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BMC Medical Imaging Dec 2023The purpose of this study was to investigate the clinical utility of three-dimension (3D) high-resolution inversion recovery (IR)-prepared fast spoiled gradient-recalled...
PURPOSE
The purpose of this study was to investigate the clinical utility of three-dimension (3D) high-resolution inversion recovery (IR)-prepared fast spoiled gradient-recalled (SPGR) magnetic resonance imaging (MRI) in the diagnosis of cranial nerve meningeal carcinomatosis (MC).
METHODS
A total of 114 patients with MC from January 2015 to March 2020 were enrolled and their MRIs were analyzed retrospectively. All patients underwent MRIs before being administered a contrast agent. Both a 2D conventional MRI sequence and a 3D IR-prepared fast SPGR high-resolution T1-weighted (BRAVO) scan sequence were measured after contrast agent administration. The characteristics of MC and the involved cranial nerves were then examined.
RESULTS
Among the 114 MC patients, 81 (71.05%) had cranial nerve enhancement on contrast-enhanced 3D-BRAVO imaging, while only 41 (35.96%) had image enhancement on conventional MRI. The contrast-enhanced 3D-BRAVO displayed stronger image contrast enhancement of the cranial nerves than the conventional MRI (P < 0.001). Furthermore, detection rates for the facial and auditory nerves, trigeminal nerve, oculomotor nerve, sublingual nerve, optic nerve, glossopharyngeal/vagal/accessory nerve, and abductor nerve on contrast-enhanced 3D-BRAVO imaging were 58.77%, 47.37%, 9.65%, 8.77%, 5.26%, 3.51%, and 0.88%, respectively. We found a statistically significant difference between the affected facial and auditory nerves, as well as the trigeminal nerve, oculomotor nerve, sublingual nerve, and optic nerve.
CONCLUSION
In MC, contrast-enhanced 3D-BRAVO imaging displayed the cranial nerves more effectively than 2D conventional enhanced MRI. The facial, auditory, and trigeminal nerves are the primary nerves involved in MC, and improved scanning of these nerves would aid in the early detection and treatment of MC.
Topics: Humans; Contrast Media; Retrospective Studies; Meningeal Carcinomatosis; Cranial Nerves; Magnetic Resonance Imaging; Imaging, Three-Dimensional
PubMed: 38082242
DOI: 10.1186/s12880-023-01166-4 -
Brain & NeuroRehabilitation Nov 2023Patients with brainstem stroke can present with various oculomotor disorders, including ptosis. Neurogenic ptosis, which results from total or partial dysfunction of the...
Patients with brainstem stroke can present with various oculomotor disorders, including ptosis. Neurogenic ptosis, which results from total or partial dysfunction of the third cranial nerve and/or the Müller muscle, can significantly restrict activities of daily living and participation in rehabilitation. Therefore, surgical intervention is an effective therapeutic strategy. However, owing to complications associated with incomplete eyelid closure, such as exposure keratitis and corneal injury, patients with neurogenic ptosis should first be observed, as natural recovery without surgery can be expected despite a poor prognosis. We reported the case of a 66-year-old woman with bilateral Claude syndrome who presented with severe bilateral ptosis, quadriparesis, and cognitive impairment after a bilateral midbrain infarction. After 3 months of intensive rehabilitation using soft elastic eyelid bands, her ptosis improved without the need for eyelid bands and visual field significantly increased, with improved functional level to the point of walking independently without assistance. This report demonstrates the potential advantages of the simple yet effective nonsurgical intervention of a soft elastic eyelid band for ptosis to restore significant functional gains in patients with severe bilateral ptosis after acute stroke.
PubMed: 38047092
DOI: 10.12786/bn.2023.16.e29 -
Case Reports in Ophthalmology 2022The third cranial nerve divides into superior and inferior branches at the level of anterior carotid sinus and superior orbital fissure. In extremely rare scenarios,...
The third cranial nerve divides into superior and inferior branches at the level of anterior carotid sinus and superior orbital fissure. In extremely rare scenarios, metastatic lesions at this location may present with divisional third nerve involvement. We here describe an 85-year-old woman who presented with superior division third nerve palsy due to breast cancer metastasis. Our case demonstrates the rare presentation of double vision and ptosis because of superior division third nerve palsy. The differential diagnosis for this examination finding should include metastatic disease even in the absence of a known cancer diagnosis. This case also reiterates that the "rule of the pupil" should not be applied to superior division third nerve palsy.
PubMed: 38023821
DOI: 10.1159/000526637 -
Infectious Medicine Jun 2023In this current case series, all Coronavirus disease 2019 patients had predominant ophthalmological presentation. Only one patient sough care for concomitant respiratory...
