scholarly journals Headache with cranial nerve palsy – a diagnostic and therapeutic challenge in three cases

2020 ◽  
Vol 93 (2) ◽  
pp. 84-92
Author(s):  
Jakab Erika ◽  
Rokaly Gabriella ◽  
Balla Antal ◽  
Albert Orsolya ◽  
Mihály István ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Cranial Nerve ◽  
Unknown Origin ◽  
Symptomatic Treatment ◽  
Primary Headaches ◽  
Secondary Headaches ◽  
Cranial Nerve Palsies ◽  
Facial Nerves ◽  
Neurology Clinic ◽  
Long Term Follow Up

Abstract Headaches are among the most common complaints in the Neurology Clinic. As a symptom, headache is often a problem not only for the patient, but also for the doctor, as in addition to primary headaches, secondary headaches can have various etiologies. Among the primary headaches, migraine and cluster headaches may present cranial nerve symptoms. The differential diagnosis of secondary headaches can be difficult. We have to include vascular, neoplastic, infectious, inflammatory, toxic, autoimmune causes, where diagnosis requires complex laboratory and/or imaging studies, while the absence of abnormal findings often suggests autoimmune or unknown origin. In our review, we aim to present three cases where the headache was associated with cranial nerve involvement, mainly ophthalmoparesis. The course of the disease was long in all three cases, characterized by symptom-free periods alternating with paroxysmal headaches and diverse cranial nerve palsies. Most frequently, the oculomotor and abducent cranial nerve palsies were observed, but the involvement of trigeminal and facial nerves occurred as well. Based on the symptoms, there was a suspicion of a lesion of the cavernous sinus in all three cases, however, this couldn’t be confirmed by advanced neuroimaging techniques. In addition to symptomatic treatment, steroid therapy improved the complaints, but neurological signs did not disappear in all cases. Furthermore, the signs reappeared after a short time or a different cranial nerve was involved. The lack of a positive diagnosis, the fluctuating course of the disease, and the side effects of steroid therapy demand a long-term follow-up, which is possible only through an appropriate doctor-patient relationship. As guidelines are difficult to elaborate on for such cases, continuous re-evaluation of diagnosis and treatment are required.

Cranial Nerve Palsies As a Manifestation of Peripheral Neuritis in Alcoholic Insanity

1934 ◽  
Vol 80 (328) ◽  
pp. 103-110
Author(s):  
D. J. O'Connell ◽  
J. McLeman ◽  
Ruby O. Stern
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerves ◽  
Neurological Complications ◽  
Text Book ◽  
Peripheral Neuritis ◽  
Cranial Nerve Palsies ◽  
Facial Nerves

In the literature on neurological complications of alcoholism but scant reference has been made to the occurrence of cranial nerve palsies in alcoholic peripheral neuritis. Although Russell Brain (1) states that there is no form of polyneuritis in which the cranial nerves may not suffer, he refers to the rarity with which they are affected in the alcoholic form, and mentions only the vagus and the facial nerves as being occasionally involved. Collier and Adie (2) in Price's Text-book of Medicine state that facial palsies, ptosis, nystagmus and weakness of the extra-ocular muscles have been observed, whilst Feiling (3) writes in the Oxford Medicine that with the exception of nystagmus, involvement of the cranial nerves is very rare in alcoholic neuritis.

Combination of microsurgery and Gamma Knife surgery for the treatment of intracranial chondrosarcomas

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 18-25 ◽  
Author(s):  
Petter Förander ◽  
Tiit Rähn ◽  
Lars Kihlström ◽  
Elfar Ulfarsson ◽  
Tiit Mathiesen
Keyword(s):  
Gamma Knife ◽  
Cranial Nerve ◽  
Residual Tumor ◽  
Local Tumor Control ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Tumor Control ◽  
Low Grade ◽  
Cranial Nerve Palsies ◽  
Tumor Volume Reduction

