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1.
Am J Case Rep ; 23: e938571, 2022 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-36582127

RESUMO

BACKGROUND Emerging cases of SARS-CoV-2 infection associated with cerebral thromboembolism episodes manifesting as arterial strokes or cerebral venous thrombosis have been reported. However, the co-occurrence of arterial strokes and cerebral venous thrombosis is rare. CASE REPORT We report the case of a previously healthy young patient with recent SARS-CoV-2 infection, who presented with encephalopathy. His computed tomography venography and magnetic resonance imaging of the brain showed thrombosis of the vein of Galen and straight sinus, and arterial infarcts in both hemispheres. His inflammatory markers, D-dimer levels, and coagulation profile were normal. He was started on anticoagulation and recovered well. CONCLUSIONS Concurrent arterial and venous thrombosis can happen rarely in patients with SARS-CoV-2 infection, including patients who have recently recovered from COVID-19. Cerebral thromboembolism associated with SARS-CoV-2 can present with a variety of subtle clinical manifestations, including encephalopathy without focal neurological deficits. Inflammatory markers, D-dimer levels, and coagulation profiles can be normal, especially in patients with mild infection or who have recovered from the infection. Therefore, it is important to be vigilant and recognize this clinical entity so that the diagnosis can be made and treatment can be started promptly. However, larger and prospective studies are needed to determine the clinical outcomes, therapeutic benefits, and complications of concurrent arterial stroke and cerebral venous thrombosis associated with SARS-CoV-2 infection.


Assuntos
COVID-19 , Trombose Intracraniana , Trombose dos Seios Intracranianos , Acidente Vascular Cerebral , Tromboembolia , Trombose Venosa , Masculino , Humanos , COVID-19/diagnóstico , SARS-CoV-2 , Trombose Venosa/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Tromboembolia/complicações , Trombose Intracraniana/tratamento farmacológico , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/etiologia , Infarto
3.
J Clin Neurosci ; 99: 367-372, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35364439

RESUMO

BACKGROUND: This study aimed to describe the clinical features of patients with orbital apex syndrome (OAS) as a complication of herpes zoster ophthalmicus (HZO) and to identify factors associated with poor visual acuity outcomes. METHODS: We performed a systematic review and retrospective analysis of the clinical characteristics and outcomes of patients with OAS secondary to HZO reported in the literature over 42 years (1978-2020). RESULTS: We analysed 21 cases, 20 of which were identified in the literature, together with our patient. Their median age was 65 years, with equal involvement in both sexes. The median onset of OAS due to HZO was 10 days (range 1-28 days). The median time of treatment initiation was five days (range 1-21 days). All patients presented with reduced visual acuity, complete ophthalmoplegia, and ptosis. Most patients (17/21, 80.95%) were treated with systemic antiviral and corticosteroid therapy. Three (3/21, 14.29%) patients were immunocompromised. Recovery for ophthalmoplegia (19/21, 90.48%) and ptosis (16/21, 76.19%) was good. Half of the patients (9/18, 50%) showed poor vision recovery. Starting treatment more than 72 h after HZO onset (p = 0.045) was more likely to cause poor vision recovery. CONCLUSION: OAS is a rare, serious, and potentially late complication of HZO and continued observation up to and perhaps beyond four weeks is justifiable, if not encouraged. Early initiation of treatment with systemic antiviral and/or corticosteroids within 72 h of onset of HZO appears beneficial for the recovery of visual acuity.


Assuntos
Blefaroptose , Herpes Zoster Oftálmico , Oftalmoplegia , Idoso , Antivirais/uso terapêutico , Blefaroptose/complicações , Blefaroptose/tratamento farmacológico , Feminino , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/tratamento farmacológico , Humanos , Masculino , Oftalmoplegia/tratamento farmacológico , Oftalmoplegia/etiologia , Estudos Retrospectivos , Síndrome , Transtornos da Visão/tratamento farmacológico
4.
BMJ Case Rep ; 15(3)2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-35232748

RESUMO

Nasopharyngeal carcinoma is very rarely associated with bilateral vision loss, and only in advanced disease. We report a case of bilateral severe compressive optic neuropathy as a first presentation from massive nasopharyngeal carcinoma with poor visual outcome despite corticosteroid, chemotherapy and radiotherapy. Red flag symptoms and signs of mass lesions in the posterior nasal space should be investigated and treated promptly to prevent devastating visual and prognostic consequences.


Assuntos
Neoplasias Nasofaríngeas , Doenças do Nervo Óptico , Humanos , Carcinoma Nasofaríngeo/complicações , Neoplasias Nasofaríngeas/complicações , Neoplasias Nasofaríngeas/tratamento farmacológico , Neoplasias Nasofaríngeas/radioterapia , Nervo Óptico/patologia , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/etiologia , Transtornos da Visão/etiologia
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