High-flow carotid cavernous fistula and 'white eye': A rare and easily misdiagnosed presentation - A case report and literature review.

The three classic symptoms of carotid cavernous fistula (CCF) are pulsating exophthalmos, bruit and conjunctival chemosis. Here, we present a clinical case of isolated abducens nerve palsy due to a high-flow CCF in an 84-year-old woman, without the typical congestive orbito-ocular features. It was a diagnostic challenge because, for patients older than 50 years with cardiovascular risk factors, ischaemic mononeuropathy is the most frequent aetiology. This case illustrates the least common type of CCF that can be easily misdiagnosed. Physicians should consider fistula as a possible diagnosis in a patient with isolated abducens nerve palsy even without the classic triad.

Simultaneous Unilateral Abducens Nerve Palsy and Contralateral Anterior Ischaemic Optic Neuropathy as the Presenting Signs of Giant Cell Arteritis.

Ischaemic optic neuropathy is the most common, feared, and recognised ocular manifestation of giant cell arteritis (GCA), while extraocular muscle palsy rarely occurs in the disease. Overlooking the diagnosis of GCA in aged patients with acquired diplopia and strabismus is not only sight- but also life-threatening. Here, we present, for the first time, a case of unilateral abducens nerve palsy and contralateral anterior ischaemic optic neuropathy as the presenting signs of GCA in a 98-year-old woman. Prompt diagnosis and treatment prevented further visual loss and systemic complications and allowed for rapid resolution of the abducens nerve palsy. We also aim to discuss the possible pathophysiological mechanisms of diplopia in GCA and to emphasise that acquired cranial nerve palsy must raise suspicion of this severe disease in elderly patients, particularly in association with ischaemic optic neuropathy.

Síndrome de Moebius y ortotropía en posición primaria: ¿es infrecuente esta asociación? (Colombia) / Moebius syndrome and orthotropia in primary position: is this association uncommon? (Colombia) / Síndrome de Moebius e ortotropia em posição primária: é uma associação incomum? (Colômbia)

El síndrome de Moebius es una enfermedad congénita poco común que se caracteriza por el compromiso unilateral o bilateral del VI y VII par craneal, lo que compromete los músculos que controlan la oculomotricidad, produciendo una parálisis en la abducción del globo ocular y los músculos involucrados en la expresión facial. Su presentación clínica y grados de severidad son variables, puede presentar compromiso simétrico o asimétrico. Adicionalmente, gran parte de los casos se relacionan con trastornos del lenguaje, anomalías musculoesqueléticas y orofaciales. En el presente artículo se presenta el caso de una paciente femenina de 3 años producto de un embarazo trigemelar con diagnóstico clínico de síndrome de Moebius al nacer, confirmado por neuroimagen en la que se evidencia la ausencia bilateral del nervio facial en ángulos pontocerebelosos, adicionalmente con un defecto completo en los movimientos oculares de abducción y aducción lo que impide el estrabismo convergente común en estos pacientes.

Moebius syndrome is a rare congenital disease characterized by unilateral or bilateral involvement of the VI and VII cranial nerves, which compromises the muscles that control ocular motricity with paralysis in the abduction of the eyeball and the muscles involved in the facial expression. Its clinical presentation and degrees of severity are variable, and it can be symmetric or asymmetric. Additionally, most of the cases are related to language disorders, musculoskeletal and orofacial anomalies. This paper presents the case of a 3-year-old female patient, product of a trigemellar pregnancy with a clinical diagnosis of Moebius syndrome at birth, confirmed by neuroimaging, which shows the bilateral absence of the facial nerve in point-lateral angles. Additionally she has a complete defect in abduction and adduction eye movements, which prevents the common convergent strabismus in these patients.

A síndrome de Moebius é uma doença congênita rara caracterizada pelo envolvimento unilateral ou bilateral dos nervos cranianos VI e VII, que compromete os músculos que controlam a oculomotricidade com paralisia na abdução do globo ocular e dos músculos envolvidos na expressão facial. Sua apresentação clínica e graus de gravidade são variáveis, podendo ser um comprometimento simétrico ou assimétrico. Além disso, a maioria dos casos está relacionada a distúrbios de linguagem, anomalias musculoesqueléticas e orofaciais. Este paper apresenta o caso de uma paciente de 3 anos de idade, fruto de uma gravidez trigêmea com diagnóstico clínico de Síndrome de Moebius ao nascimento, confirmado por neuroimagem em que é evidente a ausência bilateral do nervo facial nos ângulos ponto-cerebelares. Além disso, ela tem um defeito completo nos movimentos oculares de abdução e adução, o que impede o estrabismo convergente comum nesses pacientes.

