RESUMO
PURPOSE: Craniosynostosis can lead to symptoms resulting from cranial compliance (CC) changes and intracranial hypertension (ICH), which may cause cognitive and visual impairment. Non-invasive methods have emerged, including a new device that captures and processes the intracranial pressure waveform (ICPw) by the skull's oscillation. The present study evaluates ICPw obtained non-invasively (NIICPw) in patients with craniosynostosis. METHODS: This prospective, cross-sectional, and descriptive study was conducted at a single center. Patients diagnosed with craniosynostosis and who provided informed consent were included. A US Food and Drug Administration-approved mechanical extensometer device (Brain4Care Corp.) was used to obtain a NIICPw. An ophthalmologist did a point-of-care retinography to check the optic nerve papilla. The P2/P1 ratio and the morphology of the NIICPw were analyzed, as well as the retinography. RESULTS: Thirty-five patients were evaluated, and 42 registers were obtained because seven were assessed before and after the surgery. The two patients who presented papilledema had low CC (NIICPw shape Class 3 or 4). There was a significant association between NIICPw and papilledema. CONCLUSION: The ratio P2/P1 and the NIICPw morphology provided by a non-invasive monitor are related to CC changes before papilledema occurs. This is especially useful in patients with craniosynostosis because invasive ICP monitoring is not always feasible. Further studies are warranted to establish the clinical utility of NIICPw in patients with craniosynostosis.
Assuntos
Craniossinostoses , Hipertensão Intracraniana , Papiledema , Humanos , Pressão Intracraniana/fisiologia , Papiledema/etiologia , Estudos Transversais , Estudos Prospectivos , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/complicaçõesRESUMO
A 13-year-old girl with a 7-day history of painless vision loss and central scotoma in her left eye was referred to the hospital. Dilated fundus examination revealed a bilateral sectorial macular star that was more extended in the left eye and some faint, small, tan-yellow dots were observed at the level of the retinal pigment epithelium in the posterior pole. What would you do next?
Assuntos
Disco Óptico , Papiledema , Criança , Humanos , Letargia , Papiledema/diagnóstico , Papiledema/tratamento farmacológico , Papiledema/etiologia , Fundo de OlhoRESUMO
Increased intracranial pressure is the most common cause of papilledema. Multiple etiologies such as cerebral edema, hydrocephalus, space occupying lesions, infection, and idiopathic intracranial hypertension among others should be considered. Imaging plays a critical role in the detection of pathologies that can cause papilledema. MRI with contrast and CE-MRV, in particular, are key for the diagnosis of idiopathic intracranial hypertension. This review will focus in common and infrequent causes of papilledema, the role of imaging in patients with papilledema as well as its potential mimickers.
Assuntos
Papiledema , Pseudotumor Cerebral , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Papiledema/diagnóstico por imagem , Papiledema/etiologia , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/diagnóstico por imagemRESUMO
BACKGROUND AND AIM: Shunt dysfunction is a common event, especially in children who have this intervention performed early in life. The consequences of chronic shunt overdrainage can be multiple since the cerebral hydrodynamics is altered. A thrombotic event with consequent symptoms of intracranial hypertension is discussed in this article. MATERIAL AND METHODS: We performed a detailed review of cerebral hydrodynamics and intracranial pressure compensation mechanisms and how this can alter cerebral venous circulation. Next, we report the case of a 4-year-old child with such a clinical presentation that was conducted by our team. RESULTS: A child with a history of hydrocephalus treated with a ventriculo-peritoneal (VP) shunt in his early childhood presented with symptoms of intracranial hypertension, initial computed tomography (CT) demonstrating reduced-sized ventricles. Complementary investigation showed bilateral papilledema, cranial suture closure, changes compatible with Chiari type I, and venous sinus thrombosis (transverse and sigmoid, bilaterally). The case was managed conservatively with full anticoagulation with enoxaparin. Four months after the onset of symptoms, there was an improvement in the clinical and imaging status. CONCLUSION: A condition of severe headache in a patient with an apparently functioning shunt and small ventricles on initial CT should open up a range of diagnostic possibilities, with pseudotumor cerebri syndrome and cerebral venous sinus thrombosis being suggested. The therapeutic approach in these cases must be individualized.
