Eye oscilations with neurological implications in pediatric age.

INTRODUCTION: Eye oscillations, both nystagmic and non-nystagic, can occur from birth. Most correspond to infantile nystagmus that dubates in the first six months of life, which include idiopathic, sensory, latent, or overt latent motor nystagmus. Those associated with neurological diseases or syndromes correspond to approximately 33%, their identification and correct evaluation being important given the potential visual and vital complications. MATERIAL AND METHODS: We made a systematic review of the literature on supranuclear gaze control mechanisms and the main ocular oscillations with possible neurological implications, both in childhood. With this, we intend to assess if there are already established clinical-anatomical associations, and to propose a protocol on the complementary studies to be carried out in these cases. RESULTS: There are still anatomical pathways involved in supranuclear gaze control that are not fully clarified and understood. Besides, except in the case of nystagmus in seesaw and upbeat, we did not find anatomical explanations for their pathogenesis. The need for complete neuro-ophthalmological physical examinations and the request for additional tests in children who present ocular oscillations with neurological characteristics are clear. CONCLUSIONS: Supranuclear gaze control follows a complex neurological network that still needs to be studied better. With a better dissection of the same we could try to understand why the ocular oscillations that we studied have these specific forms of presentation. As for the complementary requests, the request for neuroimaging tests is practically constant, making the others according to the specific case before which we find ourselves.

Oscilaciones oculares con implicaciones neurológicas en la edad infantil / Eye oscilations with neurological implications in pediatric age

Introducción Oscilaciones oculares, tanto nistágmicas como no nistágmicas, pueden ocurrir desde el nacimiento. La mayoría corresponden a nistagmos infantiles que aparecen en los seis primeros meses de vida, donde se incluyen el nistagmo motor idiopático, sensorial, latente o latente manifiesto. Aquellas asociadas con enfermedades o síndromes neurológicos corresponden aproximadamente al 33%, siendo importante su identificación y correcta valoración dadas las potenciales complicaciones tanto visuales como vitales. Material y métodos Hemos realizado una revisión sistemática de la literatura sobre los mecanismos de control supranuclear de la mirada y de las principales oscilaciones oculares con posibles implicaciones neurológicas, ambas en la edad infantil. Pretendemos con ello valorar si existen asociaciones clínico-anatómicas ya establecidas, y plantear un protocolo sobre los estudios complementarios a realizar en estos casos. Resultados Existen todavía vías anatómicas implicadas en el control supranuclear de la mirada que no están totalmente esclarecidas y entendidas. Además, salvo en el caso de los nistagmos en seesaw y en upbeat, no hemos encontrado explicaciones anatómicas sobre la patogénesis de los mismos. Sí que queda clara la necesidad de realizar exploraciones físicas neurooftalmológicas completas y la petición de pruebas complementarias en los niños que presenten oscilaciones oculares con características neurológicas. Conclusiones El control supranuclear de la mirada sigue una compleja red neurológica que aún necesita ser estudiada en mayor profundidad. Con una mejor definición de la misma podríamos intentar entender por qué las oscilaciones oculares que estudiamos tienen esas formas de presentación específicas. En cuanto a las peticiones complementarias, es prácticamente constante la solicitud de pruebas de neuroimagen, realizando las demás según el caso concreto ante el que nos econtremos. (AU)

Introduction Eye oscillations, both nystagmic and non-nystagmic, can occur from birth. Most correspond to infantile nystagmus that appears in the first six months of life, which include idiopathic, sensory, latent, or overt latent motor nystagmus. Those associated with neurological diseases or syndromes correspond to approximately 33%, their identification and correct evaluation being important given the potential visual and vital complications. Material and methods We made a systematic review of the literature on supranuclear gaze control mechanisms and the main ocular oscillations with possible neurological implications, both in childhood. With this, we intend to assess if there are already established clinical-anatomical associations, and to propose a protocol on the complementary studies to be carried out in these cases. Results There are still anatomical pathways involved in supranuclear gaze control that are not fully clarified and understood. Besides, except in the case of nystagmus in seesaw and upbeat, we did not find anatomical explanations for their pathogenesis. The need for complete neuro-ophthalmological physical examinations and the request for additional tests in children who present ocular oscillations with neurological characteristics are clear. Conclusions Supranuclear gaze control follows a complex neurological network that still needs to be studied better. With a better definition thereof we could try to understand why the ocular oscillations that we studied have these specific forms of presentation. As for the complementary requests, the request for neuroimaging tests is practically constant, making the others according to the specific case before which we find ourselves. (AU)

[Surgical treatment of Duane's syndrome type I by recession of the medial rectus of the affected eye and faden operation of the contralateral medial rectus]. / Tratamiento quirúrgico del síndrome de Duane, tipo I mediante retroinserción del recto medial del lado afecto y faden del recto medial contralateral.

