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1.
Neurology ; 96(6): e866-e875, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33318162

RESUMO

OBJECTIVE: To describe the spectrum, treatment, and outcome of cranial nerve disorders associated with immune checkpoint inhibitor (Cn-ICI). METHODS: This nationwide retrospective cohort study on Cn-ICI (2015-2019) was conducted using the database of the French Refence Center. In addition, a systematic review of the literature (MEDLINE, Scopus, and Web of Science) for records published between 2010 and 2019 was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the search terms cranial nerve or neuropathy or palsy and immune checkpoint inhibitors. RESULTS: Among 67 cases with ICI-related neurologic toxicities diagnosed in our reference center, 9 patients with Cn-ICI were identified (7 men, 78%, median age 62 years [range 26-82 years]). Patients were receiving a combination of anti-cytotoxic T-lymphocyte antigen 4 and anti-programmed cell death 1 (PD-1)/PD-1 ligand (n = 5, 56%) or anti-PD-1 antibodies alone (n = 4, 44%). Cn-ICI involved optic (n = 3), vestibulocochlear (n = 3), abducens (n = 2), facial (n = 2), and oculomotor (n = 1) nerves. Two patients had involvement of 2 different cranial nerves. Treatment comprised corticosteroids (n = 8, 89%), ICI permanent discontinuation (n = 7, 78%), plasma exchange (n = 2, 22%), and IV immunoglobulin (n = 1, 11%). Median follow-up was 11 months (range 1-41 months). In 3 cases (33%), neurologic deficit persisted/worsened despite treatment: 2 optic and 1 vestibulocochlear. Among cases from the literature and the present series combined (n = 39), the most commonly affected cranial nerves were facial (n = 13, 33%), vestibulocochlear (n = 8, 21%), optic (n = 7, 18%), and abducens (n = 4, 10%). Trigeminal, oculomotor, and glossopharyngeal nerves were less frequently affected (total n = 7). CONCLUSION: Cranial nerve disorders can complicate treatment with ICIs. Approximately one-third of the patients had persisting deficits, most frequently involving hearing and vision loss.


Assuntos
Doenças dos Nervos Cranianos/induzido quimicamente , Doenças dos Nervos Cranianos/fisiopatologia , Inibidores de Checkpoint Imunológico/efeitos adversos , Neoplasias/tratamento farmacológico , Doenças do Nervo Abducente/induzido quimicamente , Doenças do Nervo Abducente/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Nervo Facial/induzido quimicamente , Doenças do Nervo Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/induzido quimicamente , Doenças do Nervo Oculomotor/fisiopatologia , Neurite Óptica/induzido quimicamente , Neurite Óptica/fisiopatologia , Estudos Retrospectivos , Doenças do Nervo Vestibulococlear/induzido quimicamente , Doenças do Nervo Vestibulococlear/fisiopatologia
2.
Med J Aust ; 213(8): 352-353.e1, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32946596

Assuntos
Doenças dos Nervos Cranianos/diagnóstico , Herpes Zoster/diagnóstico , Mononeuropatias/diagnóstico , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/tratamento farmacológico , Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/virologia , Idoso , Doenças dos Nervos Cranianos/tratamento farmacológico , Doenças dos Nervos Cranianos/fisiopatologia , Doenças dos Nervos Cranianos/virologia , Diagnóstico Diferencial , Diplopia/fisiopatologia , Dor de Orelha/fisiopatologia , Edema/fisiopatologia , Doenças do Nervo Facial/diagnóstico , Doenças do Nervo Facial/tratamento farmacológico , Doenças do Nervo Facial/fisiopatologia , Doenças do Nervo Facial/virologia , Paralisia Facial/fisiopatologia , Doenças do Nervo Glossofaríngeo/diagnóstico , Doenças do Nervo Glossofaríngeo/tratamento farmacológico , Doenças do Nervo Glossofaríngeo/fisiopatologia , Doenças do Nervo Glossofaríngeo/virologia , Glucocorticoides/uso terapêutico , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Neurossensorial/virologia , Herpes Zoster/tratamento farmacológico , Herpes Zoster/fisiopatologia , Humanos , Masculino , Mononeuropatias/tratamento farmacológico , Mononeuropatias/virologia , Osteomielite/diagnóstico , Otite Externa/diagnóstico , Prednisolona/uso terapêutico , Base do Crânio , Doenças do Nervo Vago/diagnóstico , Doenças do Nervo Vago/tratamento farmacológico , Doenças do Nervo Vago/fisiopatologia , Doenças do Nervo Vago/virologia , Doenças do Nervo Vestibulococlear/diagnóstico , Doenças do Nervo Vestibulococlear/tratamento farmacológico , Doenças do Nervo Vestibulococlear/fisiopatologia , Doenças do Nervo Vestibulococlear/virologia , Ativação Viral
3.
J Stroke Cerebrovasc Dis ; 29(6): 104750, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32220556

