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2.
Strabismus ; 27(4): 215-217, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31621456

RESUMO

The authors describe a patient with Parry-Romberg syndrome (PRS) who had acquired monocular elevation deficit (MED), ptosis, and facial hemiatrophy. A 12-year-old female patient manifested progressive ptosis and hypotropia companied with progressive hemifacial atrophy was conducted to the ophthalmology clinic for diagnosis and treatment. Forced duction and generation testing confirmed that her incomitant hypotropia was caused by paralytic muscles and not due to restriction, so it was diagnosed as MED. Knapp procedure was conducted to correct her eye positions. Six months later, the frontal muscle suspension surgery was performed to treat her ptosis. Postoperatively, the patient had orthotropia without residual left hypotropia in the primary position and her left upper eyelid function improved significantly. The ocular motor defect, in this case, is best explained by nerve paresis rather than muscle fibrosis.


Assuntos
Blefaroptose/etiologia , Hemiatrofia Facial/complicações , Estrabismo/etiologia , Blefaroptose/cirurgia , Criança , Feminino , Humanos , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Estrabismo/cirurgia
3.
BMJ Case Rep ; 12(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31537606

RESUMO

Oculopharyngeal muscular dystrophy (OPMD) is a relatively rare, adult-onset disorder characterised by proximal limb weakness, progressive eyelid drooping and swallowing difficulties. Preliminary research suggests there could be a link between OPMD and dementia; however, the current literature is relatively limited and inconsistent. This case study describes a 75-year-old female with OPMD, presenting to an older adults community mental health team with memory problems and word finding difficulties. A neuropsychological assessment was carried out. The results of her assessment were difficult to interpret; she demonstrated impairments in most cognitive domains tested and her presentation did not appear to reflect any typical dementia profile. It was thought she was most likely presenting with a dementia; however, the exact aetiology remains unclear. The dementia could be a result of OPMD, vascular changes or both. This report emphasises the need for further research into the possible causal link between OPMD and dementia/cognitive decline.


Assuntos
Disfunção Cognitiva , Demência/complicações , Distrofia Muscular Oculofaríngea/complicações , Idoso , Blefaroptose/etiologia , Transtornos de Deglutição/etiologia , Feminino , Humanos , Debilidade Muscular/etiologia , Testes Neuropsicológicos
4.
J Craniofac Surg ; 30(7): 2211-2213, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31369506

RESUMO

In this report, the authors introduce a rare complication after reduction malarplasty in 2 patients. One patient underwent temporal rhytidectomy and malar osteotomy. The other patient underwent zygoma grinding without osteotomy. Both patients presented malar depression and cheek ptosis after surgery and visited the clinic. Physical examination, cephalometric radiographs, and facial 3-dimensional computed tomography were conducted, which indicated total zygomatic arch bone resorption. After examining the possible causes of the complication, the authors concluded that preserving enough blood supply and performing adequate rigid fixation of the separated zygoma bone are key prevention for bone resorption. This is the first report of total zygomatic arch bone resorption after reduction malarplasty.


Assuntos
Reabsorção Óssea/diagnóstico por imagem , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Zigoma/diagnóstico por imagem , Adulto , Blefaroptose/diagnóstico por imagem , Blefaroptose/etiologia , Reabsorção Óssea/etiologia , Craniotomia/efeitos adversos , Face/cirurgia , Ossos Faciais/cirurgia , Feminino , Humanos , Osteotomia , Exame Físico , Radiografia , Ritidoplastia , Tomografia Computadorizada por Raios X/métodos
6.
J Med Case Rep ; 13(1): 273, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31466520

RESUMO

BACKGROUND: With increasing treatment options available, neuroendocrine tumor has become a chronic disease and may present later on with atypical manifestation of disease spread once resistant to treatment. CASE PRESENTATION: A 74-year-old white British woman undergoing treatment for metastatic well-differentiated neuroendocrine tumor for the past 9 years presented with a brief history of mild frontal headache, and progressive left ptosis and ocular palsy. She had no visual loss, and had neither speech nor motor deficit. At the outset, it was crucial to exclude acute or missed stroke. An urgent magnetic resonance imaging of her head revealed an unusual skull base metastasis extending into the cavernous sinus, with no peritumoral edema. Following discussion at a specialist neuro-oncology meeting and a neuroendocrine tumor multidisciplinary team meeting, she proceeded to have conventional fractionated radiotherapy followed by subsequent palliative chemotherapy. CONCLUSIONS: Intracranial metastasis is rare in patients with neuroendocrine tumor, particularly in those with well-differentiated histology; skull base metastasis is even more uncommon. Management of intracranial metastasis from a rare tumor should always be discussed in a specialist multidisciplinary meeting. Surgery or radiotherapy, including stereotactic radiosurgery, should be considered in skull base metastases. Hormonal abnormalities may occur following radiotherapy to skull base metastases and should be monitored closely in the first few months post treatment.


