Síndrome del uno y medio de Fisher a causa de un cavernoma bulbo-protuberancial

Abstract

espanolEl sindrome del uno y medio de Fisher esta producido por una lesion unilateral en la parte dorsal e inferior de la protuberancia localizada especificamente en el tegmento pontino, area que contiene el fasciculo longitudinal medial (FLM), la formacion reticular paramediana pontina (FRPP) y el nucleo del VI par craneal, responsables de los movimientos horizontales de la mirada. Clinicamente se manifiesta con una paralisis conjugada de la mirada con oftalmoplejia internuclear ipsilateral. Se presenta el caso de una paciente de 60 anos de edad que, tras presentar diplopia binocular, oftalmoplejia y paralisis de la mirada conjugada a la izquierda se realizaron estudios de imagen observandose un hematoma hemiprotuberancial secundario a un cavernoma. Tras conducta expectante presento varios episodios de resangrados con empeoramiento clinico: cefalea, diplopia, tetraparesia e hipoestesia en hemicara derecha, por lo que ante tal evolucion se planteo exeresis microquirurgica del cavernoma protuberancial. EnglishThe one and a half Fisher syndrome is produced by an unilateral lesion in the dorsal and inferior part of the pons located specifically in the pontine tegmentum. This is an area that contains the medial longitudinal fasciculus (LMF), the paramedian pontine reticular formation (PPRF) and the nucleus of the sixth cranial nerve, responsible for the horizontal movements of the gaze. Clinically it manifests with conjugate gaze palsy with internuclear ophthalmoplegia. The case is reported on a 60 year-old patient, who presented with binocular diplopia, ophthalmoplegia and paralysis of the gaze conjugated to the left. Imaging studies were performed that showed a hemi-protuberant haematoma secondary to a cavernoma. As expected, he presented with several episodes of re-bleeding with clinical worsening: headache, diplopia, tetraparesis, and hypoaesthesia in the right side of the face, as such that the microsurgical exeresis of the protuberant cavernoma was considered.