RESUMO

Isolated pontine infarcts are common and are often associated with well-described syndromes that are classified based on their specific clinical presentation and arterial stroke territories. Here we present a case of acute combined diplopia and unilateral lower extremity sensory abnormality. Diffusion-weighted magnetic resonance imaging revealed a punctate area of acute ischemia in the right medial pontine mid-tegmentum. These findings suggest a unique pontine stroke syndrome characterized by acute ischemic injury at the intersection of the medial lemniscus and cranial nerve VI.


Assuntos
Doenças do Nervo Abducente/etiologia , Infartos do Tronco Encefálico/complicações , Diplopia/etiologia , Extremidade Inferior/inervação , Tegmento Pontino/irrigação sanguínea , Transtornos das Sensações/etiologia , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Infartos do Tronco Encefálico/diagnóstico por imagem , Infartos do Tronco Encefálico/fisiopatologia , Imagem de Difusão por Ressonância Magnética , Diplopia/diagnóstico , Diplopia/fisiopatologia , Feminino , Humanos , Pessoa de Meia-Idade , Tegmento Pontino/diagnóstico por imagem , Valor Preditivo dos Testes , Transtornos das Sensações/diagnóstico , Transtornos das Sensações/fisiopatologia , Síndrome
4.
Indian J Ophthalmol ; 67(11): 1793-1799, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31638036

RESUMO

Multiple transposition procedures have been described for management of lateral rectus palsy. However, relative effect and indications of each procedure are unclear. This systematic review was planned to evaluate functional and anatomical outcomes of vertical rectus transposition (VRT) surgery in patients with lateral rectus palsy. We searched databases in English language, namely, MEDLINE, PubMed Central, EMBASE, Google Scholar, Scopus, and Index Copernicus without any date restrictions in electronic searches, using the search words 'vertical rectus transposition for lateral rectus palsy," "vertical rectus transposition for abducens palsy," "superior rectus transposition," "inferior rectus transposition," and "Hummelsheim procedure." References of the selected publications were also searched to find any relevant studies. We searched for studies that provided data on single VRT and double VRT surgeries for lateral rectus palsies. Three authors independently assessed the related studies gathered from electronic and manual searches. We found 27 studies which were relevant to the review question. As there were no randomized control trials (RCTs) available related to our study question, nonrandomized studies were used to arrive at summarization of outcomes of different transposition procedures. There is a need for prospective RCTs to investigate the different types of transposition procedures for lateral rectus palsy.


Assuntos
Doenças do Nervo Abducente/cirurgia , Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/patologia , Doenças do Nervo Abducente/fisiopatologia , Esotropia/etiologia , Esotropia/fisiopatologia , Humanos , Músculos Oculomotores/fisiopatologia
5.
Semin Ophthalmol ; 34(7-8): 541-542, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31657259

RESUMO

Regarding the review article by Escuder AG, Hunter DG, entitled "The Role of Botulinum Toxin in the Treatment of Strabismus" Seminars in Ophthalmology. 2019;34(4): 198-204, we cannot agree with you more with your point of view about the dosage preparation for botulinum toxin A (BTA) in the strabismus surgery. Moreover, we also included a case series that used BTA as an adjunct in the surgery for large-angle sensory exotropia and abducens nerve palsy.


