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Oxford Medical Case Reports Mar 2024We report the case of a male in his 50s with a history of smoking admitted to our hospital for three transient recurrent episodes of less than 60 min of cheiro-oral...
We report the case of a male in his 50s with a history of smoking admitted to our hospital for three transient recurrent episodes of less than 60 min of cheiro-oral paresthesias and binocular horizontal diplopia with convergent strabismus. On admission, his neurological examination was normal. Cerebral magnetic resonance imaging showed no cerebral lesion. Computed tomography angiography showed a sub-occlusive right carotid bulb atherosclerotic stenosis, the absence of abnormality of the subclavian arteries and the origin of the vertebral arteries, and no stenosis of the basilar artery or posterior cerebral arteries. Routine blood tests were normal with glycated hemoglobin of 6.5%. The patient underwent right carotid endarterectomy. One year after carotid endarterectomy, the patient has had no other cerebrovascular events.
PubMed: 38532760
DOI: 10.1093/omcr/omae020 -
Medicine International 2024The abducens nerve (sixth cranial nerve) is essential for lateral eye movement, and its malfunction can cause a variety of issues with vision. Pseudo-abducens palsy is a...
The abducens nerve (sixth cranial nerve) is essential for lateral eye movement, and its malfunction can cause a variety of issues with vision. Pseudo-abducens palsy is a rare neurological condition that causes a limitation in eye abduction, while the abducens nerve is still functioning. Thalamic pain syndrome, a severe complication of cerebrovascular events, presents as intense neuropathic pain provoked by temperature fluctuations. Although thalamic strokes are infrequently associated with ocular abnormalities, some studies suggest an association between isolated pseudo-abducens palsy and thalamic infarctions. The present study describes the case of a 38-year-old male patient with 1-day progressive diplopia and occipital headache who had abducens palsy on the left side as a result of a right thalamic infarction. The patient had a 10-year history of smoking and a 1-year history of hypertension, which was poorly controlled. The diagnosis was supported by a neurological examination, imaging and stroke etiology investigations. The patient recovered well within 5 days, highlighting the good prognosis of an acute thalamic presentation. In addition, a mini-review of the literature was performed and two similar reports were identified upon searching the literature using the Embase, Google Scholar, Lilacs, Medline, SciELO and ScienceDirect databases. On the whole, the present study demonstrates that understanding the complex neuronal connections inside the thalamus is critical for a proper diagnosis and appropriate intervention strategies in patients with thalamic stroke with oculomotor impairments. Further research is required to elucidate the underlying causes and develop treatment techniques for thalamic infarction consequences.
PubMed: 38481539
DOI: 10.3892/mi.2024.142 -
Nature Communications Mar 2024In May 2022, individuals infected with the monkeypox virus were detected in the UK without clear travel links to endemic areas. Understanding the clinical...
In May 2022, individuals infected with the monkeypox virus were detected in the UK without clear travel links to endemic areas. Understanding the clinical characteristics and infection severity of mpox is necessary for effective public health policy. The study period of this paper, from the 1 June 2022 to 30 September 2022, included 3,375 individuals that tested positive for the monkeypox virus. The posterior mean times from infection to hospital admission and length of hospital stay were 14.89 days (95% Credible Intervals (CrI): 13.60, 16.32) and 7.07 days (95% CrI: 6.07, 8.23), respectively. We estimated the modelled Infection Hospitalisation Risk to be 4.13% (95% CrI: 3.04, 5.02), compared to the overall sample Case Hospitalisation Risk (CHR) of 5.10% (95% CrI: 4.38, 5.86). The overall sample CHR was estimated to be 17.86% (95% CrI: 6.06, 33.11) for females and 4.99% (95% CrI: 4.27, 5.75) for males. A notable difference was observed between the CHRs that were estimated for each sex, which may be indicative of increased infection severity in females or a considerably lower infection ascertainment rate. It was estimated that 74.65% (95% CrI: 55.78, 86.85) of infections with the monkeypox virus in the UK were captured over the outbreak.
Topics: Female; Male; Humans; Mpox (monkeypox); Hospitalization; Length of Stay; Abducens Nerve Diseases; United Kingdom
PubMed: 38467622
DOI: 10.1038/s41467-024-45110-8 -
Cureus Jan 2024One-and-a-half syndrome (OHS) is a horizontal gaze palsy in one direction with internuclear ophthalmoplegia (INO) in the other. The only eye movement possible is the...
One-and-a-half syndrome (OHS) is a horizontal gaze palsy in one direction with internuclear ophthalmoplegia (INO) in the other. The only eye movement possible is the abduction of the contralateral eye with nystagmus. The usual structures affected are the medial longitudinal fasciculus and paramedian pontine reticular formation or the abducens nucleus. Most commonly, the OHS is caused by ischemia and demyelinating lesions. The other causes include infectious, neoplastic, and rarely traumatic. We report a case of a 42-year-old non-compliant hypertensive female who presented with giddiness, projectile vomiting, and right-sided hemiparesis and was found to have OHS on cranial nerve examination in the emergency department (ED). In the ED, the presence of complete horizontal gaze palsy in one direction with INO in the other direction should raise suspicion of a brainstem pathology.
PubMed: 38425582
DOI: 10.7759/cureus.53193 -
International Journal of Surgery Case... Mar 2024Breast cancer, comprising 25 % of all diagnosed cancers, predominantly affects women globally. While bone metastasis is common, occurrences at the clivus or skull base...
INTRODUCTION
Breast cancer, comprising 25 % of all diagnosed cancers, predominantly affects women globally. While bone metastasis is common, occurrences at the clivus or skull base are rarely documented. Treatment varies from surgery in early stages to a multifaceted approach for advanced cases, incorporating chemotherapy, radiotherapy, and surgery based on staging and histology.
CLINICAL PRESENTATION
A 40-year-old female presented with a rapidly enlarging lump in her left breast and diplopia on right gaze. Histology was positive for invasive breast cancer (no special type) and Contrast-Enhanced Computed Tomography demonstrated metastatic deposits in multiple vertebrae and bilateral ilium. Further, magnetic resonance imaging of the brain and orbits revealed metastatic deposits in the clivus which extended up-to medial wall of the cavernous sinus, causing compression of the right abducens nerve. Multidisciplinary Tumor Board review recommended chemoradiotherapy.
DISCUSSION
Metastases from breast cancer can occur locally or to distant sites like lymph nodes, bones, lungs, liver, and brain. Unusual symptoms, such as new-onset diplopia, trigger further investigation. Although bone metastases occur in 50-65 % of cases, clivus metastasis is rare. Treatment aims at extending survival, symptom management, and enhancing quality of life through chemotherapy and radiotherapy. Outcomes hinge on metastatic burden and regional therapy responsiveness. Distant metastases substantially reduce the 5-year survival rate from 80 % to approximately 25 %, but cases often improve with regional interventions.
CONCLUSION
Although an extremely rare occurrence, clivus metastasis might be considered in patients with a history of malignancy, in particular, breast malignancy, presenting with new-onset sixth nerve palsy.
PubMed: 38412597
DOI: 10.1016/j.ijscr.2024.109437 -
Clinical Ophthalmology (Auckland, N.Z.) 2024Although various studies have explored the causes and clinical aspects of cranial nerve palsies, there remains a significant gap in understanding the prognostic factors...
Retrospective Analysis of Factors Related to the Long-Term Recovery of Third, Fourth, and Sixth Cranial Nerve Palsy with Etiologies and Clinical Course in a Tertiary Hospital.
PURPOSE
Although various studies have explored the causes and clinical aspects of cranial nerve palsies, there remains a significant gap in understanding the prognostic factors that influence outcomes. In this study, we sought to address this gap by investigating the incidence, etiologies, clinical courses, and factors associated with long-term recovery, with the aim of enhancing the knowledge base in this field and providing valuable insights for improved patient care.
PATIENTS AND METHODS
This retrospective study evaluated the data gathered from subjects who had third, fourth, and sixth cranial nerve palsy at the ophthalmology outpatient clinic of Phramongkutklao Hospital between April 1, 2012, and April 30, 2022.
RESULTS
Among the three nerves, abducens nerve palsy was the most prevalent finding by most commonly involved. Our study revealed that ischemic and compressive lesions were the most common etiology of oculomotor nerve palsy, comprising 24.6% each. In addition, the most common etiology of trochlear and abducens nerve palsy was trauma, at 31.6% and 27.1%, respectively. Compared with the other nerves, oculomotor nerve palsy was associated with a shorter duration onset of symptoms and recovery period. The best recovery outcomes among the various etiologies were inflammation, ischemic events, and trauma in oculomotor, trochlear, and abducens nerve palsy, respectively. Logistic regression revealed that an onset of <7 days and isolated nerve involvement were significantly associated with good long-term outcomes, with an adjusted odds ratio of 1.73 (95% confidence interval, 1.03-2.89) and 2.56 (95% confidence interval, 1.21-5.39) adjusted for the type of cranial nerve palsy, aged at 50 years, sex, diabetes mellitus, hypertension, dyslipidemia, onset at 7 days, and number of cranial nerves involved, respectively.
CONCLUSION
The onset of symptoms in less than 1 week and isolated nerve involvement were associated with better prognosis in subjects with third, fourth, and sixth cranial nerve palsy.
PubMed: 38352051
DOI: 10.2147/OPTH.S449127 -
Cureus Jan 2024Wernicke encephalopathy (WE) is a rare but life-threatening syndrome that is commonly associated with chronic alcoholism. It has also been found to be associated with...
Wernicke encephalopathy (WE) is a rare but life-threatening syndrome that is commonly associated with chronic alcoholism. It has also been found to be associated with malnutrition, prolonged parenteral nutrition, hemodialysis, hyperemesis gravidarum, gastroplasty, and AIDS. It usually presents as a clinical triad of confusion, ophthalmoplegia, and gait ataxia. Nystagmus is usually the most common and earliest ophthalmologic sign. We report a case of non-alcoholic WE in a patient who had prior bariatric surgery and was treated for malnutrition and sepsis, with nystagmus being the initial presentation. The MRI of the brain was normal. The diagnosis of WE was made clinically and was supported by the patient's symptomatic and clinical recovery following intravenous thiamine treatment. It is essential to highlight that a high level of suspicion is needed to diagnose non-alcoholic WE to allow the commencement of appropriate treatment and reduce morbidity and mortality rates related to this condition.
PubMed: 38344547
DOI: 10.7759/cureus.52121