Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.278
Filtrar
1.
Fortschr Neurol Psychiatr ; 88(5): 331-336, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32422672

RESUMO

A 72-year-old woman presented to our emergency centre with acute horizontal diplopia. Neurological examination revealed an isolated abducens nerve paresis on the left. Hilar enlargement seen on the chest x-ray and an elevated serum ACE level led us to suspect sarcoidosis, but the patient declined further evaluation. In the following days, her visual acuity decreased steadily, and she developed cervicothoracic pain, left sided ptosis, weakness of the right arm, and general asthenia. When she was readmitted as an emergency case, neurological examination revealed decreased visual acuity, external ophthalmoplegia and ptosis on the left and a C8 radicular lesion on the right. Imaging studies showed multilocular lesions, e. g. in the left orbital space, spinal epidural manifestations and lymphoma nodular involvement, including retroperitoneally. Laboratory chemistry showed elevated serum levels of ACE, sIL2 receptor and an elevated CD4 / CD8 ratio while bronchoalveolar lavage indicated lymphocytic alveolitis. The biopsy performed under the left M. masseter with a presumptive diagnosis of sarcoidosis, showed a diffuse large-cell B-cell lymphoma. We initiated immuno-chemotherapy following the R-CHOP schema with a curative approach. The case shows the lack of specificity of clinical, imaging and laboratory findings and thus underlines the need for histology in the differential diagnosis of sarcoidosis.


Assuntos
Diplopia/etiologia , Diplopia/fisiopatologia , Sarcoidose/complicações , Sarcoidose/diagnóstico , Idoso , Diagnóstico Diferencial , Diplopia/diagnóstico , Feminino , Humanos , Sarcoidose/fisiopatologia
4.
World Neurosurg ; 136: 323-325, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32001411

RESUMO

BACKGROUND: A pressure wire offers a dynamic tool to assist in the measurement of the pressure gradient and assessment of the functional significance of stenosis. The author presents a patient with idiopathic intracranial hypertension who was diagnosed with cerebral venous sinus stenosis (CVSS). Venography accompanied by pressure measurement was used to guide the stent placement for CVSS. CASE DESCRIPTION: A 27-year-old woman was referred to our hospital with a chief complaint of headache and neckache lasting for 7 weeks, with an 8-day history of binocular diplopia and blurred vision. Magnetic resonance venography and digital subtraction angiography showed a filling defect in the right transverse sinus. A pressure wire was used before endovascular treatment and showed that the pressure gradient was 10 mm Hg, which meets the surgical indication. After a stent was placed, no pressure gradient was recorded by the pressure wire. CONCLUSIONS: This is the first report about using a pressure wire for CVSS. The finding suggests that use of a pressure wire can be a new approach in the diagnosis and treatment of CVSS.


Assuntos
Procedimentos Endovasculares/métodos , Seios Transversos/diagnóstico por imagem , Seios Transversos/cirurgia , Adulto , Angiografia Digital , Anticoagulantes/uso terapêutico , Constrição Patológica , Diplopia/etiologia , Feminino , Cefaleia/etiologia , Hemodinâmica , Humanos , Angiografia por Ressonância Magnética , Flebografia , Pressão , Pseudotumor Cerebral/etiologia , Stents , Seios Transversos/patologia , Resultado do Tratamento
6.
Ophthalmic Plast Reconstr Surg ; 35(6): e142-e145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31693640

RESUMO

A retrospective review of the medical reports of a patient who was undergoing treatment for graft versus host disease following bone marrow transplant for acute myeloid leukemia was conducted. The patient presented with persistent ocular irritation and injection. For an unclear period of time, he developed proptosis and binocular diplopia with limitation of extraocular motility insidiously. MRI revealed gross enlargement of extraocular muscles and bone marrow aspiration trephine confirmed relapse of leukemia. He then underwent chemotherapy with marked improvement of proptosis and extraocular motility. This case report highlights the importance of the eye care provider's careful assessment of patients with a history of malignancy. The presence of ocular irritation must not distract from the detection of other signs. Proptosis and extraocular motility limitation are rarely associated with graft versus host disease. The presence of these signs warrants orbital imaging to rule out recurrence of the primary malignancy.This case report highlights how proptosis and extraocular motility limitation seen in a patient with graft versus host disease may point to recurrence of the primary malignancy.