Assuntos
Doenças do Nervo Abducente/terapia , Toxinas Botulínicas Tipo A/administração & dosagem , Exotropia/terapia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Exotropia/fisiopatologia , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Adulto Jovem
7.
J Pediatr Ophthalmol Strabismus ; 56: e53-e56, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31282962

RESUMO

A 53-year-old woman presented with diplopia and deviation of the left eye for the past 3 years. She had non-resolving isolated left lateral rectus palsy. She underwent a medial rectus recession and Hummelsheim (Wright's modification) procedure in her left eye. Postoperatively, the anterior segment ischemia resolved with steroids. [J Pediatr Ophthalmol Strabismus. 2019;56:e53-e56.].


Assuntos
Doenças do Nervo Abducente/cirurgia , Segmento Anterior do Olho/irrigação sanguínea , Isquemia/etiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Complicações Pós-Operatórias , Visão Binocular , Doenças do Nervo Abducente/fisiopatologia , Angiografia , Segmento Anterior do Olho/diagnóstico por imagem , Movimentos Oculares/fisiologia , Feminino , Humanos , Isquemia/diagnóstico , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Doenças Raras
8.
Clin Neurol Neurosurg ; 184: 105443, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31336359

RESUMO

OBJECTIVE: To retrospectively analyze the data of 72 patients with tuberculous meningitis (TBM) combined with cranial nerve palsy, to explore the incidence, clinical features, CSF assay changes and outcome in patients with TBM. PATIENTS AND METHODS: A total of 72 patients were diagnosed as TBM with cranial nerve palsy. The gender, age, clinical manifestations, CSF examinations, cerebral magnetic resonance imaging (MRI) enhancement scan were collected. All these patients had completed at least 2 months of follow up after anti-tuberculous treatment. RESULTS: This study retrospectively evaluated 486 patients; include 254 (52.3%) men and 232 (47.7%) women. The mean age was 35.2 ±â€¯17.0 years. 72 patients (14.8%) were diagnosed as TBM with cranial nerve palsy. Among them, 38 cases (52.8%) had optic nerve palsy (the 2nd nerve), 41 cases (56.9%) had oculomotor nerve palsy (the 3rd nerve), 3 cases (4.2%) had abducens nerve palsy (the 6th nerve), and 10 cases (13.9%) had auditory nerve palsy (the 8th nerve). 16 patients (22.2%) had two groups of cranial nerve involvement (oculomotor nerve and optic nerve in 10 cases, optic nerve and auditory nerve in 5 cases, and optic nerve and abducens nerve in 1 case). Two patients (2.8%) had three groups of cranial nerve involvement (oculomotor nerve, optic nerve and abducens nerve). CSF MTB was detected by acid fast bacilli (no patient was positive), MTB DNA detection by multiplex polymerase chain reaction (PCR) (3 patients were positive) and MTB cultures (2 patients were positive). There was no significant difference of CSF cells and biochemistry investigations between the patients with or without cranial nerve palsy. Magnetic resonance imaging (MRI) enhancement scan were done in 66 (91.7%) patients after admission. It was abnormal in 57 (86.3%) patients. 15 cases (26.3%) had meningeral enhancement, 25 cases (43.9%) had tuberculoma, 11 cases (19.3%) had hydrocephalus and 6 cases (10.5%) with infarct. All patients were followed up after 2 months of anti-tuberculous treatment. 70 patients (97.2%, 70/72) with the cranial nerve palsy were fully recovered without obvious sequel. CONCLUSION: The complications of cranial nerve palsy in TBM patients are not uncommon, and the rate of misdiagnosis is high, which makes them vulnerable to emergencies such as disturbance of consciousness. Effective anti-tuberculous treatment can restore most cranial nerve palsy.


