scholarly journals Isolated Abducens Palsy as the First Presenting Sign of Multiple Sclerosis

2017 ◽  
Vol 8 (3) ◽  
pp. 272-275 ◽  
Author(s):  
Sargon Bet-Shlimon ◽  
Mill Etienne
Keyword(s):  
Multiple Sclerosis ◽  
Differential Diagnosis ◽  
Brain Stem ◽  
Cranial Nerve ◽  
Prior History ◽  
Abducens Palsy ◽  
Cranial Nerve Palsies ◽  
Pontine Lesion ◽  
History Of ◽  
New Diagnosis

While brain stem involvement in multiple sclerosis (MS) is relatively common, isolated cranial nerve palsies are rare, especially when they represent the initial presenting sign of a new diagnosis of MS. This report describes a patient with no prior history of MS whose sole presenting sign was an isolated abducens palsy. An enhancing pontine lesion was found on MRI which correlated with his abducens palsy, and additional nonactive lesions on MRI led to a diagnosis of MS. This case demonstrates the importance of considering MS as part of the differential diagnosis of patients with isolated cranial nerve palsies.

scholarly journals Vascular Headache: A Presenting Symptom of Multiple Sclerosis

1989 ◽  
Vol 16 (1) ◽  
pp. 63-66 ◽  
Author(s):  
Mark S. Freedman ◽  
Trevor A. Gray
Keyword(s):  
Multiple Sclerosis ◽  
Differential Diagnosis ◽  
Posterior Fossa ◽  
Severe Headache ◽  
Prior History ◽  
Initial Attack ◽  
Vascular Headache ◽  
Neurological Signs ◽  
History Of ◽  
Type Headache

ABSTRACT:Vascular headache of migraine-type may be a presenting symptom of multiple sclerosis (MS), a condition usually not considered in the differential diagnosis of a severe headache accompanied by neurological signs. We reviewed records of 1,113 patients with MS seen from 1967-1987 and found 44 cases whose initial attack or subsequent exacerbations were heralded by a migraine-type headache. Twenty-seven patients had no prior history of migraine, and of these, 12 presented simultaneously with their first headache and MS attack. Twenty-three patients had symptoms of a posterior fossa mass lesion. The significance of these results and possible pathogenesis is discussed.

Familial paraganglioma

1996 ◽  
Vol 110 (7) ◽  
pp. 688-690 ◽  
Author(s):  
S. M. Wharton ◽  
A. Davis
Keyword(s):  
Family History ◽  
Head And Neck ◽  
Cranial Nerve ◽  
Unusual Case ◽  
Positive Family History ◽  
Diagnosis And Management ◽  
Cranial Nerve Palsies ◽  
Rare Tumours ◽  
History Of

AbstractNon-secreting paragangliomas are rare tumours usually present in the head and neck. We describe an unusual case of familial paraganglioma with cranial nerve palsies. After exhaustive investigation, a vagal paraganglioma was found and excised. The positive family history of paraganglioma was of significance, although this was only present in one of five generations. The diagnosis and management of non-secreting paragangliomas is discussed.

scholarly journals OCT based evaluation of retinal changes in multiple sclerosis

2017 ◽  
Vol 5 (9) ◽  
pp. 4117
Author(s):  
Sonal Singh ◽  
Rishi Sharma ◽  
V. S. Gurunadh ◽  
Sandeep Shankar
Keyword(s):  
Multiple Sclerosis ◽  
Optic Neuritis ◽  
Retinal Nerve Fibre Layer ◽  
Macular Thickness ◽  
Prior History ◽  
P Value ◽  
Central Macular Thickness ◽  
Fiber Layer ◽  
History Of ◽  
Age And Sex

