Cranial Nerves Three, Four, Six, and Their Syndromes

2014 ◽  
pp. 162-206
Author(s):  
Shirley H. Wray
Keyword(s):  
Diabetes Mellitus ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Pituitary Tumors ◽  
Oculomotor Nerve ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies ◽  
Aberrant Regeneration ◽  
Oculomotor Nuclear Complex

is the longest chapter in the book and perhaps the most important. Syndromes of the oculomotor nuclear complex, the fasciculus and the nerve[BluM2] include disorders such as acute dilation of the pupil due to uncal herniation, aneurysmal compression of the nerve with pupil involvement or with pupil sparing, and microinfarction of the nerve with pupil sparing due to ischemia associated diabetes mellitus. Important syndromes of the sphenocavernous sinus characterized by painful ophthalmoplegia are generally associated with multiple unilateral cranial nerve palsies. Common lesions include aneurysms, meningiomas, pituitary tumors, lymphoma, and infectious and idiopathic granulomatous infiltration (the Tolosa-Hunt syndrome). A patient with primary aberrant regeneration of the oculomotor nerve due to prolonged compression by a meningioma in the cavernous sinus is illustrated by video display.

scholarly journals A Rare Case of Tolosa-Hunt-Like Syndrome in a Poorly Controlled Diabetes Mellitus

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Glenmore Lasam ◽  
Sakshi Kapur
Keyword(s):  
Diabetes Mellitus ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Rare Case ◽  
Tight Glycemic Control ◽  
Eighth Cranial Nerve ◽  
Diagnostic Investigation ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies ◽  
The Right

We report a case of a 50-year-old female with diabetes mellitus who presented with progressive second, third, fifth, sixth, and eighth cranial nerve palsy. Diagnostic investigation revealed hyperglycemic state, and brain imaging showed a right cavernous sinus enhancement suggestive of and consistent with Tolosa-Hunt syndrome. The patient was started on steroids with tight glycemic control for eight weeks; subsequently, the cranial nerve palsies resolved as well as documented resolution of the right cavernous sinus enhancement.

scholarly journals Ophthalmoplegia and cranial nerve deficits in an adolescent with headache

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110244
Author(s):  
Margarita M Corredor ◽  
Peter J Holmberg
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Signs And Symptoms ◽  
Inflammatory Condition ◽  
Cranial Nerve Involvement ◽  
Hunt Syndrome ◽  
Nerve Involvement ◽  
Orbital Pain

Tolosa–Hunt syndrome is an idiopathic, inflammatory condition involving the cavernous sinus and is characterized by unilateral, painful ophthalmoparesis. The condition often begins with retro-orbital pain followed by select cranial nerve involvement. We report the case of a 17-year-old female whose presentation with progressive left-sided headache and ophthalmoparesis culminated in the diagnosis of Tolosa–Hunt syndrome. While many of her signs and symptoms have been previously reported in the rare pediatric cases of Tolosa–Hunt syndrome described in the literature, this case illustrates a unique presentation involving cranial nerves V and VII in addition to the more commonly reported cranial nerve III, IV, and VI palsies.

Transsphenoidal approach to infrasellar tumors involving the cavernous sinus

1990 ◽  
Vol 73 (4) ◽  
pp. 513-517 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Transsphenoidal Approach ◽  
Skull Base Tumors ◽  
Content Type ◽  
Operating Field ◽  
Cranial Nerve Palsies ◽  
Operative Complications ◽  
Fine Print

✓ The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are included in this report. Among these patients, a total of 17 cranial nerves were affected. Postoperative normalization was achieved in eight nerves, significant improvement in seven nerves, and no improvement in two nerves. There were no operative complications of aggravation of cranial nerve palsies in this series. In spite of the limited operating field, the results demonstrate the effectiveness and safety of this approach. The authors recommend that this approach be considered before more aggressive surgery is undertaken.

scholarly journals Tolosa-Hunt Syndrome: A Case Report and Review of the Literature

2013 ◽  
Vol 29 (2) ◽  
pp. 130-133
Author(s):  
Md Rafiqul Islam ◽  
Hasan Zahidur Rahman ◽  
Akm Anwar Ullah ◽  
Md Amir Hossain ◽  
- Md Ziauddin
Keyword(s):  
Cavernous Sinus ◽  
Trigeminal Nerve ◽  
Cranial Nerve ◽  
Motor Nerve ◽  
Pathological Process ◽  
Sensory Loss ◽  
Oral Steroid ◽  
Superior Orbital Fissure ◽  
Hunt Syndrome ◽  
Cranial Nerve Palsies