Assuntos
Doenças do Nervo Abducente/fisiopatologia , Doenças dos Nervos Cranianos/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Tuberculose Meníngea/fisiopatologia , Doenças do Nervo Abducente/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/epidemiologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/etiologia , Tuberculose Meníngea/complicações , Tuberculose Meníngea/epidemiologia , Adulto Jovem
9.
J Pediatr Ophthalmol Strabismus ; 56(4): 238-242, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322714

RESUMO

PURPOSE: To determine the magnitude of change between the preoperative and postoperative alignment and amount of postoperative drift for two vertical rectus muscle transpositions (VRTs). METHODS: Retrospective review of medical records of patients with total sixth cranial nerve palsy who underwent VRT procedures. The primary outcome measure was the magnitude of esotropia in prism diopters (PD) at the preoperative and postoperative visits. RESULTS: Twenty-seven patients were included. Sixteen had full tendon transposition with Foster augmentation (FTT+FA) and 11 had partial tendon transposition with resection and simultaneous medial rectus recession (PTT+R+MRR). A larger correction was obtained with PTT+R+MRR (mean ± standard deviation [SD]: 52 ± 19 PD; range: 27 to 87 PD) when compared to FTT+FA (mean: 40 ± 13 PD; range: 15 to 68 PD). At postoperative month 2, a greater esotropic drift was noted in the PTT+R+MRR group (16 PD) than the FTT+FA group (6 PD). Although the difference in the amount of correction was not statistically significant (P = .071), the difference in the amount of drift was statistically significant (P = .009). CONCLUSIONS: There was a trend toward greater correction with PTT+R+MRR than FTT+ FA, but it was not statistically significant. FTT+FA had significantly less postoperative drift than PTT+R+MRR. The results suggest that a small immediate postoperative overcorrection may be desirable in some VRT procedures. [J Pediatr Ophthalmol Strabismus. 2019;56(4):238-242.].


Assuntos
Doenças do Nervo Abducente/cirurgia , Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/fisiopatologia , Esotropia/etiologia , Esotropia/fisiopatologia , Seguimentos , Humanos , Músculos Oculomotores/fisiopatologia , Período Pós-Operatório , Estudos Retrospectivos
11.
Jpn J Ophthalmol ; 63(4): 337-343, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31006061

RESUMO

PURPOSE: To present cases with idiopathic third and sixth cranial nerve neuritis. STUDY DESIGN: Retrospective observational study METHODS: The results of high resolution pre- and post- cranial nerve magnetic resonance images (MRI) with three-dimensional sequences for visualizing cranial nerves in patients with third, fourth, and sixth cranial nerve palsies who were treated at the Neuro-ophthalmology Department of Samsung Medical Center were reviewed. Patients with cranial nerve enhancement confirmed by experienced radiologists were identified. The medical records of these patients were reviewed, and their demographics, clinical presentations, laboratory results, and clinical outcomes were analyzed. RESULTS: Of 265 patients with third, fourth, and sixth cranial nerve palsy, 60 were identified by high resolution MRI as having enhancement of the corresponding cranial nerve. Among these, 17 patients with infiltrative, granulomatous, or tumorous lesions were excluded. In addition, 28 patients with identifiable causes of cranial nerve palsy, such as Miller-fisher syndrome, virus infection, or radiation-induced neuropathy, as well as patients with vasculopathic risk factors, were also excluded. Ultimately, a total of 15 patients with idiopathic third and sixth cranial nerve neuritis were included in this study. The mean age of these patients was 43 ± 15 years. Eight patients had sixth cranial nerve palsy, six third cranial nerve palsy (two partial and four complete), and one patient with complete third and sixth cranial nerve palsy. Nine patients received steroid treatment. Eleven patients recovered fully within a period ranging from a few days to one year. Two patients were much improved up to 1 month after initial presentation, but were then ultimately lost to follow-up. Another patient was lost to follow-up after the initial work-up. The other patient lost to follow-up had partially recovered during the first 6 months. CONCLUSIONS: We present patients with idiopathic third and sixth cranial nerve neuritis. They tended to respond well to steroid treatment and to have good prognoses. In order to better understand the long-term prognosis of cranial nerve neuritis and possible association with other neurologic disorders, a larger scale and longer-term study is needed.


