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Fourth nerve palsy

Seong-Hae Jeong, Sung-Hee Kim, Seung-Han Lee, Seong-Ho Park, Hyo-Jung Kim, Ji-Soo Kim
BACKGROUND: The trochlear (fourth) nerve is the only cranial nerve that decussates before emerging from the posterior aspect of the brainstem. Lesions involving the trochlear nucleus or fascicles mostly give rise to contralesional superior oblique palsy (SOP). METHODS: We report 2 patients with SOP on the side of intraaxial lesions with a literature review on central trochlear palsy. RESULTS: The lesions are more commonly located posterior to the cerebral aqueduct in patients with ipsilesional SOP than in those with contralesional SOP...
December 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Sven Jarius, Ingo Kleiter, Klemens Ruprecht, Nasrin Asgari, Kalliopi Pitarokoili, Nadja Borisow, Martin W Hümmert, Corinna Trebst, Florence Pache, Alexander Winkelmann, Lena-Alexandra Beume, Marius Ringelstein, Oliver Stich, Orhan Aktas, Mirjam Korporal-Kuhnke, Alexander Schwarz, Carsten Lukas, Jürgen Haas, Kai Fechner, Mathias Buttmann, Judith Bellmann-Strobl, Hanna Zimmermann, Alexander U Brandt, Diego Franciotta, Kathrin Schanda, Friedemann Paul, Markus Reindl, Brigitte Wildemann
BACKGROUND: Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) are present in a subset of aquaporin-4 (AQP4)-IgG-negative patients with optic neuritis (ON) and/or myelitis. Little is known so far about brainstem involvement in MOG-IgG-positive patients. OBJECTIVE: To investigate the frequency, clinical and paraclinical features, course, outcome, and prognostic implications of brainstem involvement in MOG-IgG-positive ON and/or myelitis. METHODS: Retrospective case study...
November 1, 2016: Journal of Neuroinflammation
Yair Ivanir, Jonathan D Trobe
BACKGROUND: Isolated fourth nerve palsies are commonly caused by decompensation of a congenitally dysfunctional superior oblique muscle ("decompensated congenital palsies"). Distinguishing such palsies at initial presentation from palsies caused by presumed microvascular ischemia ("ischemic palsies") has value for patient reassurance and in forestalling ancillary testing. Abnormally large vertical fusional amplitudes traditionally have been used to identify decompensated congenital palsies, but that may not be a reliable distinguishing feature...
October 25, 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Ethan A Winkler, Harjus Birk, Michael Safaee, John K Yue, John F Burke, Jennifer A Viner, Melike Pekmezci, Arie Perry, Manish K Aghi, Mitchel S Berger, Michael W McDermott
Ependymomas are rare neuroepithelial tumors which may arise anywhere along the ventricular system. Tumors arising in the fourth ventricle present unique challenges. Complete tumor resection favors prolonged survival, but may result in inadvertent injury of surrounding neural structures-such as cranial nerve (CN) nuclei. Here, our institutional experience with surgical resection of fourth ventricular ependymomas is described. A single institution, retrospective analysis of consecutive case series of adult surgically resected fourth ventricular ependymomas with the bilateral telovelar approach...
October 24, 2016: Journal of Neuro-oncology
Rabih Hage, Sheila R Eshraghi, Nelson M Oyesiku, Adriana G Ioachimescu, Nancy J Newman, Valérie Biousse, Beau B Bruce
BACKGROUND: Pituitary apoplexy (PA) often presents with acute headache and neuro-ophthalmic manifestations, including ocular motility dysfunction (OMD) from cranial nerve palsies (CNPs). Our goal was to describe the epidemiology and outcomes of OMD in a large, single-center series of patients with PA. METHODS: We conducted a retrospective chart review of all patients with PA seen in our pituitary center between January 1995 and December 2012. Presenting neuro-ophthalmic, endocrine, and radiologic data, as well as neuro-ophthalmology follow-up data, were collected...
October 2016: World Neurosurgery
Hamed Aminiahidashti, Sajad Shafiee, Mohammad Sazegar, Nazanin Nosrati
INTRODUCTION: The abducent nucleus is located in the upper part of the rhomboid fossa beneath the fourth ventricle in the caudal portion of the pons. The abducent nerve courses from its nucleus, to innervate the lateral rectus muscle. This nerve has the longest subarachnoid course of all the cranial nerves, it is the cranial nerve most vulnerable to trauma. It has been reported that 1% to 2.7% of all head injuries are followed by unilateral abducent palsy, but bilateral abducent nerve palsy is extremely rare...