Assuntos
Diplopia/etiologia , Exoftalmia/etiologia , Doença Enxerto-Hospedeiro/complicações , Transplante de Medula Óssea/efeitos adversos , Humanos , Leucemia Mieloide Aguda/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
BMJ Case Rep ; 12(10)2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31586951

RESUMO

A 72-year-old man presented with a short history of headache, jaw claudication, double vision, amaurosis fugax and distended temporal arteries. A diagnosis of giant cell arteritis (GCA) was confirmed on temporal artery ultrasound and temporal artery biopsy. Despite treatment with high-dose oral glucocorticoid (GC) and multiple pulses of intravenous methylprednisolone, his vision deteriorated to hand movements in one eye. 8 mg/kg intravenous tocilizumab, a humanised, recombinant anti-IL-6 receptor antibody, was administered within 48 hours of vision loss and continued monthly, resulting in marked visual improvement within days, as well as sustained remission of GCA. This case suggests a possible role for tocilizumab as a rescue therapy to prevent or recover visual loss in patients with GCA resistant to GC treatment, termed refractory GCA. Further research is required to elucidate the role of intravenous administration of tocilizumab in this setting.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Arterite de Células Gigantes/diagnóstico , Artérias Temporais , Administração Intravenosa , Idoso , Anticorpos Monoclonais Humanizados/administração & dosagem , Diagnóstico Diferencial , Diplopia/etiologia , Esquema de Medicação , Resistência a Medicamentos , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Glucocorticoides , Cefaleia/etiologia , Humanos , Masculino
8.
Continuum (Minneap Minn) ; 25(5): 1362-1375, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31584541

RESUMO

PURPOSE OF REVIEW: "Double vision" is a commonly encountered concern in neurologic practice; the experience of diplopia is always sudden and is frequently a cause of great apprehension and potential disability for patients. Moreover, while some causes of diplopia are benign, others require immediate recognition, a focused diagnostic evaluation, and appropriate treatment to prevent vision- and life-threatening outcomes. A logical, easy-to-follow approach to the clinical evaluation of patients with diplopia is helpful in ensuring accurate localization, a comprehensive differential diagnosis, and optimal patient care. This article provides a foundation for formulating an approach to the patient with diplopia and includes practical examples of developing the differential diagnosis, effectively using confirmatory examination techniques, determining an appropriate diagnostic strategy, and (where applicable) providing effective treatment. RECENT FINDINGS: Recent population-based analyses have determined that diplopia is a common presentation in both ambulatory and emergency department settings, with 850,000 such visits occurring annually. For patients presenting to an outpatient facility, diagnoses are rarely serious. However, potentially life-threatening causes (predominantly stroke or transient ischemic attack) can be encountered. In patients presenting with diplopia related to isolated cranial nerve palsy, immediate neuroimaging can often be avoided if an appropriate history and examination are used to exclude worrisome etiologies. SUMMARY: Binocular diplopia is most often due to a neurologic cause. The onset of true "double vision" is debilitating for most patients and commonly prompts immediate access to health care services as a consequence of functional impairment and concern for worrisome underlying causes. Although patients may seek initial evaluation through the emergency department or from their primary care/ophthalmic provider, elimination of an ocular cause will not infrequently result in the patient being referred for neurologic consultation. A logical, localization-driven, and evidence-based approach is the most effective way to arrive at the correct diagnosis and provide the best outcome for the patient.


