Neuropatia óptica isquêmica anterior e poliarterite nodosa: relato de caso

Graf, Christie Michelle; Skare, Thelma Larocca; Moreira, Carlos Augusto

doi:10.1590/s0004-27492006000100020

Cited by 3 publications

(3 citation statements)

References 2 publications

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“…Cranial nerve involvement in PAN is a rare manifestation, being less frequent than the central nervous sys-tem involvement and peripheral neuropathy. According to our literature review, the most frequent cranial nerves involved in PAN are the optic (II), oculomotor (III) and abducent (IV) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. We did not find any case report with involvement of olfactory, glossopharyngeal, vagus, accessory or hypoglossal nerves in patients with PAN.…”

Section: Discussionmentioning

confidence: 89%

“…1). Each case is described in Table I [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. In 10 of the 16 patients, cranial neu-ropathy was the initial manifestation, as in our case.…”

Section: Systematic Literature Reviewmentioning

confidence: 85%

“…Treatment of cranial involvement in PAN without hepatitis B infection included glucocorticosteroids, as first-line treatment in monotherapy to rapidly control inflammation. Iimmunosuppressive agents, such as cyclophosphamide or AZT with combination with GCs may be a second line treatment [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. The described patient responded very well to intravenous methylprednisolone pulse therapy, followed by oral prednisolone and AZT, remaining in sustained remission with AZT in monotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Oculomotor nerve palsy, an unusual onset of polyarteritis nodosa

Martins¹,

Pinheiro²,

Vedor³

et al. 2023

Reumatologia

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IntroductionCranial nerve involvement in polyarteritis nodosa(PAN) is underrecognized and rarely reported. The aim of this article is to review the available literature and present an example of oculomotor nerve palsy in the course of PAN.Material and MethodsEvaluation of texts describing the analyzed problem using the terms “polyarteritis nodosa”, “nerve”, “oculomotor”, “cranial nerve” and “cranial neuropathy” for searching the PubMed database was done. Only full-text articles in English language with titles and abstracts were included in the analysis. As a guideline for the analysis of articles, the methodology described in the Principles of Individual Patient Data systematic reviews (PRISMA-IPD) was used.ResultsAfter screening articles only 16 reported cases of PAN with cranial neuropathy were included in the analysis. In 10 the cranial neuropathy was reported as the initial manifestation of PAN with optic nerve involvement as the most frequent (62.5%); among these cases the oculomotor nerve was in-volved in 3 cases. Treatment with glucocorticosteroids and cyclophosphamide was the most com-mon.ConclusionsAlthough cranial neuropathy, especially oculomotor nerve palsy is a rare first neurological manifesta-tion of PAN, this clinical problem should be considered in the differential diagnosis. Especially patients with peripheral neuropathy, general symptoms, skin lesions and hepatitis B virus infection should be evaluated for cranial nerve involvement in the course of vasculitis. In the case of unclear involvement of the cranial nerves, PAN should also be considered in the differential diagnosis as the cause of symptoms and the first manifestation of the disease.

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Section: Discussionmentioning

confidence: 89%

Section: Systematic Literature Reviewmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Oculomotor nerve palsy, an unusual onset of polyarteritis nodosa

Martins¹,

Pinheiro²,

Vedor³

et al. 2023

Reumatologia

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Chapter 7 Inflammatory Optic Neuropathies Not Associated with Multiple Sclerosis

Kidd¹

2008

Neuro-Ophthalmology

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Optic Neuropathy Secondary to Polyarteritis Nodosa, Case Report, and Diagnostic Challenges

Vázquez-Romo

Rodriguez-Hernandez

Paczka³

et al. 2017

Front. Neurol.

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PurposeTo describe a case of optic neuropathy as a primary manifestation of polyarteritis nodosa (PAN) and discuss diagnostic challenges.MethodsCase report.ResultsA 41-year-old Hispanic man presented with a 2-day history of reduced visual acuity in his left eye. Physical examination revealed a complete visual field loss in the affected eye. Best-corrected visual acuity (BCVA) in the left eye was hand motion, and fundus examination revealed a hyperemic optic disk with blurred margins, swelling, retinal folds, dilated veins, and normal size arteries. BCVA in the right eye was 20/20; no anomalies were seen during examination of the fundus. The patient was started on oral corticosteroids and once the diagnosis of PAN was made, cyclophosphamide was added to the treatment regimen. Six months later, the patient recovered his BCVA to 20/20 in his left eye.ConclusionRarely does optic neuropathy present as a primary manifestation of PAN; nevertheless, it represents an ophthalmologic emergency that requires expeditious anti-inflammatory and immunosuppressive treatment to decrease the probability of permanent visual damage. Unfortunately, diagnosing PAN is challenging as it necessitates a high index of suspicion. In young male patients who present for the first time with diminished visual acuity, ophthalmologists become cornerstones in the suspicion of this diagnosis and should be responsible for continuing the study until a diagnosis is reached to ensure rapid commencement of immunosuppressive treatment.

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Neuropatia óptica isquêmica anterior e poliarterite nodosa: relato de caso

Cited by 3 publications

References 2 publications

Oculomotor nerve palsy, an unusual onset of polyarteritis nodosa

Oculomotor nerve palsy, an unusual onset of polyarteritis nodosa

Chapter 7 Inflammatory Optic Neuropathies Not Associated with Multiple Sclerosis

Optic Neuropathy Secondary to Polyarteritis Nodosa, Case Report, and Diagnostic Challenges

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