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1.
Arq Bras Oftalmol ; 84(1): 83-86, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33470347

RESUMO

Septic cavernous sinus thrombosis is a rare but often debilitating and potentially fatal disease. We describe a case of bilateral orbital cellulitis with rapidly progressing cavernous sinus thrombosis and left sigmoidal sinus thrombosis in an immunocompetent 20-year-old military man who had undergone intensive physical training. The patient presented with rapid painful swollen left eye for 2 days. The examination results were gross proptosis with total ophthalmoplegia. He was treated with intravenous antibiotics and corticosteroid. At 1 week, visual acuity improved to 20/20 OU, with a normal intraocular pressure. There was a significant improvement in proptosis. The ocular motility of the right eye was fully restored, with slight residual ophthalmoplegia in the left eye. There was no residual illness or recurrence of illness at 3 months' follow-up.


Assuntos
Trombose do Corpo Cavernoso , Seio Cavernoso , Exoftalmia , Celulite Orbitária , Adulto , Seio Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/diagnóstico por imagem , Trombose do Corpo Cavernoso/tratamento farmacológico , Trombose do Corpo Cavernoso/etiologia , Exoftalmia/etiologia , Humanos , Masculino , Esforço Físico , Adulto Jovem
2.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370953

RESUMO

Post-traumatic direct carotid-cavernous fistulas may develop in patients with a closed head injury. The classical presentation is the Dandy's triad-chemosis, pulsatile proptosis and orbital bruit. Associated findings may include orbital pain, dilated episcleral corkscrew vessels, vision deficit and cranial nerve palsies. Cranial nerves-oculomotor (III), trochlear (IV), ophthalmic (V1), and maxillary (V2) divisions of trigeminal and the abducens (VI) lie in close association of the cavernous sinus. Abducens nerve (VI) lies close to the intracavernous internal carotid artery, within the substance of the sinus and is hence easily susceptible to vascular insult. The two sinuses connect across the midline and communicate freely with each other. Back pressure changes can present with the same sided or bilateral cranial nerve palsies. We report a rare association of a long-standing left-sided carotid-cavernous fistula with right eye abduction deficit and contralateral abducens palsy.


Assuntos
Doenças do Nervo Abducente/etiologia , Fístula Carotidocavernosa/diagnóstico , Exoftalmia/etiologia , Traumatismos Cranianos Fechados/complicações , Angiografia Digital , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Fístula Carotidocavernosa/cirurgia , Seio Cavernoso/diagnóstico por imagem , Criança , Procedimentos Endovasculares , Exoftalmia/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Rev Med Suisse ; 16(713): 2135-2139, 2020 Nov 04.
Artigo em Francês | MEDLINE | ID: mdl-33146966

RESUMO

The cavernous hemangioma (or angioma) of the orbit (HCO) is a benign, encapsulated venous malformation and the most common primary lesion of the orbit in adults. It occurs more often in women. These lesions can cause a unilateral proptosis (exophthalmos), optic nerve damage and other signs of orbital pathology, with varying degrees of visual impairment.When an HCO is suspected, ultrasound, scanner or magnetic resonance imaging (MRI) are a valuable aid to its definitive diagnosis. When HCO is symptomatic, multidisciplinary surgical management by a trained specialist in orbital surgery should be considered.This article aims to present the surgical management of HCO. Topographic classifications and surgical approaches are also discussed.


Assuntos
Exoftalmia , Hemangioma Cavernoso/cirurgia , Neoplasias Orbitárias/cirurgia , Adulto , Exoftalmia/diagnóstico , Exoftalmia/etiologia , Exoftalmia/terapia , Feminino , Hemangioma Cavernoso/diagnóstico , Humanos , Imagem por Ressonância Magnética , Neoplasias Orbitárias/diagnóstico , Ultrassonografia
4.
Medicine (Baltimore) ; 99(29): e20670, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702816

RESUMO

RATIONAL: Cavernous hemangiomas are one of the most common benign primary orbital lesions. These tumors are insidious in onset, slowly progressive and present more often in middle aged women. Multiple orbital cavernous hemangiomas are extremely rare, and only a few cases have been reported in the published literature. PATIENT CONCERNS: Here, we report the diagnosis and treatment of multiple cavernous hemangiomas in the right orbit of a female patient with impaired visual acuity and proptosis of the eye for more than 10 years. DIAGNOSIS: Magnetic resonance imaging of the orbit showed a giant and irregular soft mass filling the intraconal and extraconal space of the right orbit, compressing the right optic nerve. After tumor resection, histopathological examination confirmed the diagnosis of cavernous hemangioma. INTERVENTIONS: A lateral orbitotomy was performed and a total of 13 tumors were excised, with the largest tumor measuring approximately 2.5 × 3.0 cm. OUTCOMES: The visual acuity of the patient was preserved, with only a slightly dilated pupil of the right eye. The follow-up period was 6 months with no signs of recurrence. LESSONS: Multiple cavernous hemangiomas in the orbit is rare and should be excised surgically as soon as possible.


