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Arquivos de Neuro-psiquiatria Jan 2019Changes in postural balance and visual complaints are frequent consequences of stroke. We aimed to investigate the symptoms and the vestibular and oculomotor functions... (Observational Study)
Observational Study
OBJECTIVE
Changes in postural balance and visual complaints are frequent consequences of stroke. We aimed to investigate the symptoms and the vestibular and oculomotor functions of patients with dizziness post ischemic and hemorrhagic stroke and compare the results among them.
METHODS
Fifty patients with dizziness after stroke were evaluated through a clinical anamnesis and computerized vector electronystagmography: calibration of ocular movements, spontaneous nystagmus, semi-spontaneous nystagmus, pendular tracking, optokinetic nystagmus, rotary chair testing, and the caloric test.
RESULTS
All patients complained of dizziness, especially imbalance. Ischemic stroke in the carotid territory was the prevalent type. Visual complaints were reported by 56% of the sample and were related to abnormalities in oculomotor and caloric tests.
CONCLUSION
The occurrence of visual symptoms was related to some abnormalities in the vector electronystagmography tests, being more frequent in cases of stroke in the vertebrobasilar system, and with oscillopsia and reduced visual acuity as symptoms.
Topics: Adult; Aged; Aged, 80 and over; Caloric Tests; Cross-Sectional Studies; Dizziness; Electronystagmography; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Oculomotor Nerve; Statistics, Nonparametric; Stroke; Vestibular Function Tests; Vestibule, Labyrinth; Vision Disorders; Visual Acuity
PubMed: 30758439
DOI: 10.1590/0004-282X20180154 -
Neurology India 2023Third nerve palsy is a rare complication of transsphenoidal surgery and has been merely mentioned in different studies, but there is not any rigorous analysis focusing...
Third nerve palsy is a rare complication of transsphenoidal surgery and has been merely mentioned in different studies, but there is not any rigorous analysis focusing on this particular complication. The purpose of this study is to analyze this complication after transsphenoidal surgery for a pituitary adenoma to better understand its pathophysiology and outcome. The authors retrospectively analyzed 3 cases of third nerve palsy selected from the 377 patients operated via a transsphenoidal route between 2012 and 2021 at FLENI, a private tertiary neurology and neurosurgical medical center located in Buenos Aires, Argentina. The three patients who presented this complication were operated on via an endoscopic approach. It was observed that an extension into the cavernous sinus (Knosp grade 4) and to the oculomotor cistern was present in the three patients. The deficit was apparent immediately after surgery in two patients. For these two patients, the supposed mechanism of ophthalmoplegia was an intraoperative nerve lesion. The other patient became symptomatic in the 48 h following the surgery. The mechanism implied in this case was intracavernous hemorrhagic suffusion. The latter patient completely recovered the third nerve deficit in the 3 months that followed, while the other two recovered after 6 months postoperative. Oculomotor nerve palsy after transsphenoidal surgery is a very rare complication and appears to be transient in most cases. The invasion of both the cavernous sinus and the oculomotor cistern seems to be a major factor in its physiopathology and should be preoperatively analyzed on magnetic resonance imaging (MRI); recognizing such extension should play an important role in the surgeon's operative considerations.
Topics: Humans; Pituitary Neoplasms; Retrospective Studies; Oculomotor Nerve Diseases; Neurosurgical Procedures; Natural Orifice Endoscopic Surgery; Adenoma; Treatment Outcome
PubMed: 37322750
DOI: 10.4103/0028-3886.378673 -
Journal of Clinical Neurology (Seoul,... Oct 2020Contrast enhancement of the oculomotor nerve in MRI was recently noticed in patients with clinical ischemic isolated oculomotor nerve palsy (iIONP). The opinions about...
BACKGROUND AND PURPOSE
Contrast enhancement of the oculomotor nerve in MRI was recently noticed in patients with clinical ischemic isolated oculomotor nerve palsy (iIONP). The opinions about whether this is a sign of inflammation and whether or not to administer steroids vary between doctors. The study aimed to determine the associations between this enhancement and vascular-disease risk factors (VRFs) and inflammatory factors in iIONP patients.
METHODS
The study recruited patients who had experienced iIONP during the previous 2 years. They were divided into groups A and B based on whether or not they exhibited an enhanced oculomotor nerve in MRI of the cavernous sinus using thin-section, fat-suppressed, and contrast-enhanced sequences. VRFs, inflammatory factors, and improvement scores were compared between the two groups.