Assuntos
Diplopia , Adulto , Diplopia/diagnóstico , Diplopia/etiologia , Diplopia/fisiopatologia , Diplopia/terapia , Humanos , Masculino , Pessoa de Meia-Idade
9.
Arch. Soc. Esp. Oftalmol ; 94(10): 504-509, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-187396

RESUMO

Presentamos 2 casos consecutivos de diplopía vertical tras cirugía de blefaroplastia. Se trata de 2 mujeres de 41 y 63 años que presentaron diplopía binocular vertical tras blefaroplastia inferior bilateral con abordaje transconjuntival. La diplopía se presentó en ambos casos en el postoperatorio inmediato, siendo en uno de los casos estable y en otro progresiva. Con la sospecha de estrabismo restrictivo se planteó explorar los músculos extraoculares afectados, eliminar las adherencias y recubrimiento de los vientres musculares con membrana amniótica. La diplopía posblefaroplastia es una complicación infrecuente, pero muy grave, dadas las expectativas de estos pacientes. La literatura describe, hasta la fecha, resultados poco satisfactorios en su manejo. Consideramos que el recubrimiento muscular con membrana amniótica puede aportar mejores resultados en el manejo quirúrgico de estos pacientes, debido a su efecto antiinflamatorio y antiadherencial


Two consecutive cases are presented of vertical diplopia after blepharoplasty. They concern two women aged 41 and 63 years with vertical binocular diplopia after bilateral lower blepharoplasty using a trans-conjunctival approach. The diplopia was presented in both cases in the immediate postoperative period, being stable in one of the cases and progressive in the other. With the suspicion of restrictive strabismus, it was decided to explore the affected extra-ocular muscles, eliminate adhesions and coat the muscular bellies with amniotic membrane. Post-blepharoplasty diplopia is an uncommon, but very serious complication, given the expectations of these patients. The current literature reports unsatisfactory results in its management. In this study, it is considered that the muscular covering with amniotic membrane can provide better results in the surgical management of these patients, due to its anti-inflammatory and anti-adherence effect


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Âmnio/transplante , Blefaroplastia/efeitos adversos , Diplopia/etiologia , Diplopia/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Complicações Pós-Operatórias/etiologia
10.
Ned Tijdschr Geneeskd ; 1632019 09 13.
Artigo em Holandês | MEDLINE | ID: mdl-31556495

RESUMO

BACKGROUND Due to its long intracranial course, the abducens nerve is vulnerable in case of acceleration injury of the head. In rare cases, this may lead to posttraumatic paralysis of this cranial nerve. CASE DESCRIPTION A 4-year-old girl visited the emergency department after sustaining a head trauma. Neurological examination revealed no focal abnormalities at first. Three days later, she experienced diplopia, the consequence of isolated abducens nerve paralysis. CT and MRI brain imaging revealed no abnormalities. We treated her with an eye patch for a short time. At examination after 1 year, she was no longer experiencing any symptoms and the paralysis had almost completely disappeared. CONCLUSION Isolated paralysis of the abducens nerve may occur until up to 6 days after a trauma, without any visible intracranial abnormalities revealed by imaging. Even though only few children with this condition have been described, prognosis seems to be favourable and symptoms disappear in the majority of patients. Frequent follow-up by the ophthalmologist and the orthoptist is recommended, possibly with symptomatic treatment of the diplopia.


Assuntos
Traumatismo do Nervo Abducente/complicações , Traumatismos Craniocerebrais/complicações , Diplopia/etiologia , Paralisia/complicações , Traumatismo do Nervo Abducente/etiologia , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Exame Neurológico , Paralisia/etiologia , Prognóstico , Tomografia Computadorizada por Raios X
11.
BMJ Case Rep ; 12(9)2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31537596

RESUMO

We present an unusual case of skull base osteomyelitis in an 88-year-old woman. She presented with gradual onset unilateral headache and diplopia. On examination, there was evidence of a left-sided Horner's and ipsilateral sixth nerve palsy. In addition to persistent raised inflammatory markers, an MRI neck identified signal change in the petrous bone confirming a diagnosis of skull base osteomyelitis. Skull base osteomyelitis should be considered in presentations of subacute raised inflammatory markers in the context of ipsilateral cranial nerve signs.