Assuntos
Hemangioma Cavernoso/cirurgia , Síndromes de Compressão Nervosa/etiologia , Nervo Óptico/patologia , Neoplasias Orbitárias/patologia , Adulto , Assistência ao Convalescente , Criança , Exoftalmia/etiologia , Feminino , Hemangioma Cavernoso/complicações , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias Orbitárias/diagnóstico por imagem , Resultado do Tratamento , Transtornos da Visão/etiologia
6.
Medicine (Baltimore) ; 99(27): e21119, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629746

RESUMO

INTRODUCTION: Myeloid sarcoma (MS) is a rare tumor mass. It may occur at any extramedullary anatomic sites but is uncommon in the sinonasal location.MS commonly presents concurrently with acute myeloid leukemia (AML), but it may predate AML over several months or years, named isolated MS. PATIENT CONCERNS: We report a case of a 15-month-old child who presented with mouth breathing, bilateral rhinorrhea, palpebral edema and proptosis. The routine blood tests were normal for the first few months. Computed tomography scan revealed neoplasm in nasal cavity. DIAGNOSIS: The patient was definitely diagnosed with isolated MS in the nasal cavity through immunohistochemistry combined with clinical features and radiological investigations, and MS further progressed to AML which was confirmed by hematologist. INTERVENTIONS: Endoscopic sinus surgery was performed to acquire specimens. After diagnosis, the patient was promptly treated with systemic chemotherapy. OUTCOMES: All symptoms gradually subsided and the mass of nasal cavity was invisible. No relapse occurred during follow-up. CONCLUSION: Sinonasal MS may be misdiagnosed and should be considered when symptoms persist and worsen. Prompt clinic examinations are essential for cases with suspected MS. Diagnosis of MS is dependent on the immunohistological investigations combined with clinical features, radiological investigations. Early diagnosis and systemic chemotherapy are vital for patients to achieve best prognosis.


Assuntos
Leucemia Mieloide Aguda/tratamento farmacológico , Cavidade Nasal/diagnóstico por imagem , Sarcoma Mieloide/complicações , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Erros de Diagnóstico/prevenção & controle , Diagnóstico Precoce , Edema/etiologia , Exoftalmia/etiologia , Doenças Palpebrais/patologia , Humanos , Imuno-Histoquímica/métodos , Lactente , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/cirurgia , Masculino , Cavidade Nasal/patologia , Cavidade Nasal/cirurgia , Sarcoma Mieloide/diagnóstico por imagem , Sarcoma Mieloide/metabolismo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
J Craniofac Surg ; 31(5): 1418-1420, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32487836

RESUMO

Spiral computed tomography is a gold standard in diagnostics of intraorbital pathological changes. Modern software provides great opportunities at viewing and analyzing DICOM files. Earlier, the authors introduced a method of computed exophthalmometry for precise measurement of globes' position even in the cases of lateral orbital rim fracture. However, eye proptosis is known to be depending on the eye length (ocular component), retrobulbar volume (orbital component), as well as anatomy of neurocranium and brain (cerebral component). Nevertheless, conventional Hertel exophthalmometry and other proposed methods do not specify the component, involved in the pathogenesis of enophthalmos or exophthalmos, that is why additional examinations are required. In this article, the authors propose a novel approach, which can complement and/or substitute instrumental methods used for differential diagnostics of enophthalmos or exophthalmos.


