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1.
Ocul Immunol Inflamm ; 28(8): 1285-1289, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33021422

RESUMO

PURPOSE: To describe a case of inflammatory chorioretinopathy and Adie's syndrome possibly associated with COVID-19. METHODS: Observational case report. RESULTS: A 51-year-old woman developed fever, cough, and headache followed by retro-ocular pain and reading impairment. She tested positive for SARS-COV-2 infection by qualitative real-time reverse-transcriptase-polymerase-chain-reaction. The slit-lamp and funduscopic exam revealed abnormal pupillary response and yellowish creamy deep chorioretinal lesions, which were not present in previous examinations. Instillation of pilocarpine demonstrated denervation supersensitivity, and it was suggestive of bilateral Adie tonic pupil. A comprehensive work-up ruled out other systemic, autoimmune, or infectious diseases. CONCLUSIONS: This case illustrates the possible association between multifocal chorioretinitis and Adie's syndrome, and the SARS-COV-2 infection in humans. Further investigation of virus infectivity specifically within ocular tissues has to be conducted.


Assuntos
Síndrome de Adie/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Acuidade Visual , Síndrome de Adie/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Angiofluoresceinografia , Fundo de Olho , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Tomografia de Coerência Óptica
2.
Cesk Slov Oftalmol ; 76(5): 232-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33499645

RESUMO

The aim of the work is to approach the examination of the pupil with a focus on anisocoria, its characteristics and approach to the diagnosis of pupillotonia and Adie's syndrome and its clinical evaluation. Pupil function is important not only in neurophthalmological examination but also in general ophthalmological examination. First of all, we need to know how the reflex arc works in order to be able to exclude or confirm whether the parasympathetic or sympathetic is affected. It is also necessary to know the exact characteristics of the pupil, such as size, shape, placement, function and reaction to light and at close range. Only on this basis can we distinguish pathological features. We do not often encounter this diagnosis, but it is necessary to keep it in mind, especially in the field of neurophthalmology but also in general ophthalmology. We also present three cases of pupilotonia and Adie's syndrome, which we diagnosed at the Department of Ophthalmology, Faculty of Medicine, Comenius University, after the patient himself came by emergency admission or was sent directly to ophthalmology clinic. In the discussion, we present various other diagnoses, where the reflex arc may not be affected, but the pathological pupil is caused by intraocular tumors, general systemic diseases and, last but not least, local therapy or alkaloids.


Assuntos
Síndrome de Adie , Pupila Tônica , Síndrome de Adie/diagnóstico , Anisocoria/diagnóstico , Anisocoria/etiologia , Humanos , Pupila , Pupila Tônica/diagnóstico , Pupila Tônica/etiologia
8.
Srp Arh Celok Lek ; 143(7-8): 451-4, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26506756

RESUMO

INTRODUCTION: Adie's (tonic) pupil is a neuro-ophthalmological disorder characterized by a tonically dilated pupil, which is unresponsive to light. It is caused by damage to postganglionic fibers of the parasympathetic innervation of the eye, usually by a viral.or bacterial infection. Adie's syndrome includes diminished deep tendon reflexes. OUTLINE OF CASES: We report data of a 59-year-old female with unequal pupil sizes. She complained of blurred vision and headache mainly while reading. She had a 35-year history of hepatitis B and liver cirrhosis. On exam, left pupil was mydriatic and there was no response to light and at slit lamp we saw segments of the sphincter constrict. We performed 0.125% pilocarpine test and there was a remarkable reduction of size in the left pupil. The second case is a 55-year-old female who was referred to the University Eye Clinic because of a headache and mydriatic left pupil. She had diabetes mellitus type 2, as well as hepatitis A virus 20 years earlier. On exam, the left pupil was mydriatic, with no response to light. Test with diluted pilocarpine was positive. Neurological examinations revealed no abnormality in either case so we excluded Adie's syndrome. CONCLUSION: Adie's tonic pupil is benign neuro-ophthalmological disorder of unknown etiology. Most patients commonly present no symptoms and anisocoria is noticed accidentally. Although the etiology is unknown, there are some conditions that cause tonic pupil. It may be a part of a syndrome in which tonic pupil is associated with absent deep tendon reflexes.