February 2016: Trauma Monthly
Aline Lariessy Campos Paiva, Guilherme Brasileiro de Aguiar, Vinicius Riccieri Ferraz, João Luiz Vitorino Araújo, Milton Hikaro Toita, José Carlos Esteves Veiga
Traumatic brain injury (TBI) is less common in children than in adults. Posterior fossa lesions are even more uncommon, but, when present, are usually epidural hematomas. These lesions, even when small, may have a bad outcome because of the possibility of compression of the important structures that the infratentorial compartment contains, such as the brainstem and cranial nerves, and the constriction of the fourth ventricle, causing acute hydrocephalus. Although unusual, posterior fossa lesions are increasingly being diagnosed because of the better quality of and easier access to cranial tomography...
2016: Pediatric Neurosurgery
Alberto Gálvez-Ruiz, Patrik Schatz
BACKGROUND: Vascular risk factors are increasing rapidly in the Middle East. Growing inactivity and obesity have contributed to an epidemic of Type 2 diabetes mellitus (DM) in the Arab population. Microvascular palsies of the third, fourth, and sixth cranial nerves, which occur in an isolated manner, are relatively common in patients with DM, hypertension, or other vascular risk factors. METHODS: In this retrospective analysis, patients with diabetes with microvascular palsies were assessed for the prevalence of diabetic retinopathy (DR)...
June 2016: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
Harold P Koller, Scott E Olitsky, Mary O'Hara, Leonard B Nelson
No abstract text is available yet for this article.
March 2016: Journal of Pediatric Ophthalmology and Strabismus
James R Bateman, Pavan Murty, Michael Forbes, Kisha Young Collier, Danoushka Tememe, Octavio de Marchena, William J Powers
We report two patients with midbrain infarction with pupil-sparing third nerve palsies and hemiataxia: one with contralateral ataxia (Claude's syndrome) and one with ipsilateral ataxia (which we refer to as reverse Claude's syndrome). We highlight the importance of a thorough neurologic evaluation with partial oculomotor palsies and describe, to our knowledge, the fourth account in the literature of a pupil-sparing third nerve palsy with ipsilateral cerebellar ataxia.
June 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Jayme Augusto Bertelli, Marcos Flávio Ghizoni
OBJECTIVE Transfer of the spinal accessory nerve to the suprascapular nerve is a common procedure, performed to reestablish shoulder motion in patients with total brachial plexus palsy. However, the results of this procedure remain largely unknown. METHODS Over an 11-year period (2002-2012), 257 patients with total brachial plexus palsy were operated upon in the authors' department by a single surgeon and had the spinal accessory nerve transferred to the suprascapular nerve. Among these, 110 had adequate follow-up and were included in this study...
June 2016: Journal of Neurosurgery. Spine
Chu-Peng Hoi, Yung-Tai Chen, Jong-Ling Fuh, Chun-Pai Yang, Shuu-Jiun Wang
BACKGROUND AND PURPOSE: The aim of this nationwide cohort study was to evaluate whether the occurrence of isolated 3rd, 4th or 6th cranial nerve (CN) palsies is associated with a higher risk of ischemic stroke. METHODS: This study utilized data from Taiwan Longitudinal Health Insurance Database during 1995-2012. Subjects aged 20 years or older who had isolated CN 3/4/6 palsies diagnosed by a neurologist or ophthalmologist between January 2000 and December 2011 were included...
2016: Cerebrovascular Diseases
Oktay Gurcan, Ahmet Gurhan Gurcay, Atilla Kazanci, Ali Erdem Yildirim, Omer Faruk Turkoglu, Hatice Ferhan Komurcu, Ethem Beskonakli
Pituitary adenomas account for approximately 10% of intracranial tumors and 5% are locally invasive. Cavernous sinus invasion by pituitary tumors presents mostly with cranial nerve palsies, especially involving the third, fourth and sixth cranial nerves, which is well documented in the literature. However, an isolated complaint of trigeminal neuralgia due to pituitary adenoma is an extremely rare entity with a limited number of reported cases. A 51-year-old female patient presented to our clinic with complaints of pain and numbness on the left side of face for six months, with each event lasting 5-10 seconds...
