Loading...
Publication
Nevrite ótica em idade pediátrica: descrição de um caso clínico e revisão da literatura
| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 596.58 KB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
A nevrite ótica é uma doença inflamatória do nervo ótico, rara em crianças
quando comparada aos adultos, porém corresponde a aproximadamente 25% das
síndromes desmielinizantes agudas pediátricas.
Pode ser desencadeada por infeções virais, como o vírus da varicela-zoster, ou
por doenças autoimunes, como a esclerose múltipla, e manifesta-se por diminuição da
acuidade visual, discromatopsia e defeitos de campo visual, como escotomas.
Embora o conhecimento sobre a nevrite ótica em adultos seja substancial, a
compreensão acerca da nevrite ótica pediátrica é mais restrita devido à sua relativa
raridade, apresentando desafios diagnósticos e terapêuticos nesta faixa etária.
O diagnóstico é baseado principalmente na anamnese e no exame físico. Contudo,
os exames complementares podem ser necessários para orientar o diagnóstico etiológico,
nomeadamente análises sanguíneas, serologia, ressonância magnética, análise do
líquido cefalorraquidiano após punção lombar, tomografia de coerência ótica e
potenciais evocados visuais.
O tratamento da nevrite ótica em idade pediátrica é controverso, mas a maioria
dos profissionais segue as recomendações do Optic Neuritis Treatment Trial para
adultos, baseando-se na administração endovenosa de corticosteróides nos episódios
agudos, seguida de corticoterapia oral. A imunoglobulina endovenosa, a plasmaferese e
as terapêuticas imunomoduladoras são reservadas para os casos recorrentes ou
refratários ao tratamento com corticosteróides.
A nevrite ótica em idade pediátrica apresenta melhor prognóstico do que na idade
adulta, apresentando recuperação visual significativa. No entanto, é importante
considerar o risco de evolução do quadro para uma doença desmielinizante do sistema
nervoso central.
Esta revisão de literatura pretende expor o estado atual do conhecimento sobre a
nevrite ótica pediátrica, bem como a sua relação com as doenças neuroinflamatórias do
sistema nervoso central. Serão exploradas as opções diagnósticas e terapêuticas atuais,
destacando a importância de um diagnóstico precoce para a abordagem eficaz desta
patologia. É apresentado um caso clínico de nevrite ótica, acompanhado no Serviço de
Pediatria do Hospital Amato Lusitano, e explorada a abordagem da condição clínica.
Optic neuritis is an inflammatory disease of the optic nerve, rare in children compared to adults, yet it accounts for approximately 25% of pediatric acute demyelinating syndromes. It can be triggered by viral infections, such as the varicella-zoster virus, or by autoimmune diseases, such as multiple sclerosis, and manifests as decreased visual acuity, dyschromatopsia, and visual field defects, such as scotomas. Although knowledge of optic neuritis in adults is substantial, understanding of pediatric optic neuritis is more limited due to its relative rarity, presenting diagnostic and therapeutic challenges in this age group. The diagnosis is primarily based on the medical history and physical examination. However, additional diagnostic tests are necessary to guide the etiological diagnosis, including blood tests, serology, magnetic resonance imaging, analysis of cerebrospinal fluid following lumbar puncture, optical coherence tomography, and visual evoked potentials. The treatment of optic neuritis in the pediatric age group is not consensual, but most professionals follow the Optic Neuritis Treatment Trial recommendations for adults, which are based on intravenous corticosteroid administration during acute episodes, followed by oral corticosteroid therapy. Intravenous immunoglobulin, plasmapheresis, and immunomodulatory therapies are reserved for recurrent or steroid-refractory cases. Pediatric optic neuritis has a better prognosis than in adults, with significant visual recovery. However, it is important to consider the risk of progression to a demyelinating central nervous system disorder. This literature review aims to present the current state of knowledge on pediatric optic neuritis, as well as its relationship with neuroinflammatory diseases of the central nervous system. Current diagnostic and therapeutic options will be explored, emphasizing the importance of early diagnosis for effective management of this pathology. A clinical case of optic neuritis, managed in the Pediatric Department of the Amato Lusitano Hospital, is presented, and the clinical approach to the condition is explored.
Optic neuritis is an inflammatory disease of the optic nerve, rare in children compared to adults, yet it accounts for approximately 25% of pediatric acute demyelinating syndromes. It can be triggered by viral infections, such as the varicella-zoster virus, or by autoimmune diseases, such as multiple sclerosis, and manifests as decreased visual acuity, dyschromatopsia, and visual field defects, such as scotomas. Although knowledge of optic neuritis in adults is substantial, understanding of pediatric optic neuritis is more limited due to its relative rarity, presenting diagnostic and therapeutic challenges in this age group. The diagnosis is primarily based on the medical history and physical examination. However, additional diagnostic tests are necessary to guide the etiological diagnosis, including blood tests, serology, magnetic resonance imaging, analysis of cerebrospinal fluid following lumbar puncture, optical coherence tomography, and visual evoked potentials. The treatment of optic neuritis in the pediatric age group is not consensual, but most professionals follow the Optic Neuritis Treatment Trial recommendations for adults, which are based on intravenous corticosteroid administration during acute episodes, followed by oral corticosteroid therapy. Intravenous immunoglobulin, plasmapheresis, and immunomodulatory therapies are reserved for recurrent or steroid-refractory cases. Pediatric optic neuritis has a better prognosis than in adults, with significant visual recovery. However, it is important to consider the risk of progression to a demyelinating central nervous system disorder. This literature review aims to present the current state of knowledge on pediatric optic neuritis, as well as its relationship with neuroinflammatory diseases of the central nervous system. Current diagnostic and therapeutic options will be explored, emphasizing the importance of early diagnosis for effective management of this pathology. A clinical case of optic neuritis, managed in the Pediatric Department of the Amato Lusitano Hospital, is presented, and the clinical approach to the condition is explored.
Description
Keywords
Doenças Desmielinizantes Idade Pediátrica Nevrite Ótica Perda de Visão