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She reported that about 8 years earlier she suffered from a headache that made her seek an ophthalmologist. At the time, the patient was diagnosed with glaucoma and she has since been using hypotensive eye drops, starting with prostaglandin eye drops once daily in both eyes BE. She used the medication regularly, but despite adequate control of intraocular pressure her visual acuity and visual field defects progressively worsened in BE. Biomicroscopy of the anterior segment showed no changes, and the direct and indirect pupillary reflexes were normal in BE. Fundus examination showed pathological cupping of the optic disc and a normal macula in BE Figure 1.
ERK3 is a constitutively nuclear protein kinase. The Journal of Biological Chemistry, Bethesda, v. Transient global cerebral ischemia produces morphologically necrotic, not apoptotic neurons. Acute neuronal injury: The role of excitotoxic programmed cell death mechanisms. Robbins: Patologia estrutural e funcional.
Rio de Janeiro: Guanabara, , p. Update on mechanisms of ischemic acute kidney injury.
Myocardial damage during ischaemia and reperfusion. European Heart Journal, London, v. Experimental and molecular pathology, New York, v. Kainic acid-induced seizures produce necrotic, not apoptotic, neurons with internucleosomal DNA cleavage: implications for programmed cell death mechanisms.
Neuroscience, Oxford, v. Acesso em: 02 out. Organization and regulation of mitogen- activated protein kinase signaling pathways. Current Opinion in Cell Biology, Philadelphia, v. Pharmacological Reviews, Bethesda, v. The striking feature of pituitary adenomas in perimetry is bitemporal hemianopsia, sparing central vision and resulting from compression or destruction of the fibres that cross the centre of the optic chiasm.
Many different lesions can affect the optic chiasm depending on its anatomical variation , which will influence the exact nature of the visual field defects found in pituitary tumours 2,7. The hemianopsia can be congruous or incongruous; in incongruous defects, one eye tends to be affected much more severely than the other, as occurred in our case 7.
Despite advances in imaging methods, which provide for detailed identification of tumours, perimetry is still essential in the diagnosis and management of neuro-ophthalmic lesions 9.
It is also important to correlate visual field data with fundus examination for appropriate clinical reasoning. In the case present here, because the patient had a clinical picture of glaucoma, the tumour could have easily been missed in a routine ophthalmic evaluation.
In addition, pituitary macroadenoma can present with other visual disturbances, such as diplopia due to the lateral expansion of the adenoma toward the cavernous sinus , oculomotor nerve palsy and, more rarely, nystagmus and proptosis However, these findings were absent in our case.
It is important to note the importance of optic atrophy as a result of tumour expansion. Endocardial fibroelastosis with coronary-artery thromboembolism and myocardial-infarction.
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