Importância do raciocínio etiológico e topográfico de lesões: relato de neuropatia óptica traumática conduzida como acidente vascular cerebral / Importance of etiological and topographic injury reactions: report of a traumatic optic neuropathy conducted as a cerebrovascular accident

Introdução: O trauma ocular ou periocular pode afetar o nervo óptico e causar baixa acuidade visual ou alteração de campo visual. Essa lesão, denominada neuropatia óptica, quando de etiologia traumática, pode ser classificada como direta, através da compressão, perfuração ou laceração do nervo óptico por ação de corpos estranhos, fraturas do assoalho da órbita ou hemorragias, e indireta, quando a partir de um trauma externo ao globo ocular há lesão por transmissão da onda de choque ou desaceleração, levando à lesão do nervo óptico pelo estiramento de suas fibras ou edema comprometendo sua vascularização, comum nos acidentes automobilísticos e nas quedas. Descrição do Caso: O presente estudo objetiva relatar um caso de neuropatia óptica traumática conduzida erroneamente como acidente vascular cerebral em uma paciente do sexo feminino de 29 anos, com história de queda da própria altura. Discussão: A investigação feita pela história clínica, evolução do quadro e novos achados fundoscópicos permitiu o diagnóstico correto e melhor orientação da paciente. Conclusão: O conhecimento da neuropatia óptica traumática e da anatomia da via óptica têm extrema importância no raciocínio topográfico e etiológico das lesões traumáticas que cursam com comprometimento visual, poupando o paciente de possíveis intervenções invasivas e desnecessárias (AU)

Introduction: Eye or periocular trauma can affect the optic nerve and cause low visual acuity or visual field alteration. This lesion, called optic neuropathy, when of traumatic etiology, can be classified as direct, through compression, perforation or laceration of the optic nerve by action of foreign bodies, fractures of the orbit floor or hemorrhages, and indirect, when from an external trauma to the eyeball there is injury by transmission of the shock wave or deceleration, leading to optic nerve injury by stretching its fibers or edema compromising its vascularization, common in automobile accidents and falls. Case Report: The present study aims to describe a case of traumatic optic neuropathy mistakenly conducted as a stroke in a 29-yearold female patient with a history of falling from his own height. Discussion: The investigation was possible because of the clinical history, evolution of the condition and new fundoscopic findings that allowed the correct diagnosis and better orientation of the patient. Conclusion: Knowledge of traumatic optic neuropathy and anatomy of the optical pathway have extreme importance in the topographic and etiological reasoning of traumatic lesions that present with visual impairment, saving the patient from possible interventions invasive and unnecessary. (AU)

Noninvasive evaluation of intracranial hypertension? Is there a gold standard? / Avaliação não invasiva da hipertensão intracraniana? Existe um padrão-ouro?

Computed tomography is essential in head injuried patients for the detection of structural damage to the brain. However, the ability of CT scanning to predict the presence or absence of intracranial hypertension has been debated in the literature. Since the optic nerve is part of the central nervous system and in case of raised pressure in the cerebrospinal fluid its sheath inflates. Based in this hypothesis the authors reviewed the role of the optic nerve sheat diameter in diagnosis intracranial hypertension after traumatic brain injury. This non-invasive method is useful to predict the risk of intracranial hypertension and select patients to ICP monitoring, especially in those with normal CT scans.

A tomografia de crânio é um exame fundamental para avaliação estrutural dos pacientes com traumatismo craniano. Entretanto, a capacidade da tomografia em predizer a ausência ou presença de hipertensão intracraniana é controversa. Como o nervo óptico é parte do sistema nervoso central, em situações de hipertensão intracraniana há aumento da bainha neural. Com base nessas hipóteses, os autores revisaram o papel da análise do diâmetro da bainha do nervo óptico no diagnóstico de hipertensão intracraniana pós-traumatismo. Esse método não invasivo é útil para predizer os riscos de hipertensão intracraniana e selecionar os pacientes para monitorização da pressão intracraniana, principalmente naqueles com tomografia de crânio normal.

Functional and structural analysis of partial optic nerve avulsion due to blunt trauma: Case report.

Partial optic nerve avulsion (ONA) secondary to finger gouging is an uncommon but devastating injury. A 21-year-old man who had an acute vision loss after accidentally getting poked by himself in his right eye when he fell down during jogging is reported. The patient was diagnosed with partial ONA. Magnetic resonance imaging revealed intact optic nerve. Optical coherence tomography (OCT) revealed deep cavity at the inferior-temporal half of the optic disc. Retinal nerve fiber layer thickness was also thin at the inferior quadrant with circumpapillary OCT scan. Visual field test and electrophysiological tests showed functional abnormality compatible with optic nerve lesion. Diagnostic tools for anatomical and functional evaluation may reveal the course of this injury.