Assuntos
Hipertensão Intracraniana , Papiledema , Pseudotumor Cerebral , Trombose dos Seios Intracranianos , Pré-Escolar , Cavidades Cranianas/diagnóstico por imagem , Cavidades Cranianas/patologia , Humanos , Hipertensão Intracraniana/complicações , Papiledema/etiologia , Pseudotumor Cerebral/cirurgia , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/etiologiaRESUMO
ABSTRACT We report an unusual case of brucellosis presented with headache, diminished vision, papillitis and multiple peripapillary hemorrhages accompanied by subretinal fluid extending up to macula. Diagnosis of brucellosis was made based on positive polymerase chain reaction of cerebrospinal fluid sample for Brucella species DNA, accompanied by a raised titer of anti-brucella antibodies. Patient showed remarkable improvement on triple drug therapy in form of doxycycline, rifampicin and ceftriaxone.
RESUMO Relatamos um caso incomum de brucelose apresentada com cefaleia, visão diminuída, papilite e múltiplas hemorragias peripapilares acompanhadas por fluido sub-retinal, estendendo-se até a mácula. O diagnóstico de brucelose foi feito com base na reação em cadeia da polimerase positiva de amostra de líquido cefalorraquidiano para DNA de espécies de Brucella, acompanhada por um título elevado de anticorpos antibrucela. O paciente apresentou melhora notável com a terapia tripla com drogas na forma de doxiciclina, rifampicina e ceftriaxona.
Assuntos
Humanos , Feminino , Idoso , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Infecções Oculares Bacterianas/diagnóstico , Infecções Oculares Bacterianas/tratamento farmacológico , Oftalmoscopia , Rifampina/uso terapêutico , Ceftriaxona/uso terapêutico , Brucella/isolamento & purificação , Angiofluoresceinografia , Líquido Cefalorraquidiano/microbiologia , Papiledema , Reação em Cadeia da Polimerase , Doxiciclina/uso terapêutico , Tomografia de Coerência ÓpticaRESUMO
La neurorretinitis como manifestación de la enfermedad por arañazo de gato se presenta en el 1-2 % de los pacientes con afecciones oculares porBartonella henselae. Las manifestaciones oculares suelen suceder a las sistémicas, aunque pueden aparecer en ausencia de estas. La presencia de exudado macular en forma de estrella es característico y sugestivo de dicha infección. Se presenta el caso de un paciente de 14 años de edad, previamente sano, con disminución de la agudeza visual de 15 días de evolución, que ingresó por sospecha de neuritis óptica izquierda con edema de papila. El seguimiento oftalmológico reveló la aparición de la lesión característica en "estrella macular" que permitió arribar al diagnóstico de infección por B. henselae, confirmándose luego con serología positiva
Neurorretinitis as a manifestation of cat scratch disease occurs in 1-2 % of patients with Bartonella Henselae eye disease. Ocular manifestations tend to follow systemic ones, although they can appear in their absence. The presence of star-shaped macular exudate is characteristic and suggestive of this infection. We report a case of a 14-year-old healthy boy, with 15 days of decreased visual acuity, who was admitted for suspected left optic neuritis with papilledema. Ophthalmological examination revealed the characteristic "macular star" that led to the diagnosis of infection by Bartonella Henselae, later confirmed by positive serology.
Assuntos
Humanos , Masculino , Adolescente , Retinite/diagnóstico , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Papiledema , Bartonella henselae , Exame FísicoRESUMO
Neurorretinitis as a manifestation of cat scratch disease occurs in 1-2 % of patients with Bartonella Henselae eye disease. Ocular manifestations tend to follow systemic ones, although they can appear in their absence. The presence of star-shaped macular exudate is characteristic and suggestive of this infection. We report a case of a 14-year-old healthy boy, with 15 days of decreased visual acuity, who was admitted for suspected left optic neuritis with papilledema. Ophthalmological examination revealed the characteristic "macular star" that led to the diagnosis of infection by Bartonella Henselae, later confirmed by positive serology.
