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Current Opinion in Ophthalmology Nov 2019Describe the range of infectious causes of ocular motor neuropathies, from common presentations to unusual manifestations of diseases less frequently seen in the... (Review)
Review
PURPOSE OF REVIEW
Describe the range of infectious causes of ocular motor neuropathies, from common presentations to unusual manifestations of diseases less frequently seen in the developed world. Provide information on recent developments in diagnostic testing for pathogens that may cause ocular motor neuropathies.
RECENT FINDINGS
Antigen detection in serum or CSF has improved the diagnosis of cryptococcal disease. Cartridge PCR testing for tuberculosis has increased diagnostic accuracy, though tuberculous meningitis remains difficult to diagnose. Rapid, multiplex PCR and unbiased sequencing allow for diagnosis of a wider range of organisms.
SUMMARY
Infectious ocular motor neuropathies can occur anywhere along the length of cranial nerves III, IV, and VI. Characteristic clinical findings and imaging can be used to localize infections. Infectious causes may have characteristic clinical, laboratory, or imaging findings, but must still be carefully separated from inflammatory or neoplastic conditions.
Topics: Abducens Nerve Diseases; Cavernous Sinus Thrombosis; Eye Infections, Bacterial; Humans; Infectious Encephalitis; Oculomotor Nerve Diseases; Osteomyelitis; Skull Base; Trochlear Nerve Diseases
PubMed: 31464699
DOI: 10.1097/ICU.0000000000000615 -
RoFo : Fortschritte Auf Dem Gebiete Der... Nov 2021
Topics: Abducens Nerve
PubMed: 34139783
DOI: 10.1055/a-1460-9325 -
Oman Journal of Ophthalmology 2022
PubMed: 35937726
DOI: 10.4103/ojo.ojo_141_22 -
Strabismus Mar 2022Although coronavirus disease-2019 (COVID-19) is mainly a respiratory system disease, neurological complications due to peripheral and central nervous system involvement...
Although coronavirus disease-2019 (COVID-19) is mainly a respiratory system disease, neurological complications due to peripheral and central nervous system involvement may be seen in these patients. In this case report, we described a patient with isolated abducens nerve palsy after COVID-19. The patient was a healthy 28-year-old man who developed isolated abducens nerve palsy 10 days after COVID-19. He had no systemic risk factors. He had 20 PD left esotropia (ET) at distance and 16 PD left ET at near in primary position and ET increasing to 25 PD in left gaze. He had left abduction deficiency. His cranio-orbital magnetic resonance imaging findings were normal. He was diagnosed as left isolated abducens nerve palsy and his findings were recovered after 2 months. COVID-19 may cause ocular motor nerve palsies. Although the pathological mechanism remains unclear, direct viral invasion, inflammatory and immune mechanisms may play role. Further case reports and studies are needed to support these findings.
Topics: Abducens Nerve; Abducens Nerve Diseases; Adult; COVID-19; Humans; Magnetic Resonance Imaging; Male
PubMed: 35000539
DOI: 10.1080/09273972.2021.2022718 -
Annals of Anatomy = Anatomischer... Aug 2022Dorello's canal is an arched structure of bone-fibrous character located in the petroclival venous confluence atop the petrosal bone in the petroclival region. It is... (Review)
Review
Dorello's canal is an arched structure of bone-fibrous character located in the petroclival venous confluence atop the petrosal bone in the petroclival region. It is bordered by the petrosphenoidal ligament, the petrous part of the temporal bone and the lateral border of the upper part of clivus. Its content in the vast majority of variants comprises the abducens nerve, the inferior petrosal sinus, the venous drainage and the dorsal meningeal artery or its medial branch. With the development of microsurgical techniques, this area has gained huge clinical importance, mainly concerning the order in which the above-mentioned elements (especially the position of the abducens nerve) are arranged in relation to each other. These structures appear in different variant forms and necessitate an individual clinical approach. The main purpose of this review is to present condensed information about possible intercorrelations among them and to indicate, on the basis of the available literature and research, possible surgical approaches and the need to consider the variability when treatments in this region are planned.
Topics: Abducens Nerve; Ligaments; Neck; Petrous Bone; Veins
PubMed: 35378252
DOI: 10.1016/j.aanat.2022.151939 -
Neurocirugia (English Edition) Jun 2024This study investigates the mobilization of cranial nerves in the upper clival region to improve surgical approaches. Cadaveric specimens (n = 20) were dissected to...
