RESUMO
Two patients presented with unilateral dilated and poorly reactive pupils and were found to have a previously unsuspected intraocular iron foreign body. Both of them had normal vision and one had normal color of the iris so that the condition was missed by several physicians. The pupils reacted normally to pilocarpine 1% and also showed response to dilute (0.1%) pilocarpine. There was no response to phospholine iodide. These findings indicate that the mydriasis was due to a local siderotic parasympathetic neuropathy of the pupil.
Assuntos
Corpos Estranhos no Olho/complicações , Ferro , Midríase/etiologia , Distúrbios Pupilares/etiologia , Adulto , Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/complicações , Ferimentos Oculares Penetrantes/cirurgia , Humanos , MasculinoRESUMO
A young woman had recurrent anterior ischemic optic neuropathy for 18 years. During a recent episode of severe papillopathy in one eye, acute glomerulonephritis, transient low serum complement levels, and a high rheumatoid factor were detected. Despite long and careful follow-up, we could not diagnose systemic lupus erythematosus or any other specific connective tissue or autoimmune disease. We suspect transient disordered immunity may have contributed to provoking acute anterior ischemic optic neuropathy concomitant with acute glomerulonephritis despite the absence of generalized connective tissue disease. An extensive search for immunologic mechanisms in some patients with presumed idiopathic anterior ischemic optic neuropathy may be warranted because immunosuppressive treatment may be beneficial in preventing recurrences.
Assuntos
Doenças Autoimunes/patologia , Isquemia/patologia , Nefrose/patologia , Nervo Óptico/irrigação sanguínea , Fator Reumatoide/sangue , Adulto , Proteínas do Sistema Complemento/análise , Feminino , Fundo de Olho , Humanos , Papiledema/patologia , Recidiva , Campos VisuaisRESUMO
We report the clinical and laboratory findings in 2 siblings with a syndrome of pigmentary retinopathy, blepharospasm, and dystonia. This entity most resembles Hallervorden-Spatz disease, but appears to be a distinct disorder without identifiable neuroimaging or biochemical abnormalities.
Assuntos
Doenças dos Gânglios da Base/genética , Blefarospasmo/genética , Distonia/genética , Doenças Palpebrais/genética , Retinose Pigmentar/genética , Adolescente , Adulto , Doenças dos Gânglios da Base/diagnóstico por imagem , Distonia/diagnóstico por imagem , Humanos , Masculino , Retinose Pigmentar/diagnóstico por imagem , Síndrome , Tomografia Computadorizada por Raios XRESUMO
A previously healthy 60-year-old woman developed headache, cervical pain, bilateral mydriasis (right greater than left), and bilateral conjunctival injection as the sole manifestations of acute giant-cell arteritis.
Assuntos
Arterite/complicações , Midríase/etiologia , Arterite/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
A migrating endothelial line of keratic precipitates associated with overlying corneal edema suggests an immune attack on the corneal endothelium. This is seen most commonly in corneal allotransplantation rejection. The etiology of such lines in the absence of this condition is unclear. We document the presence of an intranuclear virus compatible with herpesvirus in this condition.
Assuntos
Conjuntivite/etiologia , Herpes Zoster Oftálmico , Ceratite/etiologia , Endotélio Corneano/imunologia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Masculino , Pessoa de Meia-IdadeRESUMO
Two case histories, each spanning more than 20 years, demonstrate the complexity and persistence of modern neurosyphilis. Both patients present uncommon manifestations of neurosyphilis that may be easily overlooked today: superior orbital fissure syndrome, posterior fossa gumma, and bilateral deafness. Computed tomographic scans were performed in both patients but were diagnostically nonspecific, and syphilis serology testing in both serum and cerebrospinal fluid was repeatedly misleading. Numerous mistaken diagnoses were put forward until tissue was finally available for histologic examination. Perhaps the most disturbing aspects of these two cases are the persistent failure of specific treponemal serologic testing to indicate the diagnosis, and the inability of repeated "adequate" and/or supramaximal doses of penicillin to prevent continued neurologic deterioration. We believe that chronic neurosyphilis may demand a reevaluation of current diagnostic and therapeutic practice.
