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Seminars in Neurology Oct 2015An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing... (Review)
Review
An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing neurologic signs or symptoms. When occurring in patients aged 50 or older, the most common cause is microvascular ischemia, but serious etiologies such as aneurysm, malignancy, and giant cell arteritis should always be considered. In this article, the authors review the clinical approach, anatomy, and differential diagnosis of each isolated ocular motor nerve palsy and discuss the clinical characteristics, pathophysiology, and treatment of microvascular ischemia.
Topics: Abducens Nerve Diseases; Humans; Oculomotor Nerve Diseases; Paralysis; Trochlear Nerve Diseases
PubMed: 26444399
DOI: 10.1055/s-0035-1563568 -
Italian Journal of Pediatrics Jun 2016Moebius syndrome (MBS) is rare disease characterized by nonprogressive congenital uni- or bi-lateral facial (i. e. VII cranial nerve) and abducens (i. e. VI cranial...
BACKGROUND
Moebius syndrome (MBS) is rare disease characterized by nonprogressive congenital uni- or bi-lateral facial (i. e. VII cranial nerve) and abducens (i. e. VI cranial nerve) palsy. Although the neurological and ophthalmological findings are quite well-known, data concerning the attendant functional difficulties and their changes over time are seldom addressed. In this study we attempt to estimate the prevalence of clinical and functional data in an Italian cohort affected by MBS.
METHODS
The study included 50 children, 21 males and 29 females, aged 1 month to 14 years. The patients entered into a multidisciplinary diagnostic and follow-up protocol that had the specific purpose of detecting clinical and developmental deficits related to MBS.
RESULTS
Involvement of the VII cranial nerve (total/partial, bilateral or unilateral) was present in 96 % of patients, and of the VI nerve in 85 %. Two patients were without impairment of the VII nerve and seven patients had no involvement of the VI nerve and were thus classified as Moebius-like because of the involvement of other CNs. Additional affected CNs were numbers III-IV in 16 %, V in 11 %, VIII and X each in 8 %, the XI in 6 %, the IX, most often partially, in 22 %, and the XII in 48 % of cases. Their development was characterized by global delay at one year of age, motor, emotional and speech difficulties at two years of age, a trend toward normalization at three years of age but with weakness in hand-eye coordination, and achieving average results at five years of age. Overall 90 % of children had a normal developmental quotient whereas only 10 % manifested cognitive deficits.
CONCLUSION
Early rehabilitation may enhance the recovery of normal function, particularly in vulnerable areas of development. It is possible that early intervention that integrates sensory and visual information with emotional difficulties can improve the prognosis of the child with MBS.
Topics: Abducens Nerve; Adolescent; Child; Child, Preschool; Cohort Studies; Disability Evaluation; Early Medical Intervention; Facial Nerve; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Italy; Male; Mobius Syndrome; Neuropsychological Tests; Rare Diseases; Risk Assessment; Treatment Outcome
PubMed: 27260152
DOI: 10.1186/s13052-016-0256-5 -
The Kurume Medical Journal Mar 2022An ossified left petroclinoid ligament was found during routine dissection of the skull base in an adult male cadaver. The petroclinoid ligament is clinically and... (Review)
Review
An ossified left petroclinoid ligament was found during routine dissection of the skull base in an adult male cadaver. The petroclinoid ligament is clinically and surgically important given its anatomical relationships to cranial nerves III, V, and VI, so its ossification is a risk factor for injuries due to trauma, increased intracranial pressure, and vascular and tumor compression resulting in abducens and oculomotor palsies. The causes of petroclinoid ligament ossification are yet to be completely elucidated although several reports have associated them with age-related and physiological processes. Assessing the integrity of the petroclinoid ligament is important during skull base surgical interventions to avoid postoperative complications. Therefore, this paper reviews the petroclinoid ligament and its variation, the ossified petroclinoid ligament.
Topics: Abducens Nerve; Adult; Cadaver; Dissection; Humans; Ligaments; Male; Osteogenesis
PubMed: 35095019
DOI: 10.2739/kurumemedj.MS671007 -
Seminars in Ultrasound, CT, and MR Oct 2022The abducens, or the sixth cranial nerve, is purely motor and runs a long course from the brainstem to the lateral rectus. Travels with the inferior petrosal sinus...
The abducens, or the sixth cranial nerve, is purely motor and runs a long course from the brainstem to the lateral rectus. Travels with the inferior petrosal sinus through the Dorello's canal before entering the cavernous sinus. Based on the location of an abnormality, other neurologic structures may be involved with the disturbs related to this nerve. This article aims to review the abducens nerve anatomy and demonstrates the imaging aspect of the diseases that most commonly affect it.
Topics: Abducens Nerve; Cavernous Sinus; Humans
PubMed: 36116854
DOI: 10.1053/j.sult.2022.04.008 -
World Neurosurgery Apr 2018Branching and/or replication of the abducens nerve is not an uncommon occurrence. Although numerous variations have been documented, the rarest forms are duplicated or... (Review)
Review
BACKGROUND
Branching and/or replication of the abducens nerve is not an uncommon occurrence. Although numerous variations have been documented, the rarest forms are duplicated or triplicated nerves, where multiple nerve roots originate from the brainstem, travel intracranially, and attach to the lateral rectus as separate entities.
METHODS
We conducted a systematic literature search on the topic of supernumerary abducens nerve, using PubMed and Google Scholar.
