scholarly journals 18 Lyme disease as an emerging cause of Seventh Cranial Nerve Palsy (“Bell’s palsy”) in Nova Scotia

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e7-e7
Author(s):  
Julia LeBlanc ◽  
Michael Young ◽  
Ellen Wood ◽  
Donna MacKinnon-Cameron ◽  
Joanne Langley
Keyword(s):  
Emergency Department ◽  
Lyme Disease ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Health Centre ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Seventh Cranial Nerve

Abstract Introduction/Background Lyme disease, a tick-borne zoonosis caused by the bacterium Borrelia burgdorferi, has emerged in Nova Scotia (NS) as a common illness. Since 2002 when Lyme disease was first diagnosed in NS, >1000 cases have been reported. Seventh cranial nerve palsy (CNP-7) is said to be the most common presentation of early disseminated Lyme disease in children in endemic areas. Objectives We aimed to determine the frequency of CNP-7 in NS and if physicians are considering Lyme disease as an etiology. Design/Methods A retrospective review of health records of children seen at the IWK Health Centre from 2000-2018 who were ≤18 years of age with an ICD-9 or 10 diagnosis of Bell’s palsy (CNP-7) was conducted. CNP-7 due to local infection, trauma, malignancy, or systemic neurologic disease was excluded. Results Of 237 ICD “Bell’s palsy” diagnoses, 66 cases were eligible, of which 60.6 % (n=40) were female. The median age was 10 years (range 0-16). Five cases of Lyme disease-associated CNP-7 were recognized (7.6%), all since 2013. No bilateral CNP-7 occurred; 59.1% of cases were on the left. Most children presented within 3 days of symptom onset (84.8%) to the emergency department (95.4%), and 56.1% subsequently saw a pediatric neurologist. The most common associated symptom with CNP-7 was headache (22.7%). Lyme disease was considered in the differential diagnosis in 34.8 % (n=23) of cases, and only since 2012. Systemic steroids were prescribed to 51.5 % (34/66) of children in the emergency department, for durations varying from 1 to 10 days. The most common steroid course length was 5 days. Antimicrobials were prescribed for 18 (27.3%) children including acyclovir, beta lactams and tetracyclines. Resolution of the facial palsy findings was documented in 45 children, of whom 36 (54.5%) had complete resolution and 9 (13.6%) had partial resolution. Four children with Lyme disease associated CNP-7 had complete resolution, and one had partial resolution. Conclusion There does not appear to be a standard approach to diagnosis and management of CNP-7 in this pediatric health centre. Lyme disease is not regularly considered in the differential diagnosis, which is surprising given the high incidence of Lyme disease in NS. These findings will be shared with health care providers most likely to see CNP-7 in order to develop a standard algorithm to the initial presentation of 7th cranial nerve palsy in children.

Disseminated lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy

2019 ◽  
pp. 112067211987327
Author(s):  
Raida Ben Salah ◽  
Sonda Kammoun ◽  
Faten Frikha ◽  
Yosra Bouattour ◽  
Imen Chabchoub ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Lymphoblastic Lymphoma ◽  
Cranial Neuropathy ◽  
Atypical Case ◽  
The Third ◽  
Non Hodgkin Lymphoma ◽  
Third Cranial Nerve Palsy

Dysfunction of the third cranial nerve can be provoked by a number of different conditions. An isolated cranial neuropathy as a first clinical sign of a non-Hodgkin lymphoma is very infrequent. We represent here an atypical case of lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. The patient was managed by alternating cycles of cyclophosphamide, vincristine, and prednisone. She made a full recovery with a complete resolution of the symptomatology.

Eight-and-a-half syndrome: video evidence and updated literature review

2020 ◽  
Vol 13 (5) ◽  
pp. e234075
Author(s):  
Marco A Cárdenas-Rodríguez ◽  
Sergio A Castillo-Torres ◽  
Beatriz Chávez-Luévanos ◽  
Laura De León-Flores
Keyword(s):  
Literature Review ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Inflammatory Lesion ◽  
Seventh Cranial Nerve

The eight-and-a-half syndrome (EHS)—defined by the combination of a seventh cranial nerve palsy and an ipsilateral one-and-a-half syndrome—is a rare brainstem syndrome, which localises to the caudal tegmental region of the pons. We present a case of the EHS secondary to an inflammatory lesion on a previously healthy 26-year-old woman, with a literature review emphasising the relevance of aetiological assessment.

