Presentation
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]
and Management; Carotid Cavernous Fistulas: Epidemiology, Clinical Presentation, and Management. [books.google.com]
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]
If the child presents soon after onset, suppression of the non-dominant eye has usually not been present long enough to produce suppression amblyopia, but a difference in visual acuity may be present later on. [reviewofophthalmology.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]
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]
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]
Cranial Nerve Muscle(s) Lesion(s) Oculomotor nerve (CN III) Extraocular muscles innervated by CN III are superior rectus (SR) infecrior rectus (IR) medial rectus (MR) inferior oblique (IO) Levator palpebrae superioris Ciliary muscle Sphincter pupillae Diplopia [medbullets.com]
- 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]
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]
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]
Sixth nerve palsy causes the eyes to deviate inward (see: Pathophysiology of strabismus ). [en.wikipedia.org]
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]
Neurologic
- 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]
- Oscillopsia
Superior oblique myokymia, also known as superior oblique microtremor, is a rare condition that causes intermittent diplopia or the sense of oscillopsia in one eye. [medtextfree.wordpress.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]
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]
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]
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]
Microbiology
- Toxoplasma Gondii
Serological studies were negative for Mycoplasma pneumoniae, Epstein–Barr virus, cytomegalovirus, and Toxoplasma gondii. Her AchR Ab levels were negative. No beta-hemolytic streptococci were isolated in her throat culture. [healio.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]
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]
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]
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]
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]
Etiology of Infranuclear Sixth Nerve Palsy. [guwsmedical.info]
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]
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
Sixth nerve palsy causes the eyes to deviate inward (see: Pathophysiology of strabismus ). [en.wikipedia.org]
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]
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]
With advances in neuroimaging techniques and a growing understanding of the pathophysiology of IIH, it is mandatory to exclude other causes of increased ICP without ventriculomegaly or mass lesions, such as gliomatosis cerebri, meningitis, and intracranial [neurologyindia.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]
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]
Occlusion may also prevent secondary contracture of the medial rectus muscle of the deviating eye. [healio.com]
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]
In younger patients, patching may be necessary to prevent or treat amblyopia. If a compensatory head posture allowing binocular fusion is present, patching may be optional unless there is a change in visual acuity or angle of deviation. [reviewofophthalmology.com]