Fresnel Prism on Hess Screen Test

Case Reports in Ophthalmological Medicine ◽

10.1155/2013/187459 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Kyung Min Koh ◽

Ungsoo Samuel Kim

Keyword(s):

Cataract Surgery ◽

Eye Movement ◽

Male Patient ◽

Nerve Palsy ◽

Abducens Nerve ◽

Screen Test ◽

Abducens Nerve Palsy ◽

The Right

A 65-year-old male patient complained of diplopia after a cataract surgery. He had esotropia of 18 prism diopters (PDs) at distant and near deviation, and therefore, we performed the Hess screen test to identify any abnormal eye movement. However, the indicator was found to be out of bounds, and therefore, the test could not be completed. Therefore, the test was subsequently performed with a 20 PD base-out Fresnel prism, and an abduction deficit was observed in the right eye, but not in the left eye. Therefore, we speculated that the patient had abducens nerve palsy in the right eye. The results obtained in the present study imply that performing the Hess screen test with the Fresnel prism may be very useful in diagnosing ambiguous abnormalities in patients with extraocular movement. The Hess screen test can be performed for patients with a strabismus of greater than 15 PD by using a Fresnel prism. Thus, a Fresnel prism may be useful for performing both the Hess screen test and Lancaster screen test.

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Pitfalls in Endovascular Treatment of Dural Arteriovenous Fistulas Involving the Cavernous Sinus

Interventional Neuroradiology ◽

10.1177/15910199970030s217 ◽

1997 ◽

Vol 3 (2_suppl) ◽

pp. 88-92

Author(s):

N. Kuwayama ◽

S. Endo ◽

M. Kubo ◽

T. Akai ◽

A. Takaku

Keyword(s):

Endovascular Treatment ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Transarterial Embolization ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Arteriovenous Fistulas ◽

Type D ◽

Dural Arteriovenous Fistulas ◽

The Right

Angiographic changes of the sylvian veins, superior ophthalmic vein (SOV), and superior petrosal sinus (SPS) before and after endovascular treatment were determined for 18 patients with dural arteriovenous fistulas (AVFs) involving the cavernous sinus, and pitfalls of endovascular treatment, especially regarding venous drainage routes, for 3 of the patients were reported. Case 1: 57-year-old woman who presented with right abducens nerve palsy had a Barrow type D fistula in the right cavernous sinus draining into the bilateral inferior petrosal sinuses (IPS). One of the ipsilateral sylvian veins that had drained antegradely before treatment was occluded, and a small lacunar infarction in the corona radiata developed after transvenous embolization (TVE) of the right cavernous sinus. Case 2: 72-year-old woman who presented with symptoms of right ocular hypertension had a type D fistula in the right cavernous sinus draining into only the ipsilateral SOV. Conjunctival hyperemia persisted and was aggravated after angioanatomical obliteration of the fistula by transarterial embolization. Case 3: 55-year-old man who presented with left abducens nerve palsy had a type D fistula in the left cavernous sinus draining into the ipsilateral IPS and sylvian vein. The dural AVF was obliterated once with TVE, but recurred 1 week later with retrograde drainage into the ipsilateral SPS and mesencephalic veins. A second TVE resulted in complete obliteration of the fistula. In conclusion, detailed analysis of drainage routes is necessary for planning of treatment of patients with dural AVF, and prompt treatment is needed when redistribution of drainage routes develops during or after TVE.

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CELLULAR SCHWANNOMA OF THE GREATER SUPERFICIAL PETROSAL NERVE PRESENTING WITH ABDUCENS NERVE PALSY AND XEROPHTHALMIA

Neurosurgery ◽

10.1227/01.neu.0000325501.75772.fd ◽

2008 ◽

Vol 63 (4) ◽

pp. E813-E814 ◽

Cited By ~ 8

Author(s):

Giyas Ayberk ◽

Mehmet F. Ozveren ◽

Nuket Uzum ◽

Ozgur Tosun ◽

Emine K. Akcay

Keyword(s):

