scholarly journals A Hospital-Based Study on Aetiology of Third, Fourth and Sixth Cranial Nerve Palsies

2021 ◽  
Vol 10 (41) ◽  
pp. 3587-3591
Author(s):  
Sri Gautham Bodduluri ◽  
Mary Thomas ◽  
Uma Radhakrishnan ◽  
Adithya Tellakula
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Motor Nerve ◽  
Common Symptom ◽  
Key Words Diabetes ◽  
Ocular Motility ◽  
Ocular Motor ◽  
Cranial Nerve Palsies ◽  
Third Nerve ◽  
Sixth Nerve

BACKGROUND Neuro-ophthalmology deals with complex systemic diseases that affect the visual system and pose a challenge for ophthalmologists. Here the focus is on the diseases of the nervous system that affect vision, ocular motility, or pupillary reflexes. Diplopia, a common symptom of cranial nerve palsy, may result from ophthalmic, orbital, or neurologic disorders. Our study intended to determine the aetiology of ocular motor nerve palsies. METHODS A cross-sectional study was conducted for two years at a tertiary care centre in South India. We evaluated 30 patients who came to the Ophthalmology OPD or were admitted, after obtaining the approval of the Ethics committee. RESULTS A total number of 30 patients who fulfilled the inclusion criteria were studied. There were 14 male and 16 female patients. The age range was 12 - 87 years with a mean age of 45 years. The highest incidence noticed was isolated sixth nerve palsy in 13 (43.3 %) patients. 11 patients had isolated third nerve palsy (36.7 %), while mixed ocular motor nerve palsies (third, fourth and sixth) were seen in 6 patients (20 %). None of them had isolated fourth nerve palsy. CONCLUSIONS  The sixth nerve continued to be the most common among the ocular motor nerve palsies. Meningitis was the major cause.  Diabetes and trauma, infections with CNS inflammation accounted for a majority of third nerve palsies.  Multiple cranial nerve palsies had varied aetiology like HIV Infection, Tolosa Hunt Syndrome, aneurysm of intracavernous part of ICA, cavernous sinus thrombosis and trauma.  The patient’s age, associated symptoms, clinical features and types of palsy are of great importance to choose appropriate radiological methods to study and treat these isolated cranial nerve palsies. KEY WORDS Diabetes, Meningitis, Oculomotor Nerve, Trochlear Nerve, Abducent Nerve, Trauma

Sixth cranial nerve palsy secondary to compression by dolichoectatic vertebrobasilar artery

2020 ◽  
Vol 13 (7) ◽  
pp. e234949
Author(s):  
Trishal Jeeva-Patel ◽  
Edward A Margolin ◽  
Daniel Mandell
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
High Spatial Resolution ◽  
Cranial Nerves ◽  
Three Dimensional ◽  
Sixth Cranial Nerve ◽  
Vertebrobasilar Artery ◽  
Cranial Nerve Palsies ◽  
Mri Sequences ◽  
Sixth Nerve

Dolichoectasia refers to distinct elongation, dilatation and tortuosity of an artery. We present a rare well-illustrated case of dolichoectatic vertebrobasilar artery compressing the cisternal portion of the sixth cranial nerve resulting in chronic sixth nerve palsy. High spatial resolution, three-dimensional, heavily T2-weighted MRI sequences are uniquely positioned to assess the cranial nerves especially in their cisternal and canalicular portions and need to be performed for all patients with non-resolving cranial nerve palsies. Dolichoectatic vessels can be the cause of neurovascular conflict and cause non-resolving oculomotor palsies.

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 Frequency of Neurogenic Strabismus in Al-Ibrahim Eye Hospital, Karachi

2019 ◽  
Vol 34 (2) ◽  
Author(s):  
Shua Azam Priyanka Muhammad Qasim
Keyword(s):  
Motor Nerve ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Third Nerve Palsy ◽  
Cranial Nerve Palsies ◽  
The Right ◽  
Third Nerve ◽  
Cover Test ◽  
Sixth Nerve

Purpose: To determine the frequency of Neurogenic Strabismus presenting at the Orthoptics Clinic in Al-Ibrahim Eye Hospital, Malir Karachi. Study Design: Cross-sectional study. Sampling Technique: Non-probability convenient sampling. Place and Duration of Study: Orthoptics Clinic of Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2018. Material and Methods: This study included 349 subjects age ranged from 5 to 75 years. All ocular examinations for strabismus were performed, including cover test, prism cover test and Hess chart. Demographic features and etiologies were recorded, and the causes of extra ocular muscle palsies were grouped as; trauma, diabetes, hypertension and others. SPSS version 20.0 was used to analyze the data. Results: Frequency of neurogenic strabismus was found to be 6%. Out of 21 subjects, 8 (38.1%) subjects had diabetes, followed by 2 (9.5%) subjects with hypertension, 5 (23.8%) subjects with ocular trauma and 6 (28.6%) subjects with other causes. The most commonly affected side was the right eye seen in 13 (61.9%) subjects. The most common ocular motor nerve involved was abducent (sixth) nerve in 13 (61.9%) subjects, followed by oculomotor (third) nerve in 4 (19%) subjects. Out of the patients with third nerve palsy 3 (14.3%) subjects had pupil sparing and only 1 (4.8%) subject had no pupil sparing. Conclusion: Sixth nerve was the most common nerve involved and most common etiology was uncontrolled diabetes. Keywords: Neurogenic Strabismus, Cranial nerve palsies, Paralytic strabismus

scholarly journals Intracavernous Internal Carotid Artery Aneurysm Presenting as Acute Diplopia: A Case Report