Background: Optical coherence tomography is a non-invasive imaging technique routinely used in ophthalmology to visualize and quantify the layers of the retina. It also provides information on optic nerve head topography, peripapillary retinal nerve fibre layer thickness and macular volume which correlate with axonal loss. These measurements are of interest in optic neuropathies and in multiple sclerosis. The OCT parameters are now used as endpoints in neurologic clinical trials.Methods: A prospective study involving 30 patients of multiple sclerosis and equal number of age and sex matched controls were subjected to evaluation of retinal changes (peripapillary retinal nerve fiber layer and central macular thickness) using Zeiss Cirrus HD-OCT machine. The results collected were then subjected to statistical analysis.Results: Significant RNFL thinning was seen in patients of multiple sclerosis compared to the age and sex matched controls. Marked thinning was seen in superior and temporal quadrants of right eye (p value of 0.002 and 0.008 respectively) and all quadrants in left eye with a p value of < 0.001. Patients with multiple sclerosis for more than 5 yrs showed statistically significant RNFL thinning in the superior quadrant of right eye (p<.005), however, no such changes were seen in rest of the quadrants of right eye and in none of the quadrants of left eye Significant RNFL thinning was seen in the patients of multiple sclerosis without prior history of optic neuritis than patients with prior history of optic neuritis which was statistically significant with p value of .001.Conclusions: Patients with multiple sclerosis for more than 5 yrs showed statistically significant RNFL thinning in the superior quadrant of right eye (p<.005). Significant RNFL thinning was seen in the patients of multiple sclerosis without prior history of optic neuritis than patients with prior history of Optic neuritis which was statistically significant with p value of .001. No significant changes were seen in central macular thickness in multiple sclerosis compared to the controls which was corroborated by statistical analysis (p value of 0.37).

scholarly journals Metastatic Prostate Cancer to the Left Temporal Bone: A Case Report and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Erynne A. Faucett ◽  
Hal Richins ◽  
Rihan Khan ◽  
Abraham Jacob
Keyword(s):  
Prostate Cancer ◽  
Hearing Loss ◽  
Temporal Bone ◽  
Metastatic Prostate Cancer ◽  
Prior History ◽  
Presenting Symptoms ◽  
Radiologic Findings ◽  
Cranial Nerve Palsies ◽  
History Of ◽  
High Index Of Suspicion

Breast, lung, and prostate cancers are the three most common malignancies to metastasize to the temporal bone. Still, metastatic prostate cancer of the temporal bone is a rare finding, with approximately 21 cases reported in the literature and only 2 cases discovered more than 10 years after initial treatment of the primary. This disease may be asymptomatic and discovered incidentally; however, hearing loss, otalgia, cranial nerve palsies, and visual changes can all be presenting symptoms. We present the case of a 95-year-old man with history of primary prostate cancer treated 12 years earlier that was seen for new-onset asymmetric hearing loss and otalgia. The tympanic membranes and middle ears were normal; however, based on radiologic findings and eventual biopsy, the patient was diagnosed with extensive metastatic prostate cancer to the left temporal bone. This case (1) demonstrates that a high index of suspicion for unusual etiologies of seemingly benign symptoms must be maintained in elderly patients having prior history of cancer and (2) substantiates the value of temporal bone imaging when diagnosis may be unclear from history and physical exam.

scholarly journals Cranial Nerve VI Palsy as Presenting Sign of Previously Undiagnosed Metastatic Prostate Adenocarcinoma to the Clivus

2020 ◽  
Vol 5 (3) ◽  
pp. 1-4
Author(s):  
Jennifer E. Douglas ◽  
John Y.K. Lee ◽  
Karthik Rajasekaran
Keyword(s):  
Differential Diagnosis ◽  
Systemic Chemotherapy ◽  
The United States ◽  
Prostate Adenocarcinoma ◽  
Sudden Onset ◽  
Cranial Neuropathy ◽  
Abducens Palsy ◽  
History Of ◽  
Skull Base Lesions ◽  
Common Malignancy

Prostate adenocarcinoma is the most common malignancy in males in the United States and is typically highly treatable. Herein we present a case report of a male with a history of prostate adenocarcinoma previously managed with definitive radiation therapy who presented with sudden onset diplopia and examination consistent with an abducens palsy. He was ultimately found to have prostate adenocarcinoma metastatic to the clivus causing cranial neuropathy, and was referred for systemic chemotherapy and palliative Cyberknife stereotactic radiosurgery. While relatively rare, metastatic disease should be included in the differential diagnosis of atypical skull base lesions.

scholarly journals Neurosyphilis presenting as cranial nerve palsy, an entity which is easy to miss

2019 ◽  
Vol 12 (2) ◽  
pp. e226509 ◽  
Author(s):  
Yoav Piura ◽  
Yair Mina ◽  
Orna Aizenstein ◽  
Avi Gadoth
Keyword(s):  
Hiv Infection ◽  
Cranial Nerve ◽  
Unprotected Sex ◽  
Prior History ◽  
Acute Hiv Infection ◽  
Syphilis Infection ◽  
Efficient Treatment ◽  
Early Syphilis ◽  
Cranial Nerve Palsies ◽  
Acute Hiv