2016: Turkish Neurosurgery
Jennifer L Bailit, William A Grobman, Madeline Murguia Rice, Ronald J Wapner, Uma M Reddy, Michael W Varner, John M Thorp, Steve N Caritis, Jay D Iams, George Saade, Dwight J Rouse, Jorge E Tolosa
BACKGROUND: Cesarean delivery in the second stage of labor is common, whereas the frequency of operative vaginal delivery has been declining. However, data comparing outcomes for attempted operative vaginal delivery vs cesarean in the second stage are scant. Previous studies that examine operative vaginal delivery have compared it to a baseline risk of complications from a spontaneous vaginal delivery and cesarean delivery. However, when a woman has a need for intervention in the second stage, spontaneous vaginal delivery is not an option she or the provider can choose...
May 2016: American Journal of Obstetrics and Gynecology
Lisa McAnena, Michael O'Keefe, Caitriona Kirwan, John Murphy
PURPOSE: To report a case series of neonatal ophthalmic trauma induced by forceps-assisted vaginal delivery. METHODS: Retrospective, non-comparative case series focusing on presentation and long-term outcomes. RESULTS: Eleven cases of ophthalmic injury secondary to forceps delivery (7 male, 4 female) from October 1997 to July 2014 are presented. Eight cases were born at a single center from January 2006 to July 2014, a rate of 1 case per 413 forceps-assisted deliveries...
November 2015: Journal of Pediatric Ophthalmology and Strabismus
Jan Kalimullah, Abdul Malik Amir Humza Sohail, Rai Dilawar Shahjehan, Sabeehuddin Siddique, Muhammad Ehsan Bari
BACKGROUND: Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome with a frequency of 1 in 25,000 live births and a penetrance of almost 100% by the sixth decade of life. The main tumors occurring in NF2 patients are bilateral vestibular schwannomas, other peripheral, cranial and spinal nerve schwannomas, intracranial and intraspinal meningiomas, ependymomas, and gliomas. CASE DESCRIPTION: We report the case of a 6-year-old boy who presented with a 1-month history of nausea and recurrent vomiting...
2015: Surgical Neurology International
Benjamin Storm, Knut Dybwik, Erik Waage Nielsen
OBJECTIVES/HYPOTHESIS: In large international studies, upper airway-related stenosis, granulomas, malacias, and laryngeal nerve palsies following percutaneous tracheostomy have an estimated incidence of 6% to 31%. The incidence following prolonged oral intubation is estimated to be 10% to 22%. The purpose of this study was to assess the incidence of late complications in our unit. STUDY DESIGN: Retrospective search of a single-unit intensive care patient population...
May 2016: Laryngoscope
Diana Reser, Tomas Holubec, Etem Caliskan, Andrea Guidotti, Francesco Maisano
Since the 1990 s, minimally invasive cardiac surgery has gained wide acceptance due to patient and economic demand. The advantages are less trauma, bleeding, wound infections, pain and faster recovery. Many studies showed that the outcomes are comparable with those of conventional sternotomy. Left anterior small thoracotomy (LAST) evolved into a routine and safe access in specialized centres for minimally invasive direct coronary artery bypass grafting. The 6-cm incision is localized above the fourth intercostal space, 3-4 cm lateral to the left sternal border and below the left mammilla...
2015: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Madhura A Tamhankar, Nicholas J Volpe
PURPOSE OF REVIEW: This article will discuss the management of isolated, acute cranial nerve 3,4 and 6 palsies with special focus on the role of neuroimaging in older adults based on recently published data. RECENT FINDINGS: Acute cranial nerve palsies affecting the third, fourth or sixth cranial nerves in isolation or in combination with other neurological signs and symptoms can be due to a variety of causes such as ischemia, inflammation, infection and compression of the ocular motor nerves...
November 2015: Current Opinion in Ophthalmology
Alexandre Simonin, Marc Levivier, Jocelyne Bloch, Mahmoud Messerer
An isolated fourth ventricle is characterised by cerebrospinal fluid (CSF) trapping in the fourth ventricle. Although there is no consensus regarding treatment, ventriculoperitoneal (VP) shunting of the fourth ventricle is an option. Complications include infection, mechanical irritation of the brainstem, malfunction and overdrainage. Cranial nerve palsy is a rare complication and has been mostly described in children. We present two adult cases of abducens and facial nerve palsies occurring secondary to this procedure...
2015: BMJ Case Reports
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