Arteritis de células gigantes en el sistema vertebrobasilar, isquemias cerebelo-occipitales y parálisis III par: caso clínico / Giant cell arteritis of the vertebrobasilar system, posterior ischemia and palsy of the third nerve: report of one case

Giant cell arteritis is the most common vasculitis in patients aged over 50 years. We report an 89-year-old woman with significant weight loss and persistent frontal-occipital headaches lasting two months. The neurological examination at admission identified a decrease in visual acuity of the left eye, paralysis of the third cranial nerve of the right eye and alterations of body motility without objective signs of damage of the motor or sensitive pathways. Magnetic resonance imaging showed changes of the temporal artery wall and in both vertebral arteries, as well as bilateral cerebellar and occipital ischemic lesions. The Doppler ultrasound of the temporal arteries was compatible with Giant cell arteritis. Treatment with steroids was started. While receiving oral prednisone, the patient suffered new infarcts of the posterior territory, documented with a CAT scan.

Arachnoid Cyst in Oculomotor Cistern

Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of arachnoid cyst in oculomotor cistern, manifesting as oculomotor nerve palsy. The oblique sagittal MRI, parallel to the oculomotor nerve, showed well-defined and enlarged subarachnoid spaces along the course of oculomotor nerve. Simple fenestration was done with immediate regression of symptom. When a disease develops in oculomotor cistern, precise evaluation with proper MRI sequence should be performed to rule out tumorous condition and prevent injury of the oculomotor nerve.

Cyclic oculomotor spasm and third nerve palsy

In the present report, cyclic oculomotor spasm occurring in a patient with third nerve paresis is described, which is a rare occurrence. An 11 year old female presented with decreased vision of the right eye and drooping of the right upper lid since early childhood. Third nerve paresis was seen with limited adduction and elevation. During examination the right exotropic eye became esotropic, over which the patient had no voluntary control. After orthoptic assessment, right superior oblique resection and transposition close to the medial rectus, with a large lateral rectus recession was done

Correlación entre el grado de desviación y la limitación de abducción en afección del VI nervio / Correlation between the degree of deviation and limitation of abduction in the VI nerve

Se presentan 40 casos con afección del VI nervio por diversas causas etiológicas, siendo parcial (paresial) en 26 casos y total (parálisis) en 14 casos examinados. Fueron evaluados al mes de iniciado el cuadro, enfatizando la correlación entre el grado de endodesviación con el grado de limitación de abducción, encontrando congruencia en 25 casos (62 por ciento), incongruencia por mayor endodesviación que limitación de abducción en 7 casos (18 por ciento) e incongruencia por mayor limitación de abducción que endodesviación en 8 casos (20 por ciento). Se infiere que la afección del recto lateral (grado de limitación de abducción) puede ser congruente o incongruente con el grado de hipertonia del recto medial (endodesviación).

Forty cases with VI nerve alteration caused by different ethiologic factors were studied, being 26 cases with partial alteration (paresis) and 14 with total alteration (paralysis). Clinical evaluation took place one month after the onset of the alteration, emphasizing the correlation between degree of esodeviation with degree of limitation of abduction, founding congruency in 25 cases (62 percent), incongruency by more degree of esodeviation than limitation of abduction in 7 cases (18 percent), and incongruency by more degree of limitation of abduction than esodeviation in 8 cases (20 percent). It is inferred than lateral rectus affection (limitation of abduction) may be congruent or not with the medial rectus hypertonia (esodeviation).

Hallazgos en la RNM en pacientes con fibrosis congénita generalizada de los músculos extraoculares (CFEOM) / Findings on MRI in patients with congenital generalized fibrosis of the extraocular muscles (CFEOM)

Objetivo: Mostrar los hallazgos en la RNM de pacientes afectados de CFEOM Pacientes y métodos: Se presentan las RNM de 4 pacientes afectados de CFEOM Resultados: En todos se observa una marcada atrofia del recto superior y los otros músculos extraoculares inervados por el III nervio se ven adelgazados. El recto lateral en 1 paciente aparece bilobulado. En un paciente con oftalmoplegia, en la T1 se observa una señal brillante en el interior del cuerpo muscular. Conclusiones: La RNM de estos pacientes con CFEOM muestra 2 características: atrofia muscular del recto superior, elevador del párpado superior y señal brillante en el interior del cuerpo muscular.

