scholarly journals Case Report: Isolated, unilateral oculomotor palsy with anti-GQ1b antibody following COVID-19 vaccination

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 1142
Author(s):  
Takafumi Kubota ◽  
Takafumi Hasegawa ◽  
Kensuke Ikeda ◽  
Masashi Aoki
Keyword(s):  
Ivig Therapy ◽  
Neurological Complications ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Ivig Treatment ◽  
Laboratory Findings ◽  
Residual Symptoms ◽  
First Case ◽  
The Right ◽  
Vertical Gaze

Neurological complications following vaccinations are extremely rare, but cannot be eliminated. Here, we report the first case of unilateral oculomotor nerve palsy (ONP) with anti-GQ1b antibody after receiving the Pfizer-BioNTech COVID-19 (BNT162b2) mRNA vaccine. A 65-year-old man developed diplopia and ptosis in the right eye 17 days after vaccination, without preceding infection. Neurological examination revealed mild blepharoptosis, limitation of adduction, and vertical gaze on the right side. Increased levels of anti-GQ1b ganglioside antibody in the serum and albuminocytologic dissociation in the cerebrospinal fluid were detected. Cranial magnetic resonance imaging showed swelling and enhancement of the right oculomotor nerve. The patient was diagnosed with right ONP accompanied with anti-GQ1b antibody, and intravenous immunoglobulin (IVIG) therapy for 5 days was administered. The limitation of adduction and vertical gaze improved, and ptosis markedly resolved after IVIG treatment. Given the temporal sequence of disease progression, laboratory findings, and a favorable response to IVIG, a causal relationship cannot be ruled out between the occurrence of ONP and COVID-19 immunization. Since immunomodulatory treatments significantly hasten the recovery and minimize the residual symptoms in anti-GQ1b antibody syndrome, clinicians should be aware of this clinical condition following COVID-19 vaccination.

Left suboccipital supracerebellar transtentorial approach for resection of tectal cavernous malformation

2019 ◽  
Vol 1 (2) ◽  
pp. V19
Author(s):  
Hussam Abou-Al-Shaar ◽  
Timothy G. White ◽  
Ivo Peto ◽  
Amir R. Dehdashti
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Entry Zone ◽  
Third Nerve Palsy ◽  
History Of ◽  
Tectal Plate ◽  
The Right ◽  
Transtentorial Approach ◽  
Third Nerve

A 64-year-old man with a midbrain cavernoma and prior bleeding presented with a 1-week history of diplopia, partial left oculomotor nerve palsy, and worsening dysmetria and right-sided weakness. MRI revealed a hemorrhagic left tectal plate and midbrain cavernoma. A left suboccipital supracerebellar transtentorial approach in the sitting position was performed for resection of his lesion utilizing the lateral mesencephalic sulcus safe entry zone. Postoperatively, he developed a partial right oculomotor nerve palsy; imaging depicted complete resection of the cavernoma. He recovered from the right third nerve palsy, weakness, and dysmetria, with significant improvement of his partial left third nerve palsy.The video can be found here: https://youtu.be/ofj8zFWNUGU.

scholarly journals Ocular neuromyotonia caused by a recurrent sphenoidal ridge meningioma

2021 ◽  
Vol 12 ◽  
pp. 219
Author(s):  
Yuto Shingai ◽  
Hidenori Endo ◽  
Toshiki Endo ◽  
Shin-ichiro Osawa ◽  
Kuniyasu Nizuma ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Posterior Part ◽  
Residual Tumor ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Vascular Compression ◽  
Ocular Motility ◽  
Imaging Results ◽  
The Right ◽  
Ocular Neuromyotonia

Background: Ocular neuromyotonia (ONM) is a rare ocular motility disorder characterized by involuntary paroxysmal extraocular muscle contraction and is caused by radiation therapy, vascular compression, and inflammatory disease. This study includes a rare case of ONM caused by a recurrent meningioma. Case Description: A 56-year-old man presented with diplopia due to the right oculomotor nerve palsy caused by a sphenoidal atypical meningioma, with improved symptoms after initial surgery. During the next 7 years, he underwent local radiation therapy, second surgery, and Gamma Knife radiosurgery to control the tumor’s repetitive recurrence around the right anterior clinoid process. After these treatments, residual tumor was controlled for the next 3 years. However, 3 months after his last visit, he started to suffer from the right ONM and visual disturbance. The magnetic resonance imaging results revealed a rapid growth of the posterior part of the residual tumor, involving the right oculomotor nerve. The third tumor resection was performed to prevent further aggravation of the symptoms. Decompression of the right oculomotor nerve was achieved, and ONM disappeared immediately after surgery. Conclusion: If nerve compression by the tumor is clearly indicated with the neuroradiological assessment, surgical intervention is the treatment of choice to improve ONM.

scholarly journals Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus

2021 ◽  
Vol 6 (1) ◽  
pp. 1-4
Author(s):  
Marcelo de Pinho Teixeira Alves ◽  
João Pedro Gouveia Nóbrega
Keyword(s):  
Median Nerve ◽  
Metabolic Diseases ◽  
Severe Disease ◽  
Neurological Complications ◽  
Neurological Manifestations ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
First Case ◽  
Asymptomatic Patients ◽  
The Right

Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.

