#1
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Ìèîçèò?
Òîâàðèùè íåâðîëîãè, åñëè ìîæíî - äàéòå ïàðó ñîâåòîâ.
Ïàöèåíòêà ëåò 25. 2 äíÿ íàçàä ïîÿâèëèñü æàëîáû íà áîëü "â ãëóáèíå ãëàçíèöû" ïðè âçãëÿäå ââåðõ, è îñîáåííî ââåðõ-âëåâî. Íå ìîæåò îïðåäåëèòüñÿ, êàêàÿ èç ãëàçíèö áîëèò (ñðàâíèâàåò ýòó áîëü ñ ìûøå÷íîé áîëüþ îò òðåíèðîâîê). Ãëàçíîé ñòàòóñ ñîâñåì-ñîâñåì íå ïðèìå÷àòåëåí. Ïåðåäíèé îòðåçîê ãëàçà è ãëàçíîå äíî áåç îñîáåííîñòåé. Îñòðîòà çðåíèÿ â íîðìå. Ãäå-òî äíÿ 2-3 íàçàä, êðîìå òîãî, îáúåëàñü ìàíäàðèíîâ è îòìåòèëà ñûïü àëëåðãè÷åñêóþ íà ëáó è åäèíè÷íûå ïÿòíà íà ù¸êàõ (ÿ ýòó ñûïü âèäåë). Ãîâîðèò, ÷òî ýòî îáû÷íîå äëÿ íå¸ äåëî, êîãäà ïîåñò ìàíäàðèíîê. Âîïðîñû ñëåäóþùèå: òðåáóåòñÿ ëè êîíñóëüòàöèÿ íåâðîëîãà? Òðåáóþòñÿ ëè âèçóàëèçèðóþùèå èññëåäîâàíèÿ ãëàçíèöû (ÌÐÒ? ÊÒ? ÓÇÈ?)? Êîãäà èìååò ñìûñë ÷òî-ëèáî âûïîëíÿòü? (Ñðîêè). Ñîáñòâåííî - ÷òî ïîäîçðåâàòü? Ìèîçèò? Îí áûâàåò àëëåðãè÷åñêîé ïðèðîäû? Íó, â îáùåì - âîïðîñîâ ìíîãî, áîëüøèíñòâî èç íèõ ñêîðåå âñåãî áàíàëüíûå. Ñïàñèáî. |
#2
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Ïðàâèëüíî ëè ÿ ïîíÿëà, ÷òî êðîìå áîëåâûõ îùóùåíèé ïàöèåíòêó íè÷åãî íå áåñïîêîèò è ïðè îñìîòðå íåò ýêçîôòàëüìà, èíúåêöèè ñêëåð, õåìîçà, îãðàíè÷åíèÿ äâèæåíèÿ ãëàçíûõ ÿáëîê?
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#3
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Òàê òî÷íî, êðîìå áîëåé ïðè äâèæåíèè ãëàç - íèêàêèõ ïðèçíàêîâ íåáëàãîïîëó÷èÿ. Åñòü âàðèàíò - æäàòü... è ïîñåòèòü íåâðîëîãà ÷åðåç 2-3 äíÿ, åñëè íå ïðîèçîéä¸ò óëó÷øåíèÿ. Èëè...?
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#4
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Eñëè ðàññìàòðèâàòü âîçìîæíûå ðàðèòåòû, òî ìîæåò áûòü ýòî îêóëÿðíûé ìèîçèò? [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Ñûïü íà ëèöå âìåñòå ñ ìûøå÷íîé áîëüþ òàêæå ìîæåò óêàçûâàòü íà äåðìàòîìèîçèò. Êàê ÿ ïîíèìàþ îêóëÿðíûé ìèîçèò íå ÿâëÿåòñÿ ôîðìîé äåðìàòîìèîçèòà, õîòÿ ãäå-òî (â ïîïóëÿðíûõ ðàçäåëàõ èíòåðíåòà) âèäåë, ÷òî ïèøóò âîçìîæíî è òàêîå. |
#5
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ß áû ïîíàáëþäàëà â òå÷åíèå íåñêîëüêèõ äíåé. Ïðè îòñóòñòâèè ïîëîæèòåëüíîé äèíàìèêè - âèçóàëèçàöèÿ îðáèò.