Assuntos
Neoplasias Intestinais/patologia , Tumores Neuroendócrinos/patologia , Neoplasias da Base do Crânio/diagnóstico por imagem , Neoplasias da Base do Crânio/secundário , Idoso , Blefaroptose/etiologia , Evolução Fatal , Feminino , Cefaleia/etiologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Imagem por Ressonância Magnética , Doenças do Nervo Oculomotor/etiologia , Tomografia por Emissão de Pósitrons
7.
Ophthalmic Plast Reconstr Surg ; 35(4): 383-386, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283689

RESUMO

PURPOSE: To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups. METHODS: Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair. RESULTS: Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = -0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group. CONCLUSIONS: Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group.


Assuntos
Blefaroplastia/métodos , Blefaroptose/cirurgia , Pálpebras/cirurgia , Músculos Oculomotores/cirurgia , Esclera/cirurgia , Adolescente , Adulto , Blefaroptose/etiologia , Pálpebras/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
10.
Semin Ophthalmol ; 34(6): 442-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31314625

RESUMO

Purpose: To objectively measure the upper eyelid position following phacoemulsification cataract surgery and to identify the determinants of postoperative transient ptosis. Methods: This is a single arm prospective study of patients who underwent cataract surgery from January to May 2017 at a tertiary Eye Hospital in Spain. Data comprised of: the type of anesthesia, the duration that the speculum remained in place and the total surgical time (duration of the procedure). The total surgical time was defined as, the time from the beginning of the paracentesis to the closure of the wounds (incision time). Digital photographs were obtained of: the face with the eye in primary gaze, looking inferiorly and superiorly, preoperatively, and 1, 30, 90 and 180 days postoperatively. Measurements for eyelid crease, levator function, and marginal reflex distance 1 (MRD1) were performed using ImageJ. Statistical analysis was performed of the difference between the preoperative and postoperative measurements. Results: The study consisted of 112 patients. The median lid crease was 9.0 mm [IQR (interquartile range) 7.5; 10.0] both preoperatively and at 180 days postoperatively (IQR 8.0; 10.8). No statistical difference was determined in the lid crease measurements between these two times (P = .17). The median levator function differed significantly preoperatively, at day 1 and 30, 60 and 180 days postoperatively (P < .01). MRD1 decreased significantly from a median of 3.01 mm preoperatively to 2.7 mm at 30 days postoperatively (P = .05) but was similar at preoperative and after 180 days (P = .7). The correlation of MRD1 to the duration of the speculum in place (P = .2) and the incision time (P = .57) was not significant. Conclusions: Ptosis, following phacoemulsification cataract surgery, is mild and transient, occurring only in the early postoperative period.


Assuntos
Blefaroplastia/métodos , Blefaroptose/etiologia , Piscadela/fisiologia , Pálpebras/fisiopatologia , Facoemulsificação/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Blefaroptose/fisiopatologia , Blefaroptose/cirurgia , Pálpebras/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Prospectivos , Reoperação , Fatores de Tempo
11.
J Craniofac Surg ; 30(7): e649-e653, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31261339

RESUMO

The purpose of this study was to evaluate the changes of lower eyelid position and the incidence of reverse ptosis after reconstruction of orbital floor fracture. The authors retrospectively reviewed the clinical records of patients who received reconstruction of orbital floor wall fractures between 2014 and 2017. Digital photographs were taken preoperatively, and at 1 week, 1 month, and 3 months postoperatively. Main measurements were marginal reflex distance 2 (MRD 2), which was measured by analyzing the digital photographs using ImageJ software. Among 264 patients with orbital wall fracture, The authors enrolled 32 eyes (18 right eyes and 14 left eyes) of 32 patients (21 males and 11 females) with a mean age of 32.1 years (range, 16-57 years). 7 (21.9%) of 32 patients had reverse ptosis at postoperative 3 months. When MRD2 of affected eye was compared based on the fellow eye, 7 patients with reversed ptosis showed a definite MRD 2 decrease (>1 mm) of affected eye from postoperative 1 month. Age showed a significant negative correlation with the difference of MRD2 between affected and fellow eye at postoperative 1 and 3 months (r = -0.378, P = 0.033 and r = -0.372, P = 0.036, respectively). Postoperative complications were not observed in all patients. The transconjunctival access in orbital floor wall surgery is a safe and useful surgical approach. However, some may have a reverse ptosis postoperatively, especially older patients. Reverse ptosis is a major clinical finding that should not be overlooked in post-operative follow-up.


