RESUMO
CASO CLÍNICO: Mujer de 38 años con pérdida visual en ojo izquierdo y papiledema bilateral. La resonancia magnética nuclear (RMN) mostraba engrosamiento de la duramadre y la presión intracraneal estaba elevada. Se descartó enfermedad infecciosa, tumoral y autoinmune. DISCUSIÓN: La respuesta inicial a corticoides fue satisfactoria con desaparición del edema de disco óptico, mejoría de la agudeza visual y mejoría radiológica. Después de un año sin tratamiento presentó un nuevo brote, desarrollando una neuropatía óptica izquierda con pérdida irreversible de visión a pesar del retratamiento con corticoides y azatioprina
CASE REPORT: A 38-year-old female patient with bilateral papilledema who presented with loss of vision in her left eye. The Magnetic Resonance Imagining (MRI) showed thickening of the dura mater, and the intracranial pressure was elevated. A cancer, infectious, and autoimmune origin was ruled out. DISCUSSION: The initial response to high doses of corticoids was satisfactory, with disappearance of the optic disc enema, with visual acuity and an improvement in the MRI. However, after one year without treatment she had a new outbreak of the disease. Despite renewed treatment with corticoids and azathioprine, the patient developed a left optic neuropathy and irreversible visual loss
Assuntos
Humanos , Feminino , Meningite/metabolismo , Meningite/patologia , Atrofia Óptica/metabolismo , Atrofia Óptica/patologia , Corticosteroides/administração & dosagem , Corticosteroides/síntese química , Diplopia/congênito , Diplopia/patologia , Meningite/diagnóstico , Meningite/genética , Atrofia Óptica/diagnóstico , Atrofia Óptica/genética , Corticosteroides , Corticosteroides/farmacocinética , Diplopia/complicações , Diplopia/diagnósticoRESUMO
CASO CLÍNICO: Mujer de 80 años intervenida mediante trabeculectomía por glaucoma primario de ángulo abierto en la que, debido al incremento tensional, se inició tratamiento con latanoprost. La monitorización de la tensión arterial (TA) demostró un incremento estadísticamente significativo de la TA tanto sistólica como diastólica coincidiendo con el uso del hipotensor tópico, que se resolvió al suspender voluntariamente el tratamiento, volviendo a elevarse al reintroducir la prostaglandina. DISCUSIÓN: Los análogos de las prostaglandinas disminuyen la presión intraocular al producir vasodilatación de las arterias ciliares y epiesclerales, aumentando el drenaje del humor acuoso. Los efectos cardiovasculares son poco frecuentes pero se han descrito por el efecto vasoconstrictor que puede desencadenarse como el incremento reversible de la TA de este caso
CASE REPORT: An 80 year old woman operated on by trabeculectomy for primary open-angle glaucoma due to increased pressure, who started treatment with latanoprost. Monitoring of blood pressure (BP) showed a statistically significant increase in both systolic and diastolic BP, coinciding with the use of topical hypotensive, which resolved by voluntarily suspending treatment, thus increasing again to reintroduce the prostaglandin. DISCUSSION: Prostaglandin analogs reduce intraocular pressure to produce vasodilation of the episcleral and ciliary arteries, increasing the outflow of aqueous humor. Cardiovascular effects are rare, but have been described by the vasoconstrictor effect that can trigger the reversible increase in BP, as in this case
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Hipertensão/diagnóstico , Hipertensão/metabolismo , Terapêutica/métodos , Terapêutica , Hipertensão Ocular/metabolismo , Hipertensão Ocular/patologia , Diabetes Mellitus Tipo 2/diagnóstico , Hipertensão/complicações , Hipertensão/patologia , Terapêutica , Terapêutica/ética , Hipertensão Ocular/complicações , Hipertensão Ocular/diagnóstico , Diabetes Mellitus Tipo 2/complicaçõesRESUMO
CASE REPORT: A 38-year-old female patient with bilateral papilledema who presented with loss of vision in her left eye. The Magnetic Resonance Imagining (MRI) showed thickening of the dura mater, and the intracranial pressure was elevated. A cancer, infectious, and autoimmune origin was ruled out. DISCUSSION: The initial response to high doses of corticoids was satisfactory, with disappearance of the optic disc enema, with visual acuity and an improvement in the MRI. However, after one year without treatment she had a new outbreak of the disease. Despite renewed treatment with corticoids and azathioprine, the patient developed a left optic neuropathy and irreversible visual loss.
