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Sixth nerve palsy

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https://www.readbyqxmd.com/read/29456899/facial-weakness-diplopia-and-fever-in-a-31-year-old-an-atypical-case-of-tuberculous-meningitis
#1
Ahmed H Qavi, Tasnim F Imran, Zachariah Hasan, Fariha Ilyas
Tuberculous meningitis (TBM) is an infection of the central nervous system (CNS) meninges that carries high morbidity and mortality. It is important to recognize, as patients may present with atypical symptoms. We describe the case of a 31-year-old man with a history of diabetes who presented with a sub-acute onset of right-sided facial weakness and right gaze difficulty with diplopia. History revealed low-grade fever, right-sided headache, fatigue and moderate weight loss for the past several weeks. The patient did not report neck stiffness, rigidity, fever, chills or cough...
December 7, 2017: Curēus
https://www.readbyqxmd.com/read/29426788/approach-to-a-patient-with-diplopia-in-the-emergency-department
#2
Edward Margolin, Cindy T Y Lam
BACKGROUND: Diplopia can be the result of benign or life-threatening etiologies. It is imperative for the emergency physician to be proficient at assessing diplopia and recognize when urgent referral or neuroimaging is required. OBJECTIVE: The first part of this review highlights a simple framework to arrive at the appropriate disposition of diplopic patients presenting to the emergency department (ED). The second part of this review provides more detail and further management strategies...
February 6, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29386618/botulinum-toxin-as-an-initial-therapy-for-management-of-sixth-nerve-palsies-caused-by-nasopharyngeal-carcinomas
#3
E S Wong, C P S Lam, F H S Lau, W W Y Lau, J C S Yam
PurposeThe purpose of this study is to evaluate the efficacy and safety of botulinum toxin injection as a primary treatment for strabismus in a cohort of patients with nasopharyngeal carcinoma (NPC)-related chronic sixth nerve palsy.Patients and methodsWe retrospectively reviewed all cases of NPC-related sixth nerve palsy receiving botulinum toxin injection in the Hong Kong Eye Hospital between January 2009 and January 2016. Only cases with diplopia for at least 6 months; and failed a trial of Fresnel prism therapy were recruited...
January 26, 2018: Eye
https://www.readbyqxmd.com/read/29348290/an-unusual-case-of-basilar-artery-aneurysm-presenting-with-spastic-quadriparesis
#4
Chandramohan Sharma, Banshi Lal Kumawat, Deepika Sagar, Maulik Panchal
Unruptured aneurysm usually presents with headache and neuro-ophthalmic features; when it ruptures, it presents with subarachnoid haemorrhage. Basilar artery aneurysm represents only 3-5% of cerebral aneurysms. Non-haemorrhagic symptoms and the signs of unruptured aneurysms are manifested as mass effect, thromboembolic phenomenon or epileptical attacks. Clinical presentation of unruptured aneurysm depends on structures which are involved. In our case, the patient had insidious onset headache and spastic quadriparesis with sixth cranial nerve palsy, which implicate involvement of corticospinal pathways at the level of pons...
January 17, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29334776/multiple-intracranial-aneurysms-in-a-patient-with-type-i-gaucher-disease-a-case-report-and-literature-review
#5
Matthew R Reynolds, Daniel M Heiferman, Andrew B Boucher, Brian M Howard, Daniel L Barrow, Jacques E Dion
Multiple intracranial aneurysms (IAs) have never been reported in a patient with Gaucher disease (GD). A 69-year-old-female with type I GD presented with a left sixth nerve palsy due to a large posterior inferior cerebellar artery (PICA) aneurysm. Cerebral angiography demonstrated fifteen unruptured IAs (UIAs).
