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Recurrent VI cranial nerve paralysis secondary to idiopathic cavernous sinus pachymeningitis: a case report
Parálisis recurrente de VI nervio craneal secundaria a paquimeningitis idiopática del seno cavernoso: comunicación de un caso
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The choroidal thinning (white arrow) at nasal level could be physiological and attributable to the patient’s myopia. Subfoveal hyperreflectivity resolved at two weeks (B) leaving a minimal sequel of subfoveal RPE thickening at 1.5 months (C). The outer nasal layers progressively recovered (B and C). In A-OCT 8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8 <span class="elsevierStyleItalic">en-face,</span> at ellipsoid layer level, hyperreflective points were observed surrounding the papilla (green arrow) at debut (D). After two weeks (E), these peripapillary hyperreflective points decreased but hyporeflective spots were observed (white arrow), which correlate with the disruption of the outer retina in autofluorescence. After 1.5 months (F), hyporeflective spots decreased and white peripapillary spots disappeared. The A-OCT 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3 showed at choriocapillary level two apparent hypoperfusion spots in the debut of the disease (G), which correlate with the shadow of the subfoveal column hyperreflectivity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Moll-Udina, I. Hernanz, M. Dotti, V. Llorenç, A. Adán" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Moll-Udina" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Hernanz" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Dotti" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Llorenç" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Adán" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120303105" "doi" => "10.1016/j.oftal.2020.07.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120303105?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357942030219X?idApp=UINPBA00004N" "url" => "/21735794/unassign/S217357942030219X/v1_202011150602/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Recurrent VI cranial nerve paralysis secondary to idiopathic cavernous sinus pachymeningitis: a case report" "tieneTextoCompleto" => 0 "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Picasso Simón, M. Castro-Rebollo, B. Sastre Borregón, J. González-Martín-Moro" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Picasso Simón" "email" => array:1 [ 0 => "Lo.picasso.simon@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Castro-Rebollo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "B." "apellidos" => "Sastre Borregón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." 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Magnetic resonance imaging revealed localized pachymeningitis in her right cavernous sinus. Initial episodes were treated with botulinum toxin. Subsequently, she declined treatment during inter-crisis periods because she remains asymptomatic. Idiopathic hypertrophic pachymeningitis is a rare condition of unknown cause, characterized by chronic inflammation of the meninges resulting in localized or diffuse dural thickening. Clinical manifestations vary widely, from generalized processes with complex neurological symptoms to localized processes with monosymptomatic expression, as presented in this case.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Mujer de 55 años, con antecedente de endometriosis severa, seguida en nuestro centro durante 16 años por múltiples episodios de diplopía binocular horizontal siendo diagnosticada de paresia recurrente del VI par craneal del ojo derecho. Se realizó una resonancia magnética donde se identificó la presencia de una paquimeningitis localizada en el seno cavernoso derecho. Los episodios iniciales fueron tratados con toxina botulínica. Posteriormente ha rechazado tratamiento por encontrarse sin diplopía en los periodos intercrisis. La paquimeningitis hipertrófica idiopática es una enfermedad rara de causa desconocida que cursa con inflamación crónica de las meninges produciendo engrosamiento dural localizado o difuso. La expresión clínica es muy variable, desde procesos generalizados que producen compleja clínica neurológica hasta procesos localizados con expresión monosintomática como el que presentamos.</p></span>" ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/unassign/S2173579424001671/v1_202410170446/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735794/unassign/S2173579424001671/v1_202410170446/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579424001671?idApp=UINPBA00004N" ]