Isolated abducens nerve palsy associated with coronavirus disease: an 8-month follow-up / Paresia isolada do nervo abducente associada ao COVID-19: 8 meses de seguimento

ABSTRACT We report the case of a previously healthy 48-year-old man who developed an isolated abducens nerve palsy 18 days after presenting with coronavirus disease (COVID-19) confirmed by reverse transcriptase polymerase chain reaction. His main complaint at arrival was double vision. Ocular examination revealed a sixth cranial nerve palsy in the left eye. The incomitant esotropia at arrival was 30 prism diopters. Abduction was markedly limited, while adduction was normal in the left eye. The patient underwent complete clinical, neurological, and neuroimaging investigations, including cerebrospinal fluid sample analysis to rule out infectious causes. A conservative approach with orthoptic therapy and Fresnel prism was opted. Eight months after the onset of COVID-19, regression of the strabismus was observed, and the patient reported complete recovery of the diplopia. This case suggests that isolated abducens nerve palsy caused by severe acute respiratory syndrome coronavirus 2 infection may improve with a conservative approach.

RESUMO Reportamos o caso de homem previamente hígido, 48 anos, com paralisia isolada do nervo abducente 18 dias após infecção pelo novo coronavírus (COVID-19) confirmada por reação cadeia polimerase de transcriptase reversa. A principal queixa do paciente na admissão era diplopia. O exame ocular revelou paralisia do sexto nervo craniano do olho esquerdo. Esotropia incomitante no exame inicial media 30 dioptrias prismáticas. Abdução estava limitada com adução completa no olho esquerdo. O paciente foi submetido a investigação clínica e neurológica com exame de neuroimagem, incluindo análise de amostra do líquido cefalorraquidiano para descartar causas infecciosas. Optou-se por abordagem conservadora com terapia ortóptica e prisma de Fresnel. Oito meses após a infecção pelo COVID-19, o paciente evoluiu com regressão do estrabismo e informou recuperação completa do quadro. Este relato sugere que paralisia isolada do nervo abducente causada por SARS-CoV-2 pode melhorar com abordagem conservadora.

Abducens Nerve Schwannoma: Case Report and Literature Review / Schwannoma do nervo abducente: Relato de caso e revisão da literatura

The authors describe a rare case of abducens nerve schwannoma, manifested with headache and diplopia, associated to right side cerebellar syndrome. During surgery, the authors identified that the origin of the tumor was from the abducens nerve, and the histopathological diagnosis confirmed that it was a schwannoma. A gross total tumor resection was performed, and the patient recovered from her symptoms 1 month after surgery. The authors followed the Case Report guidelines (CARE) guideline and the patient authorized the authors to publish the present case report by signing an informed consent form.

Os autores descrevem um raro caso de Schwannoma do nervo abducente, cuja manifestaçao clínica foi com cefaleia e diplopia, associadas à síndrome cerebelar hemisférica direita. Durante a cirurgia, os autores identificaram que o tumor tinha sua origem junto ao nervo abducente, e o diagnóstico histopatológico confirmou schwannoma. Realizou-se uma ressecção completa do tumor e o paciente apresentou melhora total dos sintomas em um mês após a cirurgia. Os autores seguiram as diretrizes do CARE para produzir este relato e o paciente assinou o termo de consentimento livre e esclarecido, autorizando a publicação deste caso.

Síndrome de pseudo-Duane secundario a Schwannoma de nervio abducens: Reporte de caso y revisión / Pseudo-Duane syndrome secondary to abducens nerve schwannoma: Case report and review

Reporte de caso de síndrome de pseudo-Duane asociado a schwannoma de nervio abducens y neurofibromatosis tipo 2 (NF2). Este síndrome es raro, caracterizado por limitación en abducción, retracción ocular, disminución de hendidura palpebral en abducción y restricción del recto medial ipsilateral en test de ducción forzada. La NF2 es también una enfermedad infrecuente caracterizada por tumores de sistema nervioso central y periférico. Los schwannomas de nervio abducens son también poco frecuentes, y se presentan comúnmente con diplopia. Se revisan brevemente estas enfermedades. Es el primer caso reportado de pseudo-Duane secundario a schwannoma de nervio abducens y NF2 según nuestro conocimiento.