ObjectIntracranial chondrosarcomas have a high risk of recurrence after surgery. This retrospective study of patients with intracranial chondrosarcoma was conducted to determine the long-term results of microsurgery followed by Gamma Knife surgery (GKS) for residual tumor or recurrence.MethodsThe authors treated nine patients whose median age was 36 years. Seven patients had low-grade chondrosarcomas (LGCSs), whereas mesenchymal chondrosarcomas (MCSs) were diagnosed in two. Radiosurgery was performed in eight patients, whereas one patient declined further surgical intervention and tumor-volume reduction necessary for the GKS.The patients were followed up for 15 to 173 months (median 108 months) after diagnosis and 3 to 166 months (median 88 months) after GKS. Seven patients had residual tumor tissue after microsurgery, and two operations appeared radical. In the two latter cases, tumors recurred after 25 and 45 months. Thus, definite tumor control was not achieved after surgery alone in any patient, whereas the addition of radiosurgery allowed tumor control in all six patients with LGCSs. Two of these patients experienced an initial tumor regrowth after GKS; in both cases the recurrences were outside the prescribed radiation field. The patients underwent repeated GKS, and subsequent tumor control was observed. An MCS was diagnosed in the remaining two patients. Complications after microsurgery included diplopia, facial numbness, and paresis. After GKS, one patient had radiation necrosis, which required microsurgery, and two patients had new cranial nerve palsies.Conclusions Tumor control after microsurgery alone was not achieved in any patient, whereas adjuvant radiosurgery provided local tumor control in six of eight GKS-treated patients. Tumor control was not achieved in the two patients with MCS. Similar to other treatments for intracranial chondrosarcoma, morbidity after micro- and radiosurgical combination therapy was high and included severe cranial nerve palsies.

scholarly journals Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

2019 ◽  
Vol 23 (3) ◽  
pp. 325-332
Author(s):  
Manish Kuchakulla ◽  
Ashish H. Shah ◽  
Valerie Armstrong ◽  
Sarah Jernigan ◽  
Sanjiv Bhatia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Cranial Nerve ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Morbidity ◽  
Balloon Test Occlusion ◽  
Cranial Nerve Palsies ◽  
Carotid Body Tumors

OBJECTIVECarotid body tumors (CBTs), extraadrenal paragangliomas, are extremely rare neoplasms in children that often require multimodal surgical treatment, including preoperative anesthesia workup, embolization, and resection. With only a few cases reported in the pediatric literature, treatment paradigms and surgical morbidity are loosely defined, especially when carotid artery infiltration is noted. Here, the authors report two cases of pediatric CBT and provide the results of a systematic review of the literature.METHODSThe study was divided into two sections. First, the authors conducted a retrospective review of our series of pediatric CBT patients and screened for patients with evidence of a CBT over the last 10 years (2007–2017) at a single tertiary referral pediatric hospital. Second, they conducted a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of all reported cases of pediatric CBTs to determine the characteristics (tumor size, vascularity, symptomatology), treatment paradigms, and complications.RESULTSIn the systematic review (n = 21 patients [includes 19 cases found in the literature and 2 from the authors’ series]), the mean age at diagnosis was 11.8 years. The most common presenting symptoms were palpable neck mass (62%), cranial nerve palsies (33%), cough or dysphagia (14%), and neck pain (19%). Metastasis occurred only in 5% of patients, and 19% of cases were recurrent lesions. Only 10% of patients presented with elevated catecholamines and associated sympathetic involvement. Preoperative embolization was utilized in 24% of patients (external carotid artery in 4 and external carotid artery and vertebral artery in 1). Cranial nerve palsies (cranial nerve VII [n = 1], IX [n = 1], X [n = 4], XI [n = 1], and XII [n = 3]) were the most common cause of surgical morbidity (33% of cases). The patients in the authors’ illustrative cases underwent preoperative embolization and balloon test occlusion followed by resection, and both patients suffered from transient Horner’s syndrome after embolization.CONCLUSIONSSurgical management of CBTs requires an extensive preoperative workup, anesthesia, and multimodal surgical management. Due to a potentially high rate of surgical morbidity and vascularity, balloon test occlusion with embolization may be necessary in select patients prior to resection. Careful thorough preoperative counseling is vital to preparing families for the intensive management of these children.

A guide to the evaluation of fourth cranial nerve palsies

Strabismus ◽  
1998 ◽  
Vol 6 (4) ◽  
pp. 191-200 ◽  
Author(s):  
Andrew G. Lee ◽  
L. Anne Hayman ◽  
Hilary A. Beaver ◽  
Thomas C. Prager ◽  
Steve H. Kelder ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Fourth Cranial Nerve

A Woman with Pansinusitis and Cranial Nerve Palsies

2000 ◽  
Vol 35 (10) ◽  
pp. 31-33 ◽  
Author(s):  
Daniel A. Reichmuth ◽  
Kim A. Mannell ◽  
Harold M. Adelman ◽  
Edward P. Cutolo ◽  
Rajani P. Shah ◽  
...  
Keyword(s):  
Cranial Nerve ◽  
Cranial Nerve Palsies

Cranial Nerve and Hearing Function after Combined-Approach Surgery for Glomus Jugulare Tumors

