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1.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2173-2178, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31418106

RESUMO

PURPOSE: The purpose of this study was to elucidate the detailed anatomy of the trochlear nerve in the superior oblique muscle (SOM) and the intramuscular innervation pattern using Sihler staining. METHODS: SOMs were dissected from their origin to the insertion in 28 eyes of 14 cadavers. The following distances were determined: from the SOM insertion to the trochlear, from the trochlear to the entry site of the anterior branch or posterior branch, and the widths of the main trunk and anterior and posterior branches. Sihler staining was then performed. RESULTS: The trochlear nerve traveled straight ahead medially and divided. Eighteen of 28 (64.3%) orbits showed two anterior and posterior branches, six (21.4%) showed three branches, and four (14.3%) showed no branching. The most distally located intramuscular nerve ending was observed at 62.4 ± 2.4% of the length of each muscle (35.8 mm from insertion when considering that the length of the SOM was 57.4 mm) and at 29.9 ± 3.2% of the length of each muscle (17.2 mm from the trochlear). Additionally, the length of the intramuscular arborization part was 9.4 ± 1.1% of the length of the SOM (5.4 mm when considering that the length of the SOM was 57.4 mm). Nonoverlap between two intramuscular arborizations of the nerve was detected in 20 of 28 cases (71.4%). Eight cases (28.6%) showed a definite overlap of two zones. CONCLUSIONS: This study provided a good understanding of the anatomy of the trochlear nerve in the SOM.


Assuntos
Músculos Oculomotores/inervação , Órbita/anatomia & histologia , Nervo Troclear/anatomia & histologia , Idoso , Cadáver , Feminino , Humanos , Masculino
2.
J Clin Neurosci ; 66: 266-268, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31182268

RESUMO

A 48-year-old woman with intracranial hemorrhage at the right hemisphere and the right midbrain was diagnosed as Moyamoya disease (MMD). While restoring consciousness, she complained of diplopia. The left hypertropia with a compensatory right head tilt was noted. The follow up brain image showed the evidence of past hemorrhage at the level of the right inferior colliculus. In this case, the hemorrhage directly damaged the right trochlear nucleus or intra-axial trochlear nerve before decussation and caused left (contralateral) hypertropia. To our knowledge, no report has been described of the trochlear nerve palsy in hemorrhagic Moyamoya disease. Here, we present a case of the patient with trochlear nerve palsy after hemorrhagic MMD and summarize the characteristics of trochlear nerve palsy according to its lesion sites.


Assuntos
Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Doença de Moyamoya/complicações , Doença de Moyamoya/diagnóstico por imagem , Doenças do Nervo Troclear/diagnóstico por imagem , Doenças do Nervo Troclear/etiologia , Diplopia/diagnóstico por imagem , Diplopia/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Nervo Troclear/diagnóstico por imagem
3.
World Neurosurg ; 117: 419-421, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30157598

RESUMO

BACKGROUND: Neurosurgeons who operate in and around the pathway of the ocular nerves should have good knowledge of not only their normal anatomy but also their variations. CASE DESCRIPTION: During routine dissection of the orbits in an adult cadaver, an aberrant branch of the right trochlear nerve continued on to innervate the orbicularis oculi muscle. In this case, the trochlear nerve also provided a branch to the supratrochlear nerve. CONCLUSIONS: Surgeons who operate along the pathway of the trochlear nerve such as the cavernous sinus should be aware of such an anatomic variant in order to avoid unwanted complications such as weakness of the orbicularis oculi muscle.