PURPOSE: Different surgical approaches have been described for the treatment of Duane's syndrome. The purpose of our study is to report the results of patients undergoing recession of the medial rectus (MR) muscle of the affected eye and placement of contralateral MR faden posterior fixation sutures. METHODS: Retrospective study of 11 patients treated by a 4-7 mm recession of the MR of the affected eye and 13 mm faden posterior fixation suture of the contralateral MR in order to correct abnormal head position and esotropia in primary position. RESULTS: After surgery, there was no torticolis in 81.8% of patients, with less than 10 degrees of torticolis in the remainder. In all patients, postoperative esotropia was less than 5 prismatic dioptres. CONCLUSION: This is a safe and effective procedure in Duane's syndrome type I to treat moderate esotropia and torticolis.

Tratamiento quirúrgico del síndrome de Duane, tipo I mediante retroinserción del recto medial del lado afecto y faden del recto medial contralateral / Surgical treatment of Duane´s syndrome type I by recession of the medial rectus of the afected eye and faden operation of the contralateral medial rectus

Objetivo: Se han descrito numerosos tratamientos quirúrgicos para el síndrome de Duane (SD) tipo I. El objetivo de este trabajo es comunicar los resultados obtenidos en pacientes diagnosticados de SD tipo I sometidos a retroinserción del recto medial (RM) del lado afecto y operación de faden del RM contralateral. Métodos: Estudio retrospectivo sobre once pacientes con SD tipo I a los que se les realiza una retroinserción del RM del lado afecto de entre 4 y 7 mm y faden a 13 mm del RM contralateral para resolver el tortícolis y la endotropía presentes en posición primaria. Resultados: Tras la cirugía, el tortícolis desapareció en el 81,8% de los pacientes, siendo menor de 10º en el resto. En todos los pacientes la endotropía postquirúrgica fue menor de 5 dioptrías prismáticas. Conclusión: Esta técnica es un procedimiento seguro y efectivo para el tratamiento de endotropías y tortícolis moderados en el SD tipo I

Purpose: Different surgical approaches have been described for the treatment of Duane’s syndrome. The purpose of our study is to report the results of patients undergoing recession of the medial rectus (MR) muscle of the affected eye and placement of contralateral MR faden posterior fixation sutures. Methods: Retrospective study of 11 patients treated by a 4-7 mm recession of the MR of the affected eye and 13 mm faden posterior fixation suture of the contralateral MR in order to correct abnormal head position and esotropia in primary position. Results: After surgery, there was no torticolis in 81.8% of patients, with less than 10º of torticolis in the remainder. In all patients, postoperative esotropia was less than 5 prismatic dioptres. Conclusion: This is a safe and effective procedure in Duane’s syndrome type I to treat moderate esotropia and torticolis

[Cavernous sinus aneurysms. Treatment and evolution]. / Aneurismas intracavernosos. Tratamiento y evolución.

CASE REPORT: Two clinical cases of painful ophthalmoplegia from a cavernous sinus syndrome induced by carotid intracavernous aneurysm are presented. Two women presenting similar clinical patterns: total restriction of ocular movements, pthosis, alterations in the pupil and intense cephalalgia of sudden onset. Carotid aneurysms were found to be responsible for these clinical patterns. A carotid embolization was performed in one of the cases while a <> attitude was adopted for the other. DISCUSSION: Both cases showed similar favorable evolution, after a follow up period of one year. We concluded that in these cases a close collaboration with other specialties is required in order to adopt the most adequate therapeutic option.

Aneurismas intracavernosos. Tratamiento y evolución / Treatment and evolution of cavernous sinus aneurysms

Casos clínicos: Se presentan dos casos clínicos de oftalmoplejía dolorosa o síndrome del seno cavernoso producidos por aneurismas carotídeos intracavernosos. Corresponden a dos mujeres cuyos cuadros cursaron de forma similar con restricción total de los movimientos oculares, ptosis, alteraciones pupilares e intensa cefalea de instauración brusca.Se encontraron sendos aneurismas intracarotídeos como responsables de los cuadros, practicándose en un caso una embolización carotídea mientras que en el otro se adoptó una actitud expectante.Discusión: Ambos casos evolucionaron favorablemente en un período de seguimiento de un año, pudiendo concluir que en estos cuadros se requiere la estrecha colaboración de otras especialidades, para adoptar individualmente la opción terapéutica más adecuada (AU)

Epidemiological trends of suicide in Puerto Rico: 1931 to 1985.

This work fulfills the need for an historic-developmental study of suicide in Puerto Rico. Mortality trends, risk groups and other demographical data with preventive and comparative value is presented. The data for this descriptive study was mainly taken from the Puerto Rico Vital Statistics and the Forensic Institute files. Analysis was done correlating incidence, age, sex and method. Seasonal tendencies were explored. Graphs were designed to illustrate the tendencies and interrelationship of the given variables. The results show that after a decline in incidence in the first 30 years, suicide mortality has been stable for the past 25 years (9.2 x 100,000). Age, sex and method showed certain interrelationships; 1) aging is directly proportional to an increase in suicidal risk. 2) Youth suicide rates have consistently diminished. 3) Adolescents tend to choose the traditional methods in Puerto Rico, with a recent increase in firearms use. 4) At age 16, males differ from females by increasing their suicide rates, particularly by hanging. 5) Adult females show unpredictability as to their methods. Seasonal risk of suicide was found statistically significant (ANOVA) for the Christmas and summer periods and major events affecting the general public.