Assuntos
Meningite/complicações , Doenças do Nervo Óptico/etiologia , Corticosteroides/uso terapêutico , Adulto , Feminino , Humanos , Hipertrofia , Imunossupressores/uso terapêutico , Meningite/patologia , Doenças do Nervo Óptico/tratamento farmacológico , Recidiva , Falha de TratamentoRESUMO
CASE REPORT: An 80 year old woman operated on by trabeculectomy for primary open-angle glaucoma due to increased pressure, who started treatment with latanoprost. Monitoring of blood pressure (BP) showed a statistically significant increase in both systolic and diastolic BP, coinciding with the use of topical hypotensive, which resolved by voluntarily suspending treatment, thus increasing again to reintroduce the prostaglandin. DISCUSSION: Prostaglandin analogs reduce intraocular pressure to produce vasodilation of the episcleral and ciliary arteries, increasing the outflow of aqueous humor. Cardiovascular effects are rare, but have been described by the vasoconstrictor effect that can trigger the reversible increase in BP, as in this case.
Assuntos
Hipertensão/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Prostaglandinas F Sintéticas/efeitos adversos , Idoso de 80 Anos ou mais , Pressão Sanguínea/efeitos dos fármacos , Feminino , Glaucoma de Ângulo Aberto/tratamento farmacológico , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular/efeitos dos fármacos , Latanoprosta , Prostaglandinas F Sintéticas/farmacologia , Prostaglandinas F Sintéticas/uso terapêutico , Fatores de Risco , Trabeculectomia , Sistema Vasomotor/efeitos dos fármacosRESUMO
CASO CLÍNICO: Paciente alcohólico con disminución de agudeza visual en el ojo derecho, presentando una hemorragia peripapilar temporal superior y, posteriormente, trombosis de subrama venosa. La analítica mostró hiperhomocisteinemia con coagulación normal. En la evolución desarrolló una neuropatía óptica bilateral. DISCUSIÓN: La elevación de homocisteína es común en alcohólicos, considerándose un factor de riesgo cardiovascular. El ácido fólico y las vitaminas B6 y B12 participan en el metabolismo y su déficit puede incrementar sus niveles. CONCLUSIONES: Ante la observación de fenómenos vasculares oclusivos retinianos y neuropatía óptica isquémica en pacientes jóvenes, se deben descartar alteraciones en la coagulación y aumento de homocisteína
CASE REPORT: An alcoholic patient with loss of vision in his right eye and a peripapillar haemorrhage, who then presented with a venous thrombosis. Blood analysis revealed hyperhomocysteinemia with coagulation parameters within the normal range. In the follow-up he developed a bilateral optic neuropathy. DISCUSSION: An increase in homocysteine levels is common in alcoholics, and it has been considered a vascular risk factor. Folic acid and vitamins B6 and B12 deficiency may lead to hyperhomocysteinemia, as they participate in its metabolism. CONCLUSIONS: When presented with a retinal occlusive disease or ischemic optic neuropathy in young patients, coagulation disorders and elevated levels of homocysteine should be ruled out
Assuntos
Humanos , Masculino , Adulto , Hiper-Homocisteinemia/complicações , Neurite Óptica/complicações , Oclusão da Veia Retiniana/complicações , Alcoolismo/complicações , Hemorragia Ocular/etiologiaRESUMO
CASE REPORT: An alcoholic patient with loss of vision in his right eye and a peripapillar haemorrhage, who then presented with a venous thrombosis. Blood analysis revealed hyperhomocysteinemia with coagulation parameters within the normal range. In the follow-up he developed a bilateral optic neuropathy. DISCUSSION: An increase in homocysteine levels is common in alcoholics, and it has been considered a vascular risk factor. Folic acid and vitamins B6 and B12 deficiency may lead to hyperhomocysteinemia, as they participate in its metabolism. CONCLUSIONS: When presented with a retinal occlusive disease or ischemic optic neuropathy in young patients, coagulation disorders and elevated levels of homocysteine should be ruled out.