2020 ◽  
Vol 4 (3) ◽  
pp. 362-365
Author(s):  
Austin Brown ◽  
Health Jolliff ◽  
Douglas Poe ◽  
Michael Weinstock
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Internal Carotid ◽  
Artery Aneurysm ◽  
Carotid Artery Aneurysm ◽  
Internal Carotid Artery Aneurysm ◽  
Sixth Nerve

Introduction: Diplopia is an uncommon emergency department (ED) complaint representing only 0.1% of visits, but it has a large differential. One cause is a cranial nerve palsy, which may be from a benign or life-threatening process. Case Report: A 69-year-old female presented to the ED with two days of diplopia and dizziness. The physical exam revealed a sixth cranial nerve palsy isolated to the left eye. Imaging demonstrated an intracavernous internal carotid artery aneurysm. The patient was treated with embolization by neurointerventional radiology. Discussion: The evaluation of diplopia is initially divided into monocular, usually from a lens problem, or binocular, indicating an extraocular process. Microangiopathic disease is the most common cause of sixth nerve palsy; however, more serious etiologies may be present, such as an intracavernous internal carotid artery aneurysm, as in the patient described. Imaging modalities may include computed tomography or magnetic resonance imaging. Conclusion: Some causes of sixth nerve palsy are benign, while others will require more urgent attention, such as consideration of an intracavernous internal carotid artery aneurysm.

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.

Recovery of Cranial Nerve Deficits in Patients Presenting with Pituitary Apoplexy: A Case Series

2021 ◽  
Author(s):  
Mohammed Alahmari ◽  
Fahad Alkherayf ◽  
Andrea Lasso ◽  
Fatmahalzahra Banaz ◽  
Sepideh Mohajeri ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Case Series ◽  
Surgical Decompression ◽  
Tumor Type ◽  
Visual Deficit ◽  
Nerve Recovery ◽  
Sixth Nerve

Abstract Background Pituitary apoplexy (PA) is a rare complication of pituitary tumors that can present with a myriad of symptoms, including sudden onset cranial nerve deficits. After patient stabilization and hormone replacement, surgical decompression is often recommended. The timing of surgical decompression remains controversial. In this case series, we describe our institutional experience pertaining to the cranial nerve recovery in patients who underwent endoscopic endonasal transsphenoidal (EETS) surgery for PA while evaluating outcome based on tumor stage using the suprasellar infrasellar parasellar anterior posterior (SIPAP) classification. Design Present study is a single-institution retrospective cohort. Methods A retrospective review of all EETS cases for pituitary tumor resection between November 2009 and August 2018. Queries of the hospital database were completed by trained personnel to identify cases of PA treated using the EETS approach. Baseline characteristics, tumor type, endocrine data, and SIPAP classification based on preoperative magnetic resonance imaging (MRI) and operation characteristics were extracted from medical records. Postoperative results were extracted for the duration of the follow-up period available for each patient. Results Fifteen cases of PA were identified. Patient follow-up period was a mean of 30 months. The cranial nerve deficits present at admission were visual deficit (33%); unilateral third nerve palsy (47%) and unilateral sixth nerve palsy (27%). No fourth nerve palsies were observed. Following EETS, 60% of patients with preoperative visual deficit had normal visual fields. For those with third and sixth nerve palsies preoperatively, 43 and 75%, respectively, had return to normal function postoperatively. SIPAP tumor characteristics were not related to postoperative cranial nerve recovery. Conclusion In this series of surgically treated patients with pituitary apoplexy, all cranial nerve deficits normalized or improved following surgery. The tumor SIPAP classification was not associated with patient outcome. Though in a small series, the presented results suggest surgical treatment is beneficial for these patients.

Pseudomyasthenia Resulting from a Posterior Carotid Artery Wall Aneurysm: A Novel Presentation: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (6) ◽  
pp. 1466-1469 ◽  
Author(s):  
Ramachandra P. Tummala ◽  
Andrew Harrison ◽  
Michael T. Madison ◽  
Eric S. Nussbaum
Keyword(s):  
Carotid Artery ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Intracranial Aneurysms ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Artery Wall ◽  
Carotid Artery Wall ◽  
Cranial Nerve Dysfunction ◽  
Cranial Nerve Palsies

ABSTRACT OBJECTIVE AND IMPORTANCE Painful oculomotor palsy can result from enlargement or rupture of intracranial aneurysms. The IIIrd cranial nerve dysfunction in this setting, whether partial or complete, is usually fixed or progressive and is sometimes reversible with surgery. We report an unusual oculomotor manifestation of a posterior carotid artery wall aneurysm, which mimicked ocular myasthenia gravis. CLINICAL PRESENTATION A 47-year-old woman developed painless, intermittent, partial IIIrd cranial nerve palsy. She presented with isolated episodic left-sided ptosis, which initially suggested a metabolic or neuromuscular disorder. However, digital subtraction angiography revealed a left posterior carotid artery wall aneurysm, just proximal to the origin of the posterior communicating artery. INTERVENTION The aneurysm was successfully clipped via a pterional craniotomy. During surgery, the aneurysm was observed to be compressing the oculomotor nerve. The patient's symptoms resolved after the operation. CONCLUSION The variability of incomplete IIIrd cranial nerve deficits can present a diagnostic challenge, and the approach for patients with isolated IIIrd cranial nerve palsies remains controversial. Although intracranial aneurysms compressing the oculomotor nerve classically produce fixed or progressive IIIrd cranial nerve palsies with pupillary involvement, anatomic variations may result in atypical presentations. With the exception of patients who present with pupil-sparing but otherwise complete IIIrd cranial nerve palsy, clinicians should always consider an intracranial aneurysm when confronted with even subtle dysfunction of the oculomotor nerve.

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