scholarly journals Efficacy of Endovascular Surgery for Unruptured Internal Carotid Artery Aneurysms Presenting with Cranial Nerve Symptoms

2007 ◽  
Vol 13 (1_suppl) ◽  
pp. 163-169 ◽  
Author(s):  
S. Suzuki ◽  
A. Kurata ◽  
S. Kan ◽  
M. Yamada ◽  
J. Niki ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Endovascular Surgery ◽  
Detachable Coils ◽  
The Mean

Whether endovascular surgery is able to reduce the mass effects of unruptured aneurysms is still controversial, although some reports have suggested efficacy in cases of internal carotid artery aneurysms with cranial nerve palsy. Here we assessed outcome in a series of cases. Between April 1992 and April 2005, 18 patients with unruptured internal carotid artery aneurysms presenting with cranial nerve palsy were treated by endovascular surgery. The patients were two males and 16 females aged from 19 to 84 (mean 59.6 years). Aneurysms were located in the cavernous portion in 14, at the origin of the ophthalmic artery in one and at the origin of P-com in three. The aneurysms were all embolized using Guglielmi detachable coils, Interlocking detachable coils, Cook's detachable coils or Trufill DSC and detachable Balloons were applied to occlude the proximal parent artery. We analyzed the efficacy of endovascular surgery for such aneurysms retrospectively. The mean aneurysm size was 21.4 mm and the mean follow-up period was 57.7 months. Palsy of IInd cranial nerve was evident in three patients, of the IIIrd in eight, of the Vth and Vth in one each, and of the VIth in nine. Post embolization occlusion was complete in nine patients and neck remnant in the other seven. Regarding complications of endovascular surgery, one case (5.6%) showed TIA after embolization. Overall 11 (46%) cranial nerve symptoms showed complete resolution, eight (33%) showed some improvement, and five (21%) were unchanged. In three cases (12.5%), the symptoms worsened after treatment. The shorter the duration of symptoms was a factor predisposing to resolution of symptoms. In complete resolution cases, the timing of treatment after symptoms appeared and the time of complete resolution were in proportion. These results showed that there is no difference in reduction of mass effects between surgical clipping and endovascular surgery for unruptured internal carotid artery aneurysms. With endovascular surgery, the rapidity of treatment after symptoms is the most important factor for successful results.

Cranial nerve palsy as a delayed complication of attempted infanticide by insertion of a stylet through the fontanel

1990 ◽  
Vol 72 (5) ◽  
pp. 818-820 ◽  
Author(s):  
Nicolette C. Notermans ◽  
Rob H. J. M. Gooskens ◽  
Cees A. F. Tulleken ◽  
Lino M. P. Ramos
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Fourth Ventricle ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Anterior Fontanel ◽  
Content Type ◽  
Seventh Cranial Nerve ◽  
Delayed Complication ◽  
The Brain

✓ A child suffered a sixth and seventh cranial nerve palsy due to intracerebral insertion of a stylet. The stylet was introduced through the anterior fontanel, most probably in an attempt at infanticide. The migration of the stylet through the brain was monitored because the child was first examined 6 years earlier. At operation, the cranial part of the stylet lay in the fourth ventricle, compressing the facial nerve as well as the nucleus of the abducens nerve. The lower part of the stylet had reached the C-5 level.

scholarly journals Sequential contralateral facial nerve palsies following COVID-19 vaccination first and second doses

2021 ◽  
Vol 14 (7) ◽  
pp. e243829
Author(s):  
Abigail Burrows ◽  
Theo Bartholomew ◽  
James Rudd ◽  
David Walker
Keyword(s):  
Emergency Department ◽  
Facial Nerve ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Case Reports ◽  
Bell’S Palsy ◽  
First Episode ◽  
Bell's Palsy ◽  
First Case ◽  
History Of

A 61-year-old man presented to the ENT emergency clinic with a history of unilateral facial nerve palsy occurring shortly after each dose of the Pfizer-BioNTech COVID-19 vaccine. The first episode developed 5 hours after administration of the first dose and the second 2 days after administration of the second dose. Investigations at initial presentation to the emergency department were unremarkable, and the patient was diagnosed with Bell’s palsy on both occasions. We describe the first case of Bell’s palsy occurring after each dose of any UK-approved COVID-19 vaccine. Single episodes of unilateral facial nerve palsies have been reported in clinical trials and in subsequent case reports. There has been no evidence, however, of an episode after each dose. We also describe the earliest onset of symptoms from timing of administration of the vaccine, further suggesting the Bell’s palsy was associated with the vaccine.