Assuntos
Doenças do Nervo Abducente/diagnóstico , Nervo Abducente/diagnóstico por imagem , Neurite (Inflamação)/complicações , Doenças do Nervo Oculomotor/diagnóstico , Nervo Oculomotor/diagnóstico por imagem , Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Idoso , Movimentos Oculares/fisiologia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurite (Inflamação)/diagnóstico , Nervo Oculomotor/fisiopatologia , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Oculomotor/fisiopatologia , Estudos Retrospectivos , Adulto Jovem
12.
Eye (Lond) ; 33(6): 965-973, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30760897

RESUMO

PURPOSE: To describe the causes of third, fourth, and sixth cranial nerve palsies in children and adolescents. METHODS: In this retrospective case series, a total of 66 patients aged 0-19 years with third, fourth, and sixth cranial nerve palsies seen in strabismus and neuro-ophthalmic practice from 2010 to 2017 were included. Causes of palsies were determined based on clinical assessment, high-resolution magnetic resonance imaging (MRI), and laboratory work-up. RESULTS: Thirty-five patients had sixth cranial nerve palsy, 14 patients had third cranial nerve palsy (7 partial, 7 complete), 13 patients had fourth cranial nerve palsy, and 4 patients had combined cranial nerve palsies in this study. Neoplasia involving central nervous system was one of the most common causes of third, fourth, and sixth cranial nerve palsies both in children (age: 0-14 years) and adolescents (age: 15-19 years) (20% and 31%, respectively). Overall, neoplasia (23%) was the most common cause of acute third, fourth, and sixth cranial nerve palsies, followed by idiopathic cause (14%), inflammation (11%), and non-aneurysmal vascular contact (11%). Neoplasia was also the most common cause of sixth and third cranial nerve palsies (25% and 29%, respectively). The most common cause of fourth cranial nerve palsy was late decompensation in congenital fourth cranial nerve palsy (46%). CONCLUSIONS: A substantial proportion of pediatric and juvenile patients had serious pathologies for third, fourth, and sixth cranial nerve palsies. If nerve palsies are indicated, prompt diagnosis of etiologies using high-resolution MRI with contrast and laboratory work-up are important for this disease population.


Assuntos
Doenças do Nervo Abducente/complicações , Encéfalo/diagnóstico por imagem , Movimentos Oculares/fisiologia , Imageamento por Ressonância Magnética/métodos , Doenças do Nervo Oculomotor/complicações , Estrabismo/etiologia , Doenças do Nervo Troclear/complicações , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/fisiopatologia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Doenças do Nervo Troclear/diagnóstico , Doenças do Nervo Troclear/fisiopatologia , Adulto Jovem
13.
Rom J Ophthalmol ; 63(4): 375-378, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31915737

RESUMO

Objective: To describe an isolated unilateral sixth nerve palsy, as a rare neuro-ophthalmic presentation of nasopharyngeal carcinoma. Methods: We report a 54-year-old female, known case of nasopharyngeal carcinoma who was treated with chemo-radiotherapy, and presented with isolated right sixth nerve palsy. Magnetic resonance imaging (MRI) indicated extension of tumor to intracranial fossa with clival involvement. Results: The patient was referred to an otolaryngologist for further evaluation and necessary intervention due to invasion of the cancer to intracranial fossa with involvement of right abducens nerve. Conclusions: Although, isolated sixth nerve palsies in adults over the age of 50 are usually ischemic; but in enduring cases, neoplastic processes should be considered.