A pseudo-Duane syndrome case associated with abducens nerve schwannoma and neurofibromatosis type 2 (NF2) is presented. This syndrome is a rare disease characterised by abduction limitation, ocular retraction, narrowing of the palpebral fissure in abduction, and ipsilateral medial rectus restriction on forced duction test. NF2 is also an uncommon disease which is characterised by peripheral and central nervous system tumours. Abducens nerve schwannomas are also uncommon and presents usually as diplopia. A short review of these diseases is given. This is the first case of pseudo-Duane secondary to abducens nerve schwannoma, to our knowledge.

Parálisis del nervio motor ocular externo luego de anestesia neuroaxial combinada epidural-espinal / Paralysis of the external oculomotor nerve after combined epidural-spinal neuroaxial anesthesia

Introducción: El abordaje del espacio subaracnoideo fue descrito por Quincke en el 1891. En la actualidad es práctica común para la realización de la anestesia neuroaxial subaracnoidea en las pacientes obstétricas. Las complicaciones descritas, asociadas a esto, son varias. Dentro de estas, la parálisis del nervio abducens o VI par no es frecuente y en ocasiones, no está relacionada a la punción ya que se produce días después del evento. Objetivo: Revisar la información relacionada con la complicación de parálisis del VI par. Presentación del caso: Paciente de 33 años de edad, femenina, de profesión médico, con antecedentes personales de migraña, historia de anestesia neuroaxial epidural sin complicaciones, que para la realización de una cesárea de segmento arciforme y salpinguectomia parcial bilateral, recibió una anestesia combinada peridural-espinal. El transoperatorio transcurre con estabilidad hemodinámica, hizo cefalea al tercer día del posoperatorio, que la atribuyó al antecedente de migraña y fue tratada sin evaluación por anestesiología con dipirona. A los 10 días de operada hace desviación de la mirada y diplopia, se diagnostica parálisis del VI par. Fue tratada por Neurología y se plantean varios diagnósticos diferenciales. Los estudios imagenológicos resultan negativos, se trató con vitaminas y se produjo remisión a las 6 semanas. Conclusiones: El diagnóstico de esta complicación es necesario ya que puede pasar inadvertida la relación con la anestesia y, por tanto, ser mal conducido su tratamiento(AU)

Introduction: The approach to the subarachnoid space was described by Quincke in 1891. It is now a common practice to perform subarachnoid neuroaxial anesthesia in obstetric patients. The complications described, associated with this, are several. Within these, the paralysis of the abducens nerve or sixth pair is not frequent and sometimes is not related to the puncture, since it occurs days after the event. Objective: To review the information related to the complication of paralysis of the sixth pair. Case presentation: A 33-year-old female patient, a physician, with a personal history of migraine, a history of epidural neuroaxial anesthesia without complications, who underwent combined epidural-spinal anesthesia for performing a cranial segment cesarean section and bilateral partial salpingectomy. The transoperative period runs with hemodynamic stability. There was headache three days after surgery, which was attributed to the migraine history and the patient was treated, without evaluation by anesthesiology, with dipyrone. At 10 days after surgery, the eyes are diverted and diplopia is manifested, paralysis of the sixth pair is diagnosed. She was treated by neurology and several differential diagnoses were proposed. Imaging studies are negative. She was treated with vitamins and remission occurred at six weeks. Conclusions: The diagnosis of this complication is necessary, since the relationship with anesthesia may go unnoticed and, therefore, its treatment may be poorly conducted(AU)

Abducens Nerve Palsy as Initial Manifestation of Chronic Subdural Hematoma: Case Report

Chronic subdural hematoma (CSDH) is a form of progressive intracranial hemorrhage, typically associated with cases of trauma. The manifestation of this comorbidity with abducens palsy is a rare finding. The present work aims to describe the case of an adult patient with abducens nerve palsy as a manifestation of CSDH. Chronic subdural hematoma is most commonly found in elderly patients, with systemic hypertension as amanifestation. The relation with the sixth cranial nerve is unusual and draws attention to the case reported. In addition, the prognosis is positive, since trepanation and drainage surgery was performed, as it is recommended in the literature.

