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NMC Case Report Journal 2023Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been...
Ruptured cerebral aneurysms that occur in the anterior wall of the internal carotid artery (ICA) are known as blood blister-like aneurysms (BBAs); they have been reported to account for 0.3% to 1% of all ruptured ICA aneurysms. In this report, we describe the treatment of an unusual traumatic BBA (tBBA) with high-flow bypass using a radial artery graft, which resulted in a favorable outcome. A 59-year-old female suffered from an acute epidural hematoma, traumatic subarachnoid hemorrhage, and traumatic carotid-cavernous sinus fistula (tCCF) after being involved in a motor vehicle accident. Her angiography results showed tCCF and a tBBA on the anterior wall of the right ICA. On the fourth day after injury, we found rebleeding from the tBBA and performed an emergency high-flow bypass using a radial artery graft with lesion trapping as a curative procedure for the tCCF and tBBA. Postoperatively, right abducens nerve palsy appeared, but no other neurological symptoms were noted; the patient was thereafter transferred to a rehabilitation hospital 49 days after injury. Traumatic ICA aneurysms commonly occur close to the anterior clinoid process, form within 1 to 2 weeks of injury, and often rupture around 2 weeks after trauma. This case was considered rare as the ICA was likely injured and bleeding at the time of injury, resulting in a form of tBBA; this allowed early detection and appropriate treatment that resulted in a good outcome.
PubMed: 37869375
DOI: 10.2176/jns-nmc.2023-0088 -
Child Neurology Open 2023Moebius Syndrome, is a rare, non-progressive congenital neuropathological syndrome characterized primarily by the underdevelopment of the facial (CN VII) and abducens... (Review)
Review
Moebius Syndrome, is a rare, non-progressive congenital neuropathological syndrome characterized primarily by the underdevelopment of the facial (CN VII) and abducens nerve (CN VI). Other features of Moebius Syndrome include facial nerve paresis, ophthalmoplegias, orthodontic deficiencies (including crowded dentition, swollen and hyperplastic gingiva, dental calculus, etc.), musculoskeletal abnormalities, and impaired mental function. Due to the rarity of the disorder, very few case studies have been reported in the literature. This article summarizes the significant features of the disease according to commonalities in reported cases, along with several newly recognized features cited in recent literature. We have explored the different diagnostic criteria and the newly recognized imaging modalities that may be used. Understandably, the condition detrimentally affects a patient's quality of life; thus, treatment measures have also been outlined. This study aims to provide updated literature on Moebius Syndrome MBS and improve understanding of the condition.
PubMed: 37868706
DOI: 10.1177/2329048X231205405 -
Journal of Medical Cases Oct 2023The abducens or sixth cranial nerve provides motor innervation to the lateral rectus muscle, which abducts the ipsilateral eye with secondary innervation of the...
Acute Cranial Nerve VI Palsy Following Prolonged Prone Positioning in an Adolescent With Neurofibromatosis Type 1: A Rare Complication of Spinal Surgery in the Prone Position.
The abducens or sixth cranial nerve provides motor innervation to the lateral rectus muscle, which abducts the ipsilateral eye with secondary innervation of the contralateral medial rectus muscle to allow for coordinated movement of both eyes. Various acute and chronic pathologic conditions, most importantly pontine infarctions and increased intracranial pressure, can result in acute sixth cranial nerve palsies. We report the uncommon occurrence of acute abducens nerve palsy following spinal fusion surgery in an 18-year-old male patient with a history of multiple neurological and orthopedic conditions. Postoperatively, the patient presented with symptoms that included left diplopia with restricted upward and downward gaze, indicative of abducens nerve palsy. The anatomy of the sixth cranial nerve is discussed, potential etiologies of sixth nerve palsy presented, and a proposed diagnostic workup reviewed. Our report emphasizes the need for comprehensive exploration of ocular symptoms following spinal surgery, given the various potential etiologies of sixth nerve palsy.
PubMed: 37868328
DOI: 10.14740/jmc4145 -
Journal of Oral Science Jan 2024Various neuropathies of the cranil nerves can accompany trigeminal neuropathic pain attributed to space-occupying lesions. In this case report, the patient presented...