Assuntos
Síndrome de Horner/diagnóstico , Osteomielite/complicações , Osso Petroso/microbiologia , Base do Crânio/microbiologia , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/etiologia , Administração Intravenosa , Idoso de 80 Anos ou mais , Carbapenêmicos/administração & dosagem , Carbapenêmicos/uso terapêutico , Diplopia/diagnóstico , Diplopia/etiologia , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Osteomielite/tratamento farmacológico , Osso Petroso/diagnóstico por imagem , Osso Petroso/patologia , Base do Crânio/diagnóstico por imagem , Base do Crânio/patologia , Resultado do Tratamento
12.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519722

RESUMO

Monocular elevation deficit can result from either inferior rectus restriction, superior rectus palsy or from supranuclear causes. We report a case of monocular elevation deficit after scleral perforation repair which was managed by surgery on contra lateral eye. This improved elevation of the affected eye with no diplopia in the postoperative period.


Assuntos
Diplopia/etiologia , Transtornos da Motilidade Ocular/cirurgia , Oftalmoplegia/etiologia , Esclera/lesões , Adulto , Diagnóstico Diferencial , Diplopia/diagnóstico , Diplopia/prevenção & controle , Movimentos Oculares/fisiologia , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/patologia , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Oftalmoplegia/fisiopatologia , Período Pós-Operatório , Esclera/patologia , Esclera/cirurgia , Perfuração Espontânea/cirurgia , Resultado do Tratamento
13.
Niger J Clin Pract ; 22(8): 1172-1174, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417065

RESUMO

Dental anesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is extremely low, these reactions can be highly alarming and may bring up medicolegal issues when they do occur. Dentists and oral surgeons should be well-informed of these adverse reactions and should be aware that both ophthalmologists and emergency physicians might be required to care for these patients.


Assuntos
Anestesia Dentária/efeitos adversos , Anestesia Local/efeitos adversos , Anestésicos Locais/efeitos adversos , Carticaína/efeitos adversos , Diplopia/etiologia , Epinefrina/efeitos adversos , Oftalmoplegia/etiologia , Extração Dentária , Adulto , Anestesia Dentária/métodos , Anestesia Local/métodos , Anestésicos Locais/administração & dosagem , Carticaína/administração & dosagem , Epinefrina/administração & dosagem , Humanos
14.
BMJ Case Rep ; 12(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31413058

RESUMO

A 69-year-old woman presented with an 8-month history of diplopia and examination findings consistent with a right third-nerve palsy. Head MRI identified the presence of a 5.8 mm, nodular, isointense lesion in the suprasellar cistern, which demonstrated enhancement with gadolinium contrast. The lesion did not show any evidence of growth over a 3-month follow-up period. These MRI findings, alongside the clinical features, suggest oculomotor nerve schwannoma. Oculomotor schwannomas are a rare cause of third-nerve palsy. The presenting features and management options for oculomotor schwannomas are discussed to provide a framework for the diagnosis and management of these patients.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Neurilemoma/diagnóstico , Doenças do Nervo Oculomotor/etiologia , Nervo Oculomotor , Idoso , Neoplasias dos Nervos Cranianos/complicações , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Diagnóstico Diferencial , Diplopia/etiologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem
16.
Medicine (Baltimore) ; 98(34): e16906, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441871

