Presentation
and Management; Carotid Cavernous Fistulas: Epidemiology, Clinical Presentation, and Management. [books.google.com]
The aim of our study was to present the largest single-center series of patients with the longest period of follow-up to confirm the benign nature of this entity. [ncbi.nlm.nih.gov]
Here we present the case of a 6 years old girl with isolated right sided sixth nerve palsy resulting in squinting and diplopia. Case Report A 6-year-old girl presented with a sudden onset of double vision. [medresearch.in]
We present 3 cases of underlying neoplasms presenting as cranial nerve palsies: a case of glomus tumor presenting as cochlear, glossopharyngeal, vagus and hypoglossal nerve palsies, clivus tumor presenting as abducens nerve palsy, and diffuse large B-cell [karger.com]
Entire Body System
- Falling
These children continue to "fall through the cracks" of our medical education system. [books.google.com]
(Inability to look down can lead to falling down stairs.) Multiple sclerosis (MS) often presents with optic neuritis in which there is pain on eye movement and alteration or loss of vision. Diplopia can occur. [patient.info]
Nonphysiologically active paraganglia have a negative chromaffin reaction, and the glomus jugulare falls into this group. [karger.com]
One primary type of generalized seizure is tonic-clonic seizures, in which an individual loses consciousness without warning, falls, and stiffens, because of muscle contractions. [britannica.com]
- Short Stature
Clinical features of the disorder include short stature, smallness of the head, obliquely slanted eyes, a flattened face, wide hands with a single transverse palmar crease, short digits, and weak muscles. [britannica.com]
Cardiovascular
- Thrombosis
Differential diagnosis of patients with intracranial sinus venous thrombosis related isolated intracranial hypertension from those with idiopathic intracranial hypertension. J Neurol Sci 2003;215:9-12. 3. [neurologyindia.com]
implication in otitis media/mastoiditis at the apex of the petrous temporal bone, leading to Gradenigo's syndrome (otitis media, lateral gaze palsy and pain in distribution of the trigeminal nerve) complications in the cavernous sinus, for example thrombosis [mrcprevision.blogspot.com]
[…] of inferior petrosal sinus; trauma with transverse fracture of temporal bone; persistent trigeminal artery, aneurysm, or arteriovenous malformation Cavernous sinus thrombosis; carotid-cavernous fistula ; tumor; internal carotid aneurysm Tumor; pseudotumor [guwsmedical.info]
Thunderclap headache as first symptom of cerebral venous sinus thrombosis. CVST Study Group. Lancet. 1996 Dec 14;348(9042):1623-5. 12) da Motta LA, de Mello PA, de Lacerda CM, Neto AP, da Motta LD, Filho MF. Pituitary apoplexy. [jhsnet.org]
Some risk factors include multiple sclerosis, encephalitis, meningitis, cavernous sinus thrombosis, hypertension, hypercholesterolemia, aneurysm, diabetes, arteriosclerosis, and birth trauma. [eyewiki.aao.org]
Musculoskeletal
- Myopathy
Kearns-Sayre syndrome is a very rare mitochondrial myopathy related to CPEO but starting before the age of 20 and with pigmentary retinopathy [ 6 ]. [patient.info]
While most myopathies that affect extraocular muscles cause a diffuse ophthalmoplegia, occasional forms cause esotropia and diplopia. [neuroophthalmology.ca]
Local lesions of the brainstem may also cause paralysis of eye movement, as may severe myasthenia and myopathies affecting the eye muscles. [britannica.com]
Neuropathies It is important in the diagnosis of simultaneous palsies of the motor nerves of the eye to differentiate these from oculoparesis that arises from orbital inflammatory disease, such as Graves’ ophthalmopathy or orbital pseudotumor, ocular myopathies [medtextfree.wordpress.com]
Eyes
- Diplopia
Diplopia may be a complication after refractive surgery. Ocular lesions, including diplopia, can be amongst the presenting features of Creutzfeldt-Jakob disease (CJD), especially new variant CJD [ 4 ]. [patient.info]
Neuro-Ophthalmology Diplopia – Double Vision Diplopia, also known as double vision, occurs in one of two ways. The double vision is either present with one eye open (monocular diplopia) or only with both eyes open (binocular diplopia). [eye.uci.edu]
Thus the diplopia is horizontal and worse in the distance. [en.wikipedia.org]
In other studies with smaller cohorts, the prevalence of diplopia is highly variable, ranging from 0 to 43%, and the diplopia is often accompanied by other symptoms or signs ( 8 – 10 ). [frontiersin.org]
Patients will have horizontal uncrossed diplopia which is greater at distance than at near. The diplopia is also worse in the direction of the palsied muscle and gets better in the contralateral gaze (incomitant). [eyewiki.aao.org]
- Strabismus