Assuntos
Síndrome de Adie/diagnóstico , Iris/fisiopatologia , Pupila Tônica/diagnóstico , Acomodação Ocular , Síndrome de Adie/etiologia , Complicações do Diabetes , Feminino , Hepatite B/complicações , Humanos , Pessoa de Meia-Idade , Pilocarpina/administração & dosagem , Pupila/efeitos dos fármacos , Reflexo Pupilar/efeitos dos fármacos , Pupila Tônica/etiologia
9.
Rev. bras. oftalmol ; 74(5): 312-314, set.-out. 2015. tab, ilus
Artigo em Inglês | LILACS | ID: lil-757456

RESUMO

The Holmes-Adie syndrome is characterized by the presence of tonic pupil associated with absence or diminution of deep tendon reflexes. In some cases there may be autonomous nerve dysfunction. The mechanism that causes the disorder is not fully known, but is believed to be caused by denervation of the postganglionic supply to the sphincter of the pupil and the ciliary muscle which can occur following viral disease. Typically it affects young adults and is unilateral in 80% of cases, although it may develop in the contralateral eye in months or years. We report a case of a woman presenting typical signs of this syndrome, in which pharmacological test was essential for diagnosis.


A Síndrome de Holmes-Adie É caracterizada pela presença de pupila tônica associada à diminuição ou ausência dos reflexos tendíneos profundos. Em alguns casos pode haver disfunção nervosa autônoma. O mecanismo que causa a desordem não é totalmente conhecido, mas acredita-se que seja causada pela desnervação do suprimento pós-ganglionar para o esfíncter da pupila e para o músculo ciliar, que pode ocorrer após doença viral. Tipicamente afeta adultos jovens e é unilateral em 80% dos casos, embora possa se desenvolver no olho contralateral em meses ou anos. Nós relatamos o caso de uma mulher apresentando sinais típicos desta síndrome, em que o teste farmacológico foi fundamental para o diagnóstico.


Assuntos
Humanos , Feminino , Adulto , Mióticos , Pilocarpina , Pupila Tônica/diagnóstico , Síndrome de Adie/diagnóstico
11.
J Neurosurg ; 121(3): 645-52, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24995781

RESUMO

OBJECT: Prediction of outcome from initial presentation after a gunshot wound to the head (GSWH) is essential to further clinical decision making. The authors' goals are to report the survival and functional outcomes of these patients, to identify prognostic factors, and to propose a scoring system that can predict their outcome. METHODS: The records of 199 patients admitted with a GSWH with dural penetration between 1990 and 2008 were retrospectively reviewed. The inclusion criterion was a CT scan available for review. Patients declared brain dead on presentation were excluded, which yielded a series of 119 patients. Statistical analysis was performed using a logistic regression model. RESULTS: Fifty-eight (49%) of the 119 patients died. Twenty-three patients (19%) had a favorable outcome defined as a 6-month Glasgow Outcome Scale (GOS) score of moderate disability or good recovery, 35 (29%) had a poor outcome (GOS of persistent vegetative state or severe disability), and 3 (3%) were lost to follow-up. Significant prognostic factors for mortality were age older than 35 years, nonreactive pupils, bullet trajectory of bihemispheric (excluding bifrontal), and posterior fossa involvement compared with unihemispheric and bifrontal. Factors that were moderately associated with higher mortality included intracranial pressure (ICP) above 20 mm Hg and Glasgow Coma Scale (GCS) score at presentation of 3 or 4. Upon multivariate analysis, the significant factors for mortality were bullet trajectory and pupillary response. Variables found to be significant for good functional outcome were admission GCS score greater than or equal to 5, pupillary reactivity, and bullet trajectory of unihemispheric or bifrontal. Factors moderately associated with good outcome included age of 35 years or younger, initial ICP 20 mm Hg or lower, and lack of transventricular trajectory. In the multivariate analysis, significant factors for good functional outcome were bullet trajectory and pupillary response, with age moderately associated with improved functional outcomes. The authors also propose a scoring system to estimate survival and functional outcome. CONCLUSIONS: Age, pupils, GCS score, and bullet trajectory on CT scan can be used to determine likelihood of survival and good functional outcome. The authors advocate assessing patients based on these parameters rather than pronouncing a poor prognosis and withholding aggressive resuscitation based upon low GCS score alone.


