scholarly journals Benign abducens nerve palsy: diagnosis by exclusion

2019 ◽  
Vol 6 (3) ◽  
pp. 1380
Author(s):  
Praveen U. ◽  
Sushma Save ◽  
Sanjay Singh
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Cranial Nerves ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Immunological Reaction ◽  
Post Vaccination ◽  
Lateral Rectus Muscle ◽  
Diagnosis By Exclusion ◽  
History Of

Of all the cranial nerves, the abducens nerve has the longest intracranial course hence is most common cranial nerve to be affected secondary to any potentially devastating intracranial cause. It can indicate significant underlying pathology. Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. Most of the time it will be unilateral but bilateral involvement is also well known. It can recurrent without any underlying identifiable pathology. The 6th nerve palsy is considered as benign after ruling out all possible causes. Benign causes account for just 9 to 14% of all 6th nerve palsies in children. Most of the time benign 6th nerve palsy occurs after viral infection or vaccination as an immunological reaction. In our case patient had history of pentavalent vaccination 1 month back. After thorough investigation and ruling out all possible causes it was attributed to post vaccination immunological reaction. which resolved spontaneously over 4months.

scholarly journals Bilateral traumatic paralysis of abducent nerves and clivus fracture: Case Report

2014 ◽  
Vol 21 (4) ◽  
pp. 507-509
Author(s):  
Willen Guillermo Calderon-Miranda ◽  
Hernando Raphael Alvis-Miranda ◽  
Gabriel Alcala-Cerra ◽  
Luis Rafael Moscote-Salazar
Keyword(s):  
Nerve Palsy ◽  
Cranial Nerves ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Abducens Nerve Palsy ◽  
Traumatic Injuries ◽  
Cranial Trauma ◽  
Lateral Rectus Muscle ◽  
Clivus Fracture ◽  
Bilateral Abducens

Abstract Clivus fractures are a rare pathology, frecuently associated tohigh power trauma. Such injuries may be associated with vascular and cranial nerves lesions. The abducens nerve is particularly vulnerable to traumatic injuries due to its long intracranial course, since their real origin until the lateral rectus muscle. The unilateral abducens nerve palsy of 1- 2-7% occurs in patients with cranial trauma, bilateral paralysis is rare. We report a patient who presented bilateral abducens nerve palsy associated with a clivus fracture

The abducens nerve

1974 ◽  
Vol 41 (5) ◽  
pp. 561-566 ◽  
Author(s):  
Hilel Nathan ◽  
Georges Ouaknine ◽  
Isaac Z. Kosary
Keyword(s):  
Cavernous Sinus ◽  
Subarachnoid Space ◽  
Cranial Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
The Other ◽  
Sixth Cranial Nerve ◽  
Content Type ◽  
Lateral Rectus Muscle ◽  
Fine Print

✓ The authors describe the origins and course of the sixth cranial nerve in 62 cadaver or autopsy cases and describe three patterns. In Pattern 1 the nerve originates and runs all its way as a single trunk. In Pattern 2 it originates as a single trunk, but splits into two branches in the subarachnoid space, while in Pattern 3 it originates as two separate trunks. In both Patterns 2 and 3 the trunks perforate the dura mater independently and enter the cavernous sinus by passing one above and the other below the petrosphenoidal ligament. In the sinus the two trunks fuse into a single trunk which then continues to the lateral rectus muscle. The practical neurological importance of these variations is discussed.

scholarly journals Tumors Presenting as Multiple Cranial Nerve Palsies

2017 ◽  
Vol 9 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Kishore Kumar ◽  
Rafeeq Ahmed ◽  
Bharat Bajantri ◽  
Amandeep Singh ◽  
Hafsa Abbas ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Systemic Disease ◽  
Cranial Nerves ◽  
B Cell Lymphoma ◽  
Abducens Nerve ◽  
Cranial Nerve Involvement ◽  
Nerve Involvement ◽  
Cranial Nerve Palsies ◽  
Multiple Cranial Nerve

Cranial nerve palsy could be one of the presenting features of underlying benign or malignant tumors of the head and neck. The tumor can involve the cranial nerves by local compression, direct infiltration or by paraneoplastic process. Cranial nerve involvement depends on the anatomical course of the cranial nerve and the site of the tumor. Patients may present with single or multiple cranial nerve palsies. Multiple cranial nerve involvement could be sequential or discrete, unilateral or bilateral, painless or painful. The presentation could be acute, subacute or recurrent. Anatomic localization is the first step in the evaluation of these patients. The lesion could be in the brain stem, meninges, base of skull, extracranial or systemic disease itself. We present 3 cases of underlying neoplasms presenting as cranial nerve palsies: a case of glomus tumor presenting as cochlear, glossopharyngeal, vagus and hypoglossal nerve palsies, clivus tumor presenting as abducens nerve palsy, and diffuse large B-cell lymphoma presenting as oculomotor, trochlear, trigeminal and abducens nerve palsies due to paraneoplastic involvement. History and physical examination, imaging, autoantibodies and biopsy if feasible are useful for the diagnosis. Management outcomes depend on the treatment of the underlying tumor.

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

The Abducens Nerve: Microanatomic and Endoscopic Study

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-7-ONS-14 ◽  
Author(s):  
Giorgio Iaconetta ◽  
Mario Fusco ◽  
Luigi M. Cavallo ◽  
Paolo Cappabianca ◽  
Madjid Samii ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Nerve Injuries ◽  
Endoscopic Endonasal ◽  
Lateral Rectus Muscle ◽  
Endoscopic Study ◽  
Anatomic Dissection ◽  
Neurovascular Structures

Abstract Objective: Only a few anatomic studies concerning the intra- or extracranial course of the abducens nerve (Cranial Nerve VI) have been reported. This is likely because the nerve passes through anatomically intricate areas, making its neurovascular relationships complex. Here we provide an anatomically and surgically oriented classification of the abducens nerve, analyze the microanatomy of the nerve and the surrounding connective and/or neurovascular structures, and provide measurements and anatomic topography. Patients and Methods: A microsurgical anatomic dissection of 55 cadaveric human heads was performed using different skull base approaches to explore the entire course of the VIth cranial nerve, from its origin at the pontomedullary sulcus to the lateral rectus muscle. We then approached the same areas via an endoscopic endonasal transsphenoidal route, analyzed the neurovascular relationships from an anteromedial perspective, and made comparisons with the microsurgical views. Results: The abducens nerve is divided into five segments, of which three are intracranial (cisternal, gulfar, and cavernous) and two are orbital (fissural and intraconal). Using two opposing surgical routes (microsurgical transcranial and endoscopic endonasal approaches) allows us to clearly reveal the spatial relationships of the abducens nerve with other neurovascular structures on the different nerve segments. Conclusion: The classification of five segments for the abducens nerve seems anatomically valid and is surgically oriented with respect to both the microscopic and endonasal endoscopic approaches. It would be useful to explain, segment by segment, the pathogenic mechanism(s) for nerve injuries that are evidenced by lesions that exist along the entire intra- and extracranial course.

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.

Intramuscular Distribution of the Abducens Nerve in the Lateral Rectus Muscle for the Management of Strabismus

2018 ◽  
Vol 43 (6) ◽  
pp. 689-695 ◽  
Author(s):  
Hyun Jin Shin ◽  
Shin-Hyo Lee ◽  
Kang-Jae Shin ◽  
Ki-Seok Koh ◽  
Wu-Chul Song
Keyword(s):  
Rectus Muscle ◽  
Abducens Nerve ◽  
Lateral Rectus ◽  
Lateral Rectus Muscle

Orbital Nerves

2012 ◽  
Author(s):  
David Jordan ◽  
Louise Mawn ◽  
Richard L. Anderson
Keyword(s):  
Lacrimal Gland ◽  
Cranial Nerve ◽  
Motor Nerve ◽  
Rectus Muscle ◽  
Abducens Nerve ◽  
Sympathetic Nerves ◽  
Lower Eyelid ◽  
Infraorbital Nerve ◽  
Ciliary Ganglion ◽  
Orbital Surgery

The orbit contains a vast array of motor, sensory, sympathetic, and parasympathetic nerve fibers. Some of these fibers can be seen during eyelid or orbital surgery and are often landmarks of one’s location within the orbit. It is important to know the various nerve pathways, appreciate that there might be some individual variation, and preserve these pathways during orbital surgery. The discussion of nerves begins with their superficial brainstem origin, proceeds to their intracranial course, and ends with their intraorbital course and eventual termination. The following nerves enter the orbit: 1. Optic nerve (cranial nerve II). 2. Oculomotor nerve (cranial nerve III). This motor nerve gives fibers to the levator, inferior oblique, and three of the four rectus muscles. It carries parasympathetic fibers destined for the ciliary ganglion. These fibers will eventually synapse in the ciliary ganglion and then travel to the iris sphincter muscles (sphincter pupillae). Sympathetic fibers have also been recently identified in this nerve. 3. Trochlear nerve (cranial nerve IV). This motor nerve distributes fibers to the superior oblique muscle. Sympathetic fibers have recently been identified within this nerve. 4. Trigeminal nerve (cranial nerve V). a. Ophthalmic division (V 1 ) . This sensory division gives fibers to the eyeball (iris, ciliary body, cornea), lacrimal gland, conjunctiva, and eyelids, as well as to the forehead. It also carries sympathetic nerves. b. Maxillary division (V 2 ) . As it enters the orbit, the maxillary division is known as the infraorbital nerve and lies beneath the periorbita. It gives off the zygomatic nerve, which is an important branch carrying parasympathetic and sympathetic fibers to the lacrimal gland. Within the infraorbital canal, alveolar nerves arise and provide sensation to the incisor and canine teeth. The infraorbital nerve provides sensation to the lower eyelid, nose, cheek area, and upper lip. 5. Abducens nerve (cranial nerve VI). This motor nerve goes to the lateral rectus muscle. Sympathetic fibers have recently been identified within this nerve.