RESULTS
After screening, 16 studies were included: 11 cadaveric studies and 6 case reports.
CONCLUSIONS
In this paper, we review the literature on variations found, discuss current hypotheses and clinical relevance, and propose future studies. Neurosurgeons should be aware of such nerve variants when viewing imaging or operating in the regions traversed by the abducens nerve.
Topics: Abducens Nerve; Humans
PubMed: 29158094
DOI: 10.1016/j.wneu.2017.11.052 -
Current Neurology and Neuroscience... Aug 2016Abducens nerve palsy is a common clinical finding in neurology practice. In many instances, the origin is obvious and management straightforward; however, the list of... (Review)
Review
Abducens nerve palsy is a common clinical finding in neurology practice. In many instances, the origin is obvious and management straightforward; however, the list of possible etiologies and mimics is vast and diverse and diagnostic decisions can be challenging and even controversial. This is especially true when the abducens nerve is affected in isolation, since in the current era of cost-effective medicine, it is critical to accurately diagnose etiologies that may lead to major morbidity or mortality with efficiency. Topics for highlighted updates in this review include management of isolated abducens nerve palsy with a high likelihood of a microvascular ischemic etiology; common imaging pitfalls and current state-of-the-art neuroimaging; and abducens palsy mimics.
Topics: Abducens Nerve Diseases; Diplopia; Humans; Neuroimaging
PubMed: 27306521
DOI: 10.1007/s11910-016-0671-4 -
World Neurosurgery Oct 2023Neurovascular compression (NVC) as the cause of abducens nerve palsy is an infrequent event. Only a small number of cases have been reported in the literature, and the... (Review)
Review
BACKGROUND
Neurovascular compression (NVC) as the cause of abducens nerve palsy is an infrequent event. Only a small number of cases have been reported in the literature, and the efficacy of microvascular decompression (MVD) for abducens nerve palsy remains unclear.
METHODS
We reviewed previously reported cases of abducens nerve palsy caused by NVC and added our own cases. We analyzed the clinical characteristics of vascular compression abducens nerve palsy and assessed the indication for MVD.
RESULTS
Twenty-two patients with isolated abducens nerve palsy due to vascular compression were confirmed in total, consisting of 20 patients (19 publications) from the literature search and 2 cases from our experienced cases. All patients had no possible causes for isolated abducens nerve palsy except the NVC on the nerve root. Unlike the sudden onset in the typical abducens nerve palsy, all patients demonstrated gradual development of the symptom in NVC-related abducens palsy. Careful observation was the most common strategy in most patients; however, no noticeable improvement was reported in the conservative treatment. Surgical intervention was performed in 6 patients after observation for several months and showed favorable outcomes in all cases.
CONCLUSIONS
Vascular compression could be a potential cause of abducens nerve palsy. Gradual onset or episodic symptom of abducens palsy with a definitive radiological finding of vascular compression deserves considering MVD for abducens nerve palsy.
PubMed: 37451362
DOI: 10.1016/j.wneu.2023.07.019 -
Primary Care Sep 2015Defining the type of strabismus creates a framework for work-up and management. Comitant esotropia is most commonly a childhood condition treated with glasses and... (Review)
Review
Defining the type of strabismus creates a framework for work-up and management. Comitant esotropia is most commonly a childhood condition treated with glasses and surgery. Comitant exotropia is often a childhood condition that may require surgical correction. Microvascular disease is the most common cause of ocular cranial nerve palsies in adult patients.
Topics: Abducens Nerve; Cranial Nerves; Esotropia; Exotropia; Humans; Oculomotor Nerve; Primary Health Care; Referral and Consultation; Strabismus; Trochlear Nerve
PubMed: 26319345
DOI: 10.1016/j.pop.2015.05.006 -
Northern Clinics of Istanbul 2022Abducens nerve paralysis is the most common ocular motor neuropathy. In this article, we aimed to compare the causes of isolated abducens nerve palsy in terms of...
OBJECTIVE
Abducens nerve paralysis is the most common ocular motor neuropathy. In this article, we aimed to compare the causes of isolated abducens nerve palsy in terms of demographic, clinical features, and prognosis.
METHODS
Thirty-six isolated abducens nerve palsy patients were prospectively enrolled in the study. The demographic, clinical features, and prognosis compared in two etiological groups as microvascular and other causes.
RESULTS
The most common etiology was microvascular, which was seen in 16/36 (44.4%) patients. Mean clinical recovery time was 2.5±1.3 months (range, 10 days-6 months). When etiological groups were compared as microvascular and other causes, the mean age of the microvascular group was significantly higher (62.8±13.3 vs. 44.5±16.4, p=0.001). Diabetes mellitus was seen significantly higher in the microvascular group than other causes group (p=0.001), but no significant difference was observed in terms of other atherosclerotic risk factors (p>0.05). The fasting blood glucose and hemoglobin A1c value were significantly higher in the microvascular group (p=0.02 and p=0.02, respectively). There was no significant difference in terms of clinical improvement and clinical recovery times between groups (p>0.05).
CONCLUSION
There is no difference between microvascular group and other causes in terms of clinical outcome, while the mean age and presence of diabetes were higher in the microvascular group. The presence of diabetes should be questioned in cases with isolated abducens nerve palsy.
PubMed: 36276565
DOI: 10.14744/nci.2021.15483