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Diabetic Ophthalmoplegia


Presentation

  • Abstract Two patients presented with simultaneous oculomotor nerve palsies clinically associated with diabetes mellitus.[ncbi.nlm.nih.gov]
  • Case Presentation A 44 year old man was admitted to our emergency department with a dull, moderately severe headache in right orbital area that had been present for 7 days.[amhsr.org]
  • A possible anatomic substrate is presented to explain the findings. Williams & Wilkins 1990. All Rights Reserved. Related Articles[journals.lww.com]
  • In the present study as well no significant association was found (P 0.08).[biotech-asia.org]
Progressive Ophthalmoplegia
  • ophthalmoplegia gradual paralysis of all the eye muscles. total ophthalmoplegia paralysis of all the eye muscles, both intraocular and extraocular.[medical-dictionary.thefreedictionary.com]
  • Chronic progressive ophthalmoplegia or PEO tends to appear in adults between the ages of 18 and 40. Usually, it starts with drooping eyelids and difficulty controlling muscles that are normally used to coordinate the eyes.[belmarrahealth.com]
  • In a matter of hours, she had developed bilateral, progressive ophthalmoplegia and complete vision loss. She endorsed worsening “swelling” of the left upper eyelid and numbness around the left eye and cheek for the past 2 days.[healio.com]
  • They cause slowly progressive ophthalmoplegia through enlargement, often with aberrant regeneration, and may cause an acute carotid–cavernous fistula if they bleed.[medtextfree.wordpress.com]
Localized Pain
  • There are three stages of rhinocerebral mucormycosis in stage 1, local infection of the nasal mucosa and sinus typically causes nasal stuffiness, discharge, localized pain and headache.[amhsr.org]
Intravenous Drugs
  • The risk factors are poorly controlled diabetes mellitus, neutropenia, haematological malignancies, long term desferroxine therapy, and intravenous drug abuse and cyto toxic therapy. [ 1 ] Patient with diabetes constitutes the single largest category[amhsr.org]
Episodic Weakness
  • Weakness 464 Case 73B An African American Man with Hyperthyroidism and Acute Paralysis 470 Case 74 A Boy with Large Muscles Leg Pain and Elevated Serum Creatine Kinase 472 Case 75 A Woman with Proximal Muscle Weakness Calf Hypertrophy Heel Contractures[books.google.com]
Falling
  • Facial palsy in children facial paralysis at birth congenital nerve palsy Check out our new collection of these 15 Crochet Leg Warmers and get your closet ready for fall.[gospelblues.eu]
Foot Deformity
  • Deformities 510 Case 81 A Woman with Droopy Eyelids and Ophthalmoplegia 515 Case 82 A Man with Weakness and Swelling in the Neck 522 Case 83 A Woman with Muscle Pains and Dark Urine 526 Case 84 A Woman with Progressive Proximal Muscle Weakness 533 Case[books.google.com]
Strabismus
  • With the help of 2500 images and illustrations, this book covers topics such as glaucoma, ocular oncology, nystagmus, refractive surgery, strabismus and lasers in ophthalmology.[books.google.it]
  • Surgical management of strabismus associated with chronic progressive external ophthalmoplegia. Ophthalmology. 1997 Apr. 104(4):695-700. [Medline]. Ewart RM, Burrows RF. Pregnancy in chronic progressive external ophthalmoplegia: a case report.[emedicine.medscape.com]
  • J Pediatr Ophthalmol Strabismus. 2003 Jan-Feb;40(1):27-30. 15. Holmes JM, Leske DA, Christiansen SP. Initial treatment outcomes in chronic sixth nerve palsy. J AAPOS. 2001 Dec;5(6):370-6.[reviewofoptometry.com]
  • The surgery is further segmented into strabismus surgery and others. On the basis of end users the market is segmented into hospital & clinics, ambulatory clinics, and others.[marketwatch.com]
Painful Ophthalmoplegia
  • Mucormycosis presenting with painful ophthalmoplegia. Acta neurol. Belg., 2005; 105: 201-205 Ohta S, Nishizawa S, Namba H, Sugimura H. Bilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia. Case Report.[amhsr.org]
  • Keywords: Cranial nerve palsy, painful ophthalmoplegia, Tolosa-Hunt Syndrome How to cite this article: Guleria V, Jha D, Gupta S, Nair V. Painful ophthalmoplegia.[indianjpain.org]
  • The authors reviewed 58 consecutive cases of painful ophthalmoplegia with a normal cranial MRI from a single center.[aao.org]
  • It is thereby a diagnosis that we should not neglect when confronted to a painful ophthalmoplegia.[jbsr.be]
  • Available from: Introduction Acquired diplopia, painful ophthalmoplegia and ptosis are relatively common manifestation of ocular motor nerves dysfunction in diabetic patients.[biotech-asia.org]
Esotropia
  • […] patient presented with vertical diplopia, which is commonly accompanied by compensatory contra lateral head tilt, while abducens (VI) nerve palsy was considered if the ophthalmologist indicated that the patient had binocular horizontal diplopia and esotropia[bmcophthalmol.biomedcentral.com]
  • Infants who have congenital esotropia may have cross-fixation that mimics a sixth nerve paresis. This may be seen with latent nystagmus, as part of the nystagmus blockage syndrome.[medtextfree.wordpress.com]
Fear
  • However, in case of such incidence, they are associated with sever anxiety and fear in patients.[biotech-asia.org]
Facial Numbness
  • Blurred vision accompanied the headache, and he also complained of facial numbness. Nausea, vomiting, photophobia or phonophobia were not described. Clinical examination revealed that patient was drowsy, pulse 120 /min regular and BP was 130/90.[amhsr.org]
Facial Swelling
  • Patients with fungal infection who develop sino-orbito –cerebral syndrome often present with acute headache, fever, facial swelling, sinusitis, opthalmoplegia and/or blindness. [ 4, 7 ] It is rare for individuals with mucormycosis to present with orbital[amhsr.org]