Assuntos
Olho/diagnóstico por imagem , Adulto , Enoftalmia/etiologia , Exoftalmia/etiologia , Feminino , Humanos , Masculino , Fraturas Orbitárias/complicações , Tomografia Computadorizada Espiral , Adulto Jovem
8.
J Craniofac Surg ; 31(5): e477-e479, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516216

RESUMO

A 34-year-old man with Basedow disease consulted us to treat disfiguring proptosis. On examination, the patient showed right lower eyelid retraction and right inferior rectus muscle enlargement, which were consistent with thyroid eye disease. Hertel's exophthalmometric examination demonstrated proptosis of 25.5 and 24.0 mm on the right and left sides, respectively. Computed tomography (CT) images revealed absence of the sphenoid door jamb. To correct both exorbitism and exophthalmos, the patient underwent bilateral "shallow" decompression of the lateral and medial orbital walls with orbital fat removal under general anesthesia. The authors removed 2.5 and 1.0 mL of orbital fat from the inferolateral quadrant of the right and left orbits, respectively. At 3 months postoperatively, based on the measurements of the axial globe position on sagittal CT images, postoperative proptosis reductions of 7.5 and 6.5 mm were observed on the right and left sides, respectively.


Assuntos
Descompressão Cirúrgica , Exoftalmia/cirurgia , Órbita/cirurgia , Doenças da Glândula Tireoide/cirurgia , Tecido Adiposo/cirurgia , Adulto , Exoftalmia/diagnóstico por imagem , Exoftalmia/etiologia , Oftalmopatia de Graves , Humanos , Masculino , Músculos Oculomotores/cirurgia , Órbita/diagnóstico por imagem , Período Pós-Operatório , Osso Esfenoide/cirurgia , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X
10.
J Fr Ophtalmol ; 43(6): 467-476, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32376037

RESUMO

PURPOSE: Fibrous dysplasia (FD) is a benign fibro-osseous developmental disorder of growing bone, sometimes involving the craniofacial skeleton (CFD). We wish to present a patient series with CFD of the orbital region and discuss treatment modalities. METHODS: Twelve patients were referred for orbital CFD in the Nantes University Hospital between 2000 and 2018 and studied according to the clinical parameters, radiological features, and modalities of treatment. RESULTS: The mean age was 25.6 years. Ten patients exhibited facial asymmetry with vertical globe dystopia (75%), proptosis (58%) and facial bump (50%). The disease was monostotic in 83% of patients, involving the frontal bone (25%), the sphenoidal bone (33%), the fronto-sphenoidal complex (25%), and the skull base (17%). Unilateral radiological proptosis was found in 7 patients, with a mean protrusion 3.9mm. The optic canal was involved in 75% of patients, with no functional impairment. Three patients were treated with bisphosphonate therapy to stop progression of the disease; 6 patients were given a bone remodelling procedure with good aesthetic outcomes. CONCLUSION: The orbit is a rare localization for FD causing aesthetic and functional disabilities. Medical and surgical treatment can be proposed as part of a multidisciplinary approach.


Assuntos
Doenças do Desenvolvimento Ósseo , Órbita/patologia , Doenças Orbitárias , Adolescente , Adulto , Idoso , Doenças do Desenvolvimento Ósseo/diagnóstico , Doenças do Desenvolvimento Ósseo/tratamento farmacológico , Doenças do Desenvolvimento Ósseo/patologia , Criança , Estudos de Coortes , Exoftalmia/tratamento farmacológico , Exoftalmia/etiologia , Exoftalmia/cirurgia , Face/cirurgia , Assimetria Facial/tratamento farmacológico , Assimetria Facial/etiologia , Assimetria Facial/cirurgia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Órbita/efeitos dos fármacos , Órbita/cirurgia , Doenças Orbitárias/complicações , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/cirurgia , Estudos Retrospectivos , Adulto Jovem
12.
World Neurosurg ; 139: e501-e507, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311560