Tolosa-Hunt Syndrome is a painful ophthalmoplegia which is characterized by periorbital or hemicranial pain, with ipsilateral ocular motor nerve palsies, oculosympathetic paralysis, sensory loss in the distribution of the ophthalmic and occasionally the maxillary division of the trigeminal nerve. Various combinations of these cranial nerve palsies may occur, localising the pathological process to the region of the cavernous sinus/superior orbital fissure. We report the case of a patient presented with severe pain in the right side of face which was periorbital with ipsilateral 3rd,4th, 6th cranial nerve palsies along with ophthalmic and maxillary division of trigeminal nerve involvement. MRI of orbit showed hypo-intense lesion in right cavernous sinus extending to right superior orbital fissure (suggestive of granulomatous infiltration). After taking oral steroid her pain was relieved quickly and cranial nerve palsies reversed within one week. Azathioprin was added and she was completely cured of within next three months. Bangladesh Journal of Neuroscience 2013; Vol. 29 (2) : 130-133

scholarly journals Internal Carotid Artery dissection presenting as Isolated Hypoglossal nerve palsy

2009 ◽  
Vol 8 (1) ◽  
pp. 22-25
Author(s):  
Amir Ahmad ◽  
◽  
Amir Ahmad ◽  
Philip Travis ◽  
Mark Doran ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Cranial Nerve Palsies

Internal carotid dissection most commonly presents as headache, focal neurological deficits or stroke. Rarely it can manifest itself by causing a palsy of the lower cranial nerves (IX, X, XI, XII). The reported incidence of isolated cranial nerve palsies is rare. We report a case of an internal carotid artery dissection manifesting as isolated XII (hypoglossal) cranial nerve palsy.

scholarly journals Comprehensive management of malignant otitis externa with tuberculosis and cranial nerve paresis in geriatrics

2020 ◽  
Vol 50 (1) ◽  
pp. 77
Author(s):  
Ratna Dwi Restuti
Keyword(s):  
Diabetes Mellitus ◽  
Temporal Bone ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Geriatric Patients ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Multiple Cranial Nerve

Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients. Purpose: Evaluating the management of malignant otitis externa with complications in geriatric patients who had multiple comorbidities. Case: A 71 years old female with a diagnosis of left malignant otitis externa with complications of multiple cranial nerve palsies (N.VII, IX, X) and comorbidity in the form of diabetes mellitus and chronic kidney disease. The patient underwent subtotal temporal bone resection and petrosectomy. Clinical Question: “Could surgical management of malignant otitis externa with cranial nerve palsies complication in geriatric patients with multiple comorbidities achieve better result than conservative treatment?” Review Method: Literature search using keywords ’malignant otitis externa’ OR ’temporal bone osteomyelitis’ AND ’geriatric’ OR ’elderly’ AND ’multiple cranial nerve palsy’ AND ’diabetes mellitus’ AND ’tuberculosis’ AND ’surgery’ OR ’surgical’ was conducted through Cochrane, Pubmed, and Google Scholar. Result: The search obtained 11 articles published in the last 10 years. Selection based on inclusion and exclusion criteria, 2 studies were found relevant with the topic. Conclusion: Management of malignant otitis externa with complications in geriatric patients with multiple comorbidities requires a multidisciplinary approach to determine the need for surgery intervention.Keywords: malignant otitis externa, cranial nerve palsy, subtotal temporal bone resection, geriatric, diabetes mellitus ABSTRAK Latar belakang: Otitis eksterna maligna adalah suatu kondisi peradangan pada telinga luar yang memiliki kecenderungan untuk meluas hingga ke dasar tengkorak. Penyakit ini menjadi sulit ditangani karena manifestasi klinis yang bervariasi dan respons terhadap pengobatan yang berbeda antara pasien. Tujuan: Mengevaluasi tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri yang memiliki komorbiditas multipel. Kasus: Pasien perempuan 71 tahun dengan diagnosis otitis eksterna maligna telinga kiri dengan komplikasi paresis saraf kranial multipel (n.VII, IX, X) dan penyakit penyerta berupa diabetes melitus dan gagal ginjal kronik. Pasien menjalani operasi reseksi tulang temporal subtotal dan petrosektomi. Pertanyaan klinis: “Apakah tatalaksana pembedahan memberikan hasil yang lebih baik dibandingkan terapi konservatif pada pasien geriatri dengan otitis eksterna maligna disertai paresis saraf kranialis dengan komorbiditas multipel.” Telaah Literatur: Dilakukan menggunakan kata kunci ’malignant otitis externa’ ATAU ’temporal bone osteomyelitis’ DAN ’geriatric’ ATAU ’elderly’ DAN ’multiple cranial nerve palsy’ DAN ’diabetes melitus’ DAN ’tuberculosis’ DAN ’surgery’ ATAU ’surgical’ pada beberapa sumber data seperti Cochrane, Pubmed, dan Google Scholar. Hasil: Didapatkan 11 artikel publikasi 10 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi diperoleh 2 artikel yang relevan dengan topik. Kesimpulan: Tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri dengan komorbiditas multipel, membutuhkan pendekatan multidisiplin terutama untuk menentukan perlunya dilakukan tindakan pembedahan.

