Cranial nerve palsies, SIADH and atrial fibrillation: a diagnostic challenge

2021 ◽  
Vol 14 (9) ◽  
pp. e244807
Author(s):  
Rahul Karna ◽  
Bandhul Hans ◽  
Julie Murone ◽  
John Black
Keyword(s):  
Atrial Fibrillation ◽  
Lyme Disease ◽  
Cranial Nerve ◽  
Hormone Secretion ◽  
Type Ii ◽  
Diagnostic Challenge ◽  
Predisposing Factor ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Cranial Nerve Palsies ◽  
Ventricular Response

We recently encountered a 79-year-old Caucasian man who presented with blurring of vision and facial muscle weakness. The patient also had hyponatraemia, atrial fibrillation with rapid ventricular response and underlying Brugada type II pattern. Urine and serum osmolality were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH). It was only after extensive imaging and workup that we were able to tie together these three different presentations of Lyme disease—cranial nerve palsies, SIADH and atrial fibrillation and treat them accordingly. To the best of our knowledge, only eight cases of SIADH in patients with Lyme neuroborreliosis have been reported in the literature. Although our patient did not have a history of arrhythmias, case findings suggest that underlying Brugada type II morphology could have been the predisposing factor, and Lyme disease the trigger.

MULTIPLE CRANIAL NERVE PALSIES AND LYME DISEASE.

2002 ◽  
Vol 79 (Supplement) ◽  
pp. 49
Author(s):  
Christine Law ◽  
Kelly Thomann ◽  
Claudette Fiorini
Keyword(s):  
Lyme Disease ◽  
Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Multiple Cranial Nerve

scholarly journals Dural Arteriovenous Fistulas in the Cavernous Sinus: Clinical Research and Treatment

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Akira Kurata ◽  
Sachio Suzuki ◽  
Kazuhisa Iwamoto ◽  
Kuniaki Nakahara ◽  
Makoto Sasaki ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Carotid Arteries ◽  
Venous Drainage ◽  
Initial Symptom ◽  
Type I ◽  
Type Ii ◽  
Cranial Nerve Palsies ◽  
Bilateral Carotid ◽  
Classical Triad

Introduction. The purpose of this paper is to clarify the clinical course, with the dural carotid cavernous fistula (CCF), featuring a pallet of symptoms, paying special attention to radiological findings. Methods. Seventy-six consecutive patients with dural CCFs were investigated in detail, all of whom were defined by angiography. Results. The most common initial symptom was diplopia in 47 patients (62%) and the most frequently observed on arrival were type II, featuring cranial nerve palsies followed by the classical triad in 27, and then type I only with cranial nerve palsies. The time until admission with type I (mean: ) was significantly shorter than that with type II (mean: ). Branches from bilateral carotid arteries widely inflowing into bilateral carotid cavernous sinus were present in 30 (39%), 20 (26%) of which also demonstrated direct inflow into the intercavernous sinus. type I and II had more multiple venous drainage routes as compared with type III (classical triad only on arrival) and IV (initial development of the classical triad followed by cranial nerve palsy). Conclusion. In our series of dural CCF patients, the most common initial symptom was cranial nerve palsy, mostly featuring multiple venous drainage including cortical drainage. Such palsies should be added to the classical triad as indicative symptoms. Bilateral carotid arteries often inflow into cavernous and intercavernous sinuses, which should be taken into account in choice of therapeutic strategy.

scholarly journals Lyme carditis presenting as atrial fibrillation

2019 ◽  
Vol 12 (4) ◽  
pp. e228975 ◽  
Author(s):  
Abir Zainal ◽  
Amir Hanafi ◽  
Ninad Nadkarni ◽  
Mahmood Mubasher ◽  
Deeraj Lingutla ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Lyme Disease ◽  
Antibiotic Treatment ◽  
Heart Block ◽  
Cardiac Involvement ◽  
Lyme Carditis ◽  
Rare Manifestation ◽  
The Usa ◽  
Ventricular Response ◽  
Degree Heart Block

The incidence of Lyme disease in the USA is 8 per 100 000 cases and 95% of those occur in the Northeastern region. Cardiac involvement occurs in only 1% of untreated patients. We describe the case of a 46-year-old man who presented with chest pressure, dyspnoea, palpitations and syncope. He presented initially with atrial fibrillation with rapid ventricular response, a rare manifestation of Lyme carditis. In another hospital presentation, he had varying degrees of atrioventricular block including Mobitz I second-degree heart block. After appropriate antibiotic treatment, he made a full recovery and his ECG normalised. The authors aim to urge physicians treating patients in endemic areas to consider Lyme carditis in the workup for patients with atrial fibrillation and unexplained heart block, as the associated atrioventricular nodal complications may be fatal.

Combination of microsurgery and Gamma Knife surgery for the treatment of intracranial chondrosarcomas

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 18-25 ◽  
Author(s):  
Petter Förander ◽  
Tiit Rähn ◽  
Lars Kihlström ◽  
Elfar Ulfarsson ◽  
Tiit Mathiesen
Keyword(s):  
Gamma Knife ◽  
Cranial Nerve ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Low Grade ◽  
Cranial Nerve Palsies ◽  
Tumor Volume Reduction

ObjectIntracranial chondrosarcomas have a high risk of recurrence after surgery. This retrospective study of patients with intracranial chondrosarcoma was conducted to determine the long-term results of microsurgery followed by Gamma Knife surgery (GKS) for residual tumor or recurrence.MethodsThe authors treated nine patients whose median age was 36 years. Seven patients had low-grade chondrosarcomas (LGCSs), whereas mesenchymal chondrosarcomas (MCSs) were diagnosed in two. Radiosurgery was performed in eight patients, whereas one patient declined further surgical intervention and tumor-volume reduction necessary for the GKS.The patients were followed up for 15 to 173 months (median 108 months) after diagnosis and 3 to 166 months (median 88 months) after GKS. Seven patients had residual tumor tissue after microsurgery, and two operations appeared radical. In the two latter cases, tumors recurred after 25 and 45 months. Thus, definite tumor control was not achieved after surgery alone in any patient, whereas the addition of radiosurgery allowed tumor control in all six patients with LGCSs. Two of these patients experienced an initial tumor regrowth after GKS; in both cases the recurrences were outside the prescribed radiation field. The patients underwent repeated GKS, and subsequent tumor control was observed. An MCS was diagnosed in the remaining two patients. Complications after microsurgery included diplopia, facial numbness, and paresis. After GKS, one patient had radiation necrosis, which required microsurgery, and two patients had new cranial nerve palsies.Conclusions Tumor control after microsurgery alone was not achieved in any patient, whereas adjuvant radiosurgery provided local tumor control in six of eight GKS-treated patients. Tumor control was not achieved in the two patients with MCS. Similar to other treatments for intracranial chondrosarcoma, morbidity after micro- and radiosurgical combination therapy was high and included severe cranial nerve palsies.

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