In cases of subsequent acquired strabismus, with a constant angle of deviation, strabismus surgery may be required. References 1. Patel SV, Muyala S, Leske DA, Hodge DO, Holmes JM. Incidence. [nature.com]
Augmented Hummelsheim procedure for paralytic strabismus. J Pediatr Ophthalmol Strabismus. 2000;37(4):189–95. quiz 226–187. PubMed Google Scholar 36. Couser NL, Lenhart PD, Hutchinson AK. [link.springer.com]
Three children required strabismus surgery. None of the patients developed long-term recurrences or neurological abnormalities during a mean follow-up of more than 9 years. [ncbi.nlm.nih.gov]
Special Forms of Strabismus: Duane retraction syndrome In: Cantor, LB, Rapuano, CJ, Cioffi, GA, (Eds.) Basic and clinical science course (BCSC) section 6: Pediatric Ophthalmology and Strabismus. [reviewofophthalmology.com]
Sixth nerve palsy causes the eyes to deviate inward (see: Pathophysiology of strabismus ). [en.wikipedia.org]
Neurologic
- Cranial Neuropathy
Nonisolated Cranial Neuropathies MULTIPLE CRANIAL NEUROPATHIES. [medtextfree.wordpress.com]
neuropathies and are not isolated. [reviewofoptometry.com]
The largest case series of 979 cases of multiple cranial neuropathies was reported by Kaene [ 1 ]. [karger.com]
It has been hypothesized that vasospasm of the arterial supply to the sixth cranial nerve may cause ischemia followed by recovery of nerve function. 11 It has also been thought that cranial neuropathies could represent repeated episodes of demyelination [dovepress.com]
- Cranial Nerve Involvement
Cranial nerve involvement depends on the anatomical course of the cranial nerve and the site of the tumor. Patients may present with single or multiple cranial nerve palsies. [karger.com]
IIIrd, IVth, Vth cranial nerve involvement; proptosis; disc edema; orbital pain; conjunctival injection Orbit Ipsilateral IIIrd, IVth, Vth cranial nerve involvement; proptosis; disc edema; orbital pain; conjunctival injection Uncertain Tumor; demyelination [guwsmedical.info]
[…] migraine. 6 The diagnosis can be made in the presence of a healthy optic disc and in the absence of any other cranial nerve involvement. [healio.com]
The probable mechanism of third nerve (and other cranial nerves) involvement seems to be compression in the subarachnoid space in the setting of raised ICP. [neurologyindia.com]
Despite successful local therapy, about 80% will die of metastatic cancer within 5 years. [8] Our case presented with diplopia as the only sign of the cranial nerve involvement and this presentation is rare even in cases with skull base metastases from [ijo.in]
- Neuralgia
[…] orbital fissure Maxillary and mandibular divisions Provides sensory input from the teeth, gums, lip, lining of palate, and skin of the face Neuralgia Lesions of cavernous sinus or superior orbital fissure Multiple sclerosis (occasionally) Vascular loop [merckmanuals.com]
(see case 13) Radiofrequency rhizolysis for trigeminal neuralgia can cause a transient VI palsy also (29). Cavernous sinus lesions can affect the VI nerve alone or in combination with the other nerves traversing the sinus. [neuroophthalmology.ca]
Trigeminal neuralgia, also called tic douloureux, is an intense, repetitive, pain felt in the lower half of one side of the face. It occurs primarily in people over 55 years of age. [britannica.com]
- Agitation
In this disorder, individuals lose their orientation in time, space, and person; they may show altered levels of consciousness, emotional instability, physical excitability, agitation, disorderliness, hallucinations, and delusions. [britannica.com]
Workup
I will be having an MRI friday and a blood workup though I have never had diabetes, high blood pressure, or high cholesterol. [medhelp.org]
Discussion The differential diagnoses and workup of an isolated sixth nerve palsy usually depends on the age and the clinical circumstances of the patient. [dovepress.com]
For any patient who develops signs of aberrant regeneration, workup for a structural lesion is initiated, or repeated if previous workup has been carried out and no lesion found. Nonisolated Cranial Neuropathies MULTIPLE CRANIAL NEUROPATHIES. [medtextfree.wordpress.com]
Natural History and Clinical Workup Newborns may demonstrate a transient sixth nerve palsy that is frequently unilateral and occasionally accompanied by a temporary ipsilateral seventh nerve palsy.53,267,291,400 Simple observa- FIGURE 5-7. [guwsmedical.info]
The family opted for comfort measures and hospice care, hence further workup including onconeural antibodies were not pursued. He continued to deteriorate and subsequently expired. [karger.com]
Treatment
Modalities or Observation of Arteriovenous Malformations; Selection of Treatment Modalities or Observation of Dural Arteriovenous Malformations; Surgical Treatment of Cranial Arteriovenous Malformations and Dural Arteriovenous Fistulas; Anesthesia Considerations [books.google.com]
Treatment for diplopia depends on the underlying cause. [eye.uci.edu]
