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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.52 no.3 São Paulo Sept. 1994

https://doi.org/10.1590/S0004-282X1994000300010 

A forma arterítica da neuropatia óptica isquêmica anterior: estudo de 25 casos

 

The arteritic type of the anterior ischemic optic neuropathy: a study of 25 cases

 

 

Marco Aurélio Lana-Peixoto

Professor Adjunto de Neurologia, Faculdade de Medicina da Universidade Federal de Minas Gerais

 

 


RESUMO

O quadro clínico, laboratorial, campimétrico e angiofluoresceinográfico de 25 pacientes (40 olhos) com a forma arterítica da neuropatia óptica isquémica anterior (NOIA-A) foi estudada com a finalidade de definir o perfil da doença possibilitando seu diagnóstico diferencial com a forma não arterítica (NOIA-NA) e com outras doenças do nervo óptico. A NOIA-A ocorreu em pacientes entre 60 e 88 anos (média 74 anos), predominando no sexo feminino (64%). Em 15 pacientes o envolvimento foi bilateral, ocorrendo simultaneamente ou nas primeiras semanas após o acometimento inicial. Cefaléia e dor ocular foram os pródromos mais frequentes, enquanto todos os pacientes apresentavam, ao momento da perda visual, sintomas e sinais sistêmicos da arterite de células gigantes (ACG). Elevação da proteina C reativa, do fibrinogênio e da velocidade de hemossedimentação foram as alterações laboratoriais mais frequentemente encontradas. A acuidade visual, em geral, foi severamente acometida. As principais anormalidades fundoscópicas foram edema do disco óptico, usualmente pálido, com ou sem hemorrragias, e alterações retinianas. Exame do campo visual demonstrou uma variedade de defeitos, principalmente altitudinais inferiores enquanto a principal característica angiofluoresceinográfica observada foi o atraso setorial ou difuso do enchimento da coróide.

Palavras-chave: neuropatia óptica isquêmica anterior, forma arterítica, forma não arterítica, arterite de células gigantes.


SUMMARY

The clinical, laboratorial,perimetric and fluorescein angiographic features of the arteritic type of the anterior ischemic optic neuropathy (A-AION) was studied in 25 patients (40 eyes) in order to characterize the profile of the disease and to allow the differential diagnosis with the non-arteritic anterior ischemic optic neuropathy (NA-AION) and other disorders of the optic nerve. The A-AION occurred in patients 60 to 88 years old (mean 74 years) and was highly predominant in females (64 per cent). Fifteen patients had both eyes involved , either simultaneously or usually within few days or weeks after the initial involvement. Headache and eye pain were the most commonly observed prodromic complaints whereas systemic symptoms of giant cell arteritis (GCA) were seen in all patients. The laboratorial abnormalities most commonly found were high values of reactive C protein, plasmatic fibrinogen and erythrocyte sedimentation rate. In the great majority of the patients visual acuity was severely affected. The optic disc was always abnormal, usually showing a pale edema. In addition to that retinal changes were commonly found. Goldmann perimetry disclosed a wide variety of visual fields abnormalities, the most common of them being inferior altitudinal defects. Fluorescein fundus angiography revealed delayed or absent disc fluorescence, or sectorial or diffuse hypofluorescence or hyperfluorescence of the optic disc. Choroidal filling delay was the most characteristic and frequent angiographic finding in the arterite type of the disease.

Key-words: arteritic anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, giant cell arteritis.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Aceite: 24-março-1994.

 

 

Dr. Marco Aurélio Lana-Peixoto - Departamento de Neuro-Oftalmologia, Instituto Hilton Rocha - Avenida Anel da Serra 1355, Mangabeiras - 30210-090 Belo Horizonte MG - Brasil.

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