Assuntos
Meningite/etiologia , Neurossífilis/etiologia , Doenças Orbitárias/etiologia , Cegueira/etiologia , Fossa Craniana Posterior , Surdez/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/diagnóstico , Neurossífilis/tratamento farmacológico , Penicilinas/uso terapêutico , Síndrome , Sorodiagnóstico da SífilisRESUMO
A 77-year-old man with a history of Buerger's disease developed an anterior ischemic optic neuropathy. This disease, while rare in the United States at the present time, is common in other parts of the world. None the less, this appears to be the first reported case of this type of optic neuropathy in a patient with documented Buerger's disease. A possible mechanism is suggested.
Assuntos
Isquemia/etiologia , Nervo Óptico/irrigação sanguínea , Tromboangiite Obliterante/complicações , Idoso , Angiofluoresceinografia , Humanos , Isquemia/patologia , Isquemia/fisiopatologia , Masculino , Dor , Tromboangiite Obliterante/fisiopatologia , Campos VisuaisRESUMO
A patient with paranasal sinus lymphoma (recognized retrospectively) developed unilateral, acute, self-limited optic neuritis during the course of chronic lymphocytic meningitis with elevated intracranial pressure and headache. Meningeal symptoms were adequately controlled with analgesics alone for 14 months and corticosteroids alone for a subsequent 11 months without evidence of development of other involvement of organs outside the central nervous system (CNS). Eventually, the visual alteration from optic neuritis prompted a repeat evaluation, which disclosed lymphoma in bone marrow. The subject of paraneoplastic optic neuritis is reviewed.
Assuntos
Linfoma/complicações , Meningite/etiologia , Doenças do Nervo Óptico/etiologia , Neoplasias dos Seios Paranasais/complicações , Biópsia , Medula Óssea/patologia , Doença Crônica , Olho , Humanos , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Mucosa Nasal/patologia , Doenças do Nervo Óptico/tratamento farmacológico , Doenças do Nervo Óptico/fisiopatologia , Dor/tratamento farmacológico , Dor/etiologia , Papiledema/etiologia , Neoplasias dos Seios Paranasais/patologia , Prednisona/uso terapêutico , Visão Ocular/efeitos dos fármacosAssuntos
Arteriosclerose/complicações , Doenças das Artérias Carótidas/complicações , Síndrome de Horner/etiologia , Arteriosclerose/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , RadiografiaAssuntos
Malformações Arteriovenosas Intracranianas/complicações , Transtornos de Enxaqueca/complicações , Oftalmoplegia/etiologia , Adulto , Cerebelo/irrigação sanguínea , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/patologia , Malformações Arteriovenosas Intracranianas/cirurgia , Espectroscopia de Ressonância MagnéticaRESUMO
After years of episodic monocular visual loss, two migraineurs suffered sudden, persisting loss of vision from retinal vascular occlusion. One was a 34-year-old woman with systemic lupus erythematosus who showed abnormalities of the cilioretinal arterial and retinal venous circulations. The other was a 62-year-old man with hypertension and arteriosclerosis who had a central retinal vein occlusion. Persisting monocular visual loss is a rare consequence of migraine. Our cases suggest a role for venous lesions. Occlusion of retinal vessels in some migraineurs may result from the synergistic effect of another vascular disorder with the migraine.
Assuntos
Transtornos de Enxaqueca/complicações , Doenças Retinianas/etiologia , Adolescente , Adulto , Idoso , Arteriopatias Oclusivas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retina/irrigação sanguíneaRESUMO
Four patients developed a unilateral tonic pupil following ipsilateral oculomotor nerve palsy. The probable basis for this phenomenon is misdirection of injured oculoparasympathetic fibers in the oculomotor nerve proximal to the ciliary ganglion.