Síndrome de Pierre Robin associada à Síndrome de Duane familiar do tipo III / Pierre Robin Syndrome associated with type III familial Duane Retraction Syndrome

Resumo A síndrome de Pierre Robin (PRS) consiste em uma tríade de anomalias caracterizada por micrognatia, glossoptose e fissura de palato, comumente associada com outras síndromes e ocasionalmente com alterações oculares. Na Síndrome de Duane (DRS), há uma falha na inervação do reto lateral pelo VI nervo, com inervação anômala do reto lateral por fibras do III nervo. Ainda que a PRS já tenha sido associada com mais de 50 outras síndromes, não existe na literatura relato de casos de associação com a DRS familiar. Dessa forma, esse trabalho tem por objetivo relatar um caso dessa associação em um paciente de 29 anos com recorrência das síndromes na família.

Abstract The Pierre Robin Syndrome (PRS) consists of a triad of anomalies characterized by micrognathia, glossoptosis and fissure of the palate, usually associated with other syndromes e occasionally associated with ocular variations. In Duane Retraction Syndrome (DRS), there is a failure in the lateral rectus innervation by the VI cranial nerve, with anomalous innervation of the lateral rectus by fibers of the III nerve. Even though PRS has already been associated with more than 50 other syndromes, there is not any report in literature of association with familial DRS. Thus, this work aims to report a case of this association in a 29 years old patient with recurrence of the syndromes in the family.

Palsy of the Contralateral Abducens Nerve after Aneurysm Surgery and Temporal Meningioma in the Presence of Petroclival Meningioma: A Case Report

The sixth abducens nerve is subject to injury after rare complications of intracranial hypotension caused by procedures such as dural punctures and spinal surgeries. The purpose of this case report is to discuss the mechanism of nerve palsy in these situations. Therefore, we describe a case of onset of contralateral sixth cranial nerve palsy after intracranial aneurysm and temporal meningioma surgery. Moreover, in this case there is a singularity due to the presence of the petroclival meningioma that amplified the unfolding of the lesion.

O sexto nervo abducente está sujeito a lesões após raros eventos de hipotensão intracraniana gerada por procedimentos como punções de dura-máter e cirurgias de coluna. O propósito deste relato de caso é discutir o mecanismo da paralisia deste nervo nestas situações. Para isso, descrevemos um caso de aparecimento de paresia do sexto nervo craniano contralateral após cirurgia de aneurisma intracraniano e de meningioma temporal. Além do mais, neste caso há uma singularidade em razão da presença do meningioma petroclival contralateral, que amplificou o desdobramento da lesão.

Dorello´s canal or abducens nerve canal: constancy or inconstancy? / El canal de Dorello o canal para el nervio abducente: ¿constancia o inconstancia?

Dorello´s canal is an eponym term referring to a small fibro osseous landmark, by way of arc, located at the apex of the petrous temporal region and for which the nerve abducens passes before reaching the cavernous sinus. This landmark is not referenced in Terminologia Anatomica, even as a variable structure. We selected 74 adult dry skulls and six heads fixed in formalin 10 % without classifying them by ethnicity or gender. As inclusion criteria, we selected those where the middle cranial fossa and the apex of the petrous temporal region were in good condition. Fifty seven (57) skulls (83, 82 %) showed the presence of canal bilaterally; 4 (5.89 %) showed it unilaterally to the right; 4 (5,89 %) were unilaterally at the left and 3 (4,41 %) had no canal. The results of this study indicate that this bone landmark is present in most of the skulls, even bilaterally. Since it is not referenced in the Terminologia Anatomica, we propose the term canal abducens nerve to avoid using the eponymous term Dorello´s canal.