Functional anatomy of headache: circle of Willis aneurysms, third cranial nerve and pain

2011 ◽  
pp. 82-88
Author(s):  
Marcelo Moraes Valença ◽  
Luciana P. A. Andrade-Valença ◽  
Carolina Martins
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Functional Anatomy ◽  
Circle Of Willis ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Microsurgical Anatomy ◽  
Third Nerve Palsy ◽  
The Right ◽  
Third Nerve

Patients with intracranial aneurysm located at the internal carotid artery-posterior communicating artery (ICA-PComA) often present pain on the orbit or fronto-temporal region ipsilateral to the aneurysm, as a warning sign a few days before rupture. Given the close proximity between ICA-PComA aneurysm and the oculomotor nerve, palsy of this cranial nerve may occurduring aneurysmal expansion (or rupture), resulting in progressive eyelid ptosis, dilatation of the pupil and double vision. In addition, aneurysm expansion may cause compression not only of the oculomotor nerve, but of other skull base pain-sensitive structures (e.g. dura-mater and vessels), and pain ipsilateral to the aneurysm formation is predictable. We reviewed the functional anatomy of circle of Willis, oculomotor nerve and its topographical relationships in order to better understand the pathophysiology linked to pain and third-nerve palsy caused by an expanding ICAPComA aneurysm. Silicone-injected, formalin fixed cadaveric heads were dissected to present the microsurgical anatomy of the oculomotor nerve and its topographical relationships. In addition, the relationship between the right ICA-PComA aneurysm and the right third-nerve is also shown using intraoperative images, obtained during surgical microdissection and clipping of an unruptured aneurysm. We also discuss about when and how to investigate patients with headache associated with an isolated third-nerve palsy.

scholarly journals ISOLATED OCULOMOTOR NERVE PALSY

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Melissa T. E. Ratag ◽  
Ralf R Pangalila
Keyword(s):  
Ct Scan ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Uncontrolled Hypertension ◽  
Oculomotor Nerve Palsy ◽  
Relative Afferent Pupillary Defect ◽  
Primary Position ◽  
Normal Limits ◽  
The Right ◽  
Per Oral

Abstract: We reported a case of a 59-year-old male who came to the hospital with the chief complaint of a droopy upper right eyelid originating a month before, accompanied by diplopia. This patient was also suffering from uncontrolled hypertension. The ophthalmologic examination of the right eye showed a best corrected visual acuity (BCVA) of 1.0. In the primary position there was a deviation to the temporal side; limitations on elevation, adduction, and depression; and an endorotation on nasal down gaze. The aberrant regenerative trigeminal nerve was noticed, but the relative afferent pupillary defect (RAPD) was not found. The anterior and posterior segments of the right eye were normal. Laboratory tests were within normal limits and the CT-scan did not show any abnormality. Conclusion: Based on all the tests performed, the diagnosis of the patient was an isolated oculomotor nerve palsy of the right eye. The patient was treated with a non-steroid anti inflammatory drug and a neurotropic vitamine, and had to be observed for three months. Keywords: palsy, oculomotor nerve, right eye.   Abstrak: Kami melaporkan kasus seorang laki-laki berusia 59 tahun dengan keluhan utama kelopak mata atas kanan tertutup sejak satu bulan lalu, disertai diplopia. Dalam anamnesis ditemukan adanya riwayat hipertensi sedangkan riwayat trauma tidak ada. Pemeriksaan oftalmologi mata kanan didapatkan tajam penglihatan 6/6, pergerakan bola mata kanan tampak sedikit deviasi ke temporal pada posisi primer, serta keterbatasan dalam elevasi, aduksi, dan depresi. Mata kanan tampak endorotasi saat melirik ke nasal bawah dan terdapat aberrant regenerative; relative afferent pupillary defect (RAPD) tidak ditemukan. Segmen anterior dan posterior dalam batas normal. Pemeriksaan laboratorium dan CT scan kepala dalam batas normal. Simpulan: Berdasarkan hasil pemeriksaan oftalmologik dan pemeriksaan penunjang ditegakkan diagnosis isolated oculomotor nerve palsy mata kanan yang ditangani dengan pemberian anti inflamasi non steroid dan neurotropik per oral sambil diobservasi selama tiga bulan. Kata kunci: kelumpuhan, saraf okulomotor, mata kanan.

scholarly journals A rare case of iii cranial nerve palsy - mucormycosis involving the right maxillary and ethmoidal sinus

2021 ◽  
Vol 9 (3) ◽  
pp. 181-184
Author(s):  
K. Praveen Gandhi ◽  
◽  
V. Sakthivel ◽  
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Rare Case ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
The Right ◽  
Rule Out

