Focal reactive nodular gliosis: an extremely rare retinal astrocytic tumor.

Focal reactive nodular gliosis (FRNG) is an extremely rare benign retinal reactive astrocytic tumor that results from the proliferation of well-differentiated glial cells secondary to a variety of retinal conditions. We describe a case of this tumor in a 64-year-old male in association with a chorioretinal scar he has had since childhood. The symptom was sudden painful vision loss. In the clinical examination, iris rubeosis, posterior synechiae, cataract, vitreous haze and a suspected fundus mass were showed. B-scan ultrasonography demonstrated a retinal mass consistent with choroidal melanoma. The magnetic resonance imaging (MRI) showed a well-circumscribed mass with T1 hyperintensity and T2 hypointensity. Enucleation was performed and histopathologic and immunohistochemical studies confirmed the diagnosis of FRNG.

Lateral eyelid island flap for reconstruction of large central and medial full-thickness defects of the lower eyelid.

INTRODUCTION: To report our experience with lateral eyelid island flaps for reconstruction of large central and medial full-thickness defects of lower eyelid. METHODS: Retrospective case series of patients with large central and medial full-thickness lower lid defects repaired with medial transposition of the lateral lower lid combined with a temporal myocutaneous flap. Preoperatively the authors collected demographic data, etiology and percentage of the defects. Postoperatively the lids were assessed for flap viability and lower eyelid margin position and contour. RESULTS: The sample was comprised of 10 patients (5 females) with a mean of age 60.10 (SD 13.75) years. The defects ranging from 50% to 75% of the lid width resulted from excision of eight basal cell carcinomas, one (10%) malignant schwannoma and one (10%) squamous cell carcinoma. The median follow-up was 1.58 years (IQR 2.58). Flap ischemia was not observed in any eyelid. One mild ectropion was observed in just one lid. All patients were satisfied with the esthetic results. CONCLUSIONS: Medial transposition of the lateral lower lid island flap combined with horizontal myocutaneous advancement flap is an excellent one-stage procedure that avoids the drawbacks of the two-stages procedures.

Impacto de la enfermedad de pequeño vaso en la inestabilidad del anciano. Estudio descriptivo transversal / Vestibular Pathology and Instability in the Elderly and its Relationship with Small Vessel Disease. Cross-Sectional Descriptive Study

Introducción y objetivo: La elevada prevalencia de mareo e inestabilidad en los ancianos, su complejo diagnóstico e importantes consecuencias (caídas y lesiones derivadas) constituyen un grave problema sanitario. El presente estudio tiene como objetivo principal determinar si existe relación entre dichos síntomas y la presencia de enfermedad de pequeño vaso. Secundariamente intentaremos describir las causas más frecuentes de mareo e inestabilidad en los pacientes ancianos. Método: Se realiza un estudio descriptivo transversal con 214 pacientes mayores de 70 años remitidos por vértigo, mareo o inestabilidad. Se valoran los diagnósticos más frecuentes y se comparan tres grupos: 1) Patología vestibular periférica, 2) mareo o inestabilidad de causa desconocida y 3) grupo de control. Para ello se utiliza la escala de Fazekas que determina la magnitud de las lesiones de sustancia blanca por imágenes de resonancia magnética. Resultados: El vértigo posicional paroxístico benigno fue el diagnóstico más frecuente (17,3%), seguido de la enfermedad de Ménière (15%). Un 20% de los pacientes fueron clasificados como origen desconocido o multifactorial. La enfermedad de pequeño vaso se encontró con mayor frecuencia en el grupo con mareo de causas desconocidas (p=0,034). Conclusiones: se reafirma la asociación entre las lesiones de sustancia blanca, sugerentes de enfermedad de pequeño vaso, y la mayor aparición de mareo e inestabilidad en los ancianos; siendo la prevalencia de la enfermedad mucho menor en el grupo de control que en aquellos con mareo de causa desconocida. Asimismo, se determina que el vértigo posicional paroxístico benigno es el diagnóstico más frecuente de mareo e inestabilidad en el anciano. (AU)

Orbital neuromuscular choristoma of the ophthalmic nerve.

INTRODUCTION: Neuromuscular choristoma (NC) is a rare tumor composed of striated muscle fibers admixed with nerve fibers that often affects large peripheral nerve trunks in children. To the best of our knowledge, this is the first reported case in the literature of a NC of the ophthalmic nerve in an adult. CASE DESCRIPTION: A 27-year-old woman presented with a 20-day history of left periorbital headache radiating to the frontotemporal region, with associated tearing, nausea, and vomiting. The examination was normal, except for hypoesthesia in the distribution of the first trigeminal nerve branch (V1). Cranial computerized tomography showed a lesion in the left orbit and cavernous sinus with widening of the superior orbital fissure. On magnetic resonance imaging, the lesion was well-defined with fusiform morphology and showed a central cystic component and peripheral enhancement. An extradural approach was performed with subtotal tumor resection. Biopsy showed proliferation of striated muscle cells admixed with nerve fascicles and Schwann cells. A pathological diagnosis of NC of V1 was determined. Six months after surgery, left hypotropia with limitation of supraduction was observed, as well as hypoesthesia and paralysis of the left forehead with ipsilateral eyebrow ptosis. The rest of the examination remained within normal limits. CONCLUSION: NC should be considered in the differential diagnosis of a young patient with periorbital headache and hypoesthesia in the V1 region.