Acute Horner syndrome secondary to glandular fever due to Epstein Barr virus infection.

We present a clinical situation where a 47-year old female patient consulted with left partial ptosis and miosis that started, two weeks before, with an episode of glandular fever secondary to Epstein-Barr infection. Apraclonidine 0.5% and Phenylephrine 1% drop testing was performed with results consistent with suspected left Horner Syndrome (HS), with a probable postganglionic location. Magnetic Resonance Angiography (MRA) at the moment of the acute presentation did not show any image suggesting carotid arterial dissection but showed irregular narrowing of the left internal carotid artery on its paravertebral extracranial way, consistent to enlarged intra-carotid sheath lymphoid tissue. A week later, a Doppler ultrasound was performed, showing bilateral images compatible with internal carotid arterial dissection. When Postganglionar HS is suspected, the first aetiology to rule out is a carotid arterial dissection because of its potentially fatal outcome and for being a more described entity as postganglionic HS aetiology. However, it is also evidenced that a certain diagnose is not always possible. Furthermore, we describe the enlarged internal carotid artery sheath lymphoid tissue as a possible cause of sympathetic nerve disruption causing a Postganglionar HS, although not common.

Síndrome de Horner agudo secundario a mononucleosis infecciosa por virus de Epstein Barr / Acute Horner syndrome secondary to glandular fever due to Epstein Barr virus infection

Presentamos el caso clínico de una mujer de 47 años que consultó por miosis y ptosis del ojo izquierdo cuyo inicio coincidió, 15 días antes, con un episodio de mononucleosis infecciosa con serología positiva para virus de Epstein-Barr. Se realizaron test con colirios de apraclonidina al 0,5% y fenilefrina al 1%, que apoyaron el diagnóstico de síndrome de Horner(SH) izquierdo posganglionar. En el momento agudo se practicó una angiografía por resonancia magnética que descartó disección carotídea, pero evidenció una imagen de arrosariamiento de la arteria carótida interna izquierda a lo largo de su trayecto extracraneal paravertebral compatible con inflamación del tejido linfático de la capa adventicia de la arteria. Una semana más tarde la ecografía Doppler de troncos supraaórticos con la que se completó el estudio mostraba una imagen compatible con disección de la arteria carótida interna bilateral. Ante un caso de SH posganglionar la primera causa a descartar por su gravedad, y por ser una entidad más ampliamente descrita como etiología del SH de 3.ª neurona, es la disección carotídea. Sin embargo, con este caso ponemos de manifiesto que no siempre se puede llegar a un diagnóstico certero. Asimismo, describimos la inflamación del tejido linfático carotídeo como posible etiología de una lesión de la cadena simpática cervical como causa infrecuente de SH posganglionar (AU)

We present a clinical situation where a 47-year old female patient consulted with left partial ptosis and miosis that started, two weeks before, with an episode of glandular fever secondary to Epstein-Barr infection. Apraclonidine 0.5% and Phenylephrine 1% drop testing was performed with results consistent with suspected left Horner Syndrome (HS), with a probable postganglionic location. Magnetic Resonance Angiography (MRA) at the moment of the acute presentation did not show any image suggesting carotid arterial dissection but showed irregular narrowing of the left internal carotid artery on its paravertebral extracranial way, consistent to enlarged intra-carotid sheath lymphoid tissue. A week later, a Doppler ultrasound was performed, showing bilateral images compatible with internal carotid arterial dissection. When Postganglionar HS is suspected, the first aetiology to rule out is a carotid arterial dissection because of its potentially fatal outcome and for being a more described entity as postganglionic HS aetiology. However, it is also evidenced that a certain diagnose is not always possible. Furthermore, we describe the enlarged internal carotid artery sheath lymphoid tissue as a possible cause of sympathetic nerve disruption causing a Postganglionar HS, although not common (AU)

Oxigenoterapia transcorneal como tratamiento de hifema persistente en un paciente con anemia de células falciformes / Transcorneal oxygen therapy for persistent hyphema in a patient with sickle cell disease