1996 ◽  
Vol 105 (12) ◽  
pp. 949-954 ◽  
Author(s):  
Mislav Gjuric ◽  
Stephan Rüdiger Wolf ◽  
Malte Erik Wigand ◽  
Manfred Weidenbecher
Keyword(s):  
Tumor Growth ◽  
Cranial Nerve ◽  
Functional Results ◽  
Surgical Approaches ◽  
Tumor Removal ◽  
Transcervical Approach ◽  
Glomus Jugulare ◽  
Cranial Nerve Palsies ◽  
Ablative Surgery ◽  
The Individual

In this retrospective study, oncologic and functional results of 46 patients treated for glomus jugulare tumor are reported. The standard surgical approach was the combined transmastoid-transcervical approach, modified according to the individual tumor growth, and eventually combined with a transtemporal or a suboccipital approach. Complete tumor removal resulted in a cure rate of 90%. New-onset cranial nerve palsies developed in less than 22% of patients. In 54% of cases it was possible to retain middle ear function. From a total of 12 patients with incomplete tumor removal and postoperative irradiation, progressive tumor growth was noted in 4 patients, and was controlled by salvage irradiation or surgery. Radical tumor removal by ablative surgery can be modified by efforts to reduce mutilating resections. In their place, individually tailored and combined multidirectional surgical approaches may allow total tumor removal with lower morbidity.

Hypoxic mechanisms in primary headaches

Cephalalgia ◽  
2016 ◽  
Vol 37 (4) ◽  
pp. 372-384 ◽  
Author(s):  
Josefine Britze ◽  
Nanna Arngrim ◽  
Henrik Winther Schytz ◽  
Messoud Ashina
Keyword(s):  
Cluster Headache ◽  
High Altitude ◽  
Acute Mountain Sickness ◽  
Experimental Studies ◽  
Epidemiological Studies ◽  
Primary Headaches ◽  
Secondary Headaches ◽  
Novel Approach ◽  
Calcitonin Gene ◽  
Level Of Knowledge

Background Hypoxia causes secondary headaches such as high-altitude headache (HAH) and headache due to acute mountain sickness. These secondary headaches mimic primary headaches such as migraine, which suggests a common link. We review and discuss the possible role of hypoxia in migraine and cluster headache. Methods This narrative review investigates the current level of knowledge on the relation of hypoxia in migraine and cluster headache based on epidemiological and experimental studies. Findings Epidemiological studies suggest that living in high-altitude areas increases the risk of migraine and especially migraine with aura. Human provocation models show that hypoxia provokes migraine with and without aura, whereas cluster headache has not been reliably induced by hypoxia. Possible pathophysiological mechanisms include hypoxia-induced release of nitric oxide and calcitonin gene-related peptide, cortical spreading depression and leakage of the blood-brain barrier. Conclusion There is a possible link between hypoxia and migraine and maybe cluster headache, but the exact mechanism is currently unknown. Provocation models of hypoxia have yielded interesting results suggesting a novel approach to study in depth the mechanism underlying hypoxia and primary headaches.

Headache

2018 ◽  
Author(s):  
Benjamin W Friedman
Keyword(s):  
Differential Diagnosis ◽  
Clinical Characteristics ◽  
Sinus Thrombosis ◽  
International Headache Society ◽  
Primary Headache ◽  
Primary Headaches ◽  
Key Words Migraine ◽  
Secondary Headaches ◽  
Primary Headache Disorders ◽  
Greater Occipital Nerve

Headaches are one of the most common complaints of patients seen by emergency physicians. They can be classified as primary headaches, which have no identifiable underlying cause, and secondary headaches, which are classified according to their cause. The majority of headaches are benign in origin, and most patients with headache can be treated successfully in the emergency department and discharged home; however, some have potentially life-threatening causes, and consideration of a broad differential diagnosis for all patients is essential. This review covers the primary headache disorders, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes. The figure shows areas of the brain sensitive to pain. Tables review differential diagnosis of headache, International Headache Society primary headache criteria, clinical characteristics of secondary headaches, high-risk clinical characteristics among patients with a headache peaking in intensity within 1 hour, drugs associated with headache, and parenteral treatment of acute migraine. This review contains 1 figure, 9 tables, and 58 references. Key words: migraine, calcitonin gene related peptide, greater occipital nerve block, venous sinus thrombosis, reversible cerebral vasoconstriction syndrome, Ottawa, subarachnoid, cluster headache, trigeminal autonomic cephalalgias, post-traumatic headache

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