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Taiwan Journal of Ophthalmology 2023Duane syndrome is one of the most common restrictive congenital strabismus characterized by variable horizontal duction deficits with globe retraction and shoots on... (Review)
Review
Duane syndrome is one of the most common restrictive congenital strabismus characterized by variable horizontal duction deficits with globe retraction and shoots on attempted adduction and narrowing of the palpebral aperture. It is now listed as a congenital cranial dysinnervation disorder. The disease is usually unilateral with female preponderance. Basic etiopathogenesis involves dysinnervation of the lateral rectus (LR) due to aplastic/hypoplastic abducens nucleus with a secondary aberrant supply to the LR by the medial rectus (MR) subnucleus of the oculomotor nerve. Diagnosis of the disease is usually clinical. Due to the variable presentation of the disease, surgical management is a challenge and has to be individualized to achieve alignment in the primary gaze, reduction in globe retraction, upshoots and downshoots, and correction of any abnormal head posture. Differential recessions of the lateral and MR muscles are done to correct esotropia or exotropia in the primary gaze. For globe retraction and shoots, Y-split or periosteal fixation of the LR muscles is done depending on the severity.
PubMed: 38249504
DOI: 10.4103/tjo.TJO-D-23-00078 -
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 -
Human Brain Mapping May 2022The oculomotor nerve (OCN) is the main motor nerve innervating eye muscles and can be involved in multiple flammatory, compressive, or pathologies. The diffusion...
The oculomotor nerve (OCN) is the main motor nerve innervating eye muscles and can be involved in multiple flammatory, compressive, or pathologies. The diffusion magnetic resonance imaging (dMRI) tractography is now widely used to describe the trajectory of the OCN. However, the complex cranial structure leads to difficulties in fiber orientation distribution (FOD) modeling, fiber tracking, and region of interest (ROI) selection. Currently, the identification of OCN relies on expert manual operation, resulting in challenges, such as the carries high clinical, time-consuming, and labor costs. Thus, we propose a method that can automatically identify OCN from dMRI tractography. First, we choose the multi-shell multi-tissue constraint spherical deconvolution (MSMT-CSD) FOD estimation model and deterministic tractography to describe the 3D trajectory of the OCN. Then, we rely on the well-established computational pipeline and anatomical expertise to create a data-driven OCN tractography atlas from 40 HCP data. We identify six clusters belonging to the OCN from the atlas, including the structures of three kinds of positional relationships (pass between, pass through, and go around) with the red nuclei and two kinds of positional relationships with medial longitudinal fasciculus. Finally, we apply the proposed OCN atlas to identify the OCN automatically from 40 new HCP subjects and two patients with brainstem cavernous malformation. In terms of spatial overlap and visualization, experiment results show that the automatically and manually identified OCN fibers are consistent. Our proposed OCN atlas provides an effective tool for identifying OCN by avoiding the traditional selection strategy of ROIs.
Topics: Cluster Analysis; Diffusion Magnetic Resonance Imaging; Diffusion Tensor Imaging; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Oculomotor Nerve
PubMed: 35092135
DOI: 10.1002/hbm.25779 -
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 -
The British Journal of Oral &... Jul 2019We present a case series of three patients who developed acute traumatic orbital third nerve palsies. To our knowledge, reported cases have mainly been localised to the...
We present a case series of three patients who developed acute traumatic orbital third nerve palsies. To our knowledge, reported cases have mainly been localised to the intracranial course of the nerve and often associated with visual impairment. Those in which the orbit is the site of injury are rare. Our case series highlights the importance of careful preoperative assessment of patients with orbital trauma (particularly when there is a coexisting fracture) and the need to assess ocular movements and pupillary reactions to distinguish between a neurogenic and soft tissue injury. Early diagnosis is helpful in deciding on the timing of the operation and enables patients to be given appropriate counselling to make sure that their expectations are realistic.
Topics: Eye Injuries; Eye Movements; Humans; Oculomotor Nerve Diseases; Orbit; Orbital Fractures
PubMed: 31155398
DOI: 10.1016/j.bjoms.2019.01.029 -
Complementary Therapies in Medicine Dec 2022To evaluate the safety and efficacy of acupuncture in the treatment of oculomotor nerve palsy (ONP). (Meta-Analysis)
Meta-Analysis
BACKGROUND
To evaluate the safety and efficacy of acupuncture in the treatment of oculomotor nerve palsy (ONP).
METHODS
The following database will be required from PubMed, Cochrane Library, Medline, Chinese Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang data. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture or comparing acupuncture with another active therapy versus the same active therapy were included. Meta-analysis was conducted according to the 2020 PRISMA guidelines. Data was analyzed using RevMan 5.4 software. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). The Cochrane risk of bias tool was used to access the methodological quality of the trails.
RESULTS
Eighteen RCTs with 1150 participants comparing acupuncture versus other therapies were included. The results showed a significant differences in the clinical efficiency rate (RR = 1.30, 95 %CI = 1.23-1.37, P < 0.001), scores of diplopia (MD = - 0.78, 95 %CI = - 1.39 to - 0.77, P < 0.001), palpebral fissure size (MD = 1.04, 95 %CI = 0.41-1.68, P = 0.001), the pupil diameter (MD = - 0.56, 95 %CI = - 0.70 to - 0.42, P < 0.001), quality of life (MD = 8.96, 95 %CI = 6.79-11.13, P < 0.001) between the experiment and control groups. However, there were no significant differences in the adverse effects (RR = 0.52, 95 %CI = 0.22-1.22, P = 0.13). The quality of the evidence test by GRADE was low or very low.
