acuity in her right eye. Her initial visual acuity was hand motions in the right eye and 0.8 in the left eye. The right eye showed a dilated pupil, ptosis, and total ophthalmoplegia, and the left eye showed limited abduction. A fundus examination revealed multiple retinal hemorrhages, tortuous veins, and an edematous white retina with a cherry-red spot in the right eye. Brain magnetic resonance imaging revealed an entrapped right optic nerve because of bony fragments in the orbital apex. The patient was diagnosed with OAS accompanied by CRAO and CRVO in the right eye, and with traumatic abducens nerve palsy in the left eye. After 6 months, the visual acuity was hand motions, and the fundus examination showed absorbed retinal hemorrhages, pale discs, and general retinal thinning of the right eye. Ptosis of the right eye and extraocular muscle movement of both eyes were improved. CONCLUSIONS: Combined CRAO and CRVO following trauma is very rare and is even more rarely associated with OAS. It is important for clinicians to be aware of the potential for central retinal vessel occlusions and OAS in cases of blunt ocular trauma.


Subject(s)
Abducens Nerve Diseases , Accidents, Traffic , Brain , Child, Preschool , Female , Fractures, Multiple , Hand , Humans , Magnetic Resonance Imaging , Ophthalmoplegia , Optic Nerve , Orbit , Pneumocephalus , Pupil , Retina , Retinal Artery Occlusion , Retinal Artery , Retinal Hemorrhage , Retinal Vein , Retinal Vessels , Retinaldehyde , Skull , Veins , Visual Acuity
19.
Kosin Medical Journal ; : 454-462, 2018.
Article in English | WPRIM | ID: wpr-739003

ABSTRACT

A 54-year-old man, suffering from severe headache and ophthalmoplegia after undergoing endoscopic sinus surgery was referred to a tertiary hospital. Computed tomography (CT) revealed soft tissue density lesions in the left sphenoid sinus. The internal carotid artery was shown to be occluded in brain magnetic resonance imaging (MRI) scans without any other cerebral lesion. Endoscopic view of left nasal cavity shows whitish hyphae in the ethmoid and the sphenoid sinuses. We diagnosed him with cavernous sinus syndrome caused by mucormycosis and conducted endoscopic sinus surgery to remove remaining lesions and decompress orbit and optic nerves. After the revision surgery the patient's headache and ophthalmoplegia were improved. However, multifocal cerebral infarctions were newly discovered in a postoperative CT scan. We experienced a case of mucormycosis of sphenoid sinus resulting in occlusion of internal carotid artery and multifocal cerebral infarction, and report it with a brief review of these disease entities.


Subject(s)
Brain , Carotid Artery, Internal , Cavernous Sinus , Cerebral Infarction , Headache , Humans , Hyphae , Magnetic Resonance Imaging , Middle Aged , Mucormycosis , Nasal Cavity , Ophthalmoplegia , Optic Nerve , Orbit , Sphenoid Sinus , Tertiary Care Centers , Tomography, X-Ray Computed
20.
Article in Korean | WPRIM | ID: wpr-766648

ABSTRACT

Bilateral internuclear ophthalmoplegia (INO) refers to a specific gaze abnormality of bilateral adduction deficits, often accompanied by dissociated abducting nystagmus, caused by medial longitudinal fasciculus lesions usually due to multiple sclerosis or stroke. We report a 63-year-old man with clinical features of Miller-Fisher syndrome (MFS), consisting of ataxia, areflexia, and external ophthalmoplegia which mimicked bilateral-INO without an identifiable central lesion. Although bilateral adduction deficits are usually caused by central lesions, peripheral nervous damage by MFS is needed to be considered.


Subject(s)
Ataxia , Humans , Middle Aged , Miller Fisher Syndrome , Multiple Sclerosis , Ocular Motility Disorders , Ophthalmoplegia , Stroke
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