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Sixth nerve palsy

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https://www.readbyqxmd.com/read/28794092/optic-disc-swelling-in-a-patient-with-tuberculous-meningitis-a-diagnostic-challenge
#1
Hanis Zuhaimy, Sue Ngein Leow, Suresh K Vasudevan
We discuss the diagnostic challenge in an adult patient presented with purely ocular symptoms diagnosed with tuberculous meningitis (TBM). A 38-year-old woman presented with bilateral painless blurring of vision. There were bilateral sixth cranial nerve palsy and bilateral optic disc swelling. Optic nerve function tests were normal. Patient was lucid with no signs of meningism. Brain imaging were normal. She had a positive Mantoux test, high erythrocyte sedimentation rate but no clinical evidence of active pulmonary tuberculosis infection...
August 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28772000/stroke-risk-among-adult-patients-with-third-fourth-or-sixth-cranial-nerve-palsy-a-nationwide-cohort-study
#2
Tyler Hyungtaek Rim, Jinu Han, Yoon Seong Choi, Taekjune Lee, Sung Soo Kim
PURPOSE: This study sought to determine whether isolated third, fourth and sixth cranial nerve palsies (NPs) are associated with increased short- and long-term risk of a subsequent stroke. METHODS: This was a nationwide retrospective propensity score-matched cohort study. A cohort of patients with NP (n = 466) and a randomly selected, propensity-matched control cohort (n = 2281) were extracted from the Korean national insurance claim database. Subjects were tracked for 5 years total, subdivided into periods of 0-1 years, 1-3 years and 3-5 years...
August 3, 2017: Acta Ophthalmologica
https://www.readbyqxmd.com/read/28758185/cystic-chordoma-of-cavernous-sinus
#3
Prashant Sathe, Amit Mahore, Aadil Chagla
Chordomas are the tumors commonly involving base of skull which are predominantly solid in consistency. A cystic chordoma of cavernous sinus is an extremely rare entity and has never been reported. We report a 26- year-old male presenting with gradually progressive right sided sixth nerve palsy and headache. Computerized tomography (CT) scan and Magnetic resonant imaging (MRI ) scan of brain showed a cystic lesion in right cavernous sinus.Patient was successfully treated using transnasal endoscopic trans-sphenoidal approach ...
June 14, 2017: Turkish Neurosurgery
https://www.readbyqxmd.com/read/28743241/complete-ophthalmoplegia-complete-ptosis-and-dilated-pupil-due-to-internal-carotid-artery-dissection-as-the-first-manifestation-of-takayasu-arteritis
#4
H M M T B Herath, S P Pahalagamage, D Withana, Sunethra Senanayake
BACKGROUND: Takayasu arteritis is a rare, chronic large vessel vasculitis involving the aorta and its primary branches. As the disease progresses, the active inflammation of large vessels leads to dilation, narrowing and occlusion of the arteries. Arterial dissection is due to separation of the layers of the arterial wall resulting in a false lumen, where blood seeps into the vessel wall. Neurological sequelae of intracranial arterial dissection results from cerebral ischemia due to thromboembolism and hypo perfusion...
July 25, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28720313/binocular-diplopia-in-a-tertiary-hospital-aetiology-diagnosis-and-treatment
#5
P Merino, D Fuentes, P Gómez de Liaño, M A Ordóñez
OBJECTIVE: To study the causes, diagnosis and treatment in a case series of binocular diplopia. MATERIAL AND METHOD: A retrospective chart review was performed on patients seen in the Diplopia Unit of a tertiary centre during a one-year period. Diplopia was classified as: acute≤1 month since onset; subacute (1-6 months); and chronic (>6 months). Resolution of diplopia was classified as: spontaneous if it disappeared without treatment, partial if the course was intermittent, and non-spontaneous if treatment was required...
July 15, 2017: Archivos de la Sociedad Española de Oftalmología
https://www.readbyqxmd.com/read/28665866/intracranial-aneurysms-of-neuro-ophthalmologic-relevance
#6
Jonathan A Micieli, Nancy J Newman, Daniel L Barrow, Valérie Biousse
BACKGROUND: Intracranial saccular aneurysms are acquired lesions that often present with neuro-ophthalmologic symptoms and signs. Recent advances in neurosurgical techniques, endovascular treatments, and neurocritical care have improved the optimal management of symptomatic unruptured aneurysms, but whether the chosen treatment has an impact on neuro-ophthalmologic outcomes remains debated. EVIDENCE ACQUISITION: A review of the literature focused on neuro-ophthalmic manifestations and treatment of intracranial aneurysms with specific relevance to neuro-ophthalmologic outcomes was conducted using Ovid MEDLINE and EMBASE databases...