January 15, 2018: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/29299740/augmented-superior-rectus-transposition-procedure-in-duane-retraction-syndrome-compared-with-sixth-nerve-palsy
#6
Mohammadreza Akbari, Setareh Shomali, Arash Mirmohammadsadeghi, Masoud Aghsaei Fard
PURPOSE: Superior rectus transposition (SRT) with medial rectus recession has been used for the treatment of sixth nerve palsy and esotropic Duane retraction syndrome (DRS). The purpose of this study was to compare the results of augmented SRT (with scleral fixation) without medial rectus recession in DRS and sixth nerve palsy. METHODS: Patients with unilateral esotropic DRS (DRS group) and sixth nerve palsy were included in this prospective, comparative study and underwent SRT...
January 3, 2018: Graefe's Archive for Clinical and Experimental Ophthalmology
https://www.readbyqxmd.com/read/29285405/prepontine-arachnoid-cyst-presenting-with-headache-and-diplopia-a-case-report-study
#7
Omidvar Rezaee, Kaveh Ebrahimzadeh, Ehsan Nazari Maloumeh, Armin Jafari, Misagh Shafizad, Mohammad Hallajnejad
Background: Arachnoid cysts are found everywhere in cerebrospinal axis, most often in the middle cranial fossa. They are very rare in prepontine location. Case Description: In this study, we report a 26-year-old female presenting with a 3-month history of headache and diplopia. On physical examination, she had clinical manifestations of sixth cranial nerve palsy. Magnetic resonance imaging revealed a prepontine arachnoid cyst with extension into interpeduncular and suprasellar cisterns...
2017: Surgical Neurology International
https://www.readbyqxmd.com/read/29184272/approach-to-chronic-secondary-headache-a-case-report-on-unusual-drug-side-effects
#8
Hamid Reza Riasi, Forod Salehi, Morteza Hajihosseini
In this article, we present the case of a 12-year-old female child who complained of bilateral temporal and frontal headache for 2 to 3 months with nausea and vomiting. Physical examination revealed right-sided sixth cranial nerve palsy and papilledema in ophthalmoscopy. To find the cause of increased intracranial pressure, the patient underwent brain imaging and brain MRI showed no abnormality. Ultimately, lumbar puncture (LP) was performed and cerebrospinal fluid (CSF) pressure was 280 mmH2O with normal chemistry...
November 2017: Iranian Journal of Medical Sciences
https://www.readbyqxmd.com/read/29156469/-efficacy-of-vertical-muscle-transpositions-with-and-without-simultaneous-rectus-muscle-recession-for-unilateral-sixth-nerve-palsy
#9
Andrea M Hedergott, Dana Wild, Julia Fricke, Antje Neugebauer
Background We report results of a modified vertical muscle transposition procedure according to the Hummelsheim principle - with and without simultaneous rectus muscle recession - for unilateral sixth nerve palsy. We examine the influence of the duration of the palsy, preoperative angle of squint and preoperative abductive capacity on surgical results of the procedures. Patients and Methods Retrospective study of 29 consecutive patients with unilateral abducens nerve palsy who underwent surgery between 2001 and 2012...
November 20, 2017: Klinische Monatsblätter Für Augenheilkunde
https://www.readbyqxmd.com/read/29114308/calvarial-orbital-metastasis-of-prostate-carcinoma-which-was-diagnosed-with-sixth-cranial-nerve-palsy
#10
Zühtü Özbek, Emre Özkara, Deniz Arik, Metin Atasoy Ant
Sixth nerve palsy is frequently due to infectious orbital lesions, trauma, elevated intracranial pressure, brainstem lesions, and vasculopathies. Here, we describe a rare cause of sixth cranial nerve (CN) palsy secondary to calvarial and orbital metastasis of prostate carcinoma. The diagnosis of the prostate carcinoma with sixth CN palsy is a very rare condition. A 66-year-old male patient presented with complaints of blurred vision, double vision, and inability to move outward in the right eye for 3 weeks...
