Sphenoid Sinus Mucocoele and Cranial Nerve Palsies in a Patient with a History of Nasopharyngeal Carcinoma: May Mimic Local Recurrence

Nasopharyngeal carcinoma (NPC) is known to present with nasal and aural symptoms. Sometimes neck mass and cranial nerve palsies can be the presenting symptom. Frank epistaxis is relatively rare. Advanced stage disease is usually treated with concurrent chemoradiotherapy. We are reporting a case of NPC patient presented complete nasal obstruction with frank epistaxis. The bleeding was stopped and the disease cured with hemostatic-intent radiotherapy.Bangladesh Journal of Medical Science Vol.15(3) 2016 p.480-482

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RARE-31. TREATMENT OUTCOME OF CHILDREN WITH PLEOMORPHIC XANTHOASTROCYTOMA: RETROSPECTIVE ANALYSIS – A SINGLE INSTITUTION EXPERIENCE

Neuro-Oncology ◽

10.1093/neuonc/noz175.954 ◽

2019 ◽

Vol 21 (Supplement_6) ◽

pp. vi228-vi228

Author(s):

Ossama Maher ◽

Toba Niazi ◽

Ziad Khatib ◽

John Ragheb

Keyword(s):

Local Recurrence ◽

Retrospective Analysis ◽

Malignant Transformation ◽

Cranial Nerve ◽

Pleomorphic Xanthoastrocytoma ◽

Braf V600e ◽

Biological Behavior ◽

High Local Recurrence Rate ◽

Cranial Nerve Palsies

Abstract BACKGROUND Pleomorphic xanthoastrocytoma (PXA) and anaplastic pleomorphic xanthoastrocytoma (APXA) are two types of rare astrocytomas in pediatrics. There is limited literature reporting their outcomes. METHODS A retrospective analysis of pediatric patients with diagnosis of PXA and APXA treated at Nicklaus Children’s Hospital was conducted using descriptive measures. RESULTS A chart review of patients with brain tumors from 2001 to 2019 revealed that 13 patients (median age 6 years, range 2–17 years) were diagnosed with non-metastatic PXA (n=12) and APXA (n=1). Six patients (46%) were male. Clinical presentation included seizures (n=8), headaches (n=2) cranial nerve palsies (n=2). Diagnostic imaging showed tumor in the temporal lobe (n=5), parietal lobe (n=2), temporoparietal lobe (n=2), frontal lobe (n=1), occipital lobe (n=1), others (n=2). BRAF V600E mutation were identified in three of five analyzed tumors including PXA (n=4) and APXA (n=1). Surgical intervention consisted of gross total resection (n=8) and near/subtotal resection (n=5). Ten patients (76%) required a second surgery (median 2; range 1–4) due to local recurrence. The median time to recurrence was 3 years (range 6 months - 7 years). Three patients (23%) had malignant transformation of PXA, which occurred three to eight years from the initial surgery; one of them also had extensive spinal metastasis. Focal radiation was given to six patients (46%) due to multiple recurrence (n=2), malignant transformation (n=3), APXA (n=1). At a median follow up of 8 years (range 3 to 20 years), eight patients remain alive, three patients had lost to follow up, two patients died from progressive disease. Long-term sequelae varied as follows; seizures (n=5), motor weakness (n=4), cranial nerve palsies (n=2), and learning disability (n=1). CONCLUSION PXA is associated with high local recurrence rate and uncommonly malignant transformation to APXA in pediatrics, which requires close follow-up due to unpredictable biological behavior of these tumors.

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Familial paraganglioma

The Journal of Laryngology & Otology ◽

10.1017/s0022215100134644 ◽

1996 ◽

Vol 110 (7) ◽

pp. 688-690 ◽

Cited By ~ 8

Author(s):

S. M. Wharton ◽

A. Davis

Keyword(s):

Family History ◽

Head And Neck ◽

Cranial Nerve ◽

Unusual Case ◽

Positive Family History ◽

Diagnosis And Management ◽

Cranial Nerve Palsies ◽

Rare Tumours ◽

History Of

AbstractNon-secreting paragangliomas are rare tumours usually present in the head and neck. We describe an unusual case of familial paraganglioma with cranial nerve palsies. After exhaustive investigation, a vagal paraganglioma was found and excised. The positive family history of paraganglioma was of significance, although this was only present in one of five generations. The diagnosis and management of non-secreting paragangliomas is discussed.