Treatments Generally, the treatment for abducens palsy targets the underlying cause of the problem, if the cause can be determined. Solutions might include an eye patch, prism eyeglasses, or surgery in some instances. [livestrong.com]
Our patient also improved spontaneously after 4 weeks of follow up without any treatment. [medresearch.in]
Prognosis
Cause and prognosis of nontraumatic sixth nerve palsy in young adults. Ophthalmology 2002 ; 109 : 1925 –8. 7. Sanders SK, Kawasaki A, Purvin VA. Long-term prognosis in patients with vasculopathic sixth nerve palsy. [cambridge.org]
Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol. 1992 May;113(5):489-96. 4. Rush JA. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases. [reviewofoptometry.com]
Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol. 1992;113(5):489-96. Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases. [reviewdiseasehandbook.com]
Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol. 1992;113(5):489–96. CrossRef PubMed Google Scholar 2. Holmes JM, Mutyala S, Maus TL, Grill R, Hodge DO, Gray DT. [link.springer.com]
There may be some benefit in those with tumor-related (58) or traumatic VI nerve palsies (51, 59) (60), which do not have as good a natural prognosis. [neuroophthalmology.ca]
Etiology
Other uncommon etiologies include Mycoplasma pneumoniae infection, Chlamydia pneumoniae infection, and Lyme disease. 1,3,4 Benign recurrent abducens nerve palsy is a rare condition of unknown etiology. [healio.com]
Conversely, slowly progressive onset suggests a compressive etiology. Subacute onset suggests a demyelinating process as a possible etiology. Associated pain suggests a microvascular etiology. [eyewiki.aao.org]
Etiology of Infranuclear Sixth Nerve Palsy. [guwsmedical.info]
This is followed by trauma, elevated intracranial pressure, inflammatory causes and post-viral etiologies. 1,2,7-9 - Intracranial neoplasm. [reviewofophthalmology.com]
Such a clinical course suggests alternate etiologies. [reviewdiseasehandbook.com]
Epidemiology
Articles in this issue include: Arteriovenous Malformations: Epidemiology and Clinical Presentation; Dural Arteriovenous Fistulas: Epidemiology and Clinical Presentation; Historical Perspective of Treatments of Arteriovenous Malformations and Dural Arteriovenous [books.google.com]
Epidemiology of idiopathic intracranial hypertension: A prospective and case-control study. J Neurol Sci 1993;116:18-28. [ PUBMED ] 4. Giuseffi V, Wall M, Siegel PZ, Rojas PB. [neurologyindia.com]
It is also an additive in many of the non-live vaccines the patient received in childhood without incident and extensive epidemiological studies have not found a link between neurological adverse events following immunization (AEFI) and additives or adjuvants [bmcinfectdis.biomedcentral.com]
Pathophysiology
The exact pathophysiology is unknown, although hypotheses including autoimmune mechanisms and direct viral invasion could explain the pathophysiology behind immunization related nerve palsies. [bmcinfectdis.biomedcentral.com]
Sixth nerve palsy causes the eyes to deviate inward (see: Pathophysiology of strabismus ). [en.wikipedia.org]
Pinealoma Para Myokymia of the superior oblique muscle (typically with brief episodic ocular movements that cause subjective visual shimmering, ocular trembling, and/or tilted vision) Entrapment of the trochlear nerve by a vascular loop (similar to the pathophysiology [merckmanuals.com]
The pathophysiology of recurrent painful ophthalmoplegic neuropathies remains unclear. [dovepress.com]
The pathophysiology of cranial nerve palsies accompanying psudotumor cerebri is poorly understood, but in most cases probably represents a non-specific pressure relate phenomenon. [jpgmonline.com]
Prevention
Rapidly find the answers you need with separate sections on diseases and disorders, differential diagnosis, clinical algorithms, laboratory results, and clinical preventive services, plus an at-a-glance format that uses cross-references, outlines, bullets [books.google.com]
Occlusion may also prevent secondary contracture of the medial rectus muscle of the deviating eye. [healio.com]
Therefore, if close follow-up to resolution of the palsy or paresis is not possible, neuroimaging is recommended.24 Treatment Amblyopia prevention is always key in children younger than 7 to 9 years of age. [guwsmedical.info]
We suggested the patching for right eye to prevent a double vision, and followed the patient by one-week interval. At two weeks after the diagnosis, the double vision disappeared and lateral gaze palsy resolved partly. [medresearch.in]
Occlusion using Bangerter filter or pirate patch can eliminate diplopia and confusion, prevent amblyopia or suppression in younger patients, and decrease the possibility of ipsilateral medial rectus contracture. [eyewiki.aao.org]