October 2017: Asian Journal of Neurosurgery
https://www.readbyqxmd.com/read/29044089/congenital-sixth-nerve-palsy-with-associated-anomalies
#11
Nirupama Kasturi
Congenital abduction deficit is most likely due to Duane's retraction syndrome as congenital abducens nerve palsy is very rare. We report two cases of infantile abduction deficit due to sixth nerve palsy associated with other anomalies to highlight the importance of including neuroimaging in the evaluation of an infant presenting with a limitation of abduction.
October 2017: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/28987313/pneumocephalus-and-sixth-nerve-palsy-after-epidural-steroid-injection-case-report-and-review-of-the-literature
#12
Wendy F Li, Kyle Kovacs, Adeniyi A Fisayo
BACKGROUND: Pneumocephalus has been described as an unintended outcome after epidural injections. However, oculomotor palsy from pneumocephalus after epidural injection is very rare. CASE REPORT: We report a case of pneumocephalus-induced sixth nerve palsies and diplopia in an 87-year-old woman after epidural steroid injection. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pneumocephalus-induced oculomotor palsy is a rare complication after epidural injection, a commonly performed medical procedure...
November 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28969214/isolated-sixth-cranial-nerve-palsy-in-a-case-of-severe-pre-eclampsia-presenting-as-postpartum-diplopia
#13
Aarti Yevale, Akhila Vasudeva, Anjali Mundkur, Pratap Kumar, Arvind Prabhu
Visual symptoms in pregnancy are ominous. The spectrum of ocular symptoms seen in pre-eclampsia includes blurring of vision, scotoma, hemianopia and even total cortical blindness. Diplopia, though rare has also been reported in cases of pre-eclampsia and occurs due to pathological changes affecting the 6(th) cranial nerve. Ocular symptoms of pre-eclampsia usually regress after delivery but occasionally may present in the postpartum period. We present a case of a 34-year-old lady with severe pre-eclampsia at 31 weeks of gestation with diplopia presenting seven days post caesarean section...
August 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28955030/gradenigo-s-syndrome-in-a-patient-with-chronic-suppurative-otitis-media-petrous-apicitis-and-meningitis
#14
Nicholas Taklalsingh, Franco Falcone, Vinodkumar Velayudhan
BACKGROUND Gradenigo's syndrome includes the triad of suppurative otitis media, ipsilateral sixth (abducens) cranial nerve palsy and facial pain in the distribution of the fifth (trigeminal) cranial nerve. Gradenigo's syndrome is rare, and the diagnosis is easily overlooked. This case is the first to report Gradenigo's syndrome presenting with meningitis on a background of chronic suppurative otitis media (CSOM) and petrous apicitis (apical petrositis). CASE REPORT A 58-year-old male African American presented with headaches and confusion...
September 28, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28904218/early-onset-sixth-nerve-palsy-with-eccentric-fixation
#15
Kaajal D Nanda, Eve Lacey, Alki Liasis, Ken K Nischal
PURPOSE: To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation. METHODS: A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records. RESULTS: Four children with unilateral or asymmetric early onset sixth-nerve palsy were identified, of which three were congenital...
January 2017: American Orthoptic Journal
https://www.readbyqxmd.com/read/28845325/ocular-causes-of-abnormal-head-position-strabismus-clinic-data
#16
Kadriye Erkan Turan, Hande Taylan Şekeroğlu, İrem Koç, Esra Vural, Jale Karakaya, Emin Cumhur Şener, Ali Şefik Sanaç
OBJECTIVES: To determine the most common ocular causes and types of abnormal head position (AHP) and describe their clinical features. MATERIALS AND METHODS: Patients with AHP who had been followed in the strabismus unit were retrospectively reviewed. Demographic features and orthoptic characteristics were recorded. RESULTS: A total of 163 patients including 61 women (37.4%) and 102 men (62.6%), with a mean age of 19.9±18.3 were recruited...
August 2017: Turkish Journal of Ophthalmology
https://www.readbyqxmd.com/read/28794092/optic-disc-swelling-in-a-patient-with-tuberculous-meningitis-a-diagnostic-challenge
#17
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
#18
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
#19
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
#20
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
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