Assuntos
Músculos Faciais/inervação , Nervo Troclear/anatomia & histologia , Idoso , Variação Biológica Individual , Músculos Faciais/anatomia & histologia , Músculos Faciais/cirurgia , Feminino , Humanos , Órbita/anatomia & histologia , Órbita/inervação , Órbita/cirurgia , Nervo Trigêmeo/anatomia & histologia , Nervo Trigêmeo/cirurgia , Nervo Troclear/cirurgia
4.
Graefes Arch Clin Exp Ophthalmol ; 256(9): 1777-1782, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29730798

RESUMO

PURPOSE: To determine whether an infratrochlear nerve block (ITB) can reduce the oculocardiac reflex (OCR) during strabismus surgery on the medial rectus muscle (MR). METHODS: This prospective, randomized single-masked study included 60 patients with intermittent exotropia scheduled for unilateral MR resection/lateral rectus recession under general anesthesia. Patients were randomly allocated to receive a regional nerve block of the infratrochlear nerve (ITB group) prior to surgery or standard treatment without a nerve block (control group). The OCR was defined as a sudden decrease in heart rate of ≥ 15% from baseline. Changes in heart rate (HR) and the incidence of the OCR were measured during the three stages of surgery applied to the MR in each group: conjunctival incision, muscle dissection, and muscle traction. RESULTS: There were no intergroup differences in patient demographics or baseline HR. The mean HRs during conjunctival incision, muscle dissection, and muscle traction were 94, 90, and 96 bpm, respectively, in the ITB group, and 85, 68, and 84 bpm in the control group; the corresponding OCR incidence rates were 3, 20, and 10%; and 7, 87, and 38%. The HR was higher and the OCR incidence was lower in the ITB group than in the control group during muscle dissection and traction (all p < 0.05). CONCLUSIONS: An ITB maintains a stable HR and reduces the OCR during surgery on the MR. The ITB is less invasive and easily accessible to a surgeon, and can help improve the safety of strabismus surgery.


Assuntos
Anestésicos Locais/administração & dosagem , Movimentos Oculares/fisiologia , Bloqueio Nervoso/métodos , Músculos Oculomotores/cirurgia , Reflexo Oculocardíaco/fisiologia , Estrabismo/cirurgia , Adolescente , Adulto , Anestesia Geral , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Injeções Intraoculares , Masculino , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiopatologia , Estudos Prospectivos , Método Simples-Cego , Estrabismo/fisiopatologia , Nervo Troclear , Adulto Jovem
5.
World Neurosurg ; 114: 274-280, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29602005

RESUMO

OBJECTIVES: The schwannoma of the trochlear nerve is rare and originates mostly from the distal parts in the interpeduncular cistern. A lesion on the proximal segment in the inferior pineal region is extremely rare. Because of the rarity of the disease, the surgical approach to this region for the resection of trochlear nerve schwannoma has not been well documented in the literature. We herein describe a novel approach to successfully resect the trochlear nerve schwannoma. METHODS: A 12-year-old boy presented with occipital headache, abnormal gait, and disturbed conjoined eye movement. He was diagnosed with a lesion in the inferior pineal region compressing the superior medullary velum into the roof of the fourth ventricle. A bilateral midline suboccipital craniotomy was performed, and the fourth ventricle was exposed. The lesion was approached through the fourth ventricle superior medullary velum (transventricular transvelar approach). The lesion was totally resected, and his histopathology examination revealed trochlear schwannoma. RESULTS: The patient's symptoms resolved, and he had no recurrence at 12-year follow-up with normal eye movement and vision. CONCLUSION: The transventricular transvelar approach is feasible and safe to treat a lesion of the lower part of the pineal region being pushed through the superior medullary velum.


Assuntos
Neoplasias Encefálicas/cirurgia , Neoplasias dos Nervos Cranianos/cirurgia , Quarto Ventrículo/cirurgia , Neurilemoma/cirurgia , Glândula Pineal/cirurgia , Doenças do Nervo Troclear/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Criança , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Seguimentos , Quarto Ventrículo/diagnóstico por imagem , Humanos , Masculino , Neurilemoma/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Glândula Pineal/diagnóstico por imagem , Nervo Troclear/diagnóstico por imagem , Nervo Troclear/cirurgia , Doenças do Nervo Troclear/diagnóstico por imagem , Adulto Jovem
6.
J Clin Neurophysiol ; 35(1): 11-15, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29298208