Workup

  • 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]
  • Workup and management Our patient reported a “locked jaw” and pain around the temple, as well as malady. ESR was within normal limits, but CRP was 287.55 (normal range: 0.0 to 7.5).[healio.com]
Glycosuria
  • Uninalysis revealed glycosuria but no acetonuria. CSF examination revealed 20 leukocytes/mm3, protein 157mg/dl, and glucose 176mg/dl (simultaneous blood glucose level 198mg/dl). Gram and AFB staining of CSF showed nothing remarkable.[amhsr.org]
Microalbuminuria
  • […] complications including: neuropathy in the form of autonomic or polyneuropathy, retinopathy in the form of non-proliferative diabetic retinopathy (NPDR) or proliferative diabetic retinopathy (PDR) with or without macular oedema (ME), nephropathy in the form of microalbuminuria[bmcophthalmol.biomedcentral.com]

Treatment

  • Visual loss from sphenoid sinus mucoceles is usually associated with a poor prognosis if surgical treatment is delayed more than seven to ten days.[ncbi.nlm.nih.gov]
  • Most PNS disorders are secondary to other system disorders and may be responsive to treatment of the primary disease.[books.google.com]
  • The pain was diminished after 1 week of treatment. After 10 days of this treatment his creatine level started to rise. The medication was changed to liposomal amphotericin B 1mg/kg/ day and this was continued for 6 weeks.[amhsr.org]

Prognosis

  • Visual loss from sphenoid sinus mucoceles is usually associated with a poor prognosis if surgical treatment is delayed more than seven to ten days.[ncbi.nlm.nih.gov]
  • Karger AG, Basel References Richards BW, Jones FR Jr, Younge BR: Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol 1992;113:489–496.[karger.com]
  • Prognosis & Life Expectancy of Ophthalmoplegia Patients with isolated ophthalmoplegia will have a normal life expectancy with a good overall prognosis. The prognosis of ophthalmoplegia also depends on the underlying cause of this condition.[epainassist.com]
  • This case reviews the signs, symptoms, and prognosis of ischemic INO, and also includes this patient’s video presentation of the INO.[aaopt.org]

Etiology

  • Clinical, radiologic, and other laboratory investigation ruled out compressive, infectious, and inflammatory etiology.[journals.lww.com]
  • Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10data.com]
  • Often times, patients have either demyelinating or ischemic disease, but other life threatening conditions may also cause INO, making the etiology a diagnosis of exclusion.[aaopt.org]
  • Common etiology includes inflammatory, toxic, infectious, degenerative, traumatic, postsurgical, demyelinating and neoplastic conditions, but midbrain infarction is the most common reported etiology. 1 While the pathophysiology of the WEBINO syndrome[academic.oup.com]
  • In addition to inflammmatory conditions, there are various other etiologies as well.[indianjpain.org]

Epidemiology

  • The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) was used as a control. METHODS: Demographic and clinical data were extracted to determine characteristics of patients with diabetic ophthalmoplegia.[ncbi.nlm.nih.gov]
  • Statistical analysis The strengthening reporting of observational study in epidemiology (STROBE) guidelines was used to design and report this study.[bmcophthalmol.biomedcentral.com]
  • ., Wegener, HC, and Tauxe, RV Epidemiology of Campylobacter jejuni infections in the United States and other industrialized nations.[books.google.es]
  • American Journal of Epidemiology 131: 633–643. Garces‐Sanchez M, Laughlin RS, Dyck PJ et al. (2011) Painless diabetic motor neuropathy: a variant of diabetic lumbosacral radiculoplexus neuropathy? Annals of Neurology 69: 1043–1054.[els.net]
  • The writing team for the diabetes control and complications Trial and the Epidemiology of Diabetes inter-relations and complications Research Group. Effect of intensive complications of type 1 diabetes mellitus. JAMA 2002; 287: 2563-9.[biotech-asia.org]
Sex distribution
Age distribution

Pathophysiology

  • This may imply a different pathophysiologic mechanism for these two microvascular complications of DM.[ncbi.nlm.nih.gov]
  • Common etiology includes inflammatory, toxic, infectious, degenerative, traumatic, postsurgical, demyelinating and neoplastic conditions, but midbrain infarction is the most common reported etiology. 1 While the pathophysiology of the WEBINO syndrome[academic.oup.com]
  • […] are often nonspecific and include fever, lethargy, headache, facial pain, and blurry vision. 5, 6 Spreading of the infection can cause OAS, seizures, brain abscesses, coma, and death. 4, 5 Mucormycosis has been associated with ischemic strokes and the pathophysiology[n.neurology.org]

Prevention

  • Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. ‎[books.google.it]
  • Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice.[books.google.com]
  • The same things that help prevent or control these conditions also lessen the risk for heart disease.[gospelblues.eu]
  • It is also largely preventable, and hence of major importance to all those involved in the management of diabetes.[diapedia.org]
  • Effective strategies to prevent these complications are available with varying extent of implementation.[archms.org]

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