À ÷òî ó íåå ñ ùèòîâèäíîé æåëåçîé? ÒÒÃ íå ñïðàøèâàëè? |
#6
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Ïî àíàìíåçó ïîõîæ íà ìèîçèò:
Orbital myositis is an inflammatory process that primarily involves the extraocular muscles and most commonly affects young adults in the third decade of life, with a female predilection. ïî ñèìïòîìàòèêå - íå î÷åíü: Clinical characteristics of orbital myositis include orbital and periorbital pain, ocular movement impairment, diplopia, proptosis, swollen eyelids, and conjunctival hyperemia. The most common presentation is acute and unilateral, which initially responds to systemic corticosteroid therapy. --- Curr Allergy Asthma Rep. 2009 Jul;9(4):316-23. Orbital myositis: diagnosis and management.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Âû ìíå ñêàæèòå, ýòî âàøå èëè íàøå?))
ß ñîáñòâåííî ïîäðàçóìåâàë "îêóëÿðíûé"/"îðáèòàëüíûé" ìèîçèò, äà, òîëüêî âîïðîñ - ýòî ãëàçíîå èëè íåâðîëîãè÷åñêîå? Êîìó ëå÷èòü-òî?) Ñïðàøèâàë ïðî ùèòîâèäíóþ æåëåçó - îíà íå â êóðñå, íèêîãäà íè÷åãî íå áåñïîêîèëî, ê ýíäîêðèíîëîãó íå îáðàùàëàñü. Ó ðîäèòåëåé â ýòîì ïëàíå òîæå âñ¸ õîðîøî. È, ÷òî ñîáñòâåííî è íàïðÿãëî - íåò íè äèïëîïèè, íè ýêçîôòàëüìà, íè ïðèïóõàíèÿ, íè ãèïåðåìèè, íè õåìîçà... ×òî æ ýòî çà ìèîçèò òàêîé óùåðáíûé? Æä¸ì 2-3 äíÿ, ïîÿâÿòñÿ âñå ñèìïòîìû - è íà÷èíàåì ëå÷èòü?) |
#8
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òåîðåòè÷åñêè, äàííûé ìèîçèò ìîæåò ïðîòåêàòü äàæå áåçáîëåçíåííî, íî ñ òèïè÷íîé äð. ñèìïòîìàòèêîé:
Ann Indian Acad Neurol. 2012 Jul;15(3):224-6. doi: 10.4103/0972-2327.99729. Painless orbital myositis. Chakor RT, Santhosh NS. Department of Neurology, T. N. M. C. and B. Y. L. Nair Hospital, A L Nair Road, Mumbai Central, Mumbai, Maharashtra, India. Idiopathic orbital inflammation is the third most common orbital disease, following Graves orbitopathy and lymphoproliferative diseases. We present a 11 year old girl with 15 days history of painless diplopia. There was no history of fluctuation of symptoms, drooping of eye lids or diminished vision. She had near total restricted extra-ocular movements and mild proptosis of the right eye. There was no conjunctival injection, chemosis, or bulb pain. There was no eyelid retraction or lid lag. Rest of the neurological examination was unremarkable.Erythrocyte sedimentation rate was raised with eosinophilia. Antinuclear antibodies were positive. Liver, renal and thyroid functions were normal. Antithyroid, double stranded deoxyribonucleic acid and acetylcholine receptor antibodies were negative. Repetitive nerve stimulation was negative. Magnetic resonance imaging (MRI) of the orbit was typical of orbital myositis. The patient responded to oral steroids. Orbital myositis can present as painless diplopia. MRI of orbit is diagnostic in orbital myositis. ïîëíûé òåêñò [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Èíòåðåñíî, ó ýòîé äåâî÷êè èç êåéñà ìèîçèò áûë êàêîé-òî àëëåðãè÷åñêè-ýîçèíîôèëè÷åñêèé è àâòîðû â ïîëíîì òåêñòå èç ññûëêè óïîìèíàþò, ÷òî ó äåòåé ãëàçíûå ìèîçèòû ïðîòåêàþò ñ ýîçèíîôèëèåé â 30% ñëó÷àåâ - ó÷èòûâàÿ àëëåðãè÷åñêèé àíàìíåç â îðèãèíàëå è âûñûïàíèÿ, ìîæåò ïîñìîòðåòü îá. àíàëèç êðîâè íà ïðåäìåò íàëè÷èÿ ýîçèíîôèëèè?
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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#10
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Íó, çäåñü ñêîðåå âñåãî áóäåò ýîçèíîôèëèÿ, âåäü òàê?
 îáùåì, ïðèìåðíûé ïëàí äëÿ ñåáÿ ïîíÿë. Ïîíÿë, ÷òî õîðîøî áû, ÷òîáû ýòî íå áûëî äåáþòîì íåâðèòà çðèòåëüíîãî íåðâà. ×åðåç 2 äíÿ îòïèøóñü ïî äèíàìèêå. Ñïàñèáî, êîëëåãè. |