Objectives: To show the findings on MRI in patients affected by CFEOM Patients and methods: The MRI of four patients affected by CFEOM were revieved Results: In all cases a significant atrophy of the superior rectus can be seen, and the other extraocular muscles, inervated by the III nerve, are visibly thinner. The lateral rectus, in one patient, appears bilobulated. In another patient with ophthalmoplegy, in T1, a brilliant signal in the interior of the muscular body can be observed. Conclusions: Two characteristics were found on the MRI in these patients with CFEOM. One is the muscular thinness of the PSL and SR, and the other is the brilliant signal in the interior of the muscular body. Also, some structural anomalies can be observed in other extraocular muscles.

Parálisis adquiridas del III nervio en los adultos: evolución y pronóstico / Acquired III cranial nerve paralysis in adults: history and prognosis

En el período 1989/92, fueron examinados 31 pacientes con parálisis aislada del III nervio, excluyéndose las oftalmopatías restrictivas, la forma ocular de la miastenia gravis y las parálisis congénitas. La presentación clínica más común fue la parálisis parcial del III nervio y la etiología más frecuente fue la isquémica por hipertensión arterial y/o diabetes. El período de recuperación fue de 30 a 120 días. Mejoró más rápidamente la rama superior y tardíamente la rama inferior a predominio del músculo recto medial. Se enfatiza que de no ocurrir la recuperación dentro del plazo mencionado, se debe efectuar un exhaustivo estudio neuro-radiológico y que los pacientes que presentan una lesión compresiva o traumática pueden desarrollar una regeneración aberrante

Alteraçöes da motricidade extrínseca e pupilares nas neuropatias diabéticas / Ocular alterations in diabetic neuropathies

Säo feitas consideraçöes sobre os aspectos clínicos, patologia e prognóstico das alteraçöes da motricidade extrínseca e pupilares nos pacientes diabéticos

Neuropatia de III, V1 e V2 associada a arterite zosteriana? / Neuropathy of IIIrd, V1 and V2 associated with zosterian arteritis

Entre os vinte e cinco vírus (aproximadamente) da familia Herpetoviridae, o varicela-zóster (VZ) tem importância especial em clínica neurológica por produzir além da varicela e suas complicaçöes neurológicas o herpes zóster (HZ). Assinala-se, pela sua freqüência, o gânglio de Gasser (GG), como uma das localizaçöes prevalentes do HZ exteriorizando-se, eventualmente, pelo clássico herpes oftálmico (HO), quando ocorre no dermátomo do oftálmico (V1) uma erupçäo vésico-bolhosa associada a dor. Nesta eflorescência cutânea observam-se vesículas similares as da varicela, ora puntiformes ora de 0,5 cm de diâmetro, que podem confluir para compor bolhas de conteúdo seroso ou mesmo hemorrágico as quais, em algumas ocasiöes, ocupam todo o tegumento configurando o HZ disseminado. Estas vesículas ulteriormente se rompem para formar crostas. Enquanto a varicela seria causada pela infecçäo primária pelo VZ o HZ se originaria a partir da reativaçäo da lactência viral e sua replicaçäo nos gânglios espinhais ou cranianos, geralmente na idade adulta, tendo como fatores predisponentes imunodepressäo associada, por exemplo, a leucoses, linfomas, síndrome de imunodeficiência adquirida (SIDA), corticoidoterapia, tec. Em cultura de tecidos pode ser observado o efeito citopático do VZ, traduzido por células gigantes multinucleadas apresentando inclusöes nucleares acidófilas. Nos gânglios cranianos e/ou espinhais e nervos sede de zóster assinalam-se sinais inflamatórios i.e. infiltrado mononuclear e mesmo necrose. No tocante a sintomatologia clínica do HZ consigna-se como sintoma preliminar dor no território correspondente ao nervo espinhal/craniano acometido de três a cinco dias antecedendo o aparecimento da erupçäo cutânea a qual, numa fase inaugural, tem aspecto de dermatose eritêmato-papulosa logo evoluindo para pápulo-vesiculosa e pápulo-pustulosa; tal erupçäo cutânea localiza-se em um ou mais dermátomos, sendo clássica a sua unilateralidade, na topografia que se segue, no que tange a freqüência de sua incidência: torácica, cefálica (trigeminal, com predomínio franco no dermátomo de V1) e lombo sacra...

Pupillary automatism.

An unusual case of cyclic pupillary movements in an otherwise complete oculomotor nerve palsy in a five year-old girl is reported. This is considered to be due to destruction of somatic and visceral nuclei of the oculomotor nerve following injury to its fascicular part. Pupillary automatism has been explained on the basis of the presence of aberrant autonomic cells in the ciliary ganglion which are discharging in a regular rhythm independent of higher control.