Assuntos
Traumatismos Craniocerebrais/diagnóstico , Traumatismos Craniocerebrais/mortalidade , Avaliação da Deficiência , Escala de Coma de Glasgow , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/mortalidade , Síndrome de Adie/complicações , Síndrome de Adie/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Traumatismos Craniocerebrais/diagnóstico por imagem , Feminino , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/diagnóstico por imagem , Adulto Jovem
12.
Ocul Immunol Inflamm ; 22(4): 336-40, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24215593

RESUMO

We report a 37-year-old woman with uveitic phase of Vogt Koyanagi Harada disease and tonic pupil, the tonic pupil persisted after other clinical features of this syndrome had disappeared; neurological evaluation shows absent knee and arm tendon reflexes and positive cholinergic supersensitivity test with Pilocarpine 0.125% confirming the diagnosis of Holmes Adie Syndrome.


Assuntos
Síndrome de Adie/diagnóstico , Síndrome Uveomeningoencefálica/diagnóstico , Síndrome de Adie/complicações , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Síndrome Uveomeningoencefálica/complicações , Acuidade Visual
13.
Semin Ophthalmol ; 29(4): 189-91, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23952008

RESUMO

We describe a case of a female patient who presented with anisocoria and was initially diagnosed with a right acute Adie's pupil on the basis of a right tonic pupil with absent oculomotor or neurological findings and hyper-responsiveness to dilute Pilocarpine. Two months later, the patient returned with bilateral tonic pupils and limitation of extraocular movement in the right eye. Subsequent laboratory testing revealed neurosyphilis. Our case, only the second ever reported, emphasizes the importance of considering the diagnosis of neurosyphilis in patients presenting with an isolated acute tonic pupil.


Assuntos
Síndrome de Adie/diagnóstico , Neurossífilis/diagnóstico , Pupila Tônica/diagnóstico , Síndrome de Adie/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Infusões Intravenosas , Imagem por Ressonância Magnética , Neurossífilis/tratamento farmacológico , Penicilina G/uso terapêutico , Sorodiagnóstico da Sífilis , Pupila Tônica/tratamento farmacológico , Acuidade Visual
17.
Oftalmologia ; 56(3): 46-51, 2012.
Artigo em Romano | MEDLINE | ID: mdl-23713338

RESUMO

The benign syndrome of pupillotonia and absence of deep reflexes is not uncommon. It was clearly and accurately described by Adie (1932), although incompletely recognized many years, before. The pupillary abnormality was reported by ophthalmologists at the turn of the century (Saenger, 1902, Strasburger 1902), and the associated deep reflex change was described by Markus (1906), Roemheld (1921) and Parkes Weber (1923). Holmes (1932) was fully aware of the association of "partial iridoplegia" with diminished reflexes. Tonic pupils react poorly to light but constrict during viewing of a near stimulus. Adie's name is typically used in association with tonic pupils, but a review of Adie's articles reveals that he described the syndrome of tonic pupils and absent reflexes and not the pupillary abnormality per se. Therefore, it would be more appropriate to refer to a tonic pupil as simply a 'tonic pupil" and leave Adie's name for the syndrome. We report a typical case of tonic pupil.


Assuntos
Pupila Tônica/diagnóstico , Síndrome de Adie/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Mióticos , Pilocarpina , Valor Preditivo dos Testes , Pupila/efeitos dos fármacos , Sensibilidade e Especificidade , Terminologia como Assunto
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