RESUMO

The utility of extraocular cranial nerve electrophysiologic recordings lies primarily in the operating room during skull base surgeries. Surgical manipulation during skull base surgeries poses a risk of injury to multiple cranial nerves, including those innervating extraocular muscles. Because tumors distort normal anatomic relationships, it becomes particularly challenging to identify cranial nerve structures. Studies have reported the benefits of using intraoperative spontaneous electromyographic recordings and compound muscle action potentials evoked by electrical stimulation in preventing postoperative neurologic deficits. Apart from surgical applications, electromyography of extraocular muscles has also been used to guide botulinum toxin injections in patients with strabismus and as an adjuvant diagnostic test in myasthenia gravis. In this article, we briefly review the rationale, current available techniques to monitor extraocular cranial nerves, technical difficulties, clinical and surgical applications, as well as future directions for research.


Assuntos
Nervo Abducente/fisiologia , Eletromiografia/métodos , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiologia , Nervo Oculomotor/fisiologia , Nervo Troclear/fisiologia , Nervo Abducente/fisiopatologia , Humanos , Procedimentos Neurocirúrgicos , Músculos Oculomotores/fisiopatologia , Nervo Oculomotor/fisiopatologia , Nervo Troclear/fisiopatologia
7.
Cephalalgia ; 38(3): 585-591, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28114806

RESUMO

Background Infratrochlear neuralgia is a recently described painful cranial neuropathy that causes pain in the internal angle of the orbit and the medial upper eyelid, the upper bridge of the nose and/or the lacrimal caruncle. We aim to present seven new cases of infratrochlear neuralgia treated with anaesthetic nerve blocks. Methods Over an 18-month period, we prospectively identified seven cases of infratrochlear neuralgia among the patients attending the Headache Unit in a tertiary hospital. Anaesthetic blocks were performed by injecting 0.5 cc of bupivacaine 0.5% at the emergence of the nerve above the internal canthus. Results All patients were women, and the mean age was 49.1 years (standard deviation, 17.9). The pain appeared at the internal angle of the orbit and/or the medial upper eyelid in six cases, and the whole territory of the infratrochlear nerve in one case. Six patients had continuous pain and one had episodes lasting 8-24 hours. All patients showed sensory disturbances within the painful area and tenderness upon palpation of the infratrochlear nerve. Nerve blocks resulted in complete and long-lasting relief in four patients and short-lasting relief in the other three patients. Conclusions Infratrochlear neuralgia should be considered among the neuralgic causes of orbital and periorbital pain. Anaesthetic blocks may assist clinicians in the diagnosis and may also be an effective therapy.


Assuntos
Neuralgia Facial/cirurgia , Bloqueio Nervoso/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/uso terapêutico , Bupivacaína/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Nervo Troclear/efeitos dos fármacos
8.
Invest Ophthalmol Vis Sci ; 58(12): 5526-5531, 2017 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-29075763

RESUMO

Purpose: To investigate the relationship between objective ocular torsion and the presence or absence of the trochlear nerve in subjects with unilateral superior oblique palsy (SOP). Methods: A total of 159 subjects with congenital and acquired unilateral SOP were reviewed. Eighty-four subjects who had a normal trochlear nerve (present group) and 75 subjects without a trochlear nerve (absent group) were included. Cyclovertical motility parameters and objective ocular torsion were compared between groups, and factors related to ocular torsion were evaluated. Results: The degree of "net" excyclotorsion in the paretic eye was larger in the absent group compared to the present group (P = 0.002). The proportion of net excyclotorsion in the paretic eye was greater in the absent group (11% vs. 37%), while net incyclotorsion was greater in the present group (41% vs. 23%) (P < 0.001). Net excyclotorsion of the paretic eye was associated with absence of the trochlear nerve (P < 0.001) and smaller size of the paretic SO (P < 0.001). Net incyclotorsion of the paretic eye was related with a normal trochlear nerve (P = 0.005), larger size of the paretic SO (P = 0.002), and greater hypertropia during ipsilateral gaze (P = 0.024). Conclusions: The status of the trochlear nerve, paretic SO size, and hypertropia during ipsilateral gaze which reflects the tensile strength of the ipsilateral superior rectus, significantly contribute to ocular torsion in unilateral SOP.


