Assuntos
Doenças Cerebelares/etiologia , Hemorragia Cerebral/etiologia , Deficiência do Fator XI/complicações , Adolescente , Doenças Cerebelares/diagnóstico , Doenças Cerebelares/terapia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/terapia , Deficiência do Fator XI/diagnóstico , Humanos , MasculinoRESUMO
Oculomotor nerve disease is a common cause of diplopia. When strabismus is present, absence of diplopia has to induce the research of either uncovering of visual fields or monocular suppression, amblyopia or blindness. We describe the case of a 41-year-old woman presenting with right oculomotor paresis and left object-centred visual neglect due to a right fronto-parietal haemorrhage expanding to the right peri-mesencephalic cisterna caused by the rupture of a right middle cerebral artery aneurysm. She never complained of diplopia despite binocular vision and progressive recovery of strabismus, excluding uncovering of visual fields. Since all other causes were excluded in this case, we hypothesise that the absence of diplopia was due to the object-centred visual neglect. Partial internal right oculomotor paresis causes an ocular deviation in abduction; the image being perceived deviated contralaterally to the left. Thus, in our case, the neglect of the left image is equivalent to a right monocular functional blindness. However, bell cancellation test clearly worsened when assessed in left monocular vision confirming that eye patching can worsen attentional visual neglect. In conclusion, our case argues for the possibility of a functional monocular blindness induced by visual neglect. We think that in presence of strabismus, absence of diplopia should induce the search for hemispatial visual neglect when supratentorial lesions are suspected.
Assuntos
Ambliopia/etiologia , Ambliopia/fisiopatologia , Aneurisma Intracraniano/complicações , Hemorragias Intracranianas/complicações , Transtornos da Percepção/complicações , Transtornos da Percepção/fisiopatologia , Adulto , Ambliopia/diagnóstico , Feminino , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/fisiopatologia , Humanos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/fisiopatologia , Nervo Oculomotor/fisiopatologia , Lobo Parietal/irrigação sanguínea , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiopatologia , Transtornos da Percepção/diagnóstico , Radiografia , Estrabismo/etiologiaRESUMO
The syndrome of painful arm and moving fingers associates pain in one arm or hand with involuntary movement of one or several fingers. In the four cases described, an association between a central and a peripheral nervous system lesion is demonstrated or suspected. Treatment of the condition is disappointing.