scholarly journals Abducens nerve palsy with associated retinal involvement secondary to rickettsia typhi infection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kaies Abderrahim ◽  
Sourour Zina ◽  
Molka Khairallah ◽  
Hager Ben Amor ◽  
Sana Khochtali ◽  
...  
Keyword(s):  
Optic Disc ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Retinal Hemorrhage ◽  
Abducens Nerve Palsy ◽  
Fundus Examination ◽  
Rickettsia Typhi ◽  
Rickettsial Disease ◽  
History Of ◽  
Optic Disc Swelling

Abstract Objective To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection. Material and methods A single case report documented with multimodal imaging. Results A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate. Conclusion Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.

scholarly journals Abducens nerve palsy with associated retinal involvement secondary to rickettsia typhi infection

2021 ◽  
Author(s):  
Kaies Abderrahim ◽  
Sourour Zina ◽  
Molka Khairallah ◽  
Hager Ben Amor ◽  
Sana Khochtali ◽  
...  
Keyword(s):  
Optic Disc ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Retinal Hemorrhage ◽  
Abducens Nerve Palsy ◽  
Fundus Examination ◽  
Rickettsia Typhi ◽  
Rickettsial Disease ◽  
History Of ◽  
Optic Disc Swelling

Abstract Objective: To report a case of abducens nerve palsy with associated retinal involvement due to rickettsia typhi infection Material and methods: A single case report documented with multimodal imagingResults: A 18-year-old woman with a history of high-grade fever was initially diagnosed with typhoid fever and treated with fluoroquinolone. She presented with a 5-day history of diplopia and headaches. Her best-corrected visual acuity was 20/20 in both eyes. Ocular motility examination showed left lateral gaze restriction. Lancaster test confirmed the presence of left abducens palsy. Fundus examination showed optic disc swelling in both eyes associated with superotemporal retinal hemorrhage and a small retinal infiltrate with retinal hemorrhage in the nasal periphery in the left eye. Magnetic resonance imaging (MRI) of the brain and orbits showed no abnormalities. A diagnosis of rickettsial disease was suspected and the serologic test for Richettsia Typhi was positive. The patient was treated with doxycycline (100 mg every 12 h) for 15 days with complete recovery of the left lateral rectus motility and resolution of optic disc swelling, retinal hemorrhages, and retinal infiltrate.Conclusion: Rickettsial disease should be considered in the differential diagnosis of abducens nerve palsy in any patient with unexplained fever from endemic area. Fundus examination may help establish an early diagnosis and to start an appropriate rickettsial treatment.

scholarly journals Reversible Unilateral Abducens Nerve Palsy in a patient with Scrub Typhus - A Clinical Diagnostic Dilemma

2020 ◽  
Vol 40 (3) ◽  
pp. 278-281
Author(s):  
Rahul Choudhary ◽  
Gaurav Katoch ◽  
Garima Sachdeva ◽  
Sweta Kushwah
Keyword(s):  
Nerve Palsy ◽  
Scrub Typhus ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Pathological Feature ◽  
Orientia Tsutsugamushi ◽  
Cranial Nerve Involvement ◽  
Sixth Cranial Nerve ◽  
Diagnostic Dilemma ◽  
Rickettsial Disease

Scrub typhus is an acute febrile rickettsial disease caused by Orientia tsutsugamushi. It infects endothelial cells and causes vasculitis, the predominant clinico-pathological feature of the disease. This results in disseminated inflammatory perivascular lesions leading to damage to the blood vessels affecting multiple end organs. Abducens nerve palsy is a known but extremely rare and reversible complication of scrub typhus. We present a case of scrub typhus with sixth cranial nerve involvement which responded to treatment with doxycycline.

scholarly journals Miller Fisher Syndrome presenting as unilateral abducens nerve palsy: A case report

2019 ◽  
Author(s):  
Neomal Sawanawadu Dilantha De Silva ◽  
Suranga Singhapathirana ◽  
Chintaka Eshan De Silva
Keyword(s):  
Nerve Palsy ◽  
Abducens Nerve ◽  
Miller Fisher Syndrome ◽  
Abducens Nerve Palsy ◽  
Fisher Syndrome ◽  
Fluid Analysis ◽  
Excellent Functional Outcome ◽  
History Of ◽  
F Wave ◽  
Complete Ophthalmoplegia

Abstract Background : Miller Fisher Syndrome usually presents with complete ophthalmoplegia, areflexia and ataxia. We present an unusual case which presented with unilateral abducens nerve palsy. Case presentation : A 51 year old female patient presented with a history of difficulty in walking and double vision for 1 week which started 2 weeks following an episode of acute gastroenteritis. She didn’t have any bladder bowel incontinence or difficulty in breathing. On examination there was left side abducens nerve palsy and bilateral significant dysmetria. Upper limb and lower limb power was 4/5 with global areflexia. There was no fatigability or sensory deficit. Higher cortical functions were intact with Glasgow Coma Scale of 15/15. Brain stem cerebro vascular accident, alcohol, toxin or drug mediated disease, myasthenia gravis, Bickerstaff encephalitis and Miller-Fisher syndrome were considered as possible differential diagnosis. There was no history of alcohol consumption or any exposure to drugs or toxins. Her Non contrast brain and MRI brain were normal. Nerve conduction study showed asymmetrical sensory motor and F wave abnormalities consistent with a Guillen-Barre Sydrome variant. Cerebro Spinal Fluid analysis showed albumino-cytological dissociation. These findings suggested the diagnosis of Miller-Fisher Syndrome. She was started on plasmaphareis. Her vital parameters, vital capacity and neurological deficit were closely monitored. With 5 cycles of plasmapharesis she made a complete neurological recovery and she was discharged on 16th day of admission. Conclusion: Miller Fisher Syndrome can present as unilateral abducens nerve palsy and early diagnosis and treatment leads to excellent functional outcome.

