scholarly journals Abducens Nerve Palsy as the First Manifestation of Type Two Diabetes Mellitus

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A362-A363
Author(s):  
Amira Ibrahim ◽  
Victoria Loseva
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Reference Range ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Double Vision ◽  
Sixth Cranial Nerve

Abstract Introduction: Diabetes mellitus has varied presentations at different times from onset. One of the uncommon presentations is cranial nerve palsy secondary to microvascular ischemia. Approximately 20% of isolated abducens nerve palsies are secondary to vascular microangiopathy. Clinical Case: A 53-year-old female with no significant past medical history presented to the emergency department with concerns of double vision. The patient first noticed her symptoms five days prior to presentation. The patient endorsed blurry vision and stated that she has double vision in certain gazes that resolves with shutting either eye. Furthermore, she has also developed headaches during that period, described as a pressure-like sensation in her forehead and behind her eyes. She otherwise denied any tearing, redness, or pain. On review of systems, she denied numbness, tingling, changes in hearing, changes in speech, or extremity weakness. Due to the persistence of symptoms the patient presented to the emergency department. On exam, the patient’s vitals were normal. Pupils were equal and briskly reactive to light with no relative afferent pupillary defect. External examination was unremarkable without scalp tenderness, proptosis, or ptosis. Color vision was intact. Ocular motility testing revealed limited abduction of the left eye causing double vision on lateral gaze. Confrontation visual fields were full in each eye. Bilateral lower extremity exam revealed decreased sensation in the sole of the foot. The rest of the physical exam was unremarkable. Laboratory work revealed blood glucose level of 305 mg/dl (Reference range 70–99 mg/dl). HBA1C was 12.3% (Reference range 3.8–5.6%). CT head and CTA of the neck was performed and were unremarkable. Given the normal imaging and findings on examinations, her ocular motor findings were attributed to diabetes mellitus. The patient was started on insulin, aspirin, and received diabetic education for lifestyle modification, and was scheduled for outpatient follow up. The patient’s acute isolated left sixth cranial nerve palsy was most likely owing to microvascular ischemia from previously undiagnosed diabetes mellitus. A study of 59 patients with an isolated sixth cranial nerve palsy showed a 6-fold increase in the odds of having diabetes compared with controls.(1) Conclusion: Given the infrequent presentation of Diabetes with Abducens nerve palsy, diagnosis is usually delayed with the expense of ordering costly investigations that put a financial and psychological burden on patients. Thus, we urge clinicians’ awareness when encountering cases of isolated cranial nerve palsies. References: 1) Sanders SK, Kawasaki A, Purvin VA. Long-term prognosis in patients with vasculopathic sixth nerve palsy. Am J Ophthalmol. 2002;134(1):81–84.

Recurrent and self-remitting sixth cranial nerve palsy: pathophysiological insight from skull base chondrosarcoma

2013 ◽  
Vol 12 (6) ◽  
pp. 633-636 ◽  
Author(s):  
Paolo Frassanito ◽  
Luca Massimi ◽  
Mario Rigante ◽  
Gianpiero Tamburrini ◽  
Giulio Conforti ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Abducens Nerve ◽  
Clinical History ◽  
Skull Base Tumor ◽  
Sixth Cranial Nerve ◽  
Sixth Cranial Nerve Palsy ◽  
Wide Range

Palsy of the abducens nerve is a neurological sign that has a wide range of causes due to the nerve's extreme vulnerability. Need of immediate neuroimaging is a matter of debate in the literature, despite the risks of delaying the diagnosis of a skull base tumor. The authors present 2 cases of skull base tumors in which the patients presented with recurrent and self-remitting episodes of sixth cranial nerve palsy (SCNP). In both cases the clinical history exceeded 1 year. In a 17-year-old boy the diagnosis was made because of the onset of headache when the tumor reached a very large size. In a 12-year-old boy the tumor was incidentally diagnosed when it was still small. In both patients surgery was performed and the postoperative course was uneventful. Pathological diagnosis of the tumor was consistent with that of a chondrosarcoma in both cases. Recurrent self-remitting episodes of SCNP, resembling transitory ischemic attacks, may be the presenting sign of a skull base tumor due to the anatomical relationships of these lesions with the petroclival segment of the sixth cranial nerve. Physicians should promptly recommend neuroimaging studies if SCNP presents with this peculiar course.

scholarly journals 18 Lyme disease as an emerging cause of Seventh Cranial Nerve Palsy (“Bell’s palsy”) in Nova Scotia

2020 ◽  
Vol 25 (Supplement_2) ◽  
pp. e7-e7
Author(s):  
Julia LeBlanc ◽  
Michael Young ◽  
Ellen Wood ◽  
Donna MacKinnon-Cameron ◽  
Joanne Langley
Keyword(s):  
Emergency Department ◽  
Lyme Disease ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Complete Resolution ◽  
Nerve Palsy ◽  
Health Centre ◽  
Bell’S Palsy ◽  
Bell's Palsy ◽  
Seventh Cranial Nerve

Abstract Introduction/Background Lyme disease, a tick-borne zoonosis caused by the bacterium Borrelia burgdorferi, has emerged in Nova Scotia (NS) as a common illness. Since 2002 when Lyme disease was first diagnosed in NS, >1000 cases have been reported. Seventh cranial nerve palsy (CNP-7) is said to be the most common presentation of early disseminated Lyme disease in children in endemic areas. Objectives We aimed to determine the frequency of CNP-7 in NS and if physicians are considering Lyme disease as an etiology. Design/Methods A retrospective review of health records of children seen at the IWK Health Centre from 2000-2018 who were ≤18 years of age with an ICD-9 or 10 diagnosis of Bell’s palsy (CNP-7) was conducted. CNP-7 due to local infection, trauma, malignancy, or systemic neurologic disease was excluded. Results Of 237 ICD “Bell’s palsy” diagnoses, 66 cases were eligible, of which 60.6 % (n=40) were female. The median age was 10 years (range 0-16). Five cases of Lyme disease-associated CNP-7 were recognized (7.6%), all since 2013. No bilateral CNP-7 occurred; 59.1% of cases were on the left. Most children presented within 3 days of symptom onset (84.8%) to the emergency department (95.4%), and 56.1% subsequently saw a pediatric neurologist. The most common associated symptom with CNP-7 was headache (22.7%). Lyme disease was considered in the differential diagnosis in 34.8 % (n=23) of cases, and only since 2012. Systemic steroids were prescribed to 51.5 % (34/66) of children in the emergency department, for durations varying from 1 to 10 days. The most common steroid course length was 5 days. Antimicrobials were prescribed for 18 (27.3%) children including acyclovir, beta lactams and tetracyclines. Resolution of the facial palsy findings was documented in 45 children, of whom 36 (54.5%) had complete resolution and 9 (13.6%) had partial resolution. Four children with Lyme disease associated CNP-7 had complete resolution, and one had partial resolution. Conclusion There does not appear to be a standard approach to diagnosis and management of CNP-7 in this pediatric health centre. Lyme disease is not regularly considered in the differential diagnosis, which is surprising given the high incidence of Lyme disease in NS. These findings will be shared with health care providers most likely to see CNP-7 in order to develop a standard algorithm to the initial presentation of 7th cranial nerve palsy in children.

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.

Sixth cranial nerve palsy after first intrathecal nusinersen administration

2022 ◽  
Author(s):  
Luca Spiro Santovito ◽  
Silvia Bonanno ◽  
Luisa Chiapparini ◽  
Gabriella Cammarata ◽  
Lorenzo Maggi
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Sixth Cranial Nerve ◽  
Sixth Cranial Nerve Palsy
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