Assuntos
Blefaroptose , Pálpebras/cirurgia , Fraturas Orbitárias/cirurgia , Complicações Pós-Operatórias , Adolescente , Adulto , Blefaroptose/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Adulto Jovem
12.
Pediatr Emerg Care ; 35(8): e150-e151, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31335784

RESUMO

Acute disseminated encephalomyelitis (ADEM) is exceptionally uncommon, with approximately 3 pediatric cases reported in the United States each year. Given the uncommon nature of ADEM, most of the current data rely heavily on case reports. The overwhelming majority of cases have been reported after an acute viral infection or vaccination. Although up to 90% of cases exhibit full remission after intravenous steroids, those in which treatment is delayed can display debilitating sequelae. Here, we present a case of ADEM in a 7-year-old boy who presented with double vision and imbalance with no recent history of acute viral infections or vaccinations.


Assuntos
Diplopia/etiologia , Encefalomielite Aguda Disseminada/diagnóstico por imagem , Transtornos Neurológicos da Marcha/etiologia , Administração Intravenosa , Blefaroptose/etiologia , Criança , Diplopia/diagnóstico , Encefalomielite Aguda Disseminada/líquido cefalorraquidiano , Encefalomielite Aguda Disseminada/tratamento farmacológico , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Esteroides/administração & dosagem , Esteroides/uso terapêutico , Resultado do Tratamento
13.
J Med Case Rep ; 13(1): 221, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31324211

RESUMO

BACKGROUND: Guillain-Barré syndrome is an acute inflammatory polyradiculoneuropathy. Nearly half of patients with Guillain-Barré syndrome have cranial nerve involvement. However, isolated bilateral ptosis without ophthalmoplegia is a rare manifestation, and isolated unilateral ptosis without ophthalmoplegia in Guillain-Barré syndrome has not previously been reported in the literature. Furthermore, only few cases of Guillain-Barré syndrome with cranial nerve enhancement visualized by gadolinium-enhanced magnetic resonance imaging have previously been reported. We describe the first reported case of unilateral ptosis without ophthalmoplegia in Guillain-Barré syndrome and associated multiple cranial nerve enhancement seen by gadolinium-enhanced magnetic resonance imaging. CASE PRESENTATION: Our patient was a 55-year-old Sinhalese man who was admitted to a tertiary care hospital in Sri Lanka with acute-onset progressive weakness in the lower limbs followed by the upper limbs. He had bilateral symmetrical flaccid quadriparesis with absent reflexes and flexor plantar response. Left-sided isolated partial ptosis without associated ophthalmoplegia was noted with normal pupils. The patient's neurological examination was otherwise normal. A nerve conduction study showed a severe demyelinating type of polyneuropathy. No decremental response to repetitive nerve stimulation was observed, and the result of a single-muscle-fiber electromyogram was negative. A diagnosis of Guillain-Barré syndrome was made, and the patient was treated with intravenous immunoglobulin. His condition gradually deteriorated over the next few days, and he became quadriplegic despite the completion of immunoglobulin therapy. Later he developed multiple cranial nerve palsies, including bi-lateral lower motor neuron type facial nerve palsy, and he required mechanical ventilation. By this time, he had complete left-sided ptosis with a normal right eye. He never developed ophthalmoplegia or ataxia. Magnetic resonance imaging of the brain showed contrast enhancement in the intracranial part of multiple cranial nerve roots and basal leptomeninges. He gradually improved with plasmaparesis, and ptosis was the first to improve. CONCLUSIONS: Even though Guillain-Barré syndrome was recognized a century ago, there are still many unanswered questions about it and its florid presentation. Large-scale studies are needed for better understanding of its pathophysiology and prototypes and to find answers for still-unanswered questions. The clinician must have a high index of suspicion and be familiar with mimics and prototypes to diagnose Guillain-Barré syndrome accurately without delay.