RESUMO

RATIONALE: Brain abnormalities have frequently been reported in neuromyelitis optica spectrum disorders patients, but vertigo as an initial manifestation has rarely been described. PATIENT CONCERNS: A 64-year-old woman who initially presented with vertigo, then accompanied with other brainstem manifestations and spinal cord involvement. DIAGNOSES: MRI revealed medulla oblongata, cervical and thoracic spinal cord lesions. NMO-IgG antibody was seropositive. Taken her previous medical history and clinical manifestations into consideration, the patient was eventually diagnosed as neuromyelitis optica spectrum disorders. INTERVENTIONS: Before diagnosis, symptomatic treatment and acupuncture were adopted, whereas after diagnosis, steroid, intravenous immunoglobulin, and immunosuppressant were supplemented. OUTCOMES: Her dizziness, nausea and vomiting were gradually relieved by symptomatic treatment and acupuncture before the confirmed diagnosis and immunotherapy. After added treatment with steroid, immunosuppressant, especially intravenous immunoglobulin, diplopia and nystagmus disappeared, and superficial sensation was improving. She was fully recovered six months after admission. LESSONS: Vertigo as a rare prodrome of neuromyelitis optica spectrum disorders deserves attention. The symptoms and signs were improved by a combined treatment of steroid, immunosuppressant, acupuncture, and particularly intravenous immunoglobulin.


Assuntos
Neuromielite Óptica/diagnóstico , Vertigem/etiologia , Terapia por Acupuntura , Diplopia/etiologia , Diplopia/terapia , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Pessoa de Meia-Idade , Náusea/etiologia , Náusea/terapia , Neuromielite Óptica/tratamento farmacológico , Vértebras Torácicas/diagnóstico por imagem , Vertigem/terapia , Vômito/etiologia , Vômito/terapia
17.
J Craniofac Surg ; 30(7): e646-e649, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31449200

RESUMO

BACKGROUND: To date, involvement of alcohol intoxication (AI) in the occurrence of traumatic bone injuries has been well described in the literature. Still, however, there is a paucity of data regarding its involvement with soft tissue injuries in the oral and maxillofacial region. Considering that it is one of the significant predisposing factors that are involved in facial bone fractures in assault victims, we have speculated that they are also vulnerable to soft tissue injuries. We therefore examined the incidence, type and, pattern of soft tissue injuries in patients with trauma owing to the AI in a single-institution setting. MATERIALS AND METHODS: A total of 488 patients underwent reconstructive surgery for orbital wall fracture at our medical institution between 2012 and 2017. Of these, 162 eligible patients were enrolled in the present study; they were divided into 2 groups (the AI group and the control group) based on a history of the AI. Then, we compared baseline and clinical characteristics, including the incidence, type, and pattern of soft tissue injury, between the 2 groups. RESULTS: In our series, assault was the most common cause of traumatic injuries. We found that the patients with AI were at increased risks of preoperatively developing subconjunctival hemorrhage and diplopia and postoperatively developing infraorbital nerve (ION) hypesthesia. CONCLUSIONS: In conclusion, our results indicate that the AI is closely associated with the preoperative risks of subconjunctival hemorrhage and diplopia and the postoperative risks of ION hypesthesia. But further large-scale, multicenter studies are warranted to establish our results.


Assuntos
Intoxicação Alcoólica/complicações , Fraturas Orbitárias/cirurgia , Lesões dos Tecidos Moles/cirurgia , Adolescente , Adulto , Idoso , Diplopia/etiologia , Hemorragia Ocular/etiologia , Feminino , Humanos , Hipestesia/cirurgia , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas Orbitárias/etiologia , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/epidemiologia , Lesões dos Tecidos Moles/etiologia , Adulto Jovem
18.
J Craniofac Surg ; 30(7): 2001-2003, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31283640

