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Manifestações neuro-oftalmológicas de esclerose múltipla
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A Esclerose Múltipla (EM) é uma doença inflamatória crónica e degenerativa do sistema nervoso central (SNC), caracterizada por desmielinização, gliose e perda neuronal. Como aproximadamente 40% do cérebro está envolvido na visão, é compreensível que este seja um dos alvos mais frequentes da EM. As manifestações neuro-oftalmológicas ocorrem em cerca de 80% dos casos durante a progressão da doença e qualquer parte da via visual pode ser afetada.
Este trabalho teve como principal objetivo analisar as diferentes manifestações neuro-oftalmológicas da EM, com base em três casos clínicos, e enfatizar a importância da valorização destes sintomas, para a definição do diagnóstico e subsequentes decisões clínicas.
Os casos clínicos apresentados representam uma parte do amplo espectro de manifestações neuro-oftalmológicas de EM, com diferentes sintomas iniciais e evoluções clínicas.
A nevrite ótica (NO) é uma síndrome inflamatória do nervo ótico observada frequentemente na EM. O risco de desenvolver EM 15 anos após um episódio de NO é de 50%, sendo que este se encontra fortemente associado à evidência na ressonância magnética inicial de lesões desmielinizantes na substância branca do SNC.
Os doentes com EM apresentam frequentemente distúrbios oculomotores (DOM), apesar de uma grande parte não referir sintomas. A gravidade destes sintomas já foi demonstrada, em vários estudos, como importante fator preditivo de incapacidade. Os DOM mais comummente associados a EM são oftalmoplegia internuclear, nistagmo evocado pela direção do olhar (“gaze-evoked nystagmus”), alterações dos reflexos oculovestibulares e do olhar conjugado.
Com base neste trabalho podemos inferir que o quadro clínico oftalmológico dos doentes com EM é bastante complexo, sendo, portanto, essencial avaliá-los de forma detalhada e sistemática, utilizando, sempre que possível, métodos complementares de diagnóstico como potenciais evocados visuais, tomografia de coerência ótica e ressonância magnética.
Multiple Sclerosis (MS) is a chronic degenerative and inflammatory disease that affects the central nervous system (CNS). This disease is characterized by demyelination, gliosis and neural loss. As approximately 40% of the brain is involved in the visual pathway, it’s understandable that this is one of the major targets of the disease. Neuro-ophthalmological manifestations occur in about 80% of cases and any portion of the visual pathway may be affected. The main objective of this work is to analyse the different neuro-ophthalmological manifestations of MS, based on three clinical cases, and emphasise the importance of this symptoms and their value in defining the diagnosis and subsequent clinical decisions. The clinical cases represent a part of the wide spectrum of neuro-ophtalmological manifestations, with different initial symptoms and clinical evolution. Optic neuritis is an inflammatory syndrome seen frequently in this patients. The risk of developing MS 15 years after the first episode of NO is 50%, with the risk being strongly associated with the observation of white matter demyelinated lesions in the initial magnetic resonance imaging. MS patients often present eye movement abnormalities (EMA), even though a big part of them doesn´t refer symptoms. The severity of this symptoms has been demonstrated, in several studies, to be an important predictive factor of disability. The EMA most commonly associated with MS are internuclear ophthalmoplegia, gaze-evokes nystagmus, abnormalities of the conjugated gaze and oculovestibularian reflexes. With this work we can conclude that the ophthalmological clinical presentation of the MS patients is rather complex. Therefore, it is essential to evaluate them in a detailed and systematic manner, using, as often as possible, complementary diagnosis tools as visual evoked potentials, optical coherence tomography and magnetic resonance imaging.
Multiple Sclerosis (MS) is a chronic degenerative and inflammatory disease that affects the central nervous system (CNS). This disease is characterized by demyelination, gliosis and neural loss. As approximately 40% of the brain is involved in the visual pathway, it’s understandable that this is one of the major targets of the disease. Neuro-ophthalmological manifestations occur in about 80% of cases and any portion of the visual pathway may be affected. The main objective of this work is to analyse the different neuro-ophthalmological manifestations of MS, based on three clinical cases, and emphasise the importance of this symptoms and their value in defining the diagnosis and subsequent clinical decisions. The clinical cases represent a part of the wide spectrum of neuro-ophtalmological manifestations, with different initial symptoms and clinical evolution. Optic neuritis is an inflammatory syndrome seen frequently in this patients. The risk of developing MS 15 years after the first episode of NO is 50%, with the risk being strongly associated with the observation of white matter demyelinated lesions in the initial magnetic resonance imaging. MS patients often present eye movement abnormalities (EMA), even though a big part of them doesn´t refer symptoms. The severity of this symptoms has been demonstrated, in several studies, to be an important predictive factor of disability. The EMA most commonly associated with MS are internuclear ophthalmoplegia, gaze-evokes nystagmus, abnormalities of the conjugated gaze and oculovestibularian reflexes. With this work we can conclude that the ophthalmological clinical presentation of the MS patients is rather complex. Therefore, it is essential to evaluate them in a detailed and systematic manner, using, as often as possible, complementary diagnosis tools as visual evoked potentials, optical coherence tomography and magnetic resonance imaging.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Esclerose múltipla Manifestações neuro-oftalmológicas Nevrite ótica Distúrbios oculomotores Tomografia de coerência ótica Oftalmologia