Assuntos
Doenças do Nervo Abducente/complicações , Diplopia/etiologia , Movimentos Oculares/fisiologia , Carcinoma Nasofaríngeo/complicações , Neoplasias Nasofaríngeas/complicações , Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Diplopia/diagnóstico , Diplopia/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico
15.
Graefes Arch Clin Exp Ophthalmol ; 257(1): 199-205, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30182295

RESUMO

BACKGROUND: To investigate prognostic factors in patients with augmented superior rectus transposition (SRT) for sixth nerve palsy. METHODS: Thirteen patients who were diagnosed with sixth nerve palsy and underwent augmented SRT between January 2015 and February 2017 in EENT Hospital of Fudan University were reviewed retrospectively. Data including age, sex, etiology of the abducens nerve palsy, degree of pre- and postoperative deviation in the primary position, pre- and postoperative abduction deficit, any induced vertical or torsional deviations, reoperations, and other complications was collected. Patients with undercorrection of SRT surgeries received additional inferior rectus transposition (IRT) surgery. RESULTS: Mean esodeviation in primary position improved from 81.92△ to 30.54△ (p < 0.001) with a 1.54-unit improvement in abduction (p = 0.001). Six patients achieved alignment defined as esodeviation in primary position within 10△ of orthotropia and seven patients were undercorrected after the first SRT surgery. Multivariable linear regression analysis showed that among factors (disease duration, preoperative esodeviation, preoperative abduction deficit), only the degree of preoperative abduction deficit (ß = - 13.68) was the prognostic factor for success of SRT surgery. After IRT procedures, the mean esodeviation in primary position improved from 40△ to 8△ (p < 0.01). CONCLUSION: The degree of preoperative abduction deficit is the prognostic factor for augmented SRT for sixth nerve palsy. Patients with worse abduction deficit have a greater likelihood of needing a secondary operation, and IRT could be a good choice for reoperation after SRT.


Assuntos
Doenças do Nervo Abducente/complicações , Esotropia/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Visão Binocular/fisiologia , Doenças do Nervo Abducente/fisiopatologia , Adulto , Idoso , Esotropia/etiologia , Esotropia/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/fisiopatologia , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
16.
Pediatr Neurol ; 91: 27-33, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30573329

RESUMO

OBJECTIVES: We assessed the clinical characteristics of primary intracranial hypertension (PIH) in children using a newly recommended threshold for cerebrospinal fluid opening pressure (280 mm H2O). METHOD: Cross-sectional study of patients age ≤21 years who had a lumbar puncture done for evaluation of PIH. Patients were excluded if lumbar puncture was done for a suspected infection, seizure, mental status changes, multiple sclerosis, or Guillain-Barre syndrome. Cases were identified using a text-search module followed by manual review. We performed χ2 analysis for categorical data and Mann-Whitney U test for continuous data, followed by a binary logistic regression. RESULTS: We identified 374 patients of whom 67% were female, median age was 13 years interquartile range (11 to 16 years), and admission rate was 24%. Using an opening pressure cutoff of 250 mm H2O, 127 patients (34%) were identified as having PIH, whereas using the new cutoff 105 patients (28%) met PIH criteria. Predictors for PIH included optic disc edema or sixth nerve palsy using both old, odds ratio (OR) 7.6 (4.3, 13.5), and new cutoffs, OR 9.7 (95% confidence interval 5.1, 18.5). Headache duration ≤61 days is predictive of PIH using the new cutoff OR 4.1 (95% confidence interval 1.3, 12.8). A model is presented which stratifies patients into groups with low (7%), medium (18%), and high (greater than 42%) risk of PIH. CONCLUSIONS: A higher cerebrospinal fluid opening pressure threshold in the criteria of PIH is associated with PIH patients with a different symptom profile. Children with optic disc edema, bulging fontanel or sixth nerve palsy, are at increased risk for PIH.