El "canal de Dorello" es un epónimo que hace referencia a un pequeño relieve osteofibroso, a manera de arco, ubicado a nivel del ápex de la región petrosa del temporal y por el cual pasa recostado el nervio abducente antes de llegar al seno cavernoso. Dicho relieve no se encuentra referenciado en Terminologia Anatomica, ni siquiera como estructura inconstante. Se seleccionaron 74 cráneos secos y completos de adultos y seis cabezas fijadas con formalina al 10 %, sin clasificarlos por grupos étnicos ni por sexo. Como criterio de inclusión, se escogieron aquellos que tuvieran en buen estado la fosa craneal media y el ápex de la región petrosa del temporal. 57 cráneos (83,82 %) mostraron presencia del canal en forma bilateral; 4 (5,89 %) lo mostraron unilateralmente a la derecha; 4 (5,89 %) lo tenían unilateralmente a la izquierda y 3 (4,41 %) no presentaban el canal. Los resultados de este estudio señalan que este relieve óseo se presenta en la mayoría de los cráneos, incluso en forma bilateral. Puesto que no aparece referenciado en Terminologia Anatomica, proponemos el término "canal para el nervio abducente", con el fin de evitar el uso del término epónimo "canal de Dorello".

Abducens palsy after temporomandibular joint arthroscopy: a rare complication.

BACKGROUND: Arthroscopy of the temporomandibular joint (TMJ) is a minimally invasive and safe procedure; nevertheless, some accidents and complications have been described in the literature. CASE REPORT: The purpose of this article is to describe a case report of a patient that progressed to paralysis of the abducens nerve after a TMJ arthroscopy procedure.

Parálisis del nervio abducens secundario a meningioma del canal de Dorello: Consideraciones anatómicas por resonancia magnética / Abducens nerve palsy secondary to Dorello’ s canal meningioma: MRI anatomical considerations

La parálisis de los músculos oculomotores comprende una patología muy variada, producida por lesiones en varios niveles (desde la corteza cerebral hasta la placa neuromuscular) que debe ser estudiada de manera exhaustiva para poder encontrar la causa etiológica exacta y definir un manejo adecuado. La inervación motora del ojo humano es producida por los pares craneales III, IV y VI, que coordinan movimientos específicos del globo ocular hacia el objeto de atención del campo visual, permitiendo que las imágenes percibidas en la retina y transmitidas a través del nervio óptico se fusionen en una sola en la corteza visual cerebral. En este artículo, nos enfocaremos en la parálisis del nervio abducens, apoyándonos en un caso de una paciente de 50 años de edad, quien consultó por diplopía izquierda como único síntoma, y a quien se le diagnosticó un meningioma del canal de Dorello. Además haremos una correlación anatómica del VI par craneal, desde su origen hasta alcanzar el músculo recto lateral, su fisiología y el tipo de lesiones que lo pueden afectar, en especial los meningiomas, su comportamiento y las características en imágenes diagnósticas.

Palsy of the extra ocular muscles can result from several diseases affecting cranial nerves at various levels from the cerebral cortex to the neuromuscular junction. These levels must be studied exhaustively to define the exact etiology to determine appropriate management. The motor function of the human eye is produced by cranial nerves III, IV and VI, which coordinate bilateral globe movements to focus attention in an object within the visual field, allowing for images perceived in the retina and transmitted by the optic nerves to be integrated in the cerebral visual cortex. In this article, we will focus on Abducens nerve palsy exemplified by the case of a 50 year old woman with left diplopia as the only presenting symptom, found to have a meningioma in Dorello’s canal. We will emphasize the anatomic correlation of the sixth cranial nerve, from its origins up to the lateral rectus muscle, its physiology and the type of injuries affecting it, especially meningiomas and their features in diagnostic imaging.

Paralisia do VI nervo (abducente) / VI nerve palsy (abducens palsy)

Neste trabalho foi realizada uma revisão da literatura com o objetivo de integrar e compilar artigos disponíveis sobre a paralisia do VI nervo (abducente) para rever suas características clínicas, etiologias possíveis e os procedimentos clínicos, farmacológicos e cirúrgicos para seu tratamento. Primeiramente, descreve-se sua ação, localização, trajeto e possíveis lesões, depois seus principais fatores etiológicos para em seguida abordar-se o diagnóstico e o tratamento. Proposta de transposição de Carlson-Jampolsky isolada no tratamento cirúrgico da paralisia do VI nervo é também apresentada.

The authors review the basic aspects, etiology, clinical signs, diagnosis and treatment of the VI nerve palsy. Review the possible causes of abducent paralysis and location of determinant lesions. The clinical signs and clinical follow up are also observed in order to guide the etiology and therapeutic. The authors describe the clinical, pharmacological and surgical treatment. The authors emphasizes their proposal of VI nerve palsy correction using the isolated Carlson-Jampolsky transposition.