RESULTS
Most (71.1%) of the 45 included iIONP patients had enhanced oculomotor nerves in MRI. VRFs, periorbital pain, elevated C-reactive protein and erythrocyte sedimentation rate, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not significantly associated with the enhancement. Four of the five patients in group A exhibited an elevated cerebrospinal fluid (CSF) IgG synthesis rate. The improvement score of eight patients who received 80 mg of methylprednisolone in addition to the routine therapy was not significantly different from the scores of the other patients (=0.485).
CONCLUSIONS
More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level.
PubMed: 33029972
DOI: 10.3988/jcn.2020.16.4.653 -
Neurosurgical Focus: Video Oct 2019Operating on the anterolateral midbrain is challenging due to limited surgical freedom provided by classic approaches and restraints imposed by the basilar artery apex...
Operating on the anterolateral midbrain is challenging due to limited surgical freedom provided by classic approaches and restraints imposed by the basilar artery apex and branches, their perforators, and the oculomotor nerve (Abla et al., 2011; Bricolo and Turazzi, 1995; Cavalcanti et al., 2016). This video demonstrates the benefits provided by the pretemporal approach for resection of an anterolateral mesencephalic cavernous malformation (Chaddad-Neto et al., 2014; de Oliveira et al., 1995). Four steps are well demonstrated in the video: 1) section of temporal pole veins to the sphenoparietal sinus; 2) division of arachnoid attaching the oculomotor nerve to the tentorial edge and uncus; 3) releasing the arachnoid between the anterior choroidal artery and uncus; and 4) following the oculomotor nerve to its origin. The video can be found here: https://youtu.be/7ZuK-ewNo6w.
PubMed: 36284872
DOI: 10.3171/2019.10.FocusVid.19435 -
Human Molecular Genetics Aug 2017Unraveling the genetics of the paralytic strabismus syndromes known as congenital cranial dysinnervation disorders (CCDDs) is both informing physicians and their... (Review)
Review
Unraveling the genetics of the paralytic strabismus syndromes known as congenital cranial dysinnervation disorders (CCDDs) is both informing physicians and their patients and broadening our understanding of development of the ocular motor system. Genetic mutations underlying ocular CCDDs alter either motor neuron specification or motor nerve development, and highlight the importance of modulations of cell signaling, cytoskeletal transport, and microtubule dynamics for axon growth and guidance. Here we review recent advances in our understanding of two CCDDs, congenital fibrosis of the extraocular muscles (CFEOM) and Duane retraction syndrome (DRS), and discuss what they have taught us about mechanisms of axon guidance and selective vulnerability. CFEOM presents with congenital ptosis and restricted eye movements, and can be caused by heterozygous missense mutations in the kinesin motor protein KIF21A or in the β-tubulin isotypes TUBB3 or TUBB2B. CFEOM-causing mutations in these genes alter protein function and result in axon growth and guidance defects. DRS presents with inability to abduct one or both eyes. It can be caused by decreased function of several transcription factors critical for abducens motor neuron identity, including MAFB, or by heterozygous missense mutations in CHN1, which encodes α2-chimaerin, a Rac-GAP GTPase that affects cytoskeletal dynamics. Examination of the orbital innervation in mice lacking Mafb has established that the stereotypical misinnervation of the lateral rectus by fibers of the oculomotor nerve in DRS is secondary to absence of the abducens nerve. Studies of a CHN1 mouse model have begun to elucidate mechanisms of selective vulnerability in the nervous system.
Topics: Animals; Axons; Congenital Abnormalities; Duane Retraction Syndrome; Eye Diseases, Hereditary; Fibrosis; Humans; Kinesins; Mice; Mutation; Mutation, Missense; Ocular Motility Disorders; Oculomotor Muscles; Ophthalmoplegia; Skull; Tubulin
PubMed: 28459979
DOI: 10.1093/hmg/ddx168 -
European Radiology Jul 2021• The intriguing "Check Mark Sign" suggests 3rd cranial nerve involvement in GCA.
• The intriguing "Check Mark Sign" suggests 3rd cranial nerve involvement in GCA.