CASO CLÍNICO: Paciente varón de 10 años, de raza negra, con antecedente de traumatismo leve en ojo izquierdo; presenta agudeza visual corregida de 0,2 en escala de Snellen, hifema con altura de 1 mm, presión intraocular (PIO) de 12 mmHg en ese ojo, con incremento de PIO a 20 mmHg a las 72 h. Con el resultado positivo del estudio de drepanocitos, se decide tratamiento médico con oxigenoterapia transcorneal. Se logra el aclaramiento de la cámara anterior, con agudeza visual corregida de 0,8 y la reducción de la PIO a 8 mmHg. DISCUSIÓN: En los pacientes con hifema persitente en el contexto de una drepanocitosis, la oxigenoterapia transcorneal es una buena alternativa terapéutica. Se obtienen resultados satisfactorios inmediatos con la disminución de la PIO y el aclaramiento de la cámara anterior

CLINICAL CASE: The case concerns a 10-year-old boy of African origin, who suffered a mild ocular trauma to the left eye. Upon examination, the best visual acuity was 0.2 using the Snellen scale, with a 1mm height hyphema, intraocular pressure (IOP) of 12 mmHg on left eye, with an increase up to 20 mmHg within 72 h. With a positive test for sickle cell disease, it was decided to treat medically with transcorneal oxygen therapy. Clearing of the anterior chamber was achieved, with and improvement in the best visual acuity to 0.8, and lowering of IOP to 8 mmHg. DISCUSSION: In the context of patients with persistent hyphema with sickle cell trait, transcorneal oxygen therapy is an effective alternative therapy. Achieving immediate and favourable results by lowering the IOP and improving the clearing of the anterior chamber

Transcorneal oxygen therapy for persistent hyphema in a patient with sickle cell disease. / Oxigenoterapia transcorneal como tratamiento de hifema persistente en un paciente con anemia de células falciformes.

Clinical case The case concerns a 10-year-old boy of African origin, who suffered a mild ocular trauma to the left eye. Upon examination, the best visual acuity was 0.2 using the Snellen scale, with a 1mm height hyphema, intraocular pressure (IOP) of 12mmHg on left eye, with an increase up to 20mmHg within 72h. With a positive test for sickle cell disease, it was decided to treat medically with transcorneal oxygen therapy. Clearing of the anterior chamber was achieved, with and improvement in the best visual acuity to 0.8, and lowering of IOP to 8mmHg. DISCUSSION: In the context of patients with persistent hyphema with sickle cell trait, transcorneal oxygen therapy is an effective alternative therapy. Achieving immediate and favourable results by lowering the IOP and improving the clearing of the anterior chamber.

Osteoma de coroides con excavación coroidea y membrana neovascular asociada: estudio mediante angiografía-TCO / Choroidal osteoma with choroidal excavation and associated neovascular membrane: An OCT-angiography study

CASO CLÍNICO: Presentamos un caso de osteoma de coroides unilateral con excavación coroidea y membrana neovascular asociada estudiado mediante angiografía-TCO. En TCO y angiografía-TCO se objetivó excavación coroidea y una membrana neovascular coroidea activa. Se administraron tres dosis de aflibercept estabilizando la neovascularización coroidea. DISCUSIÓN: La angiografía-TCO permitió el análisis morfológico de la red vascular superficial del osteoma así como el control evolutivo de la membrana neovascular

CLINICAL CASE: A case is presented of a unilateral choroidal osteoma with choroidal excavation and associated neovascular membrane that was studied using OCT-angiography. The OCT and OCT-angiography revealed an area of choroidal excavation and an active neovascular membrane. Three doses of aflibercept were administered to the patient, which stabilised the neovascularisation. DISCUSSION: OCT-angiography was used to analyse the morphology of the superficial vascular network of the osteoma, as well as to monitor the evolution of the neovascular membrane

Choroidal osteoma with choroidal excavation and associated neovascular membrane: An OCT-angiography study. / Osteoma de coroides con excavación coroidea y membrana neovascular asociada: estudio mediante angiografía-TCO.

CLINICAL CASE: A case is presented of a unilateral choroidal osteoma with choroidal excavation and associated neovascular membrane that was studied using OCT-angiography. The OCT and OCT-angiography revealed an area of choroidal excavation and an active neovascular membrane. Three doses of aflibercept were administered to the patient, which stabilised the neovascularisation. DISCUSSION: OCT-angiography was used to analyse the morphology of the superficial vascular network of the osteoma, as well as to monitor the evolution of the neovascular membrane.

Defecto pupilar eferente, ¿preganglionar o posganglionar? Diagnóstico clínico vs. neuroimagen / Preganglionic or postganglionic efferent pupillary defect? Clinical versus neuroimaging diagnosis

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