Regeneración aberrante del III nervio craneal por aneurisma cerebral bilateral. Reporte de caso / Aberrant regeneration of the III cranial nerve due to bilateral cerebral aneurism

RESUMEN Los trastornos de la motilidad ocular constituyen motivo de consulta periódica en Oftalmología. La regeneración aberrante, trastorno muy poco reportado, es considerada la sincinesia oculomotora de mayor invalidez y complejidad. Diversas condiciones neuroftalmológicas están implicadas en la etiopatogenia de la enfermedad, la mayoría de las cuales puede ocasionar la muerte. El manejo de los síntomas y signos provocados por paradójicos movimientos oculares conjugados es difícil. Se reportó un caso con remisión tardía a neuroftalmología por diagnóstico inicial y evolución desfavorable. La historia psicofísica arrojó diagnóstico definitivo de regeneración aberrante del III nervio craneal secundario, a aneurisma cerebral de la carótida interna bilateral, agravado por reanastomosis quirúrgica. Una rigurosa, obligatoria e impostergable historia neuroftalmológica, se impone ante toda parálisis del III nervio craneal para brindar un diagnóstico etiológico preciso y de esta forma proteger la vida.

ABSTRACT The disturbances in ocular motility are the cause of periodical consultation in Ophthalmology. The aberrant regeneration, a scarcely reported disturbance, is considered the oculomotor synkinesis of highest disability and complexness. Several neuro-ophthalmologic conditions are implicated in the disease ethiopathogeny, and most of them could lead to death. The management of the symptoms and signs caused by paradoxical conjugated ocular movements is difficult. A case is reported of late remission to Neuro-ophthalmology due to unfavorable diagnosis and evolution. The psycho-physical history led to a definitive diagnosis of aberrant regeneration of the III secondary cranial nerve, to cerebral aneurism of the bilateral internal carotid, worsened by surgical re-anastomosis. In front of any paralysis of the III cranial nerve, it is necessary a rigorous, obligatory and immediate neuro-ophthalmological history to arrive to a precise etiological diagnosis, protecting life in that way.

Ocular motor nerve paralysis in herpes zoster ophthalmicus / 대한피부과학회지

Only few studies focused on ocular motor paralysis in herpes zoster ophthalmicus. The manifestation of ptosis and paralysis of ocular motor nerve or one of its branches is rarely seen. However, careful examinations with regard to external ocular movements and iris would be helpful to detect the ocular motor paralysis. We report a case of ocular motor paralysis resulting from herpes zoster ophthalmicus. A 66-year-old woman was treated with acyclovir and steroid for an ophthalmic herpes zoster. Ptosis and impairment of gaze except lateral gaze appeared after the periorbital edema subsided. She showed moderately edematous cornea, corneal erosion, chemosis, but no definite dendritic lesions. The paralytic lesions cleared four months later.

Ocular motor nerve paralysis in herpes zoster ophthalmicus / 대한피부과학회지

Only few studies focused on ocular motor paralysis in herpes zoster ophthalmicus. The manifestation of ptosis and paralysis of ocular motor nerve or one of its branches is rarely seen. However, careful examinations with regard to external ocular movements and iris would be helpful to detect the ocular motor paralysis. We report a case of ocular motor paralysis resulting from herpes zoster ophthalmicus. A 66-year-old woman was treated with acyclovir and steroid for an ophthalmic herpes zoster. Ptosis and impairment of gaze except lateral gaze appeared after the periorbital edema subsided. She showed moderately edematous cornea, corneal erosion, chemosis, but no definite dendritic lesions. The paralytic lesions cleared four months later.