Assuntos
Movimentos Oculares/fisiologia , Transtornos da Motilidade Ocular/etiologia , Músculos Oculomotores/fisiopatologia , Doenças do Nervo Troclear/congênito , Nervo Troclear/anormalidades , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/inervação , Estudos Retrospectivos , Nervo Troclear/diagnóstico por imagem , Doenças do Nervo Troclear/complicações , Doenças do Nervo Troclear/fisiopatologia , Adulto Jovem
9.
Graefes Arch Clin Exp Ophthalmol ; 255(10): 2045-2050, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28770346

RESUMO

PURPOSE: To evaluate the outcomes of early intra-trochlear steroid injections in patients with acquired Brown syndrome secondary to trochleitis (ABSST). METHODS: Retrospective analysis from medical charts of patients diagnosed as affected by unilateral ABSST from January 2008 to June 2015, and treated according to our Institution protocol: intra-trochlear injection of 1ml of triamcinolone acetonide 40 mg/ml is performed under sterile conditions. In cases of no resolution/improvement within 1 month, further monthly injections are performed up to a maximum number of three. Non-responder patients after three injections undergo recession of the superior oblique muscle. RESULTS: Thirteen patients were diagnosed as affected by unilateral ABSST, and were included in the analysis (seven F, six M; median age at diagnosis 30.38 ± 25.56 years). The mean time interval from ABSST diagnosis to the first steroid injection was 7.84 ± 5.40 days (range 2-17). After a median number of 1.30 injections per patient, 11 patients (84.6% of the total) showed complete remission of symptoms and signs within 22.45 ± 13.85 days after the first injection. None of these responder patients referred to diplopia in primary gaze after injections. The remaining two non-responder patients after three injections underwent superior oblique muscle recession of 8.0 mm. CONCLUSIONS: Early intra-trochlear steroid injections are effective in patients with acquired Brown syndrome secondary to trochleitis, leading to a complete recovery of signs and symptoms in the majority of treated patients. Surgical treatment should be limited only to patients non-responding to serial steroid injections.


Assuntos
Transtornos da Motilidade Ocular/tratamento farmacológico , Músculos Oculomotores/inervação , Triancinolona Acetonida/administração & dosagem , Doenças do Nervo Troclear/complicações , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Músculos Oculomotores/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Nervo Troclear , Doenças do Nervo Troclear/tratamento farmacológico , Adulto Jovem
10.
Headache ; 57(9): 1433-1442, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28833061

RESUMO

OBJECTIVE: The aim of this study was to describe clinical features unique to supratrochlear neuralgia. BACKGROUND: The supratrochlear nerve supplies the medial aspect of the forehead. Due to the intricate relationship between supraorbital and supratrochlear nerves, neuralgic pain in this region has been traditionally attributed to supraorbital neuralgia. No cases of supratrochlear neuralgia have been reported so far. METHODS: From 2009 through 2016, we prospectively recruited patients with pain confined to the territory of the supratrochlear nerve. RESULTS: Fifteen patients (13 women, 2 men; mean age 51.4 years, standard deviation 14.9) presented with pain in the lower paramedian forehead, extending to the eyebrow in two patients and to the internal angle of the orbit in another. Pain was unilateral in 11 patients (six on the right, five on the left), and bilateral in four. Six patients had continuous pain and nine described intermittent pain. Palpation of the supratrochlear nerve at the medial third of the supraorbital rim resulted in hypersensitivity in all cases. All but one patient exhibited sensory disturbances within the painful area. Fourteen patients underwent anesthetic blockades of the supratrochlear nerve, with immediate relief in all cases and long-term remission in three. Six of them had received unsuccessful anesthetic blocks of the supraorbital nerve. Five patients were treated successfully with oral drugs and one patient was treated with radiofrequency. CONCLUSIONS: Supratrochlear neuralgia is an uncommon disorder causing pain in the medial region of the forehead. It may be differentiated from supraorbital neuralgia and other similar headaches and neuralgias based on the topography of the pain and the response to anesthetic blockade.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Neuralgia/diagnóstico , Neuralgia/terapia , Nervo Troclear/cirurgia , Adulto , Idoso , Analgésicos/administração & dosagem , Nervos Cranianos/efeitos dos fármacos , Nervos Cranianos/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Nervo Troclear/efeitos dos fármacos
11.
BMC Ophthalmol ; 17(1): 159, 2017 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-28841851