Assuntos
Doenças do Nervo Abducente/diagnóstico , Pressão do Líquido Cefalorraquidiano/fisiologia , Fontanelas Cranianas , Hipertensão Intracraniana/diagnóstico , Papiledema/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Adolescente , Criança , Fontanelas Cranianas/fisiopatologia , Estudos Transversais , Feminino , Humanos , Hipertensão Intracraniana/fisiopatologia , Masculino , Papiledema/fisiopatologia , Prognóstico , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/fisiopatologia , Estudos Retrospectivos
17.
PLoS One ; 13(9): e0204078, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30226873

RESUMO

AIM: To investigate the performance of a newly developed three-dimensional (3D) biomechanical model in various transposition procedures for correction of complete sixth nerve palsy with educational purpose. METHODS: A 3D biomechanical eye model was created using Hyperworks software based on geometry data and the biochemical properties of the eyeball and extraocular muscles. A complete sixth nerve palsy model was achieved via modification of lateral rectus muscle strength. Four different muscle transposition procedures (the Hummelsheim, Jensen, Foster, and muscle union procedures) were set up, and the objective surgical effect of each procedure was calculated using 3D model simulation. RESULTS: In the 3D simulation, sixth nerve palsy was modeled by rotating the eye 34.16 degrees in the medial direction, consistent with 70 prism diopter (PD) esotropia. In surgical model simulation, the Hummelsheim procedure resulted in a 28 PD reduction of total deviation, the Jensen procedure achieved a 34 PD reduction, the Foster procedure led to a 57 PD reduction, the muscle union procedure yielded a 57 PD reduction in esotropia in sixth nerve palsy. CONCLUSION: The 3D simulation provided a consistent model of sixth nerve palsy and objective data excluding the potential for variation of surgical skill. It could also help predict surgical outcomes.


Assuntos
Fenômenos Biomecânicos/fisiologia , Movimentos Oculares/fisiologia , Fenômenos Fisiológicos Oculares , Músculos Oculomotores/fisiologia , Software , Doenças do Nervo Abducente/fisiopatologia , Adulto , Esotropia , Feminino , Humanos , Músculos Oculomotores/diagnóstico por imagem , Procedimentos Cirúrgicos Oftalmológicos
18.
Korean J Ophthalmol ; 32(3): 221-227, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29770635

RESUMO

PURPOSE: This study aimed to evaluate the clinical course and prognostic factors of acquired third, fourth, and sixth cranial nerve (CN) palsy grouped according to etiology. METHODS: This study involved a retrospective review of the medical records of 153 patients who were diagnosed with acquired paralytic strabismus from January 2004 to July 2015. Outcomes, recovery rates, and time to recovery were investigated according to the affected CN: CN3, CN4, and CN6 palsies. The patients were classified into four groups based on etiology: idiopathic, traumatic, neoplastic, and vascular. RESULTS: The mean age of the patients was 59.8 ± 14.5 years and the mean follow-up period was 10.8 months. Out of the 153 patients, 63 (41.2%) had CN3 palsy, 35 (22.9%) had CN4 palsy, and 55 (35.9%) had CN6 palsy. The most common causes were vascular related (54.9%), followed by idiopathic (28.1%), trauma (8.5%), and neoplasm (5.88%). About 50% of the patients recovered within six months. Among the four etiologic groups, the idiopathic group showed the best prognosis because about 50% of the patients in this group recovered within three months. This was followed by the vascular, traumatic, and neoplastic groups. Cox proportional hazard analysis revealed a significant association between the baseline prism diopter and recovery rate. CONCLUSIONS: The prognosis and natural history of paralytic strabismus vary depending on its cause. The vascular group had the best recovery rate and shortest recovery time, whereas the neoplastic group required the longest time to recover.