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A Study on the intraocular pressure of the affected and unaffected eyes in patients with isolated cranial nerve palsies

Acta Medica ◽

10.32552/0.actamedica.422 ◽

2020 ◽

Vol 51 (1) ◽

pp. 15-20

Author(s):

Özlem Dikmetaş ◽

Bogomil Voykov

Keyword(s):

Intraocular Pressure ◽

Cranial Nerve ◽

Nerve Palsy ◽

Sixth Nerve Palsy ◽

Tertiary Centre ◽

Cranial Nerve Palsies ◽

Significant Difference ◽

History Of ◽

The Mean ◽

Sixth Nerve

Objective: The role of elevated intraocular pressure (IOP) in the incidence and progression of glaucoma is well known. However, the exact mechanisms of IOP regulation are still unclear. Central IOP control has been suggested, but the autonomic pathway through which it acts is not known. The aim of this study was to investigate if isolated cranial nerve (CN) palsies of the third, fourth and sixth nerves are associated with an IOP difference between the affected and the unaffected eyes. Materials and Methods: This was a retrospective study including patients diagnosed with a third, fourth and sixth nerve palsy at a single tertiary centre. We included only patients with an isolated unilateral palsy. Patients with a history of strabismus, orbital disease or neurosurgical cases were excluded. Results: The charts of 1712 patients were reviewed. Third, fourth and sixth nerve palsies were found in 469 patients, 314 patients and 929 patients, respectively. Of all patients, 190 (10.6%) were eligible for inclusion in the study. A third nerve, fourth nerve or sixth nerve palsy was present in 85 (44.7%), 65 (34.2%) and 40 (21.1%) patients, respectively. The mean IOP of the affected eyes and the unaffected eyes was not statistically significant different: 14.1 ± 3.1 mmHg vs. 14.6 ± 2.7 mmHg in the CN3 group (p=0.087); 13.6 ± 2.6 mmHg vs. 13.7 ± 2.3 mmHg in the CN4 group (p=0.69); and 14.3 ± 2.7 mmHg vs. 14.9 ± 3.3 mmHg in the CN6 group (p=0.089). There was no statistically significant difference between the mean IOP differences of the affected and unaffected eyes among the three groups (p=0.47). Conclusion: Our study demonstrated no difference in IOP between affected and unaffected eyes in patients with an isolated cranial nerve palsy. These findings are the first and important for ophthalmology practice.

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Isolated Abducens Palsy as the First Presenting Sign of Multiple Sclerosis

Case Reports in Neurology ◽

10.1159/000455023 ◽

2017 ◽

Vol 8 (3) ◽

pp. 272-275 ◽

Cited By ~ 4

Author(s):

Sargon Bet-Shlimon ◽

Mill Etienne

Keyword(s):

Multiple Sclerosis ◽

Differential Diagnosis ◽

Brain Stem ◽

Cranial Nerve ◽

Prior History ◽

Abducens Palsy ◽

Cranial Nerve Palsies ◽

Pontine Lesion ◽

History Of ◽

New Diagnosis

While brain stem involvement in multiple sclerosis (MS) is relatively common, isolated cranial nerve palsies are rare, especially when they represent the initial presenting sign of a new diagnosis of MS. This report describes a patient with no prior history of MS whose sole presenting sign was an isolated abducens palsy. An enhancing pontine lesion was found on MRI which correlated with his abducens palsy, and additional nonactive lesions on MRI led to a diagnosis of MS. This case demonstrates the importance of considering MS as part of the differential diagnosis of patients with isolated cranial nerve palsies.

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Fungal Granuloma of the Sphenoid Sinus and Clivus in a Patient Presenting with Cranial Nerve III Paresis: Case Report and Review of the Literature

Neurosurgery ◽

10.1227/01.neu.0000053026.02658.4b ◽

2003 ◽

Vol 52 (4) ◽

pp. 955-959 ◽

Cited By ~ 24

Author(s):

Manfred Petrick ◽

Jürgen Honegger ◽

Franz Daschner ◽

Friedrich Feuerhake ◽

Josef Zentner

Keyword(s):

Cranial Nerve ◽

Sphenoid Sinus ◽

Histological Analysis ◽

Pituitary Tumors ◽

Systemic Fungal Infection ◽

Serological Studies ◽

Life Threatening ◽

History Of ◽

Nerve Paresis

Abstract OBJECTIVE AND IMPORTANCE Isolated fungal granulomas originating within the sphenoid sinus are extremely rare in immunocompetent patients. In their symptoms and morphological appearance, these lesions may be mistaken for pituitary tumors. We report such a case and review the literature. CLINICAL PRESENTATION A 74-year-old man presented with a 3-week history of Cranial Nerve III paresis. The patient had a long-term history of snuff abuse. Computed tomography demonstrated a space-occupying lesion of the sellar and sphenoid sinus region with displacement of the cavernous sinus. INTERVENTION The lesion was operated on via a transnasal-transsphenoidal approach. After the sphenoid sinus was opened, mucus extruded spontaneously, and a brownish, crumbly mass was found and removed. The lesion had completely eroded the sella and clivus. Histological analysis revealed numerous Aspergillushyphae. Postoperatively, the IIIrd cranial nerve paresis resolved completely within a few days. No systemic fungal infection was found in extensive serological studies. There was no evidence of immunosuppression. CONCLUSION Fungal granuloma must be included in the differential diagnosis of lesions in the sellar region, even in nonimmunosuppressed patients. Early diagnosis and transsphenoidal extirpation is crucial with this potentially life-threatening disease.