Topics: Giant Cell Arteritis; Humans; Oculomotor Nerve
PubMed: 33713170
DOI: 10.1007/s00330-021-07739-7 -
Revista de Neurologia Mar 2022The finding of an eyelid ptosis in a manuscript of the xiii century raises the differential diagnosis of injury to the third cranial nerve. This nerve was not... (Review)
Review
INTRODUCTION
The finding of an eyelid ptosis in a manuscript of the xiii century raises the differential diagnosis of injury to the third cranial nerve. This nerve was not differentiated from the other oculomotors until the xvi century and only in the xix century a clinicopathological correlation was established for its paralysis.
AIM
Describe the characteristics and differential diagnoses of an eyelid ptosis illustrated in the Book of Divine Works (1173) by Hildegard of Bingen.
DEVELOPMENT
In the mentioned work the nun Richardis of Stade is portrayed with her left eyelid drooping. Two conspicuous signs are described, ptosis and corresponding raising of the eyebrow. The deviation of the eye downward and outward is inferred from the shape that adopts the eyelid by the position of the eye and the curvature of the cornea. The picture is consistent with an isolated paralysis of the oculomotor nerve. The causes of ptosis are discussed: aponeurotic due to levator palpebrae dehiscence; myogenic, congenital and acquired; of the neuromuscular junction, and neuropathic, the latter being the most probable in this case and of a compressive mechanism. The nun's unexpected natural death suggests a ruptured brain aneurysm.
CONCLUSIONS
Richardis of Stade's portrait shows an oculomotor paralysis centuries before its anatomy, function, and clinicopathological expression were known. Credit for this original description must go to Hildegard, whose medical vocation has long been recognized.
Topics: Blepharoptosis; Diagnosis, Differential; Eyelids; Female; Humans; Oculomotor Muscles; Ophthalmoplegia
PubMed: 35275396
DOI: 10.33588/rn.7406.2021383 -
Asia-Pacific Journal of Ophthalmology... 2020To describe the clinical, demographic, and etiological profile of patients of acquired ocular motor palsy presenting in a tertiary eye care center.
PURPOSE
To describe the clinical, demographic, and etiological profile of patients of acquired ocular motor palsy presenting in a tertiary eye care center.
DESIGN
A retrospective hospital record-based study was conducted in patients of paralytic strabismus presenting from April 2016 to December 2017.
METHODS
Data included demographic and clinical details, diagnosis, underlying etiology, imaging, laboratory reports, and the outcome.
RESULTS
Mean age of presentation of 345 patients included in the study was 38.2 ± 19.5 years (range = 365 years). Pediatric patients (age: ≤16 years) constituted 9.5% of the entire cohort. Mean duration of complaints was 5.87 ± 2 months. Of the 372 eyes of 345 cases, 42.7% were sixth nerve palsy, 34.7% were third nerve palsy, 17.7% were fourth nerve palsy, and 4.8% had multiple ocular motor nerve involvement. Third and sixth nerve palsies were mostly due to ischemic event (58.1% and 69.8% cases, respectively), whereas fourth nerve palsies were commonly caused by trauma (63.6%). Amongst traumatic cases, road traffic accident was the most common mode of trauma. Systemic risk factors were preexistent in 18.2% cases (n = 63); in the remaining (40.8%; n = 141), they were diagnosed after presentation. Complete or partial recovery was noted in 69.7% cases in third nerve palsy, 67.9% cases in sixth nerve palsy, and 45% cases in fourth nerve palsy.
CONCLUSIONS
Acquired cranial nerve palsy has younger onset in Indian scenario. Ischemia is the most common etiology raising concerns about the health issues of young Indians. Sixth nerve is most commonly involved in all age groups. Low recovery rate in fourth nerve palsy can be attributed to traumatic etiology.
Topics: Abducens Nerve Diseases; Adolescent; Adult; Age Distribution; Aged; Child; Child, Preschool; Female; Humans; India; Male; Middle Aged; Oculomotor Nerve Diseases; Retrospective Studies; Risk Factors; Sex Distribution; Strabismus; Tertiary Care Centers; Trochlear Nerve Diseases
PubMed: 31990742
DOI: 10.1097/01.APO.0000617940.70112.be -
Investigative Ophthalmology & Visual... Oct 2018Proper control of eye movements is critical to vision, but relatively little is known about the molecular mechanisms that regulate development and axon guidance in the...
PURPOSE
Proper control of eye movements is critical to vision, but relatively little is known about the molecular mechanisms that regulate development and axon guidance in the ocular motor system or cause the abnormal innervation patterns (oculomotor synkinesis) seen in developmental disorders and after oculomotor nerve palsy. We developed an ex vivo slice assay that allows for live imaging and molecular manipulation of the growing oculomotor nerve, which we used to identify axon guidance cues that affect the oculomotor nerve.
METHODS
Ex vivo slices were generated from E10.5 IslMN-GFP embryos and grown for 24 to 72 hours. To assess for CXCR4 function, the specific inhibitor AMD3100 was added to the culture media. Cxcr4cko/cko:Isl-Cre:ISLMN-GFP and Cxcl12KO/KO:ISLMN-GFP embryos were cleared and imaged on a confocal microscope.
RESULTS
When AMD3100 was added to the slice cultures, oculomotor axons grew dorsally (away from the eye) rather than ventrally (toward the eye). Axons that had already exited the midbrain continued toward the eye. Loss of Cxcr4 or Cxcl12 in vivo caused misrouting of the oculomotor nerve dorsally and motor axons from the trigeminal motor nerve, which normally innervate the muscles of mastication, aberrantly innervated extraocular muscles in the orbit. This represents the first mouse model of trigeminal-oculomotor synkinesis.
CONCLUSIONS
CXCR4/CXCL12 signaling is critical for the initial pathfinding decisions of oculomotor axons and their proper exit from the midbrain. Failure of the oculomotor nerve to innervate its extraocular muscle targets leads to aberrant innervation by other motor neurons, indicating that muscles lacking innervation may secrete cues that attract motor axons.
Topics: Animals; Anti-HIV Agents; Axons; Benzylamines; Chemokine CXCL12; Cyclams; Green Fluorescent Proteins; Heterocyclic Compounds; Immunohistochemistry; In Situ Hybridization; Mice; Mice, Inbred C57BL; Microscopy, Confocal; Oculomotor Muscles; Oculomotor Nerve; Oculomotor Nerve Diseases; Organ Culture Techniques; Receptors, CXCR4; Signal Transduction; Synkinesis; Trigeminal Motor Nucleus
PubMed: 30372748
DOI: 10.1167/iovs.18-25190 -
Investigative Ophthalmology & Visual... Apr 2017To spatially and temporally define ocular motor nerve development in the presence and absence of extraocular muscles (EOMs).
PURPOSE
To spatially and temporally define ocular motor nerve development in the presence and absence of extraocular muscles (EOMs).
METHODS
Myf5cre mice, which in the homozygous state lack EOMs, were crossed to an IslMN:GFP reporter line to fluorescently label motor neuron cell bodies and axons. Embryonic day (E) 11.5 to E15.5 wild-type and Myf5cre/cre:IslMN:GFP whole mount embryos and dissected orbits were imaged by confocal microscopy to visualize the developing oculomotor, trochlear, and abducens nerves in the presence and absence of EOMs. E11.5 and E18.5 brainstems were serially sectioned and stained for Islet1 to determine the fate of ocular motor neurons.
RESULTS
At E11.5, all three ocular motor nerves in mutant embryos approached the orbit with a trajectory similar to that of wild-type. Subsequently, while wild-type nerves send terminal branches that contact target EOMs in a stereotypical pattern, the Myf5cre/cre ocular motor nerves failed to form terminal branches, regressed, and by E18.5 two-thirds of their corresponding motor neurons died. Comparisons between mutant and wild-type embryos revealed novel aspects of trochlear and oculomotor nerve development.
CONCLUSIONS
We delineated mouse ocular motor nerve spatial and temporal development in unprecedented detail. Moreover, we found that EOMs are not necessary for initial outgrowth and guidance of ocular motor axons from the brainstem to the orbit but are required for their terminal branching and survival. These data suggest that intermediate targets in the mesenchyme provide cues necessary for appropriate targeting of ocular motor axons to the orbit, while EOM cues are responsible for terminal branching and motor neuron survival.
Topics: Animals; Axons; Eye Movements; Mice; Microscopy, Confocal; Models, Animal; Motor Neurons; Oculomotor Muscles; Oculomotor Nerve
PubMed: 28437527
DOI: 10.1167/iovs.16-21268