BACKGROUND
This study investigates the mobilization of cranial nerves in the upper clival region to improve surgical approaches. Cadaveric specimens (n = 20) were dissected to examine the oculomotor, trochlear, and abducens nerves. Dissection techniques focused on the nerves' intradural course and their relationship to surrounding structures.
METHODS
Pre-dissection revealed the nerves' entry points into the clival dura and their proximity to each other. Measurements were taken to quantify these distances. Following intradural dissection, measurements were again obtained to assess the degree of nerve mobilization.
RESULTS
Dissection showed that the abducens nerve takes three folds during its course: at the dural foramen, towards the posterior cavernous sinus, and lastly within the cavernous sinus. The trochlear nerve enters the dura and makes two bends before entering the cavernous sinus. The oculomotor nerve enters the cavernous sinus directly and runs parallel to the trochlear nerve. Importantly, intradural dissection increased the space between the abducens nerves (by 4.21 mm) and between the oculomotor and trochlear nerves (by 3.09 mm on average). This indicates that nerve mobilization can create wider surgical corridors for approaching lesions in the upper clivus region.
CONCLUSIONS
This study provides a detailed anatomical analysis of the oculomotor, trochlear, and abducens nerves in the upper clivus. The cadaveric dissections and measurements demonstrate the feasibility of mobilizing these nerves to achieve wider surgical corridors. This information can be valuable for surgeons planning endoscopic or microscopic approaches to lesions in the upper clivus region.
PubMed: 38906416
DOI: 10.1016/j.neucie.2024.06.001 -
The Indian Journal of Radiology &... Apr 2023The clivus is a midline anatomical structure in the central skull base. It is affected by a wide range of non-neoplastic, benign and malignant pathologies, some of which...
The clivus is a midline anatomical structure in the central skull base. It is affected by a wide range of non-neoplastic, benign and malignant pathologies, some of which typically affect the clivus because of its strategic location and embryological origins. Clival lesions may often be asymptomatic with occasional complaints like headache or cranial neuropathy in few. Cross-sectional imaging techniques, namely, computed tomographic scan and magnetic resonance imaging, thus, play a key role in approximating to the final diagnosis and estimating the disease extent. In this article, we highlight the important imaging features of various clival and paraclival pathologies to facilitate effective diagnosis, therapeutic planning, and management.
PubMed: 37123565
DOI: 10.1055/s-0043-1761183 -
Journal Francais D'ophtalmologie Dec 2022
Topics: Humans; Abducens Nerve; Abducens Nerve Diseases; COVID-19; COVID-19 Vaccines
PubMed: 36244866
DOI: 10.1016/j.jfo.2022.04.003 -
Journal of Binocular Vision and Ocular... 2019Paralytic strabismus in children is rare, occurring in about 0.1% of children. This rate is far less common than the 3% rate usually noted for comitant strabismus. The... (Review)
Review
Paralytic strabismus in children is rare, occurring in about 0.1% of children. This rate is far less common than the 3% rate usually noted for comitant strabismus. The relative rates of ocular motor pareses were fourth nerve palsies in 36%, sixth in 33%, third in 22%, with multiple ocular motor nerve palsies in 9%. In a single population series from Minnesota, few cases were associated with neoplasm. However, institutional case series reports a high rate of neoplasm for acquired third nerve and sixth nerve palsies after excluding trauma and congenital causes. Tumor is rare in children with fourth cranial nerve palsies, usually associated with other neurologic disease. Rare causes of external ophthalmoplegia, to be considered when the motility pattern is variable or not fitting an ocular motor nerve pattern, include myasthenia gravis and congenital fibrosis of the extraocular muscles. Myasthenia most often presents as ptosis with exotropia. Rarer still is involvement of the extraocular muscles in childhood thyroid disease.
Topics: Abducens Nerve Diseases; Child; Diagnosis, Differential; Fibrosis; Humans; Myasthenia Gravis; Ocular Motility Disorders; Oculomotor Nerve Diseases; Ophthalmoplegia; Physical Examination; Trochlear Nerve Diseases
PubMed: 31329057
DOI: 10.1080/2576117X.2019.1590141