Síndrome de Moebius: descripción de una serie de 6 casos / Moebius syndrome: description of a 6 cases series

La parálisis facial y del nervio abducens congénita fue descrita como entidad clínica en 1888. Esta definición se amplió a parálisis facial unilateral o bilateral completa o incompleta, limitación de abducción ocular, disfunción de otros pares craneales, defectos oro-faciales, músculoesqueléticos y del desarrollo. Los criterios de diagnóstico varían y la entidad sigue siendo subdiagnosticada. El objetivo de este trabajo es caracterizar el cuadro clínico de pacientes con diagnóstico de Síndrome de Moebius, a través de la revisión de seis casos en control en dos Policlínicos de Neurología Infantil. En este grupo, fueron motivo de consulta: falta de esfuerzo respiratorio, hipomimiafacial, trastorno de alimentación. En dos casos hubo uso de misoprostrol durante el embarazo. Los hallazgos del examen incluyeron parálisis facial bilateral (5), unilateral (1), alteración bilateral de abducción ocular (6). Otras malformaciones asociadas fueron: paladar alto, microretrognatia, fisurapalatina, criptorquidia, polidactilia bilateral y pie bot. El conocimiento extendido de las características mínimas para el diagnóstico y de la variedad de manifestaciones de el Síndrome de Moebius, facilitan su reconocimiento y tratamiento oportuno.

Congenital facial and abducens nerves palsy were first described as a clinical entity in 1888. Later the definition was expanded to unilateral or bilateral facial palsy, limitation of ocular abduction, other cranial nerves involvement, orofacial, musculoskeletal or developmental defects. Diagnostic criteria vary among authors and the condition remains probably underdiagnosed. The aim of this study is to characterize the clinical features of Moebius Syndrome in a group of six patients diagnosed and controlled at two Child Neurology Outpatients Clinics. In this group, the main complaint at first consultation was: lack of respiratory effort, facial hypomimia, eating disorder. The use of misoprostol during pregnancy was identified in two cases. Findings on physical examination included bilateral (5) and unilateral (1) facial palsy, bilaterally impaired conjugate gaze (6).Other associated findings were: high palate, microretrognathia, cleft palate, polydactyly, bilateral cryptorchidism and clubfoot. The extended knowledge of minimal criteria required for Moebius Syndrome diagnosis, as well as other associated features, will facilitate recognition and timely treatment.

Paquimeningitis craneal hipertrófica y estenosis traqueal idiopáticas: coincidencia o asociación? / Idiopathic hypertrophic cranial paquimeningitis and tracheal stenosis: coincidence or association?

La paquimeningitis hipertrófica idiopática crónica y la estenosis traqueal subglótica idiopática son raras condiciones de origen desconocido. En ambas existen un proceso inflamatorio fibrótico que afecta respectivamente, la duramadre y la traquea. La paquimeningitis hipertrófica idiopática crónica en forma típica, causa parálisis progresiva de nervios craneales, cefaleas, hipertensión intracraneal o disfunción cerebelosa. En la estenosis traqueal subglótica idiopática, usualmente limitada a la región subglótica y los dos primeros anillos traqueales, los sintomas son variables incluyendo disnea progresiva, sibilancias y estribor notables sobre el cuello. La paquimeningitis hipertrófica idiopática crónica ocurre en pacientes de todas las edades y el examen de elección para detectarla es la resonancia magnética cerebral, en tanto que la estenosis traqueal subglótica idiopática suele afectar mujeres jóvenes o maduras y es mejor evidenciada mediante tomografía computarizada. El diagnóstico es uno de exclusión. Deben descartarse enfermedades infecciosas como tuberculosis y lúes, y otras como sarcoidosis, carcinomatosis meníngea o vasculitis. Suelen responder inicialmente a los corticosteroides pero puede haber recurrencia al suspenderlos. La evolución a largo plazo es incierta. Este trabajo informa acerca de una paciente en quien ambas condiciones se dieron cita, discutiéndose sus manifestaciones clínicas, radiológicas y patológicas. Aunque considerada esencial para el diagnóstico, en nuestro caso no se realizó una biopsia meníngea. Planteamos la posibilidad de una asociación entre ambas condiciones, por su inicio simultáneo con recaídas, por su condición de inflamación crónica y recurrente y su respuesta a los corticosteroides.