Nerve Palsy ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Petrous Apex ◽

Clinical Prognosis ◽

Tear Secretion ◽

Pathological Evaluation ◽

Greater Superficial Petrosal Nerve ◽

Extradural Approach ◽

The Right

ABSTRACT OBJECTIVE Cellular schwannomas (CS) are rare in the cranial space. This report is the first of a patient with a greater superficial petrosal nerve CS presenting with abducens nerve palsy and xerophthalmia. CLINICAL PRESENTATION A 16-year-old female patient presented with a 1-month history of diplopia. Neurological examination was normal except for the presence of right abducens nerve palsy. Schirmer's test revealed decreased tear secretion in the right eye. Computed tomography and magnetic resonance imaging showed a mass in the right petrous apex. It was thought that the schwannoma in our patient originated from the greater superficial petrosal nerve, based on the location of the tumor in addition to the absence of partial Horner's syndrome and a persistent decrease in tear secretion. INTERVENTION: The tumor was exposed with the use of a right subtemporal extradural approach and removed entirely. Pathological evaluation of the tumor revealed a CS. CONCLUSION The abducens nerve palsy improved completely in the follow-up period, but the decreased tear secretion did not resolve. CS is one of the subtypes of ordinary schwannomas and exhibits malignant features on microscopic examination, although it has a good clinical prognosis. No adjuvant treatment was applied because of the tumor's benign character. The greater superficial petrosal nerve schwannoma should be considered in the differential diagnosis of the abducens nerve palsy and petrous apex mass.

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The right eye abducens nerve palsy as a cranial neuropathy of dengue fever: The benefit of corticosteroids in an unusual dengue sequela

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v1i2.25 ◽

2019 ◽

Vol 1 (2) ◽

pp. 145-151

Author(s):

Mohd Khairul Bin Abd Majid

Keyword(s):

Dengue Fever ◽

Nerve Palsy ◽

Abducens Nerve ◽

Acute Onset ◽

Favourable Outcome ◽

Abducens Nerve Palsy ◽

Oral Steroid ◽

Cranial Neuropathy ◽

Systemic Corticosteroids ◽

The Right

Dengue fever is very common in tropical climate countries and the number of reported cases in Malaysia shows an increasing trend recently, according to the Malaysian Clinical Practice Guidelines. Although dengue fever is common, cranial nerve mononeuropathy is a very rare manifestation in relation to other neurological-associated syndromes. We report a rare case of cranial mononeuropathy of dengue fever in Malaysia and highlight the option of steroid usage as an alternative treatment to hasten the neurological recovery. The patient, a 25-year-old healthy policeman, presented with symptomatic viral fever, which was serologically confirmed as dengue fever. He developed acute-onset binocular diplopia, which was secondary to right eye isolated abducens nerve palsy during the critical phase of dengue fever. His visual acuity was 6/6 in both eyes with slightly restricted abduction of the right eye, consistent with right abducens nerve palsy, which was confirmed with a Hess test. There was corresponding diplopia over the right paracentral visual field. Urgent contrasted brain imaging was done, which ruled out the life-threatening intracranial pathology; therefore, a diagnosis of possible subclinical inflammatory changes causing sixth nerve palsy was made. Subsequently, he was treated with intravenous methylprednisolone 500 mg daily for 3 days and regained full extraocular muscle movement after 1 week. Oral steroid was not initiated. In conclusion, although the isolated unilateral cranial mononeuropathy may improve spontaneously within a certain period of time, a short course of systemic corticosteroids may be considered to hasten the recovery, as it has a favourable outcome.

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ANCA-Negative Granulomatosis with Polyangiitis Presenting with Hypertrophic Cranial Pachymeningitis, Abducens Nerve Palsy, and Stenosis of the Internal Carotid Artery

Case Reports in Otolaryngology ◽

10.1155/2017/9687383 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Shohei Harabuchi ◽

Nobuyuki Bandoh ◽

Rika Yasukawa ◽

Michihisa Kono ◽

Takashi Goto ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Nerve Palsy ◽

Granulomatosis With Polyangiitis ◽

Internal Carotid ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

History Of ◽

The Right ◽

Hypertrophic Cranial Pachymeningitis

We report a rare case of granulomatosis with polyangiitis (GPA) presenting with hypertrophic cranial pachymeningitis (HCP), abducens nerve palsy, and stenosis of the internal carotid artery (ICA). A 59-year-old Japanese man presented with a year history of nasal obstruction and a 2-month history of slight headache. Histopathological examination of the granulomatous mucosa in the ethmoid sinuses resected by endoscopic sinus surgery revealed necrotizing vasculitis with multinucleated giant cells. The patient was diagnosed with the limited form of GPA as a result of the systemic examination. He declined immunosuppressive treatment. Eighteen months after the diagnosis of GPA, he presented with diplopia and severe headache. Though nasal findings indicating GPA were not observed in the nasal cavity, CT scan revealed a lesion of the right sphenoid sinus eroding the bone of the clivus. Gadolinium-enhanced MRI of the brain showed thickening of the dura mater around the right cavernous sinus and clivus. Magnetic resonance angiography and cerebral angiography revealed narrowing at the C5 portion of the ICA. Intravenous methylprednisolone pulse therapy followed by oral prednisolone and cyclophosphamide resolved headache and dramatically improved HCP and stenosis of the ICA.