Assuntos
Doenças do Nervo Abducente/diagnóstico , Doenças do Nervo Oculomotor/diagnóstico , Estrabismo/diagnóstico , Doenças do Nervo Troclear/diagnóstico , Doenças do Nervo Abducente/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Oculomotores/inervação , Músculos Oculomotores/fisiopatologia , Doenças do Nervo Oculomotor/fisiopatologia , Prognóstico , República da Coreia , Estudos Retrospectivos , Estrabismo/fisiopatologia , Doenças do Nervo Troclear/fisiopatologia
19.
Graefes Arch Clin Exp Ophthalmol ; 256(5): 983-987, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29299740

RESUMO

PURPOSE: Superior rectus transposition (SRT) with medial rectus recession has been used for the treatment of sixth nerve palsy and esotropic Duane retraction syndrome (DRS). The purpose of this study was to compare the results of augmented SRT (with scleral fixation) without medial rectus recession in DRS and sixth nerve palsy. METHODS: Patients with unilateral esotropic DRS (DRS group) and sixth nerve palsy were included in this prospective, comparative study and underwent SRT. Preoperative forced duction testing was negative or slightly positive in both groups. Prospective measurements were compared between the two groups. RESULTS: There were 11 patients in the DRS group and 11 patients in the sixth nerve palsy group. The mean preoperative esotropia decreased from 20.9 ± 6.0 prism diopter (PD) at far to 13.2 ± 5.8 PD in the DRS group (P = 0.003). The same measurement improved from 28.0 ± 8.5 PD to 8.4 ± 7.3 PD in the sixth nerve palsy group (P = 0.003). In the sixth nerve palsy group, the improvement in primary gaze esotropia and abnormal head posture was more than the DRS group (Both P < 0.001).The average dose effect for SRT was 7.8 ± 2.2 PD in the DRS group and 19.2 ± 4.6 PD in the sixth nerve palsy group. Although objective intorsion was significantly induced after SRT, subjective torsion was not significant after surgery in both groups. CONCLUSION: SRT appears to be more effective in improving primary gaze deviation and head posture in sixth nerve palsy compared with DRS. Subjective torsional and vertical diplopia were rare in both groups.


Assuntos
Doenças do Nervo Abducente/cirurgia , Síndrome da Retração Ocular/cirurgia , Movimentos Oculares/fisiologia , Músculos Oculomotores/transplante , Procedimentos Cirúrgicos Oftalmológicos/métodos , Doenças do Nervo Abducente/fisiopatologia , Adulto , Diplopia/fisiopatologia , Síndrome da Retração Ocular/fisiopatologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Visão Binocular/fisiologia
20.
J Neuroophthalmol ; 38(2): 156-159, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28837440

RESUMO

BACKGROUND: Late recurrence of visual symptoms associated with carotid-cavernous fistula (CCF), including diplopia, is uncommon and raises concern for new or recurrent fistula formation. METHODS: We report 2 patients with traumatic CCFs, where cranial nerve paresis resolved after endovascular CCF treatment only to reappear years later. RESULTS: No evidence of recurrent or new fistula formation was found. Both were treated successfully with strabismus surgery. CONCLUSIONS: Although the cause of delayed onset diplopia after successful treatment is still unknown, theories include late compression of cranial nerves within the cavernous sinus due to coil mass that can cause chronic ischemia, delayed inflammation due to a thrombophilic nidus created by the coil mass, or injury to the cranial nerves that manifests later due to decompensated strabismus.


Assuntos
Doenças do Nervo Abducente/etiologia , Fístula Carotidocavernosa/terapia , Diplopia/etiologia , Embolização Terapêutica/efeitos adversos , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Abducente/fisiopatologia , Doenças do Nervo Abducente/cirurgia , Acidentes de Trânsito , Adulto , Fístula Carotidocavernosa/diagnóstico por imagem , Angiografia Cerebral , Diplopia/fisiopatologia , Diplopia/cirurgia , Procedimentos Endovasculares , Movimentos Oculares/fisiologia , Humanos , Masculino , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Doenças do Nervo Oculomotor/fisiopatologia , Doenças do Nervo Oculomotor/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Recidiva , Adulto Jovem
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