Chronic idiopathic hypertrophic paquimeningitis and chronic subglottic tracheal stenosis are rare conditions of unknown origin. In both there is a fibrotic inflammatory process affecting, respectively the dura mater and the trachea. The chronic idiopathic hypertrophic paquimeningitis in its typical presentation causes progressive paralysis of cranial nerves, headaches, intracranial hypertensión or cerebellar dysfunction. In the chronic subglottic tracheal stenosis, usually limited to the subglottic region and the two first traqueal rings, its symptoms are variable including progressive shortness of breath, wheezing and stridor notable on the neck. The chronic idiopathic hypertrophic paquimeningitis occurs in patients of all ages and the test of choice for diagnosis it is the brain magnetic resonance image, while the chronic subglottic tracheal stenosis usually affect young or mature women and is best evidenced by computerizide tomography scan. The diagnósis is one of exclusion. Infectious diseases such as tuberculosis and lues, and others as sarcoidosis, meningeal carcinomatosis or vasculitides should be discarded. Often initially respond to corticosteroids but may have recurrences when stopped. The evolution in the long term is uncertain. This paper reports on a patient with both conditions, discussing their clinical, radiological and pathological manifestation. Although considered essential for the diagnosis, in our case was not performed a meningeal biopsy. We postulate the possibility of association between these two conditions, based in their simultaneous onset, the occurence of relapses in both diseases, its condition of recurrent and chronic inflammation, and its response to corticosteroids.

Treatment outcomes in VI nerve palsy corrected by Carlson & Jampolsky technique

PURPOSE: To study the results of Carlson & Jampolsky technique in 31 patients with VI nerve palsy. METHODS: We had 23 unilateral and 8 bilateral cases. The mean unilateral preoperative esotropia was 56.8 PD ± 24 PD (30 PD to 100 PD) and they had a mean postoperative follow-up of 14 ± 17.9 months (3 to 72). The mean bilateral preoperative esotropia deviation angle in primary position was 74.5 PD ± 20.7 PD (45 PD to 100 PD) and the mean postoperative follow-up was 14.7 ± 15.7 months (4 to 47). RESULTS: In the unilateral group, 18 patients had good results and reoperation was not necessary. Out of 5 patients who were reoperated (2 undercorrections and 3 overcorrections), 2 had to use prismatic glasses. Among the bilateral patients, 2 cases were reoperated (1 undercorrection and 1 overcorrection), and the undercorrected patient remained with esotropia (ET13 PD), and also had to use prismatic glasses. CONCLUSIONS: Carlson & Jampolsky technique was useful to treat patients with VI nerve palsy. We had low reoperation rates and, among the 7 patients who needed a second intervention, only 3 did not achieve good results.

OBJETIVO: Estudar os resultados da técnica de Carlson-Jampolsky em 31 pacientes com paralisia de VI nervo. MÉTODOS: Foram avaliados 23 casos unilaterais e 8 bilaterais. A média da esotropia pré-operatória em posição primária nos casos unilaterais foi de 56.8 DP ± 24 DP (30 DP a 100 DP), o seguimento dos pacientes após a cirurgia foi de 14 ± 17.9 meses (3 a 72). A média da esotropia pré-operatória em posição primária nos casos bilaterais foi de 74.5 DP ± 20.7 DP (45 DP to 100 DP), o seguimento dos pacientes após a cirurgia foi de 14.7 ± 15.7 meses (4 a 47). RESULTADOS: Entre os pacientes do grupo unilateral, 18 casos tiveram bons resultados, sem necessitar de reoperação. Entre 5 pacientes que foram reoperados (2 subcorreções e 3 supercorreções), 2 tiveram que usar óculos com adição de prismas. Entre os casos bilaterais, 2 casos foram reoperados (1 subcorreção e 1 supercorreção), o paciente que estava subcorrigido manteve após a segunda cirurgia esotropia de 13 DP, e também teve que usar correção óptica com a adição de prisma. CONCLUSÕES: A técnica de Carlson-Jampolsky foi eficaz para tratar pacientes com paralisia de VI nervo. O número de reoperações foi baixo, e entre os reoperados, apenas 3 não apresentaram bons resultados.