-
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 -
Journal of Neuro-ophthalmology : the... Dec 2022
Topics: Humans; Abducens Nerve Diseases; Oculomotor Muscles
PubMed: 36394974
DOI: 10.1097/WNO.0000000000001746 -
Journal of Neurological Surgery. Part... Aug 2020The orbit is a paired, transversely oval, and cone-shaped osseous cavity bounded and formed by the anterior and middle cranial base as well as the viscerocranium. Its...
The orbit is a paired, transversely oval, and cone-shaped osseous cavity bounded and formed by the anterior and middle cranial base as well as the viscerocranium. Its main contents are the anterior part of the visual system, globe and optic nerve, and the associated neural, vascular, muscular, glandular, and ligamentous structures required for oculomotion, lacrimation, accommodation, and sensation. A complex stream of afferent and efferent information passes through the orbit, which necessitates a direct communication with the anterior and middle cranial fossae, the pterygopalatine and infratemporal fossae, as well as the aerated adjacent frontal, sphenoidal, and maxillary sinuses and the nasal cavity. This article provides a detailed illustration and description of the microsurgical anatomy of the orbit, with a focus on the intrinsically complex spatial relationships around the annular tendon and the superior orbital fissure, the transition from cavernous sinus to the orbital apex. Sparse reference will be made to surgical approaches, their indications or limitations, since they are addressed elsewhere in this special issue. Instead, an attempt has been made to highlight anatomical structures and elucidate concepts most relevant to safe and effective transcranial, transfacial, transorbital, or transnasal surgery of orbital, periorbital, and skull base pathologies.
PubMed: 33072474
DOI: 10.1055/s-0040-1715096 -
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 -
Bratislavske Lekarske Listy 2021The aim of this paper was to point out the intradural cranial nerve roots variations in their localization and number to establish the incidence and clinical importance...
BACKGROUND
The aim of this paper was to point out the intradural cranial nerve roots variations in their localization and number to establish the incidence and clinical importance of the cranial nerve root variations.
METHODS
The anatomical study was performed on 120 sides in 60 cadavers. There were 51 male cadavers with the mean age 43.3 and 9 female cadavers with the mean age of 39.5 years.
RESULTS
Abducens nerve variations were observed in 48 cases (80 %). They were more frequently on the left side, in 25 cases (41.66 %). Duplicated abducens nerve was observed in 25 cases (41.66 %). Double and triple abducens nerve variations were also observed.
CONCLUSIONS
Cranial nerve variations are rare, but variations of abducens nerve and atypical exit of the hypoglossal nerve from the fossa cranium posterior is not a rare variation. Knowledge of this variation may be important to various fields of medicine (Tab. 3, Fig. 8, Ref. 34).
Topics: Abducens Nerve; Adult; Cadaver; Female; Humans; Male
PubMed: 33729815
DOI: 10.4149/BLL_2021_039 -
Disease-a-month : DM May 2021
Topics: Abducens Nerve; Abducens Nerve Diseases; Adult; Aged; Child; Child, Preschool; Humans; Middle Aged; Paralysis
PubMed: 33546871
DOI: 10.1016/j.disamonth.2021.101133 -
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 -
Neuro-ophthalmology (Aeolus Press) 2022A broad spectrum of neurological side effects has been reported after immunisation for COVID-19, including functional neurological disorders, cerebral vascular events,...
A broad spectrum of neurological side effects has been reported after immunisation for COVID-19, including functional neurological disorders, cerebral vascular events, cerebral venous thrombosis, intracerebral haemorrhage, neuroleptic malignant syndrome, cranial nerve palsies, and otologic manifestations. Multiple cranial neuropathies have also been reported following vaccination in which involvement of VII nerve is the most prevalent, followed by the VI, III, and IV nerves. We describe two male patients, one with with facial nerve palsy and the other with abducens nerve palsy following COVID-19 vaccination. The patient with facial nerve palsy received the AstraZeneca vaccine 2 days before the symptoms began. In contrast, the patient with the abducens palsy had received his first dose of the Sinopharm vaccine 7 days previously. Both patients demonstrated a gradual recovery within the next 2 months. Further studies are required to investigate the proper relationship between cranial nerve palsies and vaccinations.
PubMed: 35574171
DOI: 10.1080/01658107.2022.2032204 -
Journal of Neuro-ophthalmology : the... Dec 2021Ophthalmic involvement in acute leukemia is common, with 36% of patients having ophthalmic involvement at the time of diagnosis. However, neuro-ophthalmic involvement is...
BACKGROUND
Ophthalmic involvement in acute leukemia is common, with 36% of patients having ophthalmic involvement at the time of diagnosis. However, neuro-ophthalmic involvement is relatively rare. We present a characterization of neuro-ophthalmic findings in patients with acute leukemia and discuss the implications of these findings on patient management and prognosis.
METHODS
We performed a retrospective review of cases of acute leukemia with central nervous system (CNS) involvement and neuro-ophthalmic manifestations that were evaluated at the Wilmer Eye Institute between January 2013 and September 2019. Data collected included demographic information, leukemia details, results of diagnostic testing, and features of associated neuro-ophthalmic manifestations.
RESULTS
Twelve patients with mean age 42 years (range 9-65, median 39) were included. Seven (58%) patients were men and 5 (42%) women. Eight (67%) were diagnosed with acute myeloid leukemia and 4 (33%) with acute lymphoid leukemia. Neuro-ophthalmic findings included 4 patients with isolated sixth nerve palsies, 2 with multiple cranial nerve palsies, 2 with orbital lesions with proptosis, 4 with optic disc swelling, and 1 with isolated fourth nerve palsy. Five (42%) neuro-ophthalmic presentations were associated with known CNS disease, 3 (25%) were associated with active disease but heralded the discovery of CNS involvement, 3 (25%) were the presenting features of relapse, and 1 (8%) led to the original leukemia diagnosis. Neuroimaging showed 4 with leptomeningeal enhancement, 4 with cranial nerve enhancement/thickening, 3 with optic nerve/sheath enhancement, 1 with lytic lesion of bone, 1 with soft tissue mass, and 1 with cytotoxic brain edema. One case had normal neuroimaging. Overall, patients had a poor prognosis, with 7 patients dying from leukemia or its complications and only 1 achieving a sustained remission. In 58% of the cases in our series, the discovery of neuro-ophthalmic leukemic involvement directly led to a change in leukemia treatment.
CONCLUSIONS
Neuro-ophthalmic manifestations of leukemia may occur as presenting features of diagnosis, relapse, or CNS involvement, and portend a poor prognosis. Detection of neuro-ophthalmic involvement often triggers a prompt change in management. Therefore, familiarity with potential neuro-ophthalmic presentations of acute leukemia may avoid delayed diagnosis, and resultant inadequate treatment, of primary disease, relapse, or CNS involvement.
Topics: Abducens Nerve Diseases; Adolescent; Adult; Aged; Child; Cranial Nerve Diseases; Female; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Papilledema; Trochlear Nerve Diseases; Young Adult
PubMed: 32868572
DOI: 10.1097/WNO.0000000000001071