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

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.

scholarly journals Bilateral Abducens Nerve Palsy and the possible Association with COVID-19: A Case Report

2021 ◽  
Vol 4 (4) ◽  
pp. 01-03
Author(s):  
Abdulla Abu Hantash ◽  
Mohammed Abu Safieh ◽  
Salam Iriqat ◽  
Mohammad Daraghmeh
Keyword(s):  
Case Report ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Nasopharyngeal Swab ◽  
Upper Respiratory Tract ◽  
History Of ◽  
Upper Respiratory ◽  
Bilateral Abducens

Cranial nerve neuropathy could be a part of neurological spectrum of COVID-19 disease. Research suggests SARS-CoV-2 infection can trigger an aberrant immune response in some individuals, causing inflammatory nerve damage leading to anosmia and neuropathy. We report here a 50-year-old female patient who presented to the outpatient clinic in Saint John Eye Hospital with a two months history of binocular, horizontal diplopia five days after recovery from SARS-CoV-2 infection, PCR positive test obtained by a nasopharyngeal swab on April 1st, 2021 with upper respiratory tract symptoms. The patient was diagnosed with bilateral abducens nerve palsy. The main cause was presumed to be post-viral as the patient had controlled diabetes “HBA1C: 7%” and had no pre-existing microvascular risk factors. Diplopia still exists after two months of bilateral abducens nerve palsy. Measurements confirmed bilateral limited abductions in both eyes with right or alternating convergent squint. This case report supports the hypothesis that direct or indirect virally mediated injuries along the routes of the cranial nerves can cause neuropathy and olfactory dysfunction. The longer latency effects of COVID-19 infection are not well understood. This case report aims to raise awareness amongst clinicians of coronavirus-induced neurological symptoms

scholarly journals Intracranial Complication of Rhinosinusitis from Actinomycosis of the Paranasal Sinuses: A Rare Case of Abducens Nerve Palsy

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
G. L. Fadda ◽  
M. Gisolo ◽  
E. Crosetti ◽  
A. Fulcheri ◽  
G. Succo
Keyword(s):  
Nerve Palsy ◽  
Unusual Case ◽  
Clinical Symptoms ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Sinus Surgery ◽  
Facial Trauma ◽  
History Of ◽  
Extent Of Disease

Sinonasal actinomycosis should be suspected when a patient with chronic sinusitis does not respond to medical therapy or has a history of facial trauma, dental disease, cancer, immunodeficiency, long-term steroid therapy, diabetes, or malnutrition. Radiological evaluation with computed tomography and magnetic resonance imaging are important in differential diagnosis, evaluating the extent of disease, and understanding clinical symptoms. Endoscopic sinus surgery associated with long-term intravenous antibiotic therapy is the gold standard for treatment of sinonasal actinomycosis. We report an unusual case of abducens nerve palsy resulting from invasive sinonasal actinomycosis in a patient with an abnormally enlarged sphenoid sinus. A review of the current literature highlighting clinical presentation, radiological findings, and treatment of this uncommon complication is also presented.

Allergic Fungal Sinusitis Imitating an Aggressive Skull Base Lesion in the Setting of Pembrolizumab Immunotherapy

2020 ◽  
Vol 130 (1) ◽  
pp. 108-111
Author(s):  
Natalie A. Krane ◽  
Daniel M. Beswick ◽  
David Sauer ◽  
Kara Detwiller ◽  
Maisie Shindo
Keyword(s):  
Skull Base ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Non Invasive ◽  
T Cell Infiltration ◽  
History Of ◽  
Base Lesion

Objectives: We report a case of acutely worsening allergic fungal sinusitis in a patient receiving immunotherapy with pembrolizumab, a programmed cell death protein 1 (PD-1) inhibitor. Methods: A 53-year-old man with a history of metastatic melanoma and recent initiation of pembrolizumab therapy presented with acutely worsening headaches, left abducens nerve palsy, and neuroimaging demonstrating an erosive skull base lesion with bilateral cavernous sinus involvement. Results: Intraoperative findings were consistent with non-invasive allergic fungal sinus disease. Microbiology and histopathologic data ruled out malignancy and demonstrated Aspergillus fumigatus without concern for angioinvasion. After treatment with antifungal therapy, the patient’s symptoms and abducens nerve palsy resolved. Symptoms were well-controlled 7 months after his initial presentation. Conclusions: Inflammatory sinusitis in patients receiving anti-PD-1 therapy may be secondary to T-cell infiltration, a similar pathophysiology as immune-related adverse events, and warrants appreciation by otolaryngologists given our increasing exposure to immunotherapy and its head and neck manifestations.

Sign in / Sign up

Export Citation Format

Share Document