RESUMO

Although unsintered hydroxyapatite and poly-L-lactic acid (u-HA/PLLA) composite sheets have various applications, such as in craniomaxillofacial fractures, orthognathic surgery, and orthopedic surgery, and have been proven to be safe and effective, no studies have reported the use of u-HA/PLLA composite sheets for orbital wall reconstruction with long-term follow-up. This study reports our preliminary results using the u-HA/PLLA composite sheet for orbital wall fractures. The SuperFIXSORB MX sheet (u-HA/PLLA composite sheet; Takiron, Tokyo, Japan), with size of 30 × 50 mm and thickness of 0.5 mm, was used in all cases of hard reconstruction of the orbital bone defect. Seventy-two patients with acute orbital wall fractures (within 2 weeks after sustaining the injury) treated at the Jikei University between January 2014 and August 2016 were included. The authors evaluated the postoperative complications and the operability of the material. The authors did not observe any postoperative complications, such as infection, postoperative diplopia, or enophthalmos, due to the use of the u-HA/PLLA composite sheet. In pure orbital fractures (orbital fractures only), the mean (±standard deviation) operation time was significantly longer with combined inferior and medial wall fractures (201.1 ±â€Š36.6 minutes; n = 11) than with inferior wall or medial wall fractures only (135.0 ±â€Š54.4 minutes; n = 51) (Mann-Whitney U test, P < 0.001). The U-HA/PLLA composite sheet is safe and can be used for orbital wall fracture reconstruction. Further long-term functional and aesthetic assessments for infection, ocular movement disorder, enophthalmos, and any other complication are necessary.


Assuntos
Durapatita , Fraturas Orbitárias/cirurgia , Poliésteres , Adolescente , Adulto , Idoso , Criança , Diplopia/etiologia , Enoftalmia/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Adulto Jovem , Zigoma
19.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289153

RESUMO

Sarcomatoid carcinoma is a rare clinical entity, especially when presenting in the nasopharynx. We describe the first documented case of nasopharyngeal sarcomatoid carcinoma with intracranial extension in a 59-year-old Caucasian man presenting with severe bifrontal headache and diplopia, secondary to left abducens nerve palsy. We highlight some of the major diagnostic challenges and describe its unusual histological appearance. We outline the importance of a multidisciplinary approach to his management, which includes input from the medicine, neurosurgery, Ear, Nose and Throat (ENT), pathology, radiology, oncology and respiratory teams. In the context of limited evidence, we then describe the rationale to proceed with induction chemotherapy followed by concurrent chemoradiotherapy. Although there was a partial response to treatment, it was not sufficient enough to allow subsequent surgical clearance. The plan going forward is to palliate with chemotherapy as and when the disease progresses.


Assuntos
Quimiorradioterapia/métodos , Quimioterapia de Indução/métodos , Carcinoma Nasofaríngeo/patologia , Sarcoma/patologia , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/etiologia , Diplopia/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico por imagem , Carcinoma Nasofaríngeo/terapia , Neoplasias Nasofaríngeas/patologia , Invasividade Neoplásica , Equipe de Assistência ao Paciente/normas , Sarcoma/terapia , Tomografia Computadorizada por Raios X , Conduta Expectante
20.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289159

RESUMO

Orbital involvement of multiple myeloma (MM) is uncommon, with most of those reported cases occurring at the time of initial diagnosis of MM. We present a case of an extramedullary plasmacytoma involving only the right lateral rectus of a patient who had been in disease remission. The patient presented with new-onset diplopia and an abduction deficit of the right eye, with mild proptosis. In light of her past medical history of MM, an orbital MRI was obtained. The MRI demonstrated an isolated finding of eccentric enlargement of the right lateral rectus muscle limited to the muscle belly with sparing of the tendinous insertions, leading to diagnosis of plasmacytoma. Patching of the involved eye to alleviate the symptoms of diplopia was instituted. Chemotherapy was initiated, followed by orbital radiation and stem-cell transplantation for coexisting systemic disease. The orbital symptoms of proptosis and diplopia resolved within 1 month of treatment.


Assuntos
Mieloma Múltiplo/patologia , Músculos Oculomotores/patologia , Plasmocitoma/complicações , Idoso , Quimiorradioterapia/métodos , Diplopia/diagnóstico , Diplopia/etiologia , Progressão da Doença , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Evolução Fatal , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/patologia , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/terapia , Transplante de Células-Tronco/métodos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA