scholarly journals SAT-LB51 The Unique Etiology and Management of a Third Cranial Nerve Palsy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Magar
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Visual Fields ◽  
Pituitary Tumors ◽  
Pituitary Surgery ◽  
Third Nerve Palsy ◽  
Cranial Nerve Palsies ◽  
Regular Menses ◽  
Third Cranial Nerve Palsy ◽  
One Year

Abstract Background: Cranial nerve palsies (CNP) in association with a hypophyseal process can be uni/bilateral, single, multiple, with or without visual deficits and pain. It is reported 14-30% of pituitary tumors lead to a palsy. Often the acute cause of palsy is apoplexy (1) but other rare etiologies exist such as abscess or prolactinoma (2, 3). Clinical Case: A 40 year old woman with no PMH presented to the ED for acute on chronic headaches. Two days prior she started having blurry vision in her R eye. The headache improved with medications and she was sent home. Two days later she returned with new symptoms of the R eye deviating laterally and down, associated ptosis and a 6 mm nonreactive pupil. A stat MRI brain was obtained for her new CN III palsy, showing a 1.4 cm sellar mass with suprasellar extension. Further history revealed that two months prior her regular menses had stopped. Labs were obtained that included a prolactin 127 (nl 4.8-23.3); fT4 1.2 (nl .93-1.7); IGF1 129 (nl 52-328); 9 am cortisol 16.6 (nl 4-22); FSH 5.5 (nl 3.5-12.5); LH 3.8 (nl 2.4-12.6). Neurosurgery (NSGY) was consulted, recommending a trial of medical therapy since her visual fields were intact. Endocrine then advised cabergoline 0.5 mg twice weekly. In NSGY clinic ten days later, her prolactin was 0.2 but her symptoms remained the same. One month later, she was seen in Neuro-ophthalmology clinic where it was noted that her diplopia had subjectively resolved. Her eye exam was documented as normal except for sluggish pupils. Conclusion: CNP are more common in larger pituitary tumors and often associated with panhypopituitarism and necrosis. About 90% of cases resolve by one year after pituitary surgery. Although our patient had a tumor that was slightly larger than 1 cm, she did not need hormonal replacement, did not have hemorrhage/necrosis, and her symptoms resolved with a dopamine agonist. There is one other case in the literature of medically treated macroprolactinoma with resolution of CN III palsy (3). References: (1) Hage R, et al. Third, Fourth, and Sixth Cranial Nerve Palsies in Pituitary Apoplexy. World Neurosurgery. 2016; 94:447-452.(2) Wang L, et al. Pituitary abscess resulting in isolated abducens palsy. Journal of the Formosan Medical Association. 2016;115:134-135.(3) Harries A, et al. Resolution of third nerve palsy following treatment of prolactinoma with cabergoline. Acta Neurochir. 2010; 152:1741-1743.

scholarly journals P.156 Outcomes of Cranial Nerve Deficits in Patients with Pituitary Apoplexy: The Ottawa Hospital Experience

2021 ◽  
Vol 48 (s3) ◽  
pp. S64-S64
Author(s):  
M Alahmari ◽  
S Kilty ◽  
A Lasso ◽  
F Banaz ◽  
S Mohajeri ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Visual Fields ◽  
Case Series ◽  
Tumor Type ◽  
Endoscopic Endonasal ◽  
Third Nerve Palsy ◽  
Visual Deficit ◽  
Small Series

Background: One of the rare but urgent presentations of a pituitary tumor is pituitary apoplexy. In this case series, we describe our experience regarding the cranial nerve recovery in patients with pituitary apoplexy following endoscopic endonasal transsphenoidal surgery (EETS). Methods: Retrospective cohort study with patient characteristics, tumor type, endocrine data, operation data collected. Postoperative data were extracted for the follow-up period available for each patient. Results: 15 pituitary apoplexy cases were identified. The cranial nerve deficits presented at admission were: visual deficit (33% patients); unilateral third nerve palsy (47% patients), unilateral sixth nerve palsy (27% patients). Postoperatively, 60% of patients with preoperative visual deficit had normal visual fields and the other 40% showed improvement. From those with oculomotor nerve dysfunction preoperatively, 43% have returned to normal nerve function and 57% presented improvement. 75% cases of abducens nerve palsy resolved postoperatively, while 25% showed improvement. Conclusions: Based on this series, surgical treatment should be offered to patients presenting with cranial nerve deficit in the setting of pituitary apoplexy. In this series, all cranial nerve deficits either returned to normal or improved following surgery. Though a small series, the presented results are superior to those reported in the literature for conservative management.

scholarly journals Internal Carotid Artery dissection presenting as Isolated Hypoglossal nerve palsy

2009 ◽  
Vol 8 (1) ◽  
pp. 22-25
Author(s):  
Amir Ahmad ◽  
◽  
Amir Ahmad ◽  
Philip Travis ◽  
Mark Doran ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Cranial Nerves ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection ◽  
Cranial Nerve Palsies

Internal carotid dissection most commonly presents as headache, focal neurological deficits or stroke. Rarely it can manifest itself by causing a palsy of the lower cranial nerves (IX, X, XI, XII). The reported incidence of isolated cranial nerve palsies is rare. We report a case of an internal carotid artery dissection manifesting as isolated XII (hypoglossal) cranial nerve palsy.

scholarly journals Comprehensive management of malignant otitis externa with tuberculosis and cranial nerve paresis in geriatrics