Various neuropathies of the cranil nerves can accompany trigeminal neuropathic pain attributed to space-occupying lesions. In this case report, the patient presented with persistent intraoral pain and numbness on the right side of the face. Cranial nerve examination revealed dysfunctional eye movements, diplopia, and mechanical hyposensitivity in the mandibular region. The patient was diagnosed with neuropathy due to intracranial lesions and referred to the Department of Neurosurgery and Otorhinolaryngology. The patient was suspected of having malignant lymphoma and is currently undergoing neurosurgical intervention. This article discusses the importance of the examination of the cranial nerve for patients with persistent pain in the trigeminal nerve distribution.
Topics: Humans; Magnetic Resonance Imaging; Trigeminal Neuralgia; Abducens Nerve Diseases; Neuralgia
PubMed: 37853617
DOI: 10.2334/josnusd.23-0155 -
Cureus Sep 2023Moebius syndrome is a rare congenital disorder characterized by nonprogressive uni- or bilateral abducens nerve (VI) and facial nerve (VII) palsy. Other cranial nerves...
Moebius syndrome is a rare congenital disorder characterized by nonprogressive uni- or bilateral abducens nerve (VI) and facial nerve (VII) palsy. Other cranial nerves (CN) such as CN III, IV, and IX-XII may be involved leading to varied presentations. Speech development, communication, and psychomotor complications are common. Given the complexity of the disease, patients require an individualized, multidisciplinary care plan involving many medical specialists. Accessing this level of care without insurance poses seemingly insurmountable challenges and places immense financial strain on both patients with Moebius syndrome and their families. Physicians must advocate for patients with Moebius syndrome and be knowledgeable about the community resources available to them such as non-profit organizations. This report presents a case of Moebius syndrome in an uninsured, immigrant, 13-year-old male and the barriers to providing him with adequate care.
PubMed: 37846244
DOI: 10.7759/cureus.45297 -
Cureus Sep 2023A carotid-cavernous fistula is a rare vascular anomaly involving abnormal communication between the carotid artery and the cavernous sinus. This condition leads to the...
A carotid-cavernous fistula is a rare vascular anomaly involving abnormal communication between the carotid artery and the cavernous sinus. This condition leads to the shunting of arterial blood directly into the venous system, causing diverse clinical manifestations. The classification includes direct and indirect fistulas, with endovascular techniques emerging as a preferred treatment option. In this report, we present the case of a 58-year-old male who presented with progressive right-sided proptosis, headache, and visual disturbances. He exhibited right abducens nerve palsy, reduced visual acuity, and a dilated superior ophthalmic vein on imaging. A multidisciplinary team confirmed the diagnosis of a carotid-cavernous fistula and chose to pursue endovascular embolization. Catheter angiography revealed the fistula and balloon-assisted occlusion restored normal arterial flow. The patient's symptoms improved, and follow-up showed complete resolution of proptosis and enhanced visual acuity. Successful endovascular embolization underscores the significance of a multidisciplinary approach and showcases the positive outcomes achievable when diverse specialties converge for patient well-being.
PubMed: 37814772
DOI: 10.7759/cureus.44902 -
Journal of Neurosurgery. Case Lessons Oct 2023Intracranial epidermoid cysts (ECs) are rare benign lesions of ectodermal origin that can be found in the cerebellopontine angle (CPA). If large enough, they compress...
BACKGROUND
Intracranial epidermoid cysts (ECs) are rare benign lesions of ectodermal origin that can be found in the cerebellopontine angle (CPA). If large enough, they compress surrounding structures, causing cranial neuropathies, cerebellar dysfunction, and hydrocephalus.
OBSERVATIONS
In this case report, the authors present a patient with headaches and diplopia secondary to a CPA EC. The cyst had wrapped itself around and was strangulating the abducens nerve. This choking of the nerve was believed to have been the cause of the patient's double vision. The arachnoid band was released with a myringotomy knife.
LESSONS
Intracranial ECs typically cause symptoms from mass effect on surrounding structures; it is unusual for one to have choked off the nerve in the fashion presented in this case. Knowledge of the potential ways that ECs can affect nervous structures is critical for resecting them without injuring normal tissue.
PubMed: 37782964
DOI: 10.3171/CASE23383 -
American Journal of Ophthalmology Feb 2024It has been supposed that rectus muscle paralysis would cause proptosis due to the reduction in active posterior tension. This study aimed to test this proposition by...
PURPOSE
It has been supposed that rectus muscle paralysis would cause proptosis due to the reduction in active posterior tension. This study aimed to test this proposition by evaluating globe translation during horizontal duction in patients with abducens palsy.