RESUMO

BACKGROUND: Congenital Brown syndrome is characterized by limited elevation particularly during adduction. The pathogenesis of congenital Brown syndrome is still controversial. CASE PRESENTATION: A 6-year-old boy had been tilting his head to the left since infancy. He showed right hypertropia (RHT) of 2 prism diopters (Δ) in the primary position. He showed RHT 6Δ in right gaze, RHT 2Δ in left gaze, RHT 12Δ in right head tilt, and orthotropia in left head tilt. The right eye showed limitation of elevation and depression on adduction, and the left eye showed overdepression on adduction. MR images showed an absent right trochlear nerve with a hypoplastic ipsilateral superior oblique muscle. CONCLUSIONS: Congenital Brown syndrome may be associated with an absent trochlear nerve and hypoplastic superior oblique muscle suggesting an etiologic mechanism of congenital cranial dysinnervation disorder.


Assuntos
Transtornos da Motilidade Ocular/diagnóstico , Músculos Oculomotores/patologia , Doenças do Nervo Oculomotor/diagnóstico , Nervo Troclear/anormalidades , Criança , Humanos , Masculino , Síndrome
12.
J Plast Reconstr Aesthet Surg ; 70(9): 1171-1180, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28712884

RESUMO

BACKGROUND: Recent findings on the pathogenesis of frontal migraine headache support, besides a central vasogenic cause, an alternative peripheral mechanism involving compressed craniofacial nerves. This is further supported by the efficiency of botulinum toxin injections as a new treatment option in frontal migraine headache patients. METHODS: The supraorbital regions of 22 alcohol-glycerine-embalmed facial halves of both sexes were dissected. Both the supratrochlear and supraorbital nerves (STN and SON, respectively) were identified, and their relationship with the corrugator supercilii muscle (CSM) was investigated by dissection and ultrasound. The course of both nerves was defined, and the interaction between the supraorbital artery (SOA) and SON was determined. RESULTS: We discovered a new possible compression point of the STN passing through the orbital septum and verified previously described compression points of both STN and SON. Osteofibrous channels used by the STN and SON were found constantly. We described the varying topography of the STN and CSM, the SON and CSM, and the SON and SOA. Further, we provide an algorithm for the ultrasound visualization of the supraorbital neurovascular bundle. CONCLUSION: Our data support the hypothesis of a peripheral mechanism for frontal migraine headache because of following potential irritation points: first, the CSM is constantly perforated by the SON and frequently by the STN; second, the topographic proximity between SOA and SON and the osteofibrous channels is used by the SON and STN; and third, the STN passes through the orbital septum.


Assuntos
Face/irrigação sanguínea , Face/inervação , Músculos Faciais/anatomia & histologia , Nervo Troclear/anatomia & histologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/etiologia , Órbita
13.
AJNR Am J Neuroradiol ; 38(10): E83, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28642264
15.
Ann Anat ; 213: 1-7, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28549557

RESUMO

The trochlear nerve is generally considered to be a purely motor nerve supplying one extraocular muscle, the superior oblique. In the current study, 28 orbits were dissected and in one orbit (3.6%), the trochlear nerve divided into two main branches. The medial branch followed the classical course, entered the superior oblique muscle and was presumed to be motor in function. However, before entering the muscle, it partially fused with the frontal nerve, and gave a bundle of nerve fibres to the frontal nerve. The lateral branch gave a communication to the frontal nerve, travelled along the lacrimal nerve, received a branch from the lacrimal nerve then penetrated the lacrimal gland. The lateral branch was presumed to be sensory. Paraffin sections from the two branches were stained using immunohistochemistry. The two branches had different nerve fibre populations and showed distinct differences in neurofilament proteins (NFP) immuno-labelling. While both branches showed intense labelling for NFP-H, the lateral branch showed no staining or faint staining for NFP-M and NFP-L respectively, but the medial branch showed moderate labelling for both the NFP-M and NFP-L. Staining for substance P, a marker for nociceptive fibres, showed intense staining in a subset of fibres in the lateral branch, but no staining in the medial branch. Calcitonin gene-related peptide labelling was evident in some axons and some Schwann cells in the medial branch but widespread, weak and fine granular in the lateral branch. These findings indicate that, in some individuals (3.6%), the trochlear nerve may contain motor and sensory fibres, suggesting inter-nuclear communication within the brainstem during embryogenesis or mixing of nerve fibres in their extra-axial pathways.


Assuntos
Nervo Troclear/anatomia & histologia , Idoso , Cadáver , Humanos , Imuno-Histoquímica , Aparelho Lacrimal/anatomia & histologia , Aparelho Lacrimal/inervação , Masculino , Neurônios Motores/fisiologia , Fibras Nervosas/fisiologia , Proteínas de Neurofilamentos/metabolismo , Células Receptoras Sensoriais/fisiologia , Substância P/metabolismo , Nervo Troclear/anormalidades
16.
Korean J Ophthalmol ; 31(3): 183-193, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28534340

RESUMO

Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in aberrant innervation of the ocular and facial musculature. Its diagnosis could be facilitated by the development of high resolution thin-section magnetic resonance imaging. The purpose of this review is to describe the method to visualize cranial nerves III, IV, and VI and to present the imaging findings of congenital cranial dysinnervation disorders including congenital oculomotor nerve palsy, congenital trochlear nerve palsy, Duane retraction syndrome, Möbius syndrome, congenital fibrosis of the extraocular muscles, synergistic divergence, and synergistic convergence.


Assuntos
Nervo Abducente/diagnóstico por imagem , Doenças dos Nervos Cranianos/diagnóstico , Síndrome da Retração Ocular/complicações , Imagem por Ressonância Magnética/métodos , Nervo Oculomotor/diagnóstico por imagem , Nervo Troclear/diagnóstico por imagem , Doenças dos Nervos Cranianos/etiologia , Síndrome da Retração Ocular/diagnóstico , Humanos
18.
AJNR Am J Neuroradiol ; 38(5): 1026-1030, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28302606

RESUMO

BACKGROUND AND PURPOSE: The trochlear groove and trochlear cistern are anatomic landmarks closely associated with the tentorial segment of cranial nerve IV. The purposes of this study were to describe the MR imaging appearances of the trochlear groove and trochlear cistern and to test our hypothesis that knowledge of these anatomic landmarks facilitates identification of cranial nerve IV in routine clinical practice. MATERIALS AND METHODS: For this retrospective study, consecutive MR imaging examinations of the sinuses performed in 25 patients (50 sides) at our institution were reviewed. Patient characteristics and study indications were recorded. Three readers performed independent assessments of trochlear groove, cistern, and nerve visibility on coronal images obtained by using a T2-weighted driven equilibrium radiofrequency reset pulse sequence. RESULTS: Interobserver agreement was 78% for visibility of the trochlear groove, 56% for the trochlear cistern, and 68% for cranial nerve IV. Following consensus review, the trochlear groove was present in 44/50 sides (88%), the trochlear cistern was present in 25/50 sides (50%), and cranial nerve IV was identified in 36/50 sides (72%). When the trochlear groove was present, cranial nerve IV was identified in 35/44 sides (80%), in contrast to 1/6 sides (17%) with no groove (P = .0013). When the trochlear cistern was present, cranial nerve IV was identified in 23/25 sides (92%), in contrast to 13/25 sides (52%) with no cistern (P = .0016). CONCLUSIONS: The trochlear groove and trochlear cistern are anatomic landmarks that facilitate identification of cranial nerve IV in routine clinical practice.


