O nervo troclear participa do movimento extrínseco dos olhos, através do músculo oblíquo superior. Seu acometimento não é frequente entre as lesões dos pares cranianos e é comumente congênito, relacionado a hipertensão ou ao trauma. A lesão causada por trauma cranioencefálico (TCE) geralmente ocorre em acidente automobilístico, com trauma orbitário direto ou frontal e tem maior incidência no gênero masculino. Os principais achados incluem hipertropia, diplopia vertical, limitação da depressão em adução e inclinação da cabeça para o lado oposto ao músculo oblíquo superior paralisado, manobra conhecida como sinal de Bielchowsky positivo. O objetivo deste estudo é relatar o caso de um paciente de 54 anos, do gênero masculino, que apresentou diplopia após um TCE causado por um acidente automobilístico, tendo como principal hipótese, no momento da consulta, a paresia do IV nervo craniano à esquerda. A paresia dos nervos responsáveis pelos movimentos oculares após TCE é uma entidade com possibilidades de tratamento conservador e cirúrgico, que devem ser minuciosamente observados para melhor prognóstico e estratégia terapêutica.
Esthesioneuroblastoma is a rare neoplasm of the nervous system that appears in the paranasal cavities derived from the olfactory neuroepithelium, located in the cribriform region of the nasal fossa, and can invade the sinuses of the face, skull base and orbital region. Kadish classification is the most widely used to stage it according to its extension. The symptomatology is unspecific, and it may present progressive unilateral nasal obstruction, epistaxis, anosmia, headache, sinusitis, diplopia, and orbital proptosis. The diagnosis is based on the lesion biopsy, immunohistochemistry, and ultrastructural findings. Excision of the tumor is described as the treatment of choice that may be associated with radiotherapy and chemotherapy. This is a case report of an olfactory esthesioneuroblastoma in a patient admitted to the hospital complaining of orbital proptosis who, after a computed tomography of the skull, showed a suspicious lesion. After the biopsy and the anatomopathological study, a protocol with neoadjuvant chemotherapy was initiated, with the subsequent excision of the tumor. Despite the lack of other symptoms, an advanced stage of the neoplasm was identified, which reflects the importance of investigating less common complaints and thus facilitating the diagnosis and early treatment.
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