scholarly journals Bilateral surgical damage of the central tegmental tract resulting in bilateral hypertrophic olivary degeneration: An MRI case report

2017 ◽  
Vol 31 (2) ◽  
pp. 182-185 ◽  
Author(s):  
Silvia Lana ◽  
Chiara Ganazzoli ◽  
Girolamo Crisi
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Neuronal Degeneration ◽  
Inferior Olivary Nucleus ◽  
Hypertrophic Olivary Degeneration ◽  
Seventh Cranial Nerve ◽  
Central Tegmental Tract ◽  
Inferior Olivary ◽  
Olivary Nucleus

Hypertrophic olivary degeneration (HOD) is a rare trans-synaptic neuronal degeneration of the inferior olivary nucleus caused by an injury to the dentato-rubro-olivary connection, also known as Guillain-Mollaret triangle. It leads to hypertrophy of the affected nucleus rather than atrophy and is characterized by hyperintensity on T2-weighted images. Unilateral and bilateral cases are described. We present a case of a 70-year-old patient affected by a tumor inside the fourth ventricle who suffered from diplopia and right seventh cranial nerve palsy. He underwent surgery and developed left seventh cranial nerve palsy. Three months after resection, magnetic resonance imaging revealed the appearance of bilateral HOD. This is the first report of bilateral HOD occurrence after surgical bilateral damage of the rubro-olivary fibers running in central tegmental tracts.

scholarly journals Abducens Nerve Palsy as the First Manifestation of Type Two Diabetes Mellitus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A362-A363
Author(s):  
Amira Ibrahim ◽  
Victoria Loseva
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Reference Range ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Double Vision ◽  
Sixth Cranial Nerve

Abstract Introduction: Diabetes mellitus has varied presentations at different times from onset. One of the uncommon presentations is cranial nerve palsy secondary to microvascular ischemia. Approximately 20% of isolated abducens nerve palsies are secondary to vascular microangiopathy. Clinical Case: A 53-year-old female with no significant past medical history presented to the emergency department with concerns of double vision. The patient first noticed her symptoms five days prior to presentation. The patient endorsed blurry vision and stated that she has double vision in certain gazes that resolves with shutting either eye. Furthermore, she has also developed headaches during that period, described as a pressure-like sensation in her forehead and behind her eyes. She otherwise denied any tearing, redness, or pain. On review of systems, she denied numbness, tingling, changes in hearing, changes in speech, or extremity weakness. Due to the persistence of symptoms the patient presented to the emergency department. On exam, the patient’s vitals were normal. Pupils were equal and briskly reactive to light with no relative afferent pupillary defect. External examination was unremarkable without scalp tenderness, proptosis, or ptosis. Color vision was intact. Ocular motility testing revealed limited abduction of the left eye causing double vision on lateral gaze. Confrontation visual fields were full in each eye. Bilateral lower extremity exam revealed decreased sensation in the sole of the foot. The rest of the physical exam was unremarkable. Laboratory work revealed blood glucose level of 305 mg/dl (Reference range 70–99 mg/dl). HBA1C was 12.3% (Reference range 3.8–5.6%). CT head and CTA of the neck was performed and were unremarkable. Given the normal imaging and findings on examinations, her ocular motor findings were attributed to diabetes mellitus. The patient was started on insulin, aspirin, and received diabetic education for lifestyle modification, and was scheduled for outpatient follow up. The patient’s acute isolated left sixth cranial nerve palsy was most likely owing to microvascular ischemia from previously undiagnosed diabetes mellitus. A study of 59 patients with an isolated sixth cranial nerve palsy showed a 6-fold increase in the odds of having diabetes compared with controls.(1) Conclusion: Given the infrequent presentation of Diabetes with Abducens nerve palsy, diagnosis is usually delayed with the expense of ordering costly investigations that put a financial and psychological burden on patients. Thus, we urge clinicians’ awareness when encountering cases of isolated cranial nerve palsies. References: 1) Sanders SK, Kawasaki A, Purvin VA. Long-term prognosis in patients with vasculopathic sixth nerve palsy. Am J Ophthalmol. 2002;134(1):81–84.

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