Interior 2_2005.qxd - Oftalmologia.ro

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OFTALMOLOGIA 2 - 2005
SINDROMUL DUANE
- CONSIDERA}II ETIOPATOGENICE
CLINICE {I DE DIAGNOSTIC -
ANCA TOMI, CRISTA PREDA, OZANA POENARU, F. ZAMFIROIU
SPITALUL CLINIC DE URGEN|E OFTALMOLOGICE BUCURESTI
REZUMAT
Sindromul Duane este o afec\iune congenital` cunoscut` de altfel ]i ca sindromul de retrac-
\ie congenital sau sindromul de retrac\ie Stilling-Turk-Duane.
Exist` trei tipuri de sd. Duane, spectrul lor clinic fiind determinat de anomaliile de inerva\ie
ale mu]chiului drept extern. De]i afec\iunea a fost descris` din punct de vedere clinic, etiopatogenia
r`m@ne neclar`. Astfel, de]i sd. Duane a fost considerat ca un pur fenomen miogenic local (fibroza
mu]chiului drept extern), cea mai acceptat` teorie ast`zi este cea a ageneziei nucleului nervului
abducens. Datele au fost ob\inute din studii de autopsie, electromiografice ]i [n timpul opera\iilor.
Av@nd [n vedere c` diagnosticul diferen\ial cel mai frecvent se face cu paralizia de nerv
abducens ]i faptul c` simptomele bolii pot sugera o boal` intracranian`, [n\elegem teama p`rin\ilor
]i a pacien\ilor. De aceea subliniem importan\a explic`rii cauzelor ]i consecin\elor bolii ]i a educ`rii
pacien\ilor [n vederea ob\inerii confortului func\ional ]i psihic maxim.
R`m@ne totu]i, cel pu\in la nivel subiectiv, [ntrebarea: De ce este afectat tocmai nucleul
nervului abducens ]i din ce cauze?
CUVINTE CHEIE:
• Strabism,
• Sindrom de retrac\ie,
• Genetic.
SUMMARY
Duane syndrome is a congenital disease also known as congenital retraction syndrome or
Stilling-Turk-Duane retraction syndrome.
There are three types of Duane syndrome; their variability is given by the aberrant innervation
of the lateral rectus muscle. The symptoms of the disease were described and they are all
known, but the etiology and the pathology remain unclear. Although Duane syndrome was considered
as a pure local myogenic phenomenon (the lateral rectus muscle fibrosis), the modern theory
is the absence of the abducens nuclei. Various theories have been put forward on the basis of data
collected from surgical, autopsy and electromyography studies.
The most frequent and terrifying differential diagnosis is the VI nerve palsy and the symptoms
of Duane syndrome suggest an intracranial disease, so we understand the parents and patient
fear.
That's why is very important to explain them the causes and the consequences of the disease
and to educate the patients to obtain the optimal functional and mental comfort.
Finally, we have in mind one, at least subjective, question: Why is The Abducens nerve nucleus
affected and how?
KEY WORDS:
• Strabismus,
• Retraction syndrome,
• Genetic.