In this current case series, all Coronavirus disease 2019 patients had predominant ophthalmological presentation. Only one patient sough care for concomitant respiratory symptoms. We reported herein 2 cases with cranial oculomotor nerve palsy, one patient with confirmed diagnosis of branch retinal vein occlusion, and the last one patient presenting for acute kareto-conjunctivitis with several recurrences, which was unsuccessfully treated with steroids and requiring cliclosporin. These case series highlights the importance of collecting a careful history of ocular presentation, including exposures to possible infected patients with SARS-CoV-2. This this will lead to an early diagnosis and treatment and to make appropriate infection control measures.
PubMed: 38013741
DOI: 10.1016/j.imj.2023.04.001 -
Revista de Neurologia Dec 2023
Topics: Humans; Oculomotor Muscles; Trochlear Nerve Diseases; Eye Movements; Retrospective Studies; Trochlear Nerve
PubMed: 38010786
DOI: 10.33588/rn.7711.2023204 -
BMC Ophthalmology Nov 2023Conjunctival chemosis (CC) is an extremely rare symptom of pituitary neuroendocrine tumor (PitNET). We report an extremely rare case of PitNET manifesting as severe CC.
BACKGROUND
Conjunctival chemosis (CC) is an extremely rare symptom of pituitary neuroendocrine tumor (PitNET). We report an extremely rare case of PitNET manifesting as severe CC.
CASE PRESENTATION
A 48-year-old male was admitted to our hospital with severe CC, proptosis, and ptosis of the right eye. Magnetic resonance imaging demonstrated the tumor mass invading the cavernous sinus (CS) with cystic lesion. The patient underwent emergent endoscopic transsphenoidal surgery, and the pathological diagnosis was PitNET. CC of the right eye remarkably improved after the surgery. Glucocorticoid therapy was performed for right oculomotor nerve palsy, which rapidly improved. The postoperative course was uneventful and the patient was discharged from our hospital without hormone replacement.
CONCLUSIONS
CC caused by CS invasion of PitNET can be cured by early surgical treatment. Therefore, PitNET is important to consider in the differential diagnosis of CC.
Topics: Male; Humans; Middle Aged; Neuroendocrine Tumors; Pituitary Neoplasms; Cavernous Sinus; Conjunctiva; Exophthalmos
PubMed: 37993825
DOI: 10.1186/s12886-023-03224-5 -
Cureus Oct 2023A 41-year-old male with recently diagnosed diabetes mellitus type 2 presented with drooping of the left eyelid with double vision and was found to have an adduction...
A 41-year-old male with recently diagnosed diabetes mellitus type 2 presented with drooping of the left eyelid with double vision and was found to have an adduction deficit in the left eye and nystagmus in the abducting right eye during conjugated gaze: a left-sided internuclear ophthalmoplegia (INO). A medial longitudinal fasciculus (MLF) lesion was excluded exhaustively with brain imaging. The possibility of a pseudo-INO was considered. The autoantibody profile demonstrated positivity to acetylcholine receptor (AChR) antibody. Repetitive nerve stimulation (RNS) and electromyography (EMG) were unremarkable. An acetylcholinesterase inhibitor trial showed a significant improvement in the ocular symptoms. Hence, the diagnosis of ocular myasthenia was confirmed. There was no evidence of a thymic hyperplasia. Herein, we discuss pseudo-INO being an atypical presentation of myasthenia gravis (MG), emphasizing the importance of having a strong suspicion despite unremarkable test results.
PubMed: 37954777
DOI: 10.7759/cureus.46788 -
PloS One 2023Poking palpebral conjunctiva evoked upper-eyelid retraction during ophthalmic surgery. Iatrogenic eyelid ptosis occurred if eyelid branch of lachrymal nerve was...
Mesencephalic trigeminal nucleus neurons with collaterals to both eyelid and masseter muscles shown by fluorescent double-labeling, revealing a potential mechanism for Marcus Gunn Syndrome.
Poking palpebral conjunctiva evoked upper-eyelid retraction during ophthalmic surgery. Iatrogenic eyelid ptosis occurred if eyelid branch of lachrymal nerve was sectioned. Mesencephalic trigeminal nucleus (Vme) neurons were labeled when tracer injected into lachrymal nerve innervating eyelid Mueller's muscle. Masseter afferent Vme neurons projecting to oculomotor nucleus (III) was observed in toad and rat, which helps amphibians to stare prey when they open mouth widely to prey. We hypothesized single Vme neurons may have peripheral collaterals to both eyelid and masseter muscles. WGA-594 was injected into upper eyelid, and WGA-488 was simultaneously delivered into ipsilateral masseter muscle in the same rat. Then, double labeled Vme neurons were found under both conventional and confocal microscope. Meanwhile, contact of WGA-594 positive eyelid afferent Vme neurons with WGA-488 labeled masseter afferent ones were observed sometimes. Combined with our previous observation of oculomotor projection Vme neurons, we thought WGA-594/488 double labeled Vme cells, at least some of them, are oculomotor projecting ones. Contact between eyelid and masseter afferent Vme neurons are supposed to be electrotonically coupled, based on a line of previous studies. If exogenous or genetic factors make these Vme neurons misinterpret masseter input as eyelid afferent signals, these Vme neurons might feedforward massages to eyelid retractor motoneurons in the III. Besides, oculomotor projecting Vme neurons might be co-fired by adjacent masseter afferent Vme neurons through electrotonic coupling once the masseter muscle is activated. In these cases, Marcus Gunn Syndrome might occur. This finding leads to a new hypothesis for the Syndrome.
