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Fourth nerve palsy

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https://www.readbyqxmd.com/read/28574497/stepping-into-the-virtual-unknown-feasibility-study-of-a-virtual-reality-based-test-of-ocular-misalignment
#1
N Nesaratnam, P Thomas, A Vivian
IntroductionDissociated tests of strabismus provide valuable information for diagnosis and monitoring of ocular misalignment in patients with normal retinal correspondence. However, they are vulnerable to operator error and rely on a fixed head position. Virtual reality headsets obviate the need for head fixation, while providing other clear theoretical advantages, including complete control over the illumination and targets presented for the patient's interaction.PurposeWe compared the performance of a virtual reality-based test of ocular misalignment to that of the traditional Lees screen, to establish the feasibility of using virtual reality technology in ophthalmic settings in the future...
June 2, 2017: Eye
https://www.readbyqxmd.com/read/28474478/incomplete-cavernous-sinus-syndrome-as-the-initial-manifestation-of-a-previously-undetected-metastatic-prostate-adenocarcinoma
#2
María Machío Castelló, Diego Escobar Montatixe, Carlos Cenjor Español, José Miguel Villacampa Aubá, Julia Montoya Bordón, Rafael Carias Calix, Rafael Sáez Pinel
BACKGROUND: Cavernous sinus syndrome presents as unilateral ophthalmoplegia associated with sympathetic denervation, pain, paresthesias, and V1 and V2 distribution numbness. The etiology may be vascular, inflammatory, infectious, and, less commonly, neoplastic (metastatic). METHODS: We report a patient with incomplete cavernous sinus syndrome as the initial manifestation of previously undetected metastatic prostate adenocarcinoma. RESULTS: A 59-year-old man presented with a 2-month history of left hemicranial headaches with ptosis and binocular diplopia...
May 5, 2017: Head & Neck
https://www.readbyqxmd.com/read/28473604/recurrent-painful-ophthalmoplegic-neuropathy
#3
Cleo Huang, Maria Amasanti, Ben Lovell, Tim Young
Recurrent painful ophthalmologic neuropathy (RPON), previously termed ophthalmoplegic migraine, is characterised by repeated attacks of one or more ocular cranial nerve palsies with ipsilateral headache. Its cause remains unclear; it is currently thought to be neuropathic in origin, but there is debate in the literature. In documented cases, a third cranial nerve palsy is by far the most common. Here we present a case of RPON involveing the fourth and sixth cranial nervesonly. Thorough investigation, including MR scan of brain and lumbar puncture, found no alternative explanation...
May 4, 2017: Practical Neurology
https://www.readbyqxmd.com/read/28405168/the-black-evil-affecting-patients-with-diabetes-a-case-of-rhino-orbito-cerebral-mucormycosis-causing-garcin-syndrome
#4
Santhosh Narayanan, Geetha Panarkandy, Gomathy Subramaniam, Chandni Radhakrishnan, N K Thulaseedharan, Neeraj Manikath, Sreejith Ramaswamy, Suma Radhakrishnan, Danish Ekkalayil
Mucormycosis is a life-threatening infection affecting patients with diabetes. It is an angioinvasive disease often resistant to treatment with a debilitating course and high mortality. Here, we report a case of a 45 year old woman with type 2 diabetes mellitus who presented to us with history of right-sided ptosis and facial palsy, and subsequently developed loss of vision and palatal palsy. She was in diabetic ketoacidosis. Nervous system examination revealed involvement of right second, third, fourth, sixth, seventh, ninth, and tenth cranial nerves, suggestive of Garcin syndrome...
2017: Infection and Drug Resistance
https://www.readbyqxmd.com/read/28366647/adjustable-bilateral-superior-oblique-tendon-advancement-for-bilateral-fourth-nerve-palsy
#5
Bashar M Bata, David A Leske, Jonathan M Holmes
PURPOSE: Bilateral fourth nerve palsy may be symmetric or asymmetric with combined vertical and excylotropic deviations and so there may be an advantage to independent adjustment of vertical and torsional components. We report a surgical technique that allows such independent adjustment. DESIGN: Retrospective interventional case series. METHODS: 15 patients, age 17 to 73 years, underwent adjustable bilateral superior oblique tendon advancements for bilateral fourth nerve palsy (11 symmetric (≤2 prism diopters [pd] hyperdeviation in straight ahead gaze) and 4 asymmetric)...
March 30, 2017: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/28210639/an-interesting-case-of-tolosa-hunt-syndrome-in-a-young-male
#6
Ghulam Murtaza, Nicholas Konowitz, Hannah Lu, Anadil Faqah, Aneesh Kuruvilla
Tolosa-Hunt syndrome is a rare disease with a limited number of cases reported in the literature. It typically presents with orbital pain associated with palsy of the third, fourth, or sixth cranial nerve. We present an interesting case of Tolosa-Hunt syndrome in a young male who responded well to high-dose steroids and in a few days had significant improvement in his retro-orbital pain and ocular movements.