Assuntos
Blefaroptose/etiologia , Síndrome de Guillain-Barré/complicações , Paralisia Facial/etiologia , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Sri Lanka
14.
Medicine (Baltimore) ; 98(22): e15814, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145315

RESUMO

RATIONALE: Anterior chamber intraocular lens (ACIOL) remains a surgical option for visual rehabilitation during complicated cataract surgeries with minimal or no capsular support. ACIOL causing scleral perforation is rare, and the involved causes remain debatable. PATIENT CONCERNS: Here, we present the case of a 62-year-old female with spontaneous protrusion of an angle-supported ACIOL haptic tip through an extracapsular cataract extraction (ECCE) wound, who presented with progressive right-eye ptosis and right-side headache. DIAGNOSIS: The slit lamp examination showed a vertically aligned angle-supported Kelman Multiflex ACIOL in the anterior chamber. The ACIOL had deviated upward, with upper haptic protruding from the previous ECCE scleral tunnel wound. Fundus examination and optical coherence tomography (OCT) revealed cystoid macular edema (CME) with mild epiretinal membrane (ERM). INTERVENTIONS: The patient was treated with ACIOL extraction, pars plana vitrectomy, ERM peeling, and scleral-fixated posterior chamber IOL implantation. OUTCOMES: Three months after surgery, the best-corrected visual acuity in the right eye improved to 20/80 and the right-side headache and hyperemia of the conjunctiva had significantly subsided. Repeated OCT revealed improved CME. LESSONS: Poor construction of the scleral tunnel incision may cause wound dehiscence. The vertically aligned ACIOL haptic tip resting at the angle may exert stress toward the dehiscent wound, exacerbating tissue erosion and causing scleral perforation with haptic tip exposure.


Assuntos
Blefaroptose/etiologia , Blefaroptose/cirurgia , Extração de Catarata/efeitos adversos , Implante de Lente Intraocular/métodos , Lentes Intraoculares/efeitos adversos , Câmara Anterior , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia de Coerência Óptica , Acuidade Visual
15.
Nat Rev Dis Primers ; 5(1): 30, 2019 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-31048702

RESUMO

Myasthenia gravis (MG) is an autoimmune disease caused by antibodies against the acetylcholine receptor (AChR), muscle-specific kinase (MuSK) or other AChR-related proteins in the postsynaptic muscle membrane. Localized or general muscle weakness is the predominant symptom and is induced by the antibodies. Patients are grouped according to the presence of antibodies, symptoms, age at onset and thymus pathology. Diagnosis is straightforward in most patients with typical symptoms and a positive antibody test, although a detailed clinical and neurophysiological examination is important in antibody-negative patients. MG therapy should be ambitious and aim for clinical remission or only mild symptoms with near-normal function and quality of life. Treatment should be based on MG subgroup and includes symptomatic treatment using acetylcholinesterase inhibitors, thymectomy and immunotherapy. Intravenous immunoglobulin and plasma exchange are fast-acting treatments used for disease exacerbations, and intensive care is necessary during exacerbations with respiratory failure. Comorbidity is frequent, particularly in elderly patients. Active physical training should be encouraged.


Assuntos
Miastenia Gravis/diagnóstico , Miastenia Gravis/terapia , Acetilcolinesterase/genética , Acetilcolinesterase/fisiologia , Corticosteroides/uso terapêutico , Agrina/genética , Agrina/fisiologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Autoanticorpos/análise , Autoanticorpos/sangue , Biomarcadores/análise , Biomarcadores/sangue , Blefaroptose/etiologia , Colágeno/genética , Colágeno/fisiologia , Cortactina/genética , Cortactina/fisiologia , Eletromiografia/métodos , Humanos , Canal de Potássio Kv1.4/genética , Canal de Potássio Kv1.4/fisiologia , Proteínas Relacionadas a Receptor de LDL/genética , Proteínas Relacionadas a Receptor de LDL/fisiologia , Proteínas Musculares/genética , Proteínas Musculares/fisiologia , Miastenia Gravis/fisiopatologia , Receptores Proteína Tirosina Quinases/genética , Receptores Proteína Tirosina Quinases/fisiologia , Receptores Colinérgicos/genética , Receptores Colinérgicos/fisiologia , Receptores Nicotínicos/genética , Fatores de Risco , Canal de Liberação de Cálcio do Receptor de Rianodina/genética , Canal de Liberação de Cálcio do Receptor de Rianodina/fisiologia
16.
Middle East Afr J Ophthalmol ; 26(1): 37-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114123

RESUMO

Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD.