Traumatic Optic Neuropathy Accompanying Orbital Grease Gun Injury

We report a case of traumatic optic neuropathy accompanying a grease gun injury to the orbit. A 48-year-old man with a grease gun injury visited our clinic with decreased visual acuity, proptosis and limited extraocular movement (EOM). Orbital CT revealed a crescent mass of fat in the medial intraconal space. The grease was exuded from a lacerated conjunctival wound. The visual evoked potential (VEP) test demonstrated a decreased response in the left eye. Proptosis and EOM were improved after surgical removal of the grease. Systemic high-dose corticosteroid therapy was administered for suspected traumatic optic neuropathy, after which VEP nearly recovered, while visual acuity was slightly improved. A second surgery for traumatic cataract did not further improve visual acuity.

Concomitant carotid-cavernous fistula, chorioretinitis sclopetaria, and optic nerve transection

A 15- year-old boy with history of BB gun injury to his left eye was referred to our center. His visual acuity was no light perception in the left eye. Ocular findings were severe proptosis, conjunctival injection, and conjunctival vascular tortuosity. Fundus examination revealed an extensive inferior chorioretinal scar compatible with chorioretinitis sclopetaria. A distinct bruit was detected by left orbital auscultation. Orbital and brain CT- scan showed transected optic nerve by the BB gun pellet which lodged at the left parasellar area. Cerebral angiography showed a high flow direct carotid-cavernous fistula that was successfully treated by endovascular embolization. This patient is the first reported case of concomitant carotid-cavernous fistula, optic nerve transection, and chorioretintis sclopetaria due to BB gun injury

Características da fase aguda da avulsão do nervo óptico pós-trauma: relato de caso / Acute post-traumatic optic nerve avulsion: case report

A avulsão do nervo óptico representa uma entidade rara, levando a resultados devastadores na maioria dos casos e com prognóstico reservado. A presença de meios translúcidos possibilita, na maioria das vezes, diagnósticos acurados, mostrando a fundoscopia tipicamente uma cavidade localizada no local da retração do disco óptico para sua bainha dural. Embora exames complementares raramente sejam necessários para o diagnóstico desta afecção, quadros clínicos associados a graus variados de turvação de meios dióptricos e algum grau residual da visão, como nas roturas parciais, podem levar à dificuldade do diagnóstico e mesmo retardar o processo terapêutico. Neste artigo, relatamos a fase aguda de um caso típico de avulsão completa do nervo óptico, examinado no Serviço de Retina e Vítreo do Hospital de Clínicas da Universidade Federal de Uberlândia - MG.

Optic nerve avulsion is a rare, but devastating complication. In this condition, the optic nerve is forcibly disinserted from the retina, choroid, and vitreous, and the lamina cribrosa is retracted from the scleral rim. If the media are clear, the avulsion is easily diagnosed. The appearance of the fundus is striking, with a hole or cavity where the optic disc has retracted into its dural sheath. The complementary examinations are not very accurate for the diagnosis of this pathology and with some residual vision, opaque media, that occur in partial avulsion, the diagnosis may be mistaken or delayed. In this article we report a case of complete optic nerve avulsion examined at the Retina and Vitreous Department of the "Hospital das Clínicas" of the Federal University of Uberlândia - MG - Brazil.

Optic Nerve Injury Secondary to Endoscopic Sinus Surgery: an Analysis of Three Cases

Major orbital complications after the endoscopic sinus surgeries are rare and of these, optic nerve injury is one of the most serious. This study was to undertaken to analyze 3 cases of optic nerve injury after endoscopic sinus surgery. The three cases included one patient with a loss of visual acuity and visual field defect, and two patients with total blindness. In all cases, no improvement of visual acuity was observed despite treatment. It is important to frequently check the location and direction of the endoscope during surgery to avoid optic nerve injury. In addition, surgeons must have a precise knowledge of the detailed anatomy through cadaver dissections, an ability to interpret the PNS CT scan and experienced procedural surgical skills.

Causas de transtornos neuro-oftalmológicos em um serviço público especializado / Causes of neuro-ophthalmological problems in a specialized to a public health service

Foi realizado o estudo retrospectivo dos prontuários de 155 pacientes encaminhados para avaliaçäo neuro-oftalmológica, com o objetivo de identificar causas freqüentes de transtornos neuro-oftalmológicos, visando facilitar o diagnóstico diferencial, em serviços de atendimento primário. Foram obtidos dados referentes a hipótese diagnóstica final, doenças associadas e hábitos pessoais. A hipertensäo arterial sistêmica foi o antecedente mórbido pessoal mais freqüente. O etilismo foi o principal hábito pessoal. As principais causas de transtornos neuro-oftalmológicos foram: neuropatia óptica isquêmica näo-arterítica, neuropatia tóxico-carencial por alcoolismo, retinopatia associada à doença sistêmica e/ou simulando doença do nervo óptico, traumatismo crânio-encefálico, alteraçöes decorrentes de tumores cerebrais e anomalias congênitas. Várias causas freqüentes de distúrbios neuro-oftalmológicos podem ser identificadas mediante exame oftalmológico cuidadoso e exames complementares de fácil acesso e custo relativamente baixo.