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Isolated sphenoid fungal sinusitis and vision loss: the case for early intervention

The Journal of Laryngology & Otology ◽

10.1017/s0022215109004241 ◽

2009 ◽

Vol 123 (2) ◽

Cited By ~ 6

Author(s):

L Hu ◽

D Wang ◽

H Yu

Keyword(s):

Cranial Nerve ◽

Sphenoid Sinus ◽

Nerve Palsy ◽

Vision Loss ◽

Case Reports ◽

Visual Disturbance ◽

Fungal Sinusitis ◽

Advanced Imaging ◽

Fungal Ball ◽

Cranial Nerve Palsies

AbstractObjective:We report two extremely rare cases of isolated sphenoid ‘fungal ball’ in conjunction with vision loss.Method:Case reports and a literature review concerning diagnosis and management of isolated sphenoid fungal ball in conjunction with vision loss.Results:A mycetoma or fungal ball resulting from isolated sphenoid fungal sinusitis is a rare disease. It is frequently difficult to diagnose, as patients present with nonspecific symptoms such as headache, visual disturbance and cranial nerve palsies. Diagnosis of the disease is typically not made until advanced imaging has been performed. We present two cases of patients with sphenoid sinus fungal ball who developed headaches and vision loss. One patient had symptoms of IIIrd cranial nerve palsy and the other partial visual field impairment. After a timely sphenoidotomy, both patients recovered fully, with resolution of all symptoms.Conclusion:These two cases of sphenoid fungal ball in conjunction with vision loss suggest that the otolaryngologist should keep this disease in mind even when symptoms are nonspecific. Endoscopic surgery can be a safe and viable therapeutic approach for this condition.

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Case 2: Multiple Cranial Nerve Palsies in a Neonate with a History of Perinatal Asphyxia

NeoReviews ◽

10.1542/neo.21-8-e574 ◽

2020 ◽

Vol 21 (8) ◽

pp. e574-e576

Author(s):

G.S. Sanghamitra ◽

Viraraghavan Vadakkencherry Ramaswamy ◽

Sudeshna Malakar ◽

Razia Adam Kadwa

Keyword(s):

Cranial Nerve ◽

Perinatal Asphyxia ◽

Cranial Nerve Palsies ◽

History Of ◽

Multiple Cranial Nerve

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A UNIQUE CASE OF BILATERAL VOCAL FOLD PARALYSIS FOLLOWING SPINAL ANAESTHESIA

EUREKA Health Sciences ◽

10.21303/2504-5679.2020.001315 ◽

2020 ◽

Vol 3 ◽

pp. 3-5

Author(s):

Manasij Mitra ◽

Nupur Biswas ◽

Kumar Shailendra ◽

Anil Chandra Jain ◽

Maitraye Basu

Keyword(s):

Spinal Anaesthesia ◽

Cranial Nerve ◽

Vocal Fold ◽

Case Reports ◽

Cranial Nerves ◽

Trochanteric Fracture ◽

Vocal Fold Paralysis ◽

Cranial Nerve Palsies ◽

Bilateral Vocal Fold Paralysis ◽

History Of

Cranial nerve palsies are potential but rare complications of spinal anaesthesia. Most of the literatures support upper cranial nerve palsies like VI, IV and III cranial nerve palsies. Intrathecal hypotension resulting in tractional injury of the cranial nerves is the likely mechanism of injury. As on date, some cases of unilateral vocal fold paralysis and very little bilateral vocal fold paralysis have been described in case reports. We have described a patient who developed hoarseness and dysphagia 7 days after receiving spinal anaesthesia for fixation of inter-trochanteric fracture femur. The patient was diagnosed with bilateral vocal fold paralysis. He was managed conservatively and exhibited complete spontaneous recovery as has been described in the previously reported cases. Any patient presenting with idiopathic vocal fold paralysis should be enquired about the history of spinal or epidural anaesthesia. If the history is affirmative, then it points towards transient intrathecal hypotension as a potential etiology of the cranial nerve palsy.

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