Presentation
The signs and symptoms of neurological disease are elusive by their very nature, presenting a confounding diagnostic challenge. [books.google.com]
Some patients may also present with this characteristic ocular motility pattern without overt craniofacial signs ( Figure 1 ). [nature.com]
Methods Physical exam findings from an 8 month old child with bilateral abducens palsies is presented. MRI findings of the brain and orbit are reviewed, including high resolution cranial nerve imaging. [iovs.arvojournals.org]
Eyes
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Visual Impairment
There have only been 52 reported cases of patients with Bonnet–Dechaume–Blanc syndrome as of 2012, Symptoms are rarely noticed in children and the syndrome is often diagnosed in late childhood or early adulthood when visual impairment is noticed. [wikivisually.com]
Ears
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Hearing Problem
Involved specialists include: pediatricians; neurologists; plastic surgeons; ear, nose, and throat specialists (otolaryngologists); orthopedists; dental specialists; speech pathologists; specialists who assess and treat hearing problems (audiologists) [rarediseases.org]
Neurologic
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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]
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Steppage Gait
gait鶏歩行、鶏歩き、鶏歩 stiffness1.硬直、こわばり、2.不撓性〈脊椎の〉、3.剛性 straight leg raising test (SLR test)下肢伸展挙上テスト stress fracture疲労骨折 subarachnoid spaceくも膜下腔 subclavian artery鎖骨下動脈 Sudeck's atrophy Sudeck骨萎縮 suppository坐剤 supraclavicular fossa鎖骨上窩(―じょうか) suture1.縫合[法] [tokyo-med.ac.jp]
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Vertigo
Cerebellopontine angle syndrome CN V, VI, VII, VIII, IX, X Neoplasms of the cerebellopontine angle Vestibular schwannomas Meningiomas Metastases Cholesteatomas Progressive sensorineural hearing loss Gait disequilibrium Vertigo is uncommon. [amboss.com]
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Long Tract Signs
tract signs (weakness), as well as the possible involvement of cranial nerves V, VII, and VIII ( Table 1 ). [arabmedmag.com]
Workup
Mortality/Morbidity A young patient should have an aggressive workup because of the greater likelihood of a neoplasm causing the palsy. [thehealthscience.com]
Testing: A suggested workup for 6th nerve palsy, adapted from Galetta and Lawton Smith (1989) is as follows: At presentation: General physical, ophthalmologic and neurologic Blood pressure Ascultation for bruits over the eyes and mastoid Cocaine test [dizziness-and-balance.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]
Non-traumatic third nerve palsy cases must undergo a full workups with neuro-imaging. The usual clinical sign of a third nerve palsy is the outward and downward location of the involved eye. This may or may not be accompanied by lid drooping. [wrighteyecare.com]
Workup includes labwork (ESR, CRP, platelets) and potentially temporal artery biopsy in certain cases. Increased intracranial pressure (ICP) can manifest as papilledema, swelling of the optic nerves in the back of the eye. [timroot.com]
Treatment
Thorough coverage for each neurological disease clearly defines age at onset, course of illness, clinical features, and treatment options. Differential diagnosis tables and treatment algorithms expedite clinical decision making. [books.google.com]
It can be used as the sole treatment for sixth nerve palsy, or in addition to a surgical treatment. The operations performed in this study were either transpositions or recess-resect procedures. [healio.com]
A patient's age and clinical findings help a doctor decide the right course of treatment. Treatment: There are no particular treatments which can speed up the recovery of cranial nerve palsy. [lybrate.com]
Prognosis
Palsies related to trauma or brain masses have a guarded prognosis and recovery, if any, may take up to one year. [encyclopedia.com]
Introduction Anatomy Sixth NervePalsy o Incidence o Etiology o Differential Diagnosis o Clinical Signs& Symptoms o Optometric Assessment & Investigation o Other Clinical Assessment & Investigation o Optometric Management o Other Managements o Prognosis [slideshare.net]
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. 16. Bagheri A, Eshaghi M. [reviewofoptometry.com]
Cause and prognosis in 1,000 cases.Arch Ophthalmol 1981 Jan; 99(1): 76-9 [Medline]. von Noorden GK, Murray E, Wong SY: Superior Oblique Paralysis.Arch Ophthalmol 1986; 104: 1771-1776. [www2.medicine.mcgill.ca]
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
The aim of this study is to describe demographics and etiologic factors of patients with paralytic strabismus. [austinpublishinggroup.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]
An inflammatory etiology, such as Tolosa-Hunt syndrome, is painful and typically responds quickly to steroids. Other etiologic considerations would include aneurysm, bone metastasis, and ophthalmoplegic migraine. [arabmedmag.com]
Etiology Clinical features Extorsion of the eye : inability to depress and adduct the eyeball simultaneously (the pupil shoots upward during attempted adduction of the eyeball) Diplopia ( double vision ) Mild esotropia Trigeminal nerve lesion (V) Etiology [amboss.com]
Etiology of Infranuclear Sixth Nerve Palsy. [guwsmedical.info]
Epidemiology
Epidemiology Frequency United StatesSixth nerve palsies fall into the following categories: 8-30% idiopathic, 10-30% miscellaneous, 3-30% trauma, 0-6% aneurysm, and 0-36% ischemic. [thehealthscience.com]
[…] tightly together: Difficulty keeping food in mouth Facial muscle atrophy (Late) Electrophysiology EMG Denervation Synkinesis: Late Blink reflex Abnormal ipsilateral R1 (early, disynaptic) R2 (late multisynaptic) responses Synkinesis (Late) Bell's Palsy 8 Epidemiology [neuromuscular.wustl.edu]
"[Epidemiological and clinical aspects of Stilling-Turk-Duane syndrome]". J. Fr. Ophtalmol. (in French). 19 (8–9): 533–42. PMID 8944136. Further reading [ edit ] Andrews, Caroline V.; Hunter, David G.; Engle, Elizabeth C. (1993). "Duane Syndrome". [en.wikipedia.org]
This study was performed to determine epidemiologic and etiologic distribution and results of strabismus surgery in patients with third nerve palsy referred to our clinic as a tertiary center over a 10-year period. [jovr.org]
Epidemiology In 2007, the Moebius Syndrome Foundation estimated that there were at the time a total of approximately 2,000 cases of Moebius Syndrome worldwide [6]. [physio-pedia.com]
Pathophysiology
Pathophysiology Only the ipsilateral lateral rectus that is solely innervated by the involved peripheral sixth cranial nerve is affected; therefore, only deviations in the horizontal plane are produced. [thehealthscience.com]
Pathophysiology of strabismus Strabismus often occurs in children who are otherwise completely normal. [patient.info]
Pathophysiology The fourth cranial nerve nucleus is located in the dorsal mesencephalon. Nerve fibers decussate and exit the brain stem dorsally into the subarachnoid space. [reviewdiseasehandbook.com]
Cadera et al 24 studied pathophysiology of double elevator palsy in two patients with magnetic resonance imaging (MRI) with volume scanning technique. [entokey.com]
Prevention
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]
The hope is that preventing secondary contracture of the medial rectus muscle will increase the chances of recovery without strabismus surgery. [wrighteyecare.com]
Prevention Prevention of paralysis depends on prevention of the underlying causes. Risk of stroke can be reduced by controlling high blood pressure and cholesterol levels. [medical-dictionary.thefreedictionary.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]
Babies require the use of artificial tears during their waking hours, and eye ointments during sleep, to prevent eye dryness because of inability to close the eyelids completely. [news-medical.net]