Neurosyphilis is a rare disease that until the 2000s was almost eradicated due to population awareness of HIV and efficient treatment. Since then, the prevalence of the entity is rising due to risk-associated behaviour such as unprotected intercourse. Neurosyphilis is still a difficult entity to diagnose especially when combined with acute HIV infection which can influence the usual clinical course of disease. In rare occasions, both acute HIV and early syphilis infection can present as mono or multiple cranial nerve palsies. This case demonstrates a rare manifestation of misdiagnosed early syphilis infection combined with acute HIV infection in a 34-year-old man with prior history of unprotected sex with men.

scholarly journals A Study on the intraocular pressure of the affected and unaffected eyes in patients with isolated cranial nerve palsies

Acta Medica ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 15-20
Author(s):  
Özlem Dikmetaş ◽  
Bogomil Voykov
Keyword(s):  
Intraocular Pressure ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Sixth Nerve Palsy ◽  
Tertiary Centre ◽  
Cranial Nerve Palsies ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
Sixth Nerve

Objective: The role of elevated intraocular pressure (IOP) in the incidence and progression of glaucoma is well known. However, the exact mechanisms of IOP regulation are still unclear. Central IOP control has been suggested, but the autonomic pathway through which it acts is not known. The aim of this study was to investigate if isolated cranial nerve (CN) palsies of the third, fourth and sixth nerves are associated with an IOP difference between the affected and the unaffected eyes. Materials and Methods: This was a retrospective study including patients diagnosed with a third, fourth and sixth nerve palsy at a single tertiary centre. We included only patients with an isolated unilateral palsy. Patients with a history of strabismus, orbital disease or neurosurgical cases were excluded. Results: The charts of 1712 patients were reviewed. Third, fourth and sixth nerve palsies were found in 469 patients, 314 patients and 929 patients, respectively. Of all patients, 190 (10.6%) were eligible for inclusion in the study. A third nerve, fourth nerve or sixth nerve palsy was present in 85 (44.7%), 65 (34.2%) and 40 (21.1%) patients, respectively. The mean IOP of the affected eyes and the unaffected eyes was not statistically significant different: 14.1 ± 3.1 mmHg vs. 14.6 ± 2.7 mmHg in the CN3 group (p=0.087); 13.6 ± 2.6 mmHg vs. 13.7 ± 2.3 mmHg in the CN4 group (p=0.69); and 14.3 ± 2.7 mmHg vs. 14.9 ± 3.3 mmHg in the CN6 group (p=0.089). There was no statistically significant difference between the mean IOP differences of the affected and unaffected eyes among the three groups (p=0.47). Conclusion: Our study demonstrated no difference in IOP between affected and unaffected eyes in patients with an isolated cranial nerve palsy. These findings are the first and important for ophthalmology practice.  

scholarly journals The Critical Role of Imaging in Primary Progressive Multiple Sclerosis

2020 ◽  
Vol 8 (C) ◽  
pp. 195-200
Author(s):  
Yuyun Yueniwati ◽  
Dotti Inggrianita
Keyword(s):  
Multiple Sclerosis ◽  
Physical Examination ◽  
Cranial Nerve ◽  
Brain Mri ◽  
Critical Role ◽  
Disease Onset ◽  
Primary Progressive Multiple Sclerosis ◽  
Primary Progressive ◽  
The Past ◽  
Cranial Nerve Palsies

BACKGROUND: Multiple sclerosis (MS) is an autoimmune-related neurological disorder as a result of chronic inflammation and demyelination which affect the central nervous system. The number of MS cases in Indonesia is about 1–5/100.000 people. This disease causes disability and requires immense treatment costs. One of the MS subtypes is primary progressive which is marked by the decline of neurological functions since the disease onset, without any period of relapse attacks. CASE REPORT: A 59-year-old female came with complaints on spinning dizziness, accompanied by vomiting and waddling for the past month before hospital administration. Based on physical examination, we found multiple cranial nerve palsies on the cranial nerve III, IV, V, VI, and VII on the left side. Initially, it suspected as an intracranial lesion in the cerebellopontine angle. However, brain computed tomography scan showed a normal result. Brain magnetic resonance imaging (MRI) was conducted and we found multiple lesions on the supratentorial and infratentorial region. The second patient was a 24-year-old female complained about waddling gait for the past year, which grew heavier. Based on physical examination, we found a cerebellar sign on the left side, cerebellar ataxia, paraparesis of lower extremity, and paresthesia. Brain MRI with contrast displayed white matter periventricular and infratentorial lesion. CONCLUSION: In both cases, radiological imaging examination, which was MRI with contrast, was beneficial in the establishment of patient’s diagnosis, which made therapeutic management suitable as needed.

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