2020 ◽  
Vol 50 (1) ◽  
pp. 77
Author(s):  
Ratna Dwi Restuti
Keyword(s):  
Diabetes Mellitus ◽  
Temporal Bone ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Geriatric Patients ◽  
Cranial Nerve Palsies ◽  
Malignant Otitis Externa ◽  
Multiple Cranial Nerve

Background: Malignant otitis externa is an inflammatory condition of the external ear which has the propensity to spread to the skull base. It can be a difficult entity to treat as clinical presentation varies and response to treatment differs between patients. Purpose: Evaluating the management of malignant otitis externa with complications in geriatric patients who had multiple comorbidities. Case: A 71 years old female with a diagnosis of left malignant otitis externa with complications of multiple cranial nerve palsies (N.VII, IX, X) and comorbidity in the form of diabetes mellitus and chronic kidney disease. The patient underwent subtotal temporal bone resection and petrosectomy. Clinical Question: “Could surgical management of malignant otitis externa with cranial nerve palsies complication in geriatric patients with multiple comorbidities achieve better result than conservative treatment?” Review Method: Literature search using keywords ’malignant otitis externa’ OR ’temporal bone osteomyelitis’ AND ’geriatric’ OR ’elderly’ AND ’multiple cranial nerve palsy’ AND ’diabetes mellitus’ AND ’tuberculosis’ AND ’surgery’ OR ’surgical’ was conducted through Cochrane, Pubmed, and Google Scholar. Result: The search obtained 11 articles published in the last 10 years. Selection based on inclusion and exclusion criteria, 2 studies were found relevant with the topic. Conclusion: Management of malignant otitis externa with complications in geriatric patients with multiple comorbidities requires a multidisciplinary approach to determine the need for surgery intervention.Keywords: malignant otitis externa, cranial nerve palsy, subtotal temporal bone resection, geriatric, diabetes mellitus ABSTRAK Latar belakang: Otitis eksterna maligna adalah suatu kondisi peradangan pada telinga luar yang memiliki kecenderungan untuk meluas hingga ke dasar tengkorak. Penyakit ini menjadi sulit ditangani karena manifestasi klinis yang bervariasi dan respons terhadap pengobatan yang berbeda antara pasien. Tujuan: Mengevaluasi tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri yang memiliki komorbiditas multipel. Kasus: Pasien perempuan 71 tahun dengan diagnosis otitis eksterna maligna telinga kiri dengan komplikasi paresis saraf kranial multipel (n.VII, IX, X) dan penyakit penyerta berupa diabetes melitus dan gagal ginjal kronik. Pasien menjalani operasi reseksi tulang temporal subtotal dan petrosektomi. Pertanyaan klinis: “Apakah tatalaksana pembedahan memberikan hasil yang lebih baik dibandingkan terapi konservatif pada pasien geriatri dengan otitis eksterna maligna disertai paresis saraf kranialis dengan komorbiditas multipel.” Telaah Literatur: Dilakukan menggunakan kata kunci ’malignant otitis externa’ ATAU ’temporal bone osteomyelitis’ DAN ’geriatric’ ATAU ’elderly’ DAN ’multiple cranial nerve palsy’ DAN ’diabetes melitus’ DAN ’tuberculosis’ DAN ’surgery’ ATAU ’surgical’ pada beberapa sumber data seperti Cochrane, Pubmed, dan Google Scholar. Hasil: Didapatkan 11 artikel publikasi 10 tahun terakhir. Berdasarkan kriteria inklusi dan eksklusi diperoleh 2 artikel yang relevan dengan topik. Kesimpulan: Tatalaksana otitis eksterna maligna dengan komplikasi pada pasien geriatri dengan komorbiditas multipel, membutuhkan pendekatan multidisiplin terutama untuk menentukan perlunya dilakukan tindakan pembedahan.

scholarly journals Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients

2021 ◽  
pp. 1-4
Author(s):  
Pierre Decavel ◽  
Olympe Nahmias ◽  
Carine Petit ◽  
Laurent Tatu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prone Position ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
University Hospital ◽  
Cranial Neuropathy ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies

<b><i>Introduction:</i></b> A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. <b><i>Results:</i></b> Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. <b><i>Conclusion:</i></b> The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

Disseminated lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy

2019 ◽  
pp. 112067211987327
Author(s):  
Raida Ben Salah ◽  
Sonda Kammoun ◽  
Faten Frikha ◽  
Yosra Bouattour ◽  
Imen Chabchoub ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Lymphoblastic Lymphoma ◽  
Cranial Neuropathy ◽  
Atypical Case ◽  
The Third ◽  
Non Hodgkin Lymphoma ◽  
Third Cranial Nerve Palsy

Dysfunction of the third cranial nerve can be provoked by a number of different conditions. An isolated cranial neuropathy as a first clinical sign of a non-Hodgkin lymphoma is very infrequent. We represent here an atypical case of lymphoblastic lymphoma revealed by an isolated third cranial nerve palsy. The patient was managed by alternating cycles of cyclophosphamide, vincristine, and prednisone. She made a full recovery with a complete resolution of the symptomatology.

Imaging of Oculomotor (Third) Cranial Nerve Palsy

2019 ◽  
pp. 133-151 ◽  
Author(s):  
Michael S. Vaphiades ◽  
Martin W. ten Hove ◽  
Tim Matthews ◽  
Glenn H. Roberson ◽  
Alexandra Sinclair
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Third Cranial Nerve Palsy
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