CONCLUSION
Most included studies suggested that acupuncture was more effective than the control group in the treatment of ONP. However, the quality evidence of most of the studies was low and most of them were performed in China.
Topics: Humans; Acupuncture Therapy; Quality of Life; Oculomotor Nerve Diseases; China
PubMed: 36152935
DOI: 10.1016/j.ctim.2022.102888 -
American Journal of Otolaryngology 2021The purpose of this study was to assess the vestibular and oculomotor function in patients with vestibular migraine (VM). And we also investigate the relationship...
AIM
The purpose of this study was to assess the vestibular and oculomotor function in patients with vestibular migraine (VM). And we also investigate the relationship between testing results and effectiveness of preventive medications in VM.
MATERIAL AND METHOD
41 patients with VM were recruited in this study and examined with cervical and ocular vestibular evoked myogenic potential(cVEMP, oVEMP), video head impulse test(vHIT), caloric test and videonystagmography. All patients were treated with preventive medications. We calculated symptomatic improvement and record episodes frequency in patients with VM. Six months later, the effectiveness of preventive medications were evaluated and the relationship between vestibular testing and effectiveness of preventive medications were analyzed further.
RESULTS
In vestibular function testing, 73% of patients with VM showed abnormal results. Abnormal cVEMP, oVEMP, vHIT, and caloric test were found in 20%, 44%, 32% and 56% respectively. The abnormal rate of oVEMP was significantly higher than that of cVEMP(p < 0.05). And the proportion of abnormal caloric test was obviously higher than that of vHIT (p < 0.05). In oculomotor function testing, 42% of the patients with VM showed pathological results which was significantly lower than that of vestibular function testing(p < 0.05). After 6 months follow-up, the proportion of prophylactic medication effectiveness was significantly higher in normal vestibular function testing group compared with the abnormal group (p < 0.05).
CONCLUSION
Abnormal vestibular and oculomotor functions are commonly observed in patients with VM. And these patients with abnormal vestibular function possess a weak effectiveness of preventive medications.
Topics: Adult; Aged; Caloric Tests; Female; Follow-Up Studies; Head Impulse Test; Humans; Male; Middle Aged; Migraine Disorders; Oculomotor Nerve; Time Factors; Treatment Outcome; Vestibular Evoked Myogenic Potentials; Vestibular Function Tests; Vestibule, Labyrinth; Young Adult
PubMed: 34218215
DOI: 10.1016/j.amjoto.2021.103152 -
Journal of AAPOS : the Official... Feb 2023Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when... (Review)
Review
Addressing ocular misalignment secondary to partial and complete oculomotor nerve palsy presents a special challenge to the strabismus surgeon, particularly when treating patients with binocular diplopia. We review the reported surgical options and, through illustrative cases, provide our own perspective on managing this disorder.
Topics: Humans; Oculomotor Muscles; Retrospective Studies; Oculomotor Nerve Diseases; Strabismus; Diplopia; Vision, Binocular
PubMed: 36640897
DOI: 10.1016/j.jaapos.2022.11.017 -
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 -
European Journal of Ophthalmology Nov 2023To report a rare complication of oculomotor and trochlear nerve neuritis following botulinum toxin injection for masseter hypertrophy.
OBJECTIVE
To report a rare complication of oculomotor and trochlear nerve neuritis following botulinum toxin injection for masseter hypertrophy.
CASE PRESENTATION
A previously healthy 31-year-old man presented with a two-week history of left eye (OS) ptosis and diplopia, following botulinum toxin injection over the masseter area for masseter hypertrophy at an aesthetic centre. He had no proptosis or facial asymmetry. Visual acuity was 6/6 in the right eye (OD) and 6/9 in the OS. There was anisocoria, with pupils measuring 3 mm in the OD and 5 mm in the OS but no relative afferent pupillary defect. OS appeared hypertropic in primary gaze with impaired intorsion. Extraocular movement of the OS was restricted in all gazes, except for laevoversion; that of the OD was normal. This was associated with diplopia in all gazes except on laevoversion. Both eyes' anterior and posterior segment examinations were otherwise unremarkable. Besides the oculomotor and trochlear nerve, the other cranial nerves and neurological examinations were normal. Investigations including blood and cerebrospinal fluid, magnetic resonance imaging and angiography of the brain, were normal. Our impression was left oculomotor and trochlear nerve neuritis secondary to botulinum toxin injection. He was started on oral prednisolone 1 mg/kg daily and tapered by 5 mg per week. His condition improved gradually with no residual ptosis or anisocoria after three months. Extraocular movements normalised except for minimal residual restriction on depression.
CONCLUSION
Oculomotor and trochlear nerve neuritis can occur following botulinum toxin injection over the masseter area. Healthcare professionals should be aware of this potential complication before offering the injection.
PubMed: 36451540
DOI: 10.1177/11206721221143011