June 29, 2017: Journal of Neuro-ophthalmology: the Official Journal of the North American Neuro-Ophthalmology Society
https://www.readbyqxmd.com/read/28602444/abducens-nerve-palsy-in-gestational-hypertension-a-case-report-and-review-of%C3%A2-the%C3%A2-literature
#7
Albaro J Nieto-Calvache, Sara Loaiza-Osorio, José Casallas-Carrillo, María F Escobar-Vidarte
BACKGROUND: Headache, blurring of vision, and confusion are common neurologic symptoms of hypertensive disorders of pregnancy, whereas abducens nerve palsy during pregnancy is an extremely rare condition. CASE: A 28-year-old woman with gestational hypertension presented isolated sixth cranial nerve palsy after delivery. Neither simple resonance nor angioresonance showed alterations. No other specific pathology was found. Symptoms of abducens nerve palsy resolved spontaneously...
June 8, 2017: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
https://www.readbyqxmd.com/read/28589111/acute-otitis-media-induced-gradenigo-syndrome-a-dramatic-response-to-intravenous-antibiotic
#8
Tayebeh Kazemi
INTRODUCTION: Petrositis is a rare but severe complication of acute otitis media and mastoiditis. Despite efficient antibiotic therapy, there are still reports of both intratemporal and intracranial complications of otitis media with the potential risk of high morbidity and mortality. Petrositis has traditionally been treated with surgery, but recent advances in imaging, with improved antibiotic treatment, allow more conservative management. CASE REPORT: In this case report we describe the clinical course and treatment of a 33-year-old man with petrous apicitis who presented with severe otalgia, retro-orbital pain, and sixth cranial nerve palsy Gradenigo syndrome...
May 2017: Iranian Journal of Otorhinolaryngology
https://www.readbyqxmd.com/read/28527856/a-bloody-mess
#9
Michael C Brodsky, Valérie Biousse
A 15-year-old girl presented with a unilateral sixth nerve palsy and papilledema following a severe headache. MR imaging showed thrombosis of the superior sagittal sinus and proximal right transverse sinus that were attributed to oral contraceptive use after a coagulation workup was negative. Systemic anticoagulation caused a hemorrhagic papillopathy in both eyes, raising the question as to whether anticoagulation should be discontinued. Diagnostic and management issues regarding cerebral venous sinus thrombosis with secondary intracranial hypertension are discussed...
May 17, 2017: Survey of Ophthalmology
https://www.readbyqxmd.com/read/28498375/neuro-ophthalmologic-manifestations-of-cholangiocarcinoma-a-case-series
#10
G Rico, S V Smith, Y Siddiqui, A Whyte, D Gombos, A G Lee
PurposeTo describe the neuro-ophthalmologic findings of cholangiocarcinoma.MethodsWe report a retrospective chart review of cholangiocarcinoma patients presenting at two tertiary care centers in the Texas Medical Center.ResultsFive patients with neuro-ophthalmologic symptoms related to cholangiocarcinoma were identified. One patient presented with diplopia due to metastasis to the left medial rectus muscle, two patients had metastasis to the occipital lobe resulting in homonymous hemianopsia, one patient had involvement of the clivus resulting in sixth nerve palsy, and one presented with a hypercoagulable state-related stroke causing a homonymous hemianopsia and visual hallucinations...
August 2017: Eye
https://www.readbyqxmd.com/read/28474987/idiopathic-hypertrophic-pachymeningitis-mimicking-hemicrania-continua-an-unusual-clinical-case
#11
Antonio Russo, Marcello Silvestro, Mario Cirillo, Alessandro Tessitore, Gioacchino Tedeschi
Background Hemicrania continua (HC) is a primary headache syndrome characterized by a unilateral, moderate, continuous headache with exacerbations marked by migrainous and cranial autonomic symptoms. However, clinical phenotypes similar to primary HC may be subtended by several disorders. Case report We report the case of a 62-year-old man experiencing, over the previous year, a headache completely consistent with HC and its absolute responsiveness to indomethacin therapy. Later, the patient developed diplopia caused by sixth cranial nerve palsy ipsilateral to headache...
January 1, 2017: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/28474478/incomplete-cavernous-sinus-syndrome-as-the-initial-manifestation-of-a-previously-undetected-metastatic-prostate-adenocarcinoma
#12
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
#13
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...
August 2017: Practical Neurology
https://www.readbyqxmd.com/read/28432112/reduction-of-severe-visual-loss-and-complications-following-intra-arterial-chemotherapy-iac-for-refractory-retinoblastoma
#14
M Ashwin Reddy, Zishan Naeem, Catriona Duncan, Fergus Robertson, Jane Herod, Adam Rennie, Alki Liasis, Dorothy Ann Thompson, Mandeep Sagoo
BACKGROUND: Intra-arterial chemotherapy (IAC) for retinoblastoma has been documented as causing visual loss and ocular motility problems. A lack of safety data has precluded its acceptance in all centres. METHODS: Retrospective cohort study of patients with retinoblastoma from 2013 to 2015 who had a healthy foveola and relapsed following systemic chemotherapy. All required IAC. The correlation of complications with doses of melphalan +/- topotecan used and putative catheterisation complications was assessed...
