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Acute Onset Comitant Esotropia as initial manifestation of Arnold-Chiari Type 1 malformation in Children-A Case report and Review

KRISHNAMOORTHY T

Abstract


We report a case of 5 year old girl who presented with acute onset of Comitant esotropia in right eye with no neurological signs and symptoms. Cycloplegic refraction  revealed emmetropia. Her anterior and posterior segments were with in normal limits. Her general physical and  neurological examination were normal.MRI Brain revealed Arnold Chiari Type I malformation. Child was referred to  Neurosurgeon for further management. Neurosurgeon           advised Nil surgical intervention at present. She was advised and underwent Strabismus surgery in Right eye for esotropia to revert the foveal suppression and to regain the stereopsis . The exact mechanism for acute onset esotropia is not known. The casual relationship of acute onset esotropia in Arnold chiari type 1 malformation is very rare. Neuroimaging should be done in case of acute onset esotropia to rule out  Intracranial pathology. It is important to remember that acute onset comitant esotropia in the absence of other neurologic signs and symptoms in infancy or childhood may be the first sign of an underlying Arnold Chiari type 1 malformation.

 


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References


Passo M, Shults WT, Talbot T, Palmer EA. Acquired esotropia. A manifestation of Chiari I malformation. J Clin Neuroophthalmol. 1984 Sep;4(3):151–4.

Bixenman WW, Laguna JF. Acquired esotropia as initial manifestation of Arnold-Chiari malformation. J Pediatr Ophthalmol Strabismus. 1987 Apr;24(2):83–6.

Williams AS, Hoyt CS. Acute comitant esotropia in children with brain tumors. Arch Ophthalmol. 1989 Mar;107(3):376–8.

Astle WF, Miller SJ. Acute comitant esotropia: a sign of intracranial disease. Can J Ophthalmol. 1994 Jun;29(3):151–4.

Legmann Simon A, Borchert M. Etiology and prognosis of acute, late-onset esotropia. Ophthalmology. 1997 Aug;104(8):1348–52.

Fukuo Y, Abe T, Hayasaka S. Acute comitant esotropia in a boy with head trauma and convulsions receiving carbamazepine. Ophthalmologica. 1998;212(1):61–2.

Dikici K, Cicik E, Akman C, Kendirolu G, Tolun H. Cerebellar astrocytoma presenting with acute esotropia in a 5 year-old girl. Case report. Int Ophthalmol. 1999;23(3):167–70.

Lyons CJ, Tiffin PA, Oystreck D. Acute acquired comitant esotropia: a prospective study. Eye (Lond). 1999 Oct;13 ( Pt 5):617–20.

Weeks CL, Hamed LM. Treatment of acute comitant esotropia in Chiari I malformation. Ophthalmology. 1999 Dec;106(12):2368–71.

Biousse V, Newman NJ, Petermann SH, Lambert SR. Isolated comitant esotropia and Chiari I malformation. Am J Ophthalmol. 2000 Aug;130(2):216–20.

Defoort-Dhellemmes S, Denion E, Arndt CF, Bouvet-Drumare I, Hache J-C, Dhellemmes P. Resolution of acute acquired comitant esotropia after suboccipital decompression for Chiari I malformation. Am J Ophthalmol. 2002 May;133(5):723–5.

Spierer A. Acute concomitant esotropia of adulthood. Ophthalmology. 2003 May;110(5):1053–6.

Navarro R, Olavarria G, Seshadri R, Gonzales-Portillo G, McLone DG, Tomita T. Surgical results of posterior fossa decompression for patients with Chiari I malformation. Childs Nerv Syst. 2004 May;20(5):349–56.

Hentschel SJ, Yen KG, Lang FF. Chiari I malformation and acute acquired comitant esotropia: case report and review of the literature. J Neurosurg. 2005 May;102(4 Suppl):407–12.

Savino G, Colucci D, Rebecchi MT, Dickmann A. Acute onset concomitant esotropia: sensorial evaluation, prism adaptation test, and surgery planning. J Pediatr Ophthalmol Strabismus. 2005 Dec;42(6): 342–8.

Kang KD, Kang SM, Yim HB. Acute acquired comitant esotropia after orbital cellulitis. J AAPOS. 2006 Dec;10(6):581–2.

Pandey PK, Vats P, Kaur N, Kulkarni AG. Spontaneous late-onset comitant acute nonaccommodative esotropia in children. Indian J Ophthalmol. 2008 Apr;56(2):167–168; author reply 168.

Baxstrom CR. Nonsurgical treatment for esotropia secondary to Arnold-Chiari I malformation: A case report. Optometry. 2009 Sep;80(9):472–8.

Sturm V, Menke MN, Knecht PB, Schöffler C. Long-term follow-up of children with acute acquired concomitant esotropia. J AAPOS. 2011 Aug;15(4):317–20.

Schreuders J, Thoe Schwartzenberg GWS, Bos E, Versteegh FGA. Acute-onset esotropia: should we look inside? J Pediatr Ophthalmol Strabismus. 2012;49 Online:e70–72.

Herlihy EP, Phillips JO, Weiss AH. Esotropia greater at distance: children vs adults. JAMA Ophthalmol. 2013 Mar;131(3):370–5.

Burian HM, Miller JE. Comitant convergent strabismus with acute onset. Am J Ophthalmol 1958;45:55-63.

Liu GT, Hertle RW, Quinn GE, Schaffer DB. Comitant esodeviation resulting from neurologic insult in children. J AAPOS 1997;1:143-6.


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