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Extracranial arteriovenous malformation and subsequent contralateral cavernous sinus dural arteriovenous fistula showing abducens nerve palsy: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21265 ◽

2021 ◽

Vol 2 (6) ◽

Author(s):

Atsushi Tsukada ◽

Kiyoyuki Yanaka ◽

Kazuhiro Nakamura ◽

Nobuyuki Takahashi ◽

Kuniyuki Onuma ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Cavernous Sinus ◽

Nerve Palsy ◽

Spontaneous Regression ◽

Dural Arteriovenous Fistula ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Illustrative Case ◽

Vascular Structure ◽

The Right

BACKGROUND Extracranial arteriovenous malformations (AVMs) are rare clinical entities and on rare occasions cause neurological symptoms. The authors report a case of an extracranial pterygoid AVM and a subsequent contralateral cavernous sinus dural arteriovenous fistula (dAVF) presenting with abducens nerve palsy. OBSERVATIONS An 80-year-old woman was referred to the authors’ hospital with left abducens nerve palsy followed by right ophthalmalgia. Magnetic resonance imaging (MRI) showed abnormal vessel staining in the left pterygoid and the right inferior petrosal sinus (IPS). Cerebral angiography revealed a left pterygoid AVM draining into the right IPS via the cavernous sinus (CS). A dAVF in the right CS was also revealed. The right ophthalmalgia disappeared spontaneously, and, 4 months later, the left abducens nerve palsy also disappeared after conservative management. Follow-up MRI showed spontaneous regression of the AVM and dAVF. The disappearance of the dAVF was considered to be due to spontaneous regression of the left pterygoid AVM and the consequent decrease in venous pressure of the CS, and the symptoms eventually disappeared. LESSONS The authors treated an extremely rare case of extracranial AVM with dramatic changes in vascular structure and symptoms. Understanding of the pathophysiology between symptoms and dynamic changes in the vascular structure is essential for providing the appropriate treatment.

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Isolated abducens nerve palsy secondary to lung metastases

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v2i1.84 ◽

2020 ◽

Vol 2 (1) ◽

pp. 62-68

Author(s):

Hayatulrizal Muhd ◽

Hayati Abdul Aziz ◽

Francesca Martina Vendargon ◽

Jasmi Ramlan ◽

Aik Guan Yeoh

Keyword(s):

Lung Adenocarcinoma ◽

Nerve Palsy ◽

Parietal Lobe ◽

Lung Metastases ◽

Healthy Woman ◽

Abducens Nerve ◽

Abducens Nerve Palsy ◽

Systemic Review ◽

Metastatic Lung ◽

The Right

We present a rare case of metastatic lung adenocarcinoma which presented as isolated abducens nerve palsy. A 65-year-old healthy woman presented with horizontal diplopia of three months duration. Her best-corrected visual acuity was 6/18 bilaterally with no relative afferent pupillary defect. Ocular examination showed limited abduction of the right eye. Anterior and posterior segment examination was normal in both eyes. However, she had a non-tender enlarged lymph node at the left supraclavicular area. The systemic review was unremarkable.C-reactive protein, erythrocyte sedimentation rate, and serum alpha-fetoprotein were markedly raised. A chest X-ray revealed right upper lobe opacity with a satellite nodule. Computed tomography of the brain, orbit, thorax, abdomen, and pelvis exhibited a heterogeneously enhancing mass at the right upper lobe of the lungwith metastasis to the left frontal, right occipital, and left parietal lobe as well as multiple bone metastases. With histopathology confirmation of lung tissue biopsy, she was diagnosed as isolated right abducens nerve palsy secondary to metastatic lung adenocarcinoma. She was referred to the respiratory, neuromedical, andoncology units for further management. In conclusion, although this appeared to be an isolated case, lung metastasis should be considered in the differential diagnosis of isolated abducens nerve palsy. Hence, lung examination should be performed when encountering such cases.

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