Topics: Rats; Animals; Masseter Muscle; Blepharoptosis; Rats, Gunn; Neurons, Afferent; Motor Neurons; Eyelids; Tegmentum Mesencephali; Trigeminal Nuclei; Trigeminal Nerve
PubMed: 37934736
DOI: 10.1371/journal.pone.0293372 -
Frontiers in Neuroscience 2023Sleep deprivation (SD) causes several adverse functional outcomes, and understanding the associated processes can improve quality of life. Although the effects of SD on...
Sleep deprivation (SD) causes several adverse functional outcomes, and understanding the associated processes can improve quality of life. Although the effects of SD on neuronal activity in several brain regions have been identified, a comprehensive evaluation of the whole brain is still lacking. Hence, we performed SD using two different methods, gentle handling and a dedicated chamber, in targeted recombination in active populations 2 (TRAP2) mice crossed with Rosa-ZsGreen reporter mice and visualized cellular activity in the whole brain. Using the semi-automated post-imaging analysis tool Slice Histology Alignment, Registration, and Cell Quantification (SHARCQ), the number of activated cells was quantified. From the analysis of 14 brain regions, cellular activity was significantly increased in the olfactory areas and decreased in the medulla by the two SD methods. From the analysis of the further subdivided 348 regions, cellular activity was significantly increased in the vascular organ of the lamina terminalis, lateral hypothalamic area, parabigeminal nucleus, ventral tegmental area, and magnocellular reticular nucleus, and decreased in the anterior part of the basolateral amygdalar nucleus, nucleus accumbens, septohippocampal nucleus, reticular nucleus of the thalamus, preoptic part of the periventricular hypothalamic nucleus, ventromedial preoptic nucleus, rostral linear nucleus raphe, facial motor nucleus, vestibular nuclei, and some fiber tracts (oculomotor nerve, genu of corpus callosum, and rubrospinal tract) by the two SD methods. Two subdivided regions of the striatum (caudoputamen and other striatum), epithalamus, vascular organ of the lamina terminalis, anteroventral preoptic nucleus, superior colliculus optic layer, medial terminal nucleus of the accessory optic tract, pontine gray, and fiber tracts (medial lemniscus, columns of the fornix, brachium of the inferior colliculus, and mammillary peduncle) were differentially affected by the two SD methods. Most brain regions detected from these analyses have been reported to be involved in regulating sleep/wake regulatory circuits. Moreover, the results from the connectivity analysis indicated that the connectivity of cellular activity among brain regions was altered by SD. Together, such a comprehensive analysis of the whole brain is useful for understanding the mechanisms by which SD and/or sleep disruption affects brain function.
PubMed: 37928729
DOI: 10.3389/fnins.2023.1252689 -
Journal of Neurosurgery. Case Lessons Oct 2023Intraosseous clival arteriovenous fistulas (AVFs), in which the shunt drains extracranially from the posterior and anterior condylar veins rather than from the cavernous...
BACKGROUND
Intraosseous clival arteriovenous fistulas (AVFs), in which the shunt drains extracranially from the posterior and anterior condylar veins rather than from the cavernous sinus (CS), are rare. Targeting embolization of an intraosseous clival AVF is challenging because of its complex venous and skull base anatomy; therefore, a therapeutic strategy based on detailed preoperative radiological findings is required to achieve a favorable outcome. Here, the authors report the successful targeted embolization of an intraosseous clival AVF using an ingenious access route.
OBSERVATIONS
A 74-year-old woman presented with left-sided visual impairment, oculomotor nerve palsy, and right facial pain. A fusion image of three-dimensional rotational angiography and cone-beam computed tomography revealed a left CS dural AVF and a right intraosseous clival AVF. The shunt flow of the clival AVF drained extracranially from the posterior and anterior condylar veins via the intraosseous venous route. Transvenous embolization was performed by devising suboccipital, posterior condylar, and intraosseous access routes. The symptoms resolved after the bilateral AVFs were treated.
LESSONS
Accurate diagnosis and proper transvenous access based on detailed intraosseous and craniocervical venous information obtained from advanced imaging modalities are key to resolving intraosseous clival AVF.
PubMed: 37903421
DOI: 10.3171/CASE23492