DESIGN
Prospective, single-center, fellow-eye controlled, case series.
METHODS
Horizontal globe rotation and translation were quantified using orbital magnetic resonance imaging of patients with isolated unilateral abducens nerve palsy without other ocular motility disorders. Unaffected fellow eyes served as the control group. Digital image analysis was performed.
RESULTS
The study included 5 female and 2 male patients with a mean ± standard deviation age of 52 ± 15 years. The average esotropia was 39.0 ± 9.6 diopters. Mean adduction was similar at 54.9 ± 10.4° in palsied eyes and 52.0 ± 7.1° in fellow eyes. However, abduction in palsied eyes was significantly less at 11.4 ± 7.1° than 37.1 ± 11.4° in fellow eyes (P = .0023). Average anterior translation in adduction was 0.46 ± 0.42 mm in palsied orbits, similar to 0.35 ± 0.47 mm in fellow orbits (P = .90). Anterior translation in abduction averaged 0.17 ± 0.53 mm in palsied orbits, similar to 0.27 ± 0.73 mm in fellow orbits (P = .80). Average medial translation in adduction at 0.32 ± 0.23 mm in palsied orbits was statistically similar to 0.12 ± 0.44 mm in fellow orbits (P = .54). Average lateral translation in abduction at 0.19 ± 0.18 mm in palsied orbits was similar to 0.33 ± 0.15 mm in control orbits (P = .38).
CONCLUSION
Abducens palsy does not alter normal eye translation during horizontal duction.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Prospective Studies; Abducens Nerve Diseases; Oculomotor Muscles; Esotropia; Magnetic Resonance Imaging
PubMed: 37774994
DOI: 10.1016/j.ajo.2023.09.016 -
BMJ Case Reports Sep 2023We report about a case of a woman in her 50s with a chondrosarcoma of the petrous apex. She has a strabism due to a right-sided amblyopia since childhood and noticed a...
We report about a case of a woman in her 50s with a chondrosarcoma of the petrous apex. She has a strabism due to a right-sided amblyopia since childhood and noticed a slowly progressive squint angle in the last months. Her general practitioner (GP) referred her to an ophthalmologist who diagnosed a left abducens paresis and initiated an MRI demonstrating a mass in the left petrous apex. A transnasal endoscopic transsphenoidal biopsy revealed a grade I chondrosarcoma. The patient underwent an endoscopic transsphenoidal anterior petrosectomy approach with complete removal of the tumour. After surgery the squint angle gradually improved to previous levels, so that the patient was able to resume her work. This report demonstrates that even slight changes of a squint angle without diplopia, in this case because of pre-existing amblyopia, could be a hallmark of an intracranial process.
Topics: Female; Humans; Child; Amblyopia; Petrous Bone; Chondrosarcoma; Strabismus; Bone Neoplasms
PubMed: 37730429
DOI: 10.1136/bcr-2023-256273 -
Journal of Medical Case Reports Sep 2023Patients who experience angina and acute myocardial infarction often receive diagnostic coronary angiography and percutaneous coronary intervention.
BACKGROUND
Patients who experience angina and acute myocardial infarction often receive diagnostic coronary angiography and percutaneous coronary intervention.
CASE PRESENTATION
A 54-year-old Persian man with acute coronary syndrome was admitted to the hospital and underwent elective percutaneous coronary intervention. Two hours after the procedure, the patient experienced ophthalmoplegia and diplopia. The diagnosis was abducens nerve palsy resulting in transient lateral rectus palsy. The cause is presumed to have been an ischemic event affecting the unilateral abducens nerve. This could have occurred owing to the microembolism during the percutaneous coronary intervention, which resulted in left lateral rectus palsy. Within 1 month, the diplopia was relieved completely, and the physical examination was normal.
CONCLUSION
The occurrence of neuro-ophthalmic complications that may arise from percutaneous coronary intervention is extremely rare. To our knowledge, this is the second reported case of unilateral rectus palsy associated with percutaneous coronary intervention.
Topics: Male; Humans; Middle Aged; Acute Coronary Syndrome; Diplopia; Abducens Nerve Diseases; Coronary Angiography; Paralysis; Percutaneous Coronary Intervention
PubMed: 37700337
DOI: 10.1186/s13256-023-04124-4