April 21, 2017: British Journal of Ophthalmology
https://www.readbyqxmd.com/read/28405168/the-black-evil-affecting-patients-with-diabetes-a-case-of-rhino-orbito-cerebral-mucormycosis-causing-garcin-syndrome
#15
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/28362929/metastatic-liposarcoma-of-the-skull-base-a-case-report-and-review-of-literature
#16
Nirmeen Zagzoog, Greta Ra, Alex Koziarz, John Provias, Doron Sommer, Saleh A Almenawer, Kesava Reddy
BACKGROUND AND IMPORTANCE: Myxoid liposarcoma is not an uncommon form of sarcoma. However, it usually affects the lower extremity long bones. Scapular involvement is extremely rare, as is a metastasis to the parasellar region. We present a case of liposarcoma of the skull base originating in the scapular region and metastasizing to the sellar and parasellar regions and provide a review of the pertinent literature. CLINICAL PRESENTATION: A 43-year-old female patient diagnosed with left scapular myxoid liposarcoma was treated with surgical resection...
April 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28345573/clinical-correlation-of-imaging-findings-in-congenital-cranial-dysinnervation-disorders-involving-abducens-nerve
#17
Chanchal Gupta, Pradeep Sharma, Rohit Saxena, Ajay Garg, Sanjay Sharma
PURPOSE: High-resolution magnetic resonance imaging (MRI) of intracranial parts of sixth nerve and seventh nerve and the extraocular muscles (EOMs) in orbit to correlate the clinical characteristics in patients with two special forms of strabismus in congenital cranial dysinnervation disorders which are Duane's retraction syndrome (DRS) and Mobius syndrome. MATERIALS AND METHODS: Morphological analysis by 3T MRI of orbit (using surface coils) and brain (using 32 channel head coil) was performed on 6 patients with clinical DRS (1 bilateral), 2 cases with Mobius syndrome, and 1 case with congenital sixth nerve palsy...
February 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/28299356/an-exome-sequencing-study-of-moebius-syndrome-including-atypical-cases-reveals-an-individual-with-cfeom3a-and-a-tubb3-mutation
#18
Ronak M Patel, David Liu, Claudia Gonzaga-Jauregui, Shalini Jhangiani, James T Lu, V Reid Sutton, Susan D Fernbach, Mahshid Azamian, Lisa White, Jane C Edmond, Evelyn A Paysse, John W Belmont, Donna Muzny, James R Lupski, Richard A Gibbs, Richard Alan Lewis, Brendan H Lee, Seema R Lalani, Philippe M Campeau
Moebius syndrome is characterized by congenital unilateral or bilateral facial and abducens nerve palsies (sixth and seventh cranial nerves) causing facial weakness, feeding difficulties, and restricted ocular movements. Abnormalities of the chest wall such as Poland anomaly and variable limb defects are frequently associated with this syndrome. Most cases are isolated; however, rare families with autosomal dominant transmission with incomplete penetrance and variable expressivity have been described. The genetic basis of this condition remains unknown...
March 2017: Cold Spring Harbor Molecular Case Studies
https://www.readbyqxmd.com/read/28261154/sixth-nerve-palsy-from-cholesterol-granuloma-of-the-petrous-apex
#19
Ségolène Roemer, Philippe Maeder, Roy Thomas Daniel, Aki Kawasaki
Herein, we report a patient who had an isolated sixth nerve palsy due to a petrous apex cholesterol granuloma. The sixth nerve palsy appeared acutely and then spontaneously resolved over several months, initially suggesting a microvascular origin of the palsy. Subsequent recurrences of the palsy indicated a different pathophysiologic etiology and MRI revealed the lesion at the petrous apex. Surgical resection improved the compressive effect of the lesion at Dorello's canal and clinical improvement was observed...
2017: Frontiers in Neurology
https://www.readbyqxmd.com/read/28253424/botulinum-toxin-for-the-treatment-of-strabismus
#20
REVIEW
Fiona J Rowe, Carmel P Noonan
BACKGROUND: The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However, it is unclear how effective it is in comparison to other treatment options for strabismus. OBJECTIVES: The primary objective was to examine the efficacy of botulinum toxin therapy in the treatment of strabismus compared with alternative conservative or surgical treatment options. This review sought to ascertain those types of strabismus that particularly benefit from the use of botulinum toxin as a treatment option (such as small angle strabismus or strabismus with binocular potential, i...
March 2, 2017: Cochrane Database of Systematic Reviews
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