Assuntos
Imagem por Ressonância Magnética/métodos , Nervo Troclear/diagnóstico por imagem , Adulto , Pontos de Referência Anatômicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
Rev Med Interne ; 38(12): 806-816, 2017 Dec.
Artigo em Francês | MEDLINE | ID: mdl-28325621

RESUMO

Diplopia is defined as "double vision" when looking at a single object. Monocular diplopia is related to an ocular disorder and must be differentiated from binocular diplopia which is secondary to ocular misalignment. The examination of the patient with binocular diplopia is often challenging for non-specialists. However, a careful and systematic clinical examination followed by targeted ancillary testing allows the clinician to localize the lesion along the oculomotor pathways. The lesion may involve the brainstem, the ocular motor nerves III, IV or VI, the neuromuscular junction, the extraocular ocular muscles, or the orbit. Causes of binocular diplopia are numerous and often include disorders typically managed by internal medicine such as inflammatory, infectious, neoplastic, endocrine, and metabolic disorders. In addition to treating the underlying disease, it is important not to leave diplopia uncorrected. Temporary occlusion of one eye by applying tape on one lens or patching one eye relieves the diplopia until more specific treatments are offered should the diplopia not fully resolve.


Assuntos
Diplopia/diagnóstico , Diplopia/etiologia , Medicina Interna/métodos , Nervo Abducente/patologia , Retinopatia Diabética/diagnóstico , Diagnóstico Diferencial , Humanos , Neoplasias/complicações , Neoplasias/diagnóstico , Nervo Oculomotor/patologia , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/patologia , Doenças Orbitárias/complicações , Doenças Orbitárias/diagnóstico , Síndromes Paraneoplásicas Oculares , Nervo Troclear/patologia
20.
J Clin Neurosci ; 40: 59-62, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28215457

RESUMO

BACKGROUND: Cranial nerve cavernous malformations (CM) are rare benign congenital vascular anomalies, with approximately 44 preceding cases in the literature. We report the fifth case of trochlear CM, as well as the first instance of two discrete CM occurring simultaneously along the same cranial nerve. METHODS: Case report. RESULTS: A fifty-seven year-old man presented with several years of diplopia; physical examination identified a complete left trochlear nerve paralysis. MRI revealed a 1cm enhancing lesion within the left ambient cistern, and the patient underwent left pretemporal transcavernous resection. Intraoperatively, a second, discrete CM of the trochlear nerve was also discovered; wide excision of the intrinsic trochlear lesions was completed, allowing both tumors to be removed en bloc with negative margins. Pathologic analysis confirmed both to be CM of the trochlear nerve. The patient recovered with a persistent left trochlear paralysis only, and follow-up MRI was negative for residual or recurrent disease. CONCLUSION: Cranial nerve CM are rare but potentially morbid mass lesions, with the capacity to precipitate significant neuropathies. Differential diagnosis includes schwannoma and hemangioblastoma. Definitive diagnosis may not be possible preoperatively; however, resection is recommended in symptomatic patients, potentially accompanied by nerve repair.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Hemangioblastoma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Doenças do Nervo Troclear/diagnóstico por imagem , Nervo Troclear/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Diagnóstico Diferencial , Hemangioblastoma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Nervo Troclear/anormalidades , Nervo Troclear/patologia , Doenças do Nervo Troclear/patologia
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