Pseudomyasthenia Resulting from a Posterior Carotid Artery Wall Aneurysm: A Novel Presentation: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (6) ◽  
pp. 1466-1469 ◽  
Author(s):  
Ramachandra P. Tummala ◽  
Andrew Harrison ◽  
Michael T. Madison ◽  
Eric S. Nussbaum
Keyword(s):  
Carotid Artery ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Intracranial Aneurysms ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Artery Wall ◽  
Carotid Artery Wall ◽  
Cranial Nerve Dysfunction ◽  
Cranial Nerve Palsies

ABSTRACT OBJECTIVE AND IMPORTANCE Painful oculomotor palsy can result from enlargement or rupture of intracranial aneurysms. The IIIrd cranial nerve dysfunction in this setting, whether partial or complete, is usually fixed or progressive and is sometimes reversible with surgery. We report an unusual oculomotor manifestation of a posterior carotid artery wall aneurysm, which mimicked ocular myasthenia gravis. CLINICAL PRESENTATION A 47-year-old woman developed painless, intermittent, partial IIIrd cranial nerve palsy. She presented with isolated episodic left-sided ptosis, which initially suggested a metabolic or neuromuscular disorder. However, digital subtraction angiography revealed a left posterior carotid artery wall aneurysm, just proximal to the origin of the posterior communicating artery. INTERVENTION The aneurysm was successfully clipped via a pterional craniotomy. During surgery, the aneurysm was observed to be compressing the oculomotor nerve. The patient's symptoms resolved after the operation. CONCLUSION The variability of incomplete IIIrd cranial nerve deficits can present a diagnostic challenge, and the approach for patients with isolated IIIrd cranial nerve palsies remains controversial. Although intracranial aneurysms compressing the oculomotor nerve classically produce fixed or progressive IIIrd cranial nerve palsies with pupillary involvement, anatomic variations may result in atypical presentations. With the exception of patients who present with pupil-sparing but otherwise complete IIIrd cranial nerve palsy, clinicians should always consider an intracranial aneurysm when confronted with even subtle dysfunction of the oculomotor nerve.

Delayed Cranial Nerve Palsy After Coiling of Carotid Cavernous Sinus Aneurysms

Neurosurgery ◽  
2010 ◽  
Vol 66 (6) ◽  
pp. E1215-E1216 ◽  
Author(s):  
David S. Xu ◽  
Michael C. Hurley ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Clinical Presentation ◽  
Cranial Neuropathy ◽  
Aneurysm Neck ◽  
Post Procedure ◽  
Cranial Nerve Palsies ◽  
Endovascular Coils ◽  
Healthy Females

Abstract OBJECTIVE Detachable endovascular coils have become a common treatment strategy for carotid cavernous sinus aneurysms (CCAs), but previously unrecognized postprocedure complications may emerge as longer follow-up data are accumulated. In this report, the authors document the first known cases of delayed cranial neuropathy following CCA coiling in 3 patients, all of whom present at least a year postprocedure without aneurysm regrowth. The potential mechanisms underlying this syndrome are discussed as well as their implications on the selection and optimal endovascular management of CCA patients. CLINICAL PRESENTATION Three previously healthy females aged 50, 60, and 62 underwent CCA coiling at our institution and subsequently developed ipsilateral cranial nerve palsies at 56, 28, and 14 months, respectively, post-procedure. At presentation, all 3 patients had a new, recurrent area of flow in their CCA without changes in aneurysm size. INTERVENTION One patient declined further treatment. In the other 2 patients, a stent was placed across the aneurysm neck, and one patient underwent additional coiling. Unfortunately, all 3 patients remained symptomatic at their latest follow-up. Conclusion Because of the intimate anatomic environment of the cavernous sinus, neural elements within it may be particularly susceptible to persistent mass or dynamic effects exacerbated by remnant or recurrent flow across the neck of a coiled aneurysm. These 3 cases prompted the authors to advocate for more aggressive efforts to achieve and maintain CCA occlusion. Furthermore, when such efforts are unsuccessful, consideration of traditional carotid occlusion strategies with or without bypass is warranted.

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