January 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28138789/phrenic-nerve-palsy-secondary-to-parsonage-turner-syndrome-a-diagnosis-commonly-overlooked
#7
Tom McEnery, Ronan Walsh, Conor Burke, Aisling McGowan, John Faul, Liam Cormican
Neuralgic Amyotrophy (NA) or Parsonage-Turner syndrome is an idiopathic neuropathy commonly affecting the brachial plexus. Associated phrenic nerve involvement, though recognised, is thought to be very rare. We present a case series of four patients (all male, mean age 53) presenting with dyspnoea preceded by severe self-limiting upper limb and shoulder pain, with an elevated hemi-diaphragm on clinical examination and chest X-ray. Neurological examination of the upper limb at the time of presentation was normal...
January 30, 2017: Lung
https://www.readbyqxmd.com/read/28050074/isolated-fourth-cranial-nerve-palsy-due-to-pituitary-macroadenoma
#8
J Muthukrishnan, Khushboo Bharadwaj, Yashpal Singh
No abstract text is available yet for this article.
December 2016: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/28009406/the-frequency-and-causes-of-abnormal-head-position-based-on-an-ophthalmology-clinic-s-findings-is-it-overlooked
#9
Kadriye Erkan Turan, Hande Taylan Sekeroglu, Irem Koc, Meltem Kilic, Ali S Sanac
PURPOSE: To determine the frequency of abnormal head position (AHP) and identify the underlying causes in patients who presented to an ophthalmology clinic due to any ophthalmologic complaint. METHODS: The medical records of patients who presented with any ophthalmologic symptoms during a 6-month period were prospectively evaluated. In all, 2,710 patients (1,492 female and 1,218 male) aged 6 months-91 years were included in the study. Each patient underwent complete ophthalmologic evaluation...
December 2, 2016: European Journal of Ophthalmology
https://www.readbyqxmd.com/read/27994363/bilateral-abducens-and-facial-nerve-palsies-as-a-localizing-sign-due-to-reduction-in-intracranial-pressure-after-fourth-ventriculoperitoneal-shunting
#10
Boby Varkey Maramattom, Dilip Panikar
A trapped fourth ventricle often requires fourth ventriculoperitoneal shunting (4VP). Complications of this procedure include shunt blockage, infection, shunt migration, and overdrainage. Cranial nerve palsies are very rare after 4VP shunting and have been described with over drainage and brainstem distortion. We present an unusual case of bilateral abducens and facial nerve palsies after 4VP shunting after normalization of 4(th) ventricular parameters. Measurement of various brainstem angles presented us with a plausible hypothesis to explain the cranial nerve dysfunction...
October 2016: Annals of Indian Academy of Neurology
https://www.readbyqxmd.com/read/27928422/the-development-of-hypertrophic-inferior-olivary-nucleus-in-oculopalatal-tremor
#11
Bokkwan Jun
Oculopalatal tremor is an acquired clinical condition resulting from the interruption of the dentato-rubro-olivary neuronal pathway. The signal change in inferior olivary nucleus and its hypertrophy on magnetic resonance imaging (MRI) can be observed prior to the development of symptomatic oculopalatal tremor. This is a case of the fourth cranial nerve palsy followed by oculopalatal tremor, and increased signal intensity in inferior olivary nucleus on MRI was observed in 7 months after damage to the dentate-rubro-olivary pathway and 5 months prior to the development of oscillopsia and oculopalatal tremor...
December 2016: Neuro-ophthalmology
https://www.readbyqxmd.com/read/27928382/isolated-fourth-nerve-palsy-in-tuberculous-meningitis
#12
María García-Zamora, Hortensia Sánchez-Tocino, Ana Villanueva-Gómez, José Miguel Angles-Deza, Elena Pérez-Gutierrez
Tuberculous meningitis is a type of subacute meningitis and like other intracranial processes can compromise ocular motor nerves, causing palsies. Trochlear nerve is an unusual isolated manifestation in this type of pathology. The authors report a 5-year-old boy presented in their clinic with a trochlear nerve palsy as unique neurological manifestation of tuberculous meningitis. Treatment with complete anti-tuberculous therapy and botulinum A toxin was needed to get the complete resolution of the nerve palsy...
February 2016: Neuro-ophthalmology
https://www.readbyqxmd.com/read/27851717/central-trochlear-palsy-report-of-two-patients-with-ipsilesional-palsy-and-review-of-the-literature
#13
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
https://www.readbyqxmd.com/read/27802825/mog-igg-in-nmo-and-related-disorders-a-multicenter-study-of-50-patients-part-3-brainstem-involvement-frequency-presentation-and-outcome
#14
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
https://www.readbyqxmd.com/read/27787462/comparing-hypertropia-in-upgaze-and-downgaze-distinguishes-congenital-from-acquired-fourth-nerve-palsies
#15
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
https://www.readbyqxmd.com/read/27778210/surgical-resection-of-fourth-ventricular-ependymomas-case-series-and-technical-nuances
#16
REVIEW
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...
November 2016: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/27436207/third-fourth-and-sixth-cranial-nerve-palsies-in-pituitary-apoplexy
#17
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
https://www.readbyqxmd.com/read/27218062/bilateral-abducent-nerve-palsy-after-neck-trauma-a-case-report
#18
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
https://www.readbyqxmd.com/read/27193585/retroclival-pneumocephalus-associated-with-bilateral-abducens-palsy-in-a-child
#19
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
https://www.readbyqxmd.com/read/27183294/prevalence-of-diabetic-retinopathy-in-a-population-of-diabetics-from-the-middle-east-with-microvascular-ocular-motor-palsies
#20
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
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