A case of bilateral fourth nerve palsy associated with pseudotumor cerebri syndrome / Caso de paralisia bilateral de quarto nervo associada com síndrome do pseudotumor cerebral

ABSTRACT Pseudotumor cerebri syndrome is puzzling because it results in elevated intracranial pressure with no identifiable underlying cause. Ocular motor nerve palsies, other than a unilateral or bilateral sixth cranial nerve palsy, are rarely seen in patients with this condition. We report here on a 25-year-old female patient with bilateral fourth cranial nerve palsy caused by pseudotumor cerebri syndrome, whose ocular and systemic signs and symptoms of nerve palsy were completely resolved after medical treatment. We infer that fourth nerve palsy could be associated with pseudotumor cerebri syndrome; therefore, clinicians should consider rare ocular motor nerve palsies, even bilaterally, in patients with pseudotumor cerebri syndrome.

RESUMO A sindrome do pseudotumor cerebral é uma síndrome enigmática caracterizada por aumento da pressão intracraniana sem causa definida. Na síndrome do pseudotumor cerebral, as paralisias de nervo oculomotor além da paralisia unilateral ou bilateral do sexto nervo craniano são raramente vistas. Nós reportamos o caso de uma paciente feminina de 25 anos com paralisia bilateral de quarto nervo craniano como resultado da síndrome do pseudotumor cerebral. Após tratamento médico para síndrome do pseudotumor cerebral, os sinais e sintomas oculares e sistêmicos da paralisia nervosa foram resolvidos. Em conclusão, a paralisia de quarto nervo craniano pode estar associada com síndrome de pseudotumor cerebral, portanto médicos devem considerar paralisias raras de nervo oculomotor, mesmo bilateralmente, em pacientes com síndrome do pseudotumor cerebral.

Hallazgo por neuroimaginología de microangiopatía cerebral retiniana con calcificaciones y quistes / Neuroimaging findings in cerebroretinal microangiopathy with calcifications and cysts

La microangiopatía cerebral retiniana con calcificaciones y quistes es una enfermedad poco frecuente, caracterizada por alteraciones cerebrales, retinianas y óseas, así como por predisposición al sangrado gastrointestinal. Existen pocos reportes de casos de esta condición, especialmente en adultos, en quienes la incidencia es baja. Los hallazgos por medio de neuroimágenes son característicos, con calcificaciones bilaterales y múltiples formaciones quísticas. El propósito de este artículo fue hacer una revisión bibliográfica e ilustrar dos casos cuyo diagnóstico fue posible con la ayuda de neuroimágenes.

Cerebroretinal microangiopathy with calcifications and cysts is a rare condition characterized by brain, retinal and bone anomalies, as well as a predisposition to gastrointestinal bleeding. There are few reported cases of this condition in adults, among whom the incidence is low. Neuroimaging findings are characteristic, with bilateral calcifications, leukoencephalopathy and intracranial cysts. The purpose of this article was to do a literature survey and illustrate two cases diagnosed with the aid of neuroimaging.

Clinical features and outcomes of treatment for fourth nerve palsy

To evaluate the clinical features, etiology and outcomes of treatment for superior oblique [SO] palsy over a 10-year period at Labbafinejad Medical Center. A complete ophthalmologic examination with particular attention to forced duction test [FDT] and tendon laxity was performed in all patients preoperatively. The palsy was divided into congenital and acquired types. Overall, 73 patients including 45 male [61.6%] and 28 female [38.4%] subjects with mean age of 19.7 +/- 11.7 [range, 1.5-62] years, were operated from 1997 to 2007. SO palsy was congenital in 56 [76%] and acquired in 17 [24%] cases. The most common chief complaint was ocular deviation [52.1%]. FDT was positive in only 7 [9.7%] cases. Other clinical findings included amblyopia [19.2%] head tilt [13.7%], chin down position [4.1%], facial asymmetry [6.8%] and tendon laxity [2.7%]. Mean preoperative vertical deviation was 16.1 prism diopters [PD] which was decreased to 1.9 PD postoperatively. Mean exotropia and esotropia were 15 and 13.9 PD respectively before the operation and both decreased to 1.5 PD of horizontal deviation postoperatively. The most common type of SO palsy based on Knapp's classification was type 3 [42.5%]. The most common operated muscle was the inferior oblique [83.6%] and the most common type of operation was inferior oblique myectomy [83.6%]. The success rate for initial surgery was 84% and was increased to 96% with a second intervention. The most common form of SO palsy requiring surgical intervention was congenital which occurred most frequently in young males. Most cases of SO palsy can be successfully treated with a single surgical procedure

Transient Isolated Trochlear Nerve Palsy Associated with Rathke's Cleft Cyst

We report the case of a 52-year-old woman who developed vertical diplopia of 1-days duration. Neuro-ophthalmological testing revealed left trochlear nerve palsy, and sellar MRI revealed a 1.5 cm-sized pituitary mass lesion, a Rathke's cleft cyst. The diplopia disappeared spontaneously after 6 days.

Paresias e paralisias dos nervos oculomotores. Estudo retrospectivo e prospectivo - período de 30 anos / Oculomotor nerves palsies and paralysis. A retrospective and prospective study over a thirty-year period

Os autores apresentam para registro uma série que engloba 814 pacientes com paresias adquiridas dos III, IV e VI nervos cranianos correspondente a um período de estudo de trinta anos (1961-1990). Uma análise da incidência, etiologia, seguimento e posterior recuperaçäo é aqui realizada. Fatores de caráter sócio-econômico, geográfico e de co-operaçäo por parte dos pacientes acarretam maior dificuldade na realizaçäo de estudos como este, sobretudo em países em desenvolvimento como o nosso. Apesar destas dificuldades encontradas, muitos aspectos de semelhança säo observados nos resultados por nós obtidos e aqueles descritos por Rucker, e Rush e Younge, em seus trabalhos clássicos.