IIIrd Cranial nerve palsy, known as oculomotor nerve palsy, may result from various causes,however, the etiology remains unknown in some instances. This case report aims to present theauthors' experience with a case of IIIrd cranial nerve palsy, together with a review of the literature.Many etiologies have been associated with isolated oculomotor nerve palsies. We report the case ofa patient who presented with right maxillary and ethmoidal sinusitis with IIIrd cranial nerve palsyassociated with mucormycosis. Careful examinations to rule out other causes must be done and thentreatment with antifungals should be considered after early diagnosis.

scholarly journals Primary Hyperparathyroidism Caused by Single Parathyroid Adenoma

2018 ◽  
Vol 35 (9-10) ◽  
pp. 236-40
Author(s):  
Jose R. L. Batubara ◽  
Paruhum T. Siregar ◽  
M. Lutfi ◽  
Daniel Makes ◽  
Wawan Hermawan
Keyword(s):  
Parathyroid Hormone ◽  
Primary Hyperparathyroidism ◽  
Parathyroid Adenoma ◽  
Ultrasound Examination ◽  
Color Doppler ◽  
Roentgenologic Examination ◽  
Laboratory Findings ◽  
First Case ◽  
Pathologic Fractures ◽  
The Right

Primary hyperparathyroidism is rarely found in children under sixteen years old. We report the first case seen at the Department of Child Health, Medical School, University of Indonesia, Jakarta. This 15-year old girl was admitted to the Department, referred by an orthopedic surgeon because of pathologic fractures suspected to be caused by hyperparathyroidism. The physical examination was unremarkable, and the laboratory findings showed increased level of parathyroid hormone. Roentgenologic examination showed lytic skull lesions, loss of the lamina dura of the dentis, subperiosteal resorption of the symphysis and generalized osteoporosis with pathologic fractures. Color Doppler USG using a high resolution ultrasound examination was performed to find the etiology of primary hyperparathyroidism. The result revealed single parathyroid adenoma in the right superior region measuring 2.7 x 1.7 x 1 cm. The clinical manifestation and laboratory findings showed improvement following surgery.

Primary glioblastoma multiforme of the oculomotor nerve

1996 ◽  
Vol 84 (6) ◽  
pp. 1062-1066 ◽  
Author(s):  
Guido Reifenberger ◽  
Jan Boström ◽  
Martin Bettag ◽  
Wolfgang J. Bock ◽  
Wolfgang Wechsler ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Proximal Part ◽  
Oculomotor Nerve ◽  
Neurological Dysfunction ◽  
Nerve Tissue ◽  
Oculomotor Nerve Palsy ◽  
Content Type ◽  
Primary Glioblastoma ◽  
First Case ◽  
Operative Specimen

✓ Tumors of the oculomotor nerve are rare and most instances reported have been schwannomas. The authors present clinical, neuroradiological, and neuropathological findings in a 70-year-old woman with a glioblastoma multiforme (GBM) growing primarily in the proximal part of the left oculomotor nerve. The patient presented with a 1-month history of transient diplopia. Neurological examination revealed an incomplete left-sided oculomotor nerve palsy with no further signs of neurological dysfunction. Cranial computerized tomography and magnetic resonance imaging showed a tumor of the left oculomotor nerve without any obvious signs of penetration into the midbrain or upper pons. Following subtotal removal of the tumor, neuropathological examination of the operative specimen revealed a GBM that had grown diffusely within peripheral nerve tissue. Six weeks after surgery, the patient suddenly died of pulmonary thromboembolism. Postmortem examination of the brain confirmed a large leptomeningeal GBM at the left pontomesencephalic junction with complete destruction of the left oculomotor nerve. To the authors' knowledge, this represents the first case of a GBM of the oculomotor nerve, probably originating from glial cells within the most proximal part of the nerve or the adjacent leptomeninges.

Adult-to-Adult Living-Donor Liver Transplantation

Swiss Surgery ◽  
2003 ◽  
Vol 9 (5) ◽  
pp. 227-236 ◽  
Author(s):  
Majno ◽  
Mentha ◽  
Berney ◽  
Bühler ◽  
Giostra ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Therapeutic Option ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Multidisciplinary Program ◽  
First Case ◽  
Living Donor Transplantation ◽  
The Right

Living donor liver transplantation is a relatively new procedure in which the right side of the liver is harvested in a healthy donor and transplanted into a recipient. After the first case in 1994, over 3000 cases have been done worldwide. This review summarizes the reasons why the procedure is needed, describes its main technical aspects, highlights the boundaries in which it can be done safely, summarizes the current experience worldwide and describes the main points of the program in our unit. We argue that living-donor transplantation is a viable alternative to a long time on the waiting list for several patients, and it can be performed safely and successfully provided that all precautions are undertaken to minimize the risks in the donor and to increase the chances of a good outcome in the recipients. If these prerequisites are met, and within the framework of a structured multidisciplinary program, we believe that living-donor liver transplantation should be funded by health insurances as a recognized therapeutic option.

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