The Extraocular Muscles and Diplopia

2014 ◽  
pp. 124-161
Author(s):  
Shirley H. Wray ◽  
Shirley H. Wray
Keyword(s):  
Eye Movements ◽  
Nerve Palsy ◽  
Neuromuscular Junctions ◽  
Cranial Nerves ◽  
Abducens Nerve ◽  
Extraocular Muscles ◽  
Oblique Muscle ◽  
Oculomotor Nerve Palsy ◽  
Subjective Complaint ◽  
Oculomotor Nuclei

deals with action and innervation of the extraocular muscles. In their intact state, the extraocular muscles and the cranial nerves that innervate them are responsible for every movement of the eyes signaled by the cortex. Diplopia, or double vision, is the commonest subjective complaint associated with a lesion affecting the extraocular muscles, their neuromuscular junctions, the oculomotor nuclei or nerve, or pathways in the brainstem that maintain alignment of the eyes. The diplopia history focuses on distinguishing monocular from binocular diplopia and the diplopia examination pays attention to head position, ocular alignment, and the range of eye movements during monocular and binocular viewing as keys to diagnosis. Diplopia with full eye movements is fully discussed. Four illustrative cases are presented: episodic diplopia due to ocular myasthenia gravis; a case of esotropia (paresis of the lateral rectus with inward deviation of the eye) due to an abducens nerve palsy; a case of exotropia (paresis of the medial rectus with outward deviation of the eye) due to a fascicular oculomotor nerve palsy; and a case of hypertropia (vertical misalignment of the eyes due to paresis of the superior oblique muscle vs. skew deviation) caused by a post-traumatic trochlear nerve palsy.

Augmented vertical rectus transpositions: Intraoperative measurement of torsion following sequential muscle detachment

2020 ◽  
pp. 112067212094656
Author(s):  
Massimiliano Serafino ◽  
Matteo Scaramuzzi ◽  
Adriano Magli ◽  
Paolo Nucci
Keyword(s):  
Adverse Effects ◽  
Monitoring System ◽  
Intraoperative Monitoring ◽  
Nerve Palsy ◽  
Rectus Muscle ◽  
Lateral Rectus ◽  
Inferior Rectus ◽  
Complete Transposition ◽  
Lateral Rectus Muscle ◽  
Sixth Nerve

Introduction: After vertical recti transposition surgery, a torsional change may occur. We hypothesized that step-by-step monitoring of the intraoperative torsional position of the eye can avoid any unexpected complications and identify critical moments of surgery that may have adverse effects. Methods: Nine patients with sixth nerve palsy that underwent complete transposition of the superior (SR) and inferior rectus (IR) muscles to the lateral rectus muscle by means of the technique of augmented vertical recti transposition were prospectively included. The torsional position of the eye was recorded at eight stages of the procedure. Results: We observed two distinct patterns of induced torsional deviation during partial disinsertion of a vertical rectus muscle depending on whether disinsertion began medially or laterally, after cutting about 3/4 of the muscle fibers: ¾ nasal disinsertion of the SR and ¾ temporal disinserton of the IR caused intorsion, ¾ temporal disinsertion of the SR and ¾ nasal disinsertion of the IR caused extorsion. Torsion improved after the vertical rectus was attached temporally to the sclera along the spiral of Tillaux with tying of the augmentation suture to the LR. The greatest change in torsion was from ¾ temporal disinsertion of the SR (5°extorsion), to reattachment along the spiral of Tillaux temporally (5°intorsion). Conclusion: The SR and IR have different torsional effects, which only appears when more than half of the fibers are detached. Augmented transposition does not cause any additional torsional effects. This intraoperative monitoring system can be used to detect unintended torsional complications, especially during transposition surgery.

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