Assuntos
Blefaroptose/etiologia , Anormalidades do Olho/complicações , Cardiopatias Congênitas/etiologia , Anormalidades Maxilomandibulares/etiologia , Doenças do Sistema Nervoso/etiologia , Disco Óptico/anormalidades , Anisometropia/etiologia , Anisometropia/fisiopatologia , Blefaroptose/diagnóstico , Blefaroptose/fisiopatologia , Criança , Esotropia/etiologia , Esotropia/fisiopatologia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Anormalidades Maxilomandibulares/diagnóstico , Anormalidades Maxilomandibulares/fisiopatologia , Masculino , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/fisiopatologia , Reflexo Anormal
18.
Semin Ophthalmol ; 34(2): 98-105, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835589

RESUMO

PURPOSE: To investigate possible correlations between blepharoptosis and pterygium in a nationally representative sample of the Korean population. METHODS: This population-based, cross-sectional study was comprised of 3,685 males and 4,792 females (≥ 19 years of age) participating in the fifth annual Korea National Health and Nutrition Examination Survey (KNHANES) from 2010 to 2012. The enrolled subjects underwent interviews, clinical examinations, and laboratory tests. Statistical tests were used to compare the prevalence of blepharoptosis, according to pterygium subtypes or pterygium existence. Multiple logistic regression analyses were also used to find the associations of blepharoptosis with pterygium. RESULTS: Pterygium was present in 10.3% of males and 9.8% of females. The odds ratios (ORs) of pterygium in Korean males significantly decreased as the severity of blepharoptosis increased (p for trend = 0.0252). Using three models in multivariate analyses, males with blepharoptosis had an OR (95% confidence interval, (CI)) of 0.643 (0.435 ~ 0.951) for pterygium compared with males with no blepharoptosis, after adjusting for age, body mass index, smoking status, alcohol consumption, physical activity, serum vitamin D levels, diabetes mellitus, metabolic syndrome, high blood pressure, and stress intolerance. There was no significant association between blepharoptosis and females. CONCLUSIONS: The association between blepharoptosis and pterygium in the Korean population showed a gender difference. Epidemiologic evidence only showed a negative correlation between blepharoptosis and pterygium in Korean males. Further studies are needed, therefore, to examine the sex difference in the pathogenesis of pterygium.


Assuntos
Blefaroptose/etiologia , Inquéritos Nutricionais/métodos , Vigilância da População , Pterígio/complicações , Idoso , Blefaroptose/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Pterígio/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
19.
J Med Case Rep ; 13(1): 60, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30867062

RESUMO

BACKGROUND: The trigeminal autonomic cephalalgias are a group of primary headache syndromes marked by severe head pain and associated cranial autonomic symptoms which can include a full or partial Horner's syndrome. Rarely, the eye-related symptoms will become fixed even between headache attacks. There is minimal documentation that the Horner's syndrome can be reversed if successful treatment of the underlying headache disorder is initiated. CASE REPORTS: Two cases are presented of trigeminal autonomic cephalalgia subtypes with chronic persistent Horner's syndromes that alleviated with treatment of the underlying primary headache disorder. Patient 1, an 82-year-old Caucasian woman, presented with hemicrania continua with a partial Horner's syndrome that was present for 2 years. She was unable to take indomethacin as she was on anticoagulation. After a C2-3 diagnostic facet injection, not only did she become pain free but her ptosis completely resolved. She then underwent a radiofrequency facet neurotomy with complete alleviation of head pain and complete resolution of her ptosis. Patient 2, a 21-year-old Caucasian woman, presented with long-lasting autonomic symptoms with hemicrania syndrome and a fixed miosis and ptosis of 6 months' duration. After achieving 2 months of pain freedom on indomethacin her Horner's syndrome completely resolved. CONCLUSION: A chronic fixed partial or full Horner's syndrome can occur in trigeminal autonomic cephalalgia subtypes, but it can also be reversed in patients with treatment even after months to years of duration. This would suggest that the sympathetic dysfunction leading to the eye-related symptoms is from irritation of the sympathetic chain rather than permanent injury as the result of vasodilatory trauma after trigeminal autonomic reflex activation.


Assuntos
Indometacina/administração & dosagem , Bloqueio Nervoso , Ablação por Radiofrequência , Cefalalgias Autonômicas do Trigêmeo/terapia , Idoso de 80 Anos ou mais , Blefaroptose/etiologia , Blefaroptose/terapia , Vértebras Cervicais , Doença Crônica , Feminino , Síndrome de Horner/etiologia , Humanos , Resultado do Tratamento , Cefalalgias Autonômicas do Trigêmeo/complicações , Adulto Jovem
20.
Korean J Ophthalmol ; 33(1): 1-7, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30746906

RESUMO

PURPOSE: To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor. METHODS: A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. RESULTS: The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. CONCLUSIONS: The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.


Assuntos
Blefaroptose/etiologia , Tratamento Conservador/métodos , Gerenciamento Clínico , Paralisia Facial/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Blefaroptose/diagnóstico , Blefaroptose/terapia , Criança , Pré-Escolar , Progressão da Doença , Paralisia Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
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