RESUMO

BACKGROUND: The endoscopic endonasal approach (EEA) has been increasing in popularity as an alternative to traditional transcranial and transorbital approaches in the treatment of orbital pathological entities. The purpose of the present study was to examine the outcomes of patients who had undergone EEA resection of orbital lesions at our center. METHODS: We performed a retrospective medical record review of patients who had undergone the EEA for resection of orbital lesions and orbital apex decompression from January 1, 2006 to December 1, 2019. For all the patients, the demographic data, presenting symptoms, symptom duration, imaging data, operative details, and postoperative outcomes were collected and reviewed. RESULTS: Nine patients underwent endoscopic endonasal resection of orbital lesions and orbital apex decompression at our center, including 6 male patients and 3 female patients. The mean age was 49.4 years, and the mean follow-up period was 3.8 years (range, 1-13.5 years). The orbital pathological lesions that were treated included nasopharyngeal carcinoma, hemangioma, fibrous dysplasia, IgG4 pseudotumor, inverted papilloma, angioleiomyoma, adenocarcinoma, and neuroendocrine paraganglioma metastasis. All the patients presented with exophthalmos of the affected orbit. Of the 9 patients, 5 presented with decreased visual acuity on examination. Postoperatively, 1 of these 5 patients had improved to baseline visual acuity, 3 had stable vision, and 1 had brief improvement before experiencing progressive visual decline 1 month postoperatively. Two patients presented with diplopia, and both improved postoperatively. Three patients experienced new, transient, and self-limiting postoperative diplopia. CONCLUSIONS: For patients with orbital lesions causing compressive optic neuropathy, the endoscopic endonasal approach can be used as an alternative strategy in appropriately selected patients.


Assuntos
Endoscopia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Cavidade Nasal/cirurgia , Doenças Orbitárias/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Diplopia/etiologia , Endoscopia/efeitos adversos , Exoftalmia/etiologia , Exoftalmia/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/cirurgia , Doenças Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Transtornos da Visão/etiologia , Transtornos da Visão/cirurgia , Acuidade Visual
14.
J Craniofac Surg ; 31(1): e60-e61, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31609957

RESUMO

Orbital subperiosteal hematomas are commonly caused by facial trauma. Nontraumatic subperiosteal orbital hematomas (NTSOHs) are rare but may occur in patients with underlying medical diseases. A 71-year-old woman presented to the emergency department with a 5-day history of left periorbital pain and proptosis. She was known to have Behcet disease and presented with no recent trauma. Clinical features and computed tomography findings aided in establishing the diagnosis of an NTSOH. The hematoma was evacuated via sub brow incision. After surgery, the patient's clinical symptoms resolved and did not recur during the 12-month follow-up period. On the basis of the findings of this case, the authors conclude that patients diagnosed with diseases such as bleeding disorders or autoimmune vasculitis should consider visual symptoms as a sign of an NTSOH. Patients who diagnosed with disease experience visual disturbance, periorbital pain, or periorbital swelling should undergo early surgical treatment for spontaneous NTSOH to avoid permanent visual loss.


Assuntos
Síndrome de Behçet/complicações , Hematoma/diagnóstico por imagem , Doenças Orbitárias/diagnóstico por imagem , Idoso , Osso e Ossos , Exoftalmia/etiologia , Feminino , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Doenças Orbitárias/complicações , Doenças Orbitárias/cirurgia , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
15.
World Neurosurg ; 134: 211-214, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31678447

RESUMO

BACKGROUND: Direct carotid cavernous fistulas (CCFs) and sphenoid sinus traumatic aneurysms are well-known pathologies that can present concomitantly in rare cases. Patients with both lesions are usually symptomatic from both the CCF and the traumatic aneurysm. Symptoms include proptosis, chemosis, bruit, epistaxis, visual field defects, and loss of vision. Surgical treatment can be challenging, and for most cases an endovascular approach is the treatment of choice. CASE DESCRIPTION: We present an unusual case of a direct CCF with an associated large traumatic aneurysm in the sphenoid sinus due to a history of trauma presenting with unusual symptoms that was treated by a combined endoscopic and endovascular approach. CONCLUSIONS: Concurrent occurrence of a traumatic CCF and traumatic aneurysm of the cavernous segment is extremely rare. Early diagnosis and treatment of these lesions are important considering their high mortality rate. Complete occlusion of the fistula and aneurysm while preserving the patency of the carotid artery via an endovascular approach is the treatment of choice for these lesions.


Assuntos
Artéria Carótida Interna/cirurgia , Fístula Carotidocavernosa/cirurgia , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/cirurgia , Neuroendoscopia/métodos , Seio Esfenoidal , Adulto , Artéria Carótida Interna/diagnóstico por imagem , Fístula Carotidocavernosa/diagnóstico por imagem , Fístula Carotidocavernosa/etiologia , Angiografia Cerebral , Angiografia por Tomografia Computadorizada , Epistaxe/etiologia , Exoftalmia/etiologia , Traumatismos Cranianos Fechados/complicações , Humanos , Imageamento Tridimensional , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Masculino , Tomografia Computadorizada por Raios X , Transtornos da Visão/etiologia
20.
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
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