La neurorretinitis como manifestación de la enfermedad por arañazo de gato se presenta en el 1-2 % de los pacientes con afecciones oculares por Bartonella henselae. Las manifestaciones oculares suelen suceder a las sistémicas, aunque pueden aparecer en ausencia de estas. La presencia de exudado macular en forma de estrella es característico y sugestivo de dicha infección. Se presenta el caso de un paciente de 14 años de edad, previamente sano, con disminución de la agudeza visual de 15 días de evolución, que ingresó por sospecha de neuritis óptica izquierda con edema de papila. El seguimiento oftalmológico reveló la aparición de la lesión característica en "estrella macular" que permitió arribar al diagnóstico de infección por B. henselae, confirmándose luego con serología positiva.
Assuntos
Bartonella henselae , Doença da Arranhadura de Gato , Papiledema , Retinite , Adolescente , Doença da Arranhadura de Gato/complicações , Doença da Arranhadura de Gato/diagnóstico , Humanos , Exame Físico , Retinite/diagnósticoRESUMO
We have reported here the case of a 54-year-old woman with intracranial hypertension that presented with the unique features of unilateral papilledema and peripapillary polypoidal choroidal vasculopathy. Our investigations lead to the diagnosis of idiopathic intracranial hypertension and an incidental small right frontal meningioma. The patient was accordingly treated with oral acetazolamide, followed by three consecutive monthly intravitreal injections of bevacizumab, which resulted in the inactivation of the polypoidal choroidal vasculopathy, marked reduction of lipid exudation, and complete absorption of the subretinal fluid. This case serves as the first documentation of polypoidal choroidal vasculopathy associated with papilledema. It also demonstrates that choroidal vascular abnormalities may occur even when optic disk edema is unilateral, which is an uncommon manifestation of increased intracranial pressure. Prompt recognition of such findings and its appropriate management are essential for adequate treatment and prevention of irreversible visual loss.
Assuntos
Doenças da Coroide , Papiledema , Pseudotumor Cerebral , Inibidores da Angiogênese/uso terapêutico , Corioide , Doenças da Coroide/etiologia , Feminino , Angiofluoresceinografia , Humanos , Injeções Intravítreas , Pessoa de Meia-Idade , Papiledema/tratamento farmacológico , Papiledema/etiologia , Pseudotumor Cerebral/complicações , Pseudotumor Cerebral/tratamento farmacológico , Tomografia de Coerência Óptica , Acuidade VisualAssuntos
Macula Lutea/patologia , Papiledema/etiologia , Hemorragia Retiniana/complicações , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Feminino , Glioblastoma/complicações , Glioblastoma/diagnóstico , Humanos , Pessoa de Meia-Idade , Papiledema/diagnóstico , Hemorragia Retiniana/diagnósticoRESUMO
RESUMO No final do século vinte, com o surgimento de novas tecnologias e de novos programas espaciais, a medicina aeroespacial ganhou destaque no meio científico uma vez que os estudos relacionados às alterações da fisiologia humana no espaço tornaram-se cada vez mais necessário para a manutenção da saúde de cosmonautas. Os olhos são considerados uma das estruturas mais sensíveis do corpo às alterações vasculares, estruturais e bioquímicas provocadas pela microgravidade e radiação cósmica. Nesse sentido, essa revisão narrativa busca identificar e explicar as principais alterações morfológicas e funcionais que ocorrem no sistema visual em decorrência de missões espaciais.
ABSTRACT At the end of the twentieth century, with the emergence of new technologies and new space programs, aerospace medicine gained prominence in the scientific community since studies related to changes in human physiology in space have become increasingly necessary for the maintenance of cosmonaut health. The eyes are considered one of the most sensitive structures in the body to vascular, structural and biochemical changes caused by microgravity and cosmic radiation. In this sense, this narrative review seeks to identify and explain the main morphological and functional changes that occur in the visual system as a result of space missions.