RESUMO
Zika virus (ZIKV) is an emerging flavivirus which has been linked to a number of neurologic manifestations such as Guillain-Barré syndrome (GBS), transverse myelitis, and meningo-encephalitis. Ophthalmologic manifestations are increasingly being reported; however, ocular dyskinesias have not been described in this context to date. Herein, we report a case of a 22-year-old female who presented with ocular flutter and associated Guillain-Barré syndrome following acute ZIKV infection. We speculate that although such symptoms may have originated from a direct viral insult, a post-infectious autoimmune mechanism may not be excluded. Physicians should include ZIKV as well as other flaviviruses in their diagnostic workup for all patients with ocular flutter/opsoclonus, after excluding other non-infectious causes of central nervous system pathology. To the best of our knowledge, this is the first report on the association of ocular flutter, GBS, and ZIKV infection.
Assuntos
Ataxia/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , Infecção por Zika virus/diagnóstico , Aciclovir/uso terapêutico , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Ataxia/tratamento farmacológico , Ataxia/fisiopatologia , Ataxia/virologia , Feminino , Síndrome de Guillain-Barré/tratamento farmacológico , Síndrome de Guillain-Barré/fisiopatologia , Síndrome de Guillain-Barré/virologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Transtornos da Motilidade Ocular/tratamento farmacológico , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/virologia , Adulto Jovem , Zika virus/imunologia , Infecção por Zika virus/tratamento farmacológico , Infecção por Zika virus/fisiopatologia , Infecção por Zika virus/virologiaRESUMO
PURPOSE: Opsoclonus is a rare neurological disorder in adult. The etiology of opsoclonus includes parainfectious, paraneoplastic, toxic, and metabolic disorders. We reported an old female with post-infectious opsoclonus who had a benign clinical course and reversible brain MRI lesions, and its review of the literature. CASE REPORT: A 67-year-old woman presented with opsoclonus and truncal ataxia for two weeks. The magnetic resonance imaging (MRI) showed the hyperintensity lesions in bilateral medial thalamus, hypothalamus, and tegmentum of pons on Fluid-attenuated inversion recovery (FLAIR) imaging. Investigations of neoplasm and autoimmune disorders showed negative findings. Clinical symptoms subsided in two-week duration and MRI abnormalities also disappeared one month later. CONCLUSION: A benign clinical course and reversible MRI lesions could be found in the patients with postinfectious opsoclonus such as our case. However, detailed investigations and long-term follow-up are needed to exclude paraneoplastic or other systemic and immunological disorders.
Assuntos
Viroses do Sistema Nervoso Central/complicações , Transtornos da Motilidade Ocular/etiologia , Transtornos da Motilidade Ocular/virologia , Aciclovir/uso terapêutico , Idoso , Antivirais/uso terapêutico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/virologia , Feminino , Fluordesoxiglucose F18 , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/tratamento farmacológico , Tomografia por Emissão de PósitronsRESUMO
A 58-year-old man presented with vertical diplopia for 10 days which was sudden in onset. Extraocular movement examination revealed findings suggestive of internuclear ophthalmoplegia. Investigations were suggestive of diabetes mellitus, and reverse transcription-PCR for SARS-CoV-2 was positive. At 3 weeks of follow-up, his diplopia had resolved. Neuro-ophthalmic manifestations in COVID-19 are increasingly being recognised around the world. Ophthalmoplegia due to cranial nerve palsy and cerebrovascular accident in COVID-19 has been reported. We report a case of internuclear ophthalmoplegia in a patient with COVID-19.
Assuntos
COVID-19/diagnóstico , Transtornos da Motilidade Ocular/diagnóstico , COVID-19/complicações , Diagnóstico Diferencial , Diplopia/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/virologiaRESUMO
A 43-year-old woman who reported diplopia and headache was found to have comitant esotropia at distance fixation and normal alignment at reading distance (divergence paralysis). Eye movement, including abduction, was normal as was the rest of the neurologic examination. Brain MRI was normal. Lumbar puncture showed an elevated opening pressure and a cerebrospinal fluid formula consistent with viral meningitis. The patient was treated with intravenous fluids and analgesics and with a temporary prism to alleviate diplopia. Within 3 weeks, she had fully recovered. This is the first report of divergence palsy in viral meningitis.
Assuntos
Encefalite Viral/complicações , Meningite Viral/complicações , Transtornos da Motilidade Ocular/fisiopatologia , Transtornos da Motilidade Ocular/virologia , Adulto , Tronco Encefálico/fisiopatologia , Tronco Encefálico/virologia , Líquido Cefalorraquidiano/virologia , Diplopia/fisiopatologia , Diplopia/virologia , Esotropia/fisiopatologia , Esotropia/virologia , Óculos , Feminino , Humanos , Imageamento por Ressonância Magnética , Vias Neurais/fisiopatologia , Vias Neurais/virologia , Recuperação de Função Fisiológica/fisiologiaRESUMO
Herpes zoster ophthalmicus can be associated with a variety of ocular and visual sequelae, including isolated or even multiple cranial neuropathies, potentially affecting the oculomotor, trochlear, or abducens nerves. We report a case of a secondary Brown syndrome following resolution of a unilateral isolated trochlear nerve palsy associated with herpes zoster ophthalmicus in an immunocompetent 57-year-old man.
Assuntos
Herpes Zoster Oftálmico/tratamento farmacológico , Transtornos da Motilidade Ocular/virologia , Estrabismo/virologia , Doenças do Nervo Troclear/virologia , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Troclear/tratamento farmacológicoRESUMO
An adult male presenting with acute onset opsoclonus, myoclonus and cerebellar ataxia is being reported. Patient had myoclonus involving limbs and palate. There are only a few reported cases associated with palatal myoclonus. Patient showed gradual spontaneous recovery. Possibility of underlying malignancy was excluded by detailed investigations.