Paediatric rhombencephalitis presenting with bradycardia: a good recovery despite cardiac involvement

Rhombencephalitis is a rare condition, often caused by infection, commonly presenting with myoclonic jerks, ataxia and cranial nerve palsy. Typically, it has a high morbidity and mortality, with worse prognosis associated with cardiopulmonary involvement. Herein, we present the case of a 10-year-old boy, presenting with headache, vomiting, symptomatic bradycardia and rapidly progressing ophthalmoplegia from a sixth nerve palsy, without additional brainstem symptoms. Previously, pericarditis, myocarditis and heart failure have been associated with rhombencephalitis, but not bradycardia. The cause of his rhombencephalitis was presumed viral, but despite extensive screening, the virus responsible was never isolated. Following treatment with intravenous antibiotics and antivirals in a high dependency unit, he recovered well with no neurological deficit on discharge and marked radiological improvement on MRI 4 weeks later. Although rare, rhombencephalitis should be considered in a child presenting with neurological symptoms, particularly alongside a cranial nerve palsy, developing over a rapid time course.

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Parésia do Nervo Motor Ocular Comum em Contexto de Sinusite Esfenoidal

Acta Médica Portuguesa ◽

10.20344/amp.5229 ◽

2014 ◽

Vol 27 (6) ◽

pp. 782 ◽

Cited By ~ 2

Author(s):

Luís Almeida Dores ◽

Marco Alveirinho Simão ◽

Marta Canas Marques ◽

Óscar Dias

Keyword(s):

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Sphenoid Sinus ◽

Nerve Palsy ◽

Cranial Nerves ◽

Sinus Surgery ◽

Intravenous Antibiotics ◽

Motor Nerves ◽

Third Cranial Nerve Palsy ◽

High Index Of Suspicion

Sphenoid sinus disease is particular not only for its clinical presentation, as well as their complications. Although rare, these may present as cranial nerve deficits, so it is important to have a high index of suspicion and be familiar with its diagnosis and management. Symptoms are often nonspecific, but the most common are headache, changes in visual acuity and diplopia due to dysfunction of one or more ocular motor nerves. The authors report a case of a 59 years-old male, who was referred to the ENT emergency department with frontal headaches for one week which had progressively worsened and were associated, since the last 12 hours, with diplopia caused by left third cranial nerve palsy. Neurologic examination was normal aside from the left third cranial nerve palsy. Anterior and posterior rhinoscopy excluded the presence of nasal masses and purulent rhinorrhea. The CT scan revealed a soft tissue component and erosion of the roof of the left sphenoid sinus. Patient was admitted for intravenous antibiotics and steroids treatment without any benefit after 48 hours. He was submitted to endoscopic sinus surgery with resolution of the symptoms 10 days after surgery. The authors present this case for its rarity focusing on the importance of differential diagnosis in patients with headaches and cranial nerves palsies.<br /><strong>Keywords:</strong> Sphenoid Sinusitis; Oculomotor Nerve Diseases.

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A Case of Traumatic Isolated Unilateral Sixth Cranial Nerve Palsy

Journal of Ophthalmology & Clinical Research ◽

10.33140/jocr/01/01/00007 ◽

2017 ◽

Vol 1 (1) ◽

Keyword(s):

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Nerve Palsy ◽

Rare Condition ◽

Lateral Wall ◽

Lateral Rectus ◽

Sixth Cranial Nerve ◽

Sixth Cranial Nerve Palsy ◽

Eye Examination ◽

The Brain

Traumatic isolated sixth cranial nerve palsy is a rare condition that has been reported to be as low as 1% to 2, 7% following traumatic brain injury. The sixth nerve innervates the ipsilateral lateral rectus which abducts the eye. Isolated loss of lateral gaze with no other cranial nerve signs and muscular entrapment is thought to be resulted from an injury to the peripheral nerve along its course from the brain stem to the lateral rectus. We presented a case of traumatic isolated unilateral sixth cranial nerve palsy in a female patient with diplopia and restriction left eye movement to lateral following head trauma after accident. Head Computed Tomography (CT) scan showed left frontal bone fracture involving the lateral wall of the orbit and also left retro orbital hemorrhage with no other lesions noted in the brain. Eye examination revealed isolated sixth cranial nerve palsy with normal vision of both eyes. Here we discussed about the possible mechanism, differential diagnosis and also management of the patient.

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Extended Endoscopic Endonasal Neuronavigation-Assisted Approach for Clival Neoplastic Lesions with VI Cranial Nerve Palsy

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1384067 ◽

2014 ◽

Vol 75 (S 02) ◽

Author(s):

Maurizio Iacoangeli ◽

M. Iacoangeli

Keyword(s):

Cranial Nerve ◽

Cranial Nerve Palsy ◽

Nerve Palsy ◽

Endoscopic Endonasal ◽

Neoplastic Lesions

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

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.017 ◽

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.

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