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Internal Medicine (Tokyo, Japan) 2006
Topics: Abducens Nerve; Abducens Nerve Diseases; Adult; Brain Neoplasms; Cavernous Sinus; Female; Horner Syndrome; Humans; Male; Middle Aged; Sympathetic Nervous System
PubMed: 17015998
DOI: 10.2169/internalmedicine.45.0163 -
Eye (London, England) Feb 2015We review ocular motor cranial nerve palsies in childhood and highlight many of the features that differentiate these from their occurrence in adulthood. The clinical... (Review)
Review
We review ocular motor cranial nerve palsies in childhood and highlight many of the features that differentiate these from their occurrence in adulthood. The clinical characteristics of cranial nerve palsies in childhood are affected by the child's impressive ability to repair and regenerate after injury. Thus, aberrant regeneration is very common after congenital III palsy; Duane syndrome, the result of early repair after congenital VI palsy, is invariably associated with retraction of the globe in adduction related to the innervation of the lateral rectus by the III nerve causing co-contraction in adduction. Clinical features that may be of concern in adulthood may not be relevant in childhood; whereas the presence of mydriasis in III palsy suggests a compressive aetiology in adults, this is not the case in children. However, the frequency of associated CNS abnormalities in III palsy and the risk of tumour in VI palsy can be indications for early neuroimaging depending on presenting features elicited through a careful history and clinical examination. The latter should include the neighbouring cranial nerves. We discuss the impact of our evolving knowledge of congenital cranial dysinnervation syndromes on this field.
Topics: Abducens Nerve; Abducens Nerve Diseases; Child; Child, Preschool; Eye Diseases; Humans; Nerve Regeneration; Oculomotor Nerve; Oculomotor Nerve Diseases; Trochlear Nerve; Trochlear Nerve Diseases
PubMed: 25572578
DOI: 10.1038/eye.2014.292 -
Italian Journal of Pediatrics Jun 2022Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although many reports have detailed a...
BACKGROUND
Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although many reports have detailed a range of neurological symptoms in SARS-CoV-2-infected patients, studies of neuro-ophthalmological manifestations are still scarce.
CASE PRESENTATION
We report a 9-year-old girl with abducens nerve palsy after COVID-19 with no evidence of other neurological disease on neuroimaging. At 2-month follow-up clinical conditions were improved.
CONCLUSIONS
The palsy may have occurred due to a possible post-infectious immune-mediated mechanism underlying the neuropathy, as opposed to direct viral infiltration. Despite being rare, this complication must be taken into account.
Topics: Abducens Nerve Diseases; COVID-19; Child; Female; Humans; Nervous System Diseases; SARS-CoV-2
PubMed: 35717391
DOI: 10.1186/s13052-022-01298-3 -
Asian Journal of Neurosurgery 2018Abducens nerve palsy associated with subarachnoid hemorrhage (SAH) has rarely been reported. Its frequency, mechanism of palsy, association with aneurysmal location, and...
BACKGROUND
Abducens nerve palsy associated with subarachnoid hemorrhage (SAH) has rarely been reported. Its frequency, mechanism of palsy, association with aneurysmal location, and clinical course are poorly described. The purpose of our study was to evaluate patients with abducens nerve palsy caused by SAH occurring from ruptured vertebral artery (VA) dissecting aneurysm and to find aneurysmal location using initial computed tomography (CT) and its association with clinically detected cranial nerve palsy.
METHODS
Fourteen patients of SAH due to ruptured VA dissecting aneurysm were treated at our hospital from January 2011 to May 2015. The clinical courses and CT findings were reviewed retrospectively.
RESULTS
Abducens nerve palsy was observed in 77.8% of cases after excluding patients with decreased levels of consciousness. Clots within the prepontine cistern were significantly thicker in cases of VA dissecting aneurysm than in case of supratentorial aneurysm ( = 0.002).
CONCLUSION
The findings of our study indicated that ruptured VA dissecting aneurysms, even in cases of angio-negative SAH, are likely to present with abducens nerve palsy.
PubMed: 30283507
DOI: 10.4103/ajns.AJNS_156_16 -
Indian Journal of Ophthalmology Oct 2013Ischemic abducens nerve palsy usually presents as isolated cranial nerve palsy in the middle aged and elderly patients with known risk factors such as diabetes mellitus,...
Ischemic abducens nerve palsy usually presents as isolated cranial nerve palsy in the middle aged and elderly patients with known risk factors such as diabetes mellitus, hypertension, dyslipidemia, carotid artery disease, etc., In this report, we describe four patients with isolated abducens nerve palsy who presented with an acute onset diplopia whose detailed history and examination were suggestive of an ischemic etiology. Detailed systemic and laboratory evaluation revealed hyperhomocysteinemia as the only potential risk factor. To the best of our knowledge this is the first report of association of hyperhomocysteinemia and isolated abducens nerve palsy.
Topics: Abducens Nerve Diseases; Adolescent; Adult; Child; Diagnosis, Differential; Diplopia; Eye Movements; Female; Follow-Up Studies; Homocysteine; Humans; Hyperhomocysteinemia; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Risk Factors; Young Adult
PubMed: 24212315
DOI: 10.4103/0301-4738.121089 -
BMJ Case Reports Apr 2019A 47-year-old woman presented with six episodes of horizontal binocular double vision over a 2-year period. CT imaging was significant for extensive dural calcification...
A 47-year-old woman presented with six episodes of horizontal binocular double vision over a 2-year period. CT imaging was significant for extensive dural calcification in the spine and calcification of the skull base, likely involving Dorello's canal. Biochemical testing revealed a persistently low alkaline phosphatase level. Recurrent nerve palsy may possibly be induced by mechanical compression of the sixth cranial nerve in Dorello's canal from calcification due to hypophosphatasia syndrome.
Topics: Abducens Nerve Diseases; Diagnosis, Differential; Diplopia; Female; Humans; Hypophosphatasia; Middle Aged; Nerve Compression Syndromes; Ossification, Heterotopic; Skull Base; Tomography, X-Ray Computed
PubMed: 30975772
DOI: 10.1136/bcr-2018-226895 -
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 -
Current Oncology (Toronto, Ont.) Jul 2022Abducens nerve palsy is a severe dysfunction after petroclival meningioma (PC MNG) surgery. The objective of this investigation was to analyze abducens nerve outcomes in...
Abducens nerve palsy is a severe dysfunction after petroclival meningioma (PC MNG) surgery. The objective of this investigation was to analyze abducens nerve outcomes in patients who underwent the retrosigmoid approach in relation to the MIB-1 index. Thirty-two patients with primary sporadic PC MNG were retrospectively analyzed. Mean follow-up was 28.0 months. Analysis of the MIB-1 index was performed to evaluate the abducens nerve outcome. An optimal MIB-1 index cut-off value (<4/≥4) in the association with postoperative CN VI palsy was determined by ROC analysis (AUC: 0.74, 95% CI: 0.57−0.92). A new-onset CN VI palsy was present in 7 cases (21.88%) and was significantly associated with an increased MIB-1 index (≥4%, p = 0.025) and a peritumoral edema in the brachium pontis (p = 0.047) which might be caused by the increased growth rate. Tumor volume, cavernous sinus infiltration, auditory canal invasion, and Simpson grading were not associated with new CN VI deficits. Six (85.7%) of the 7 patients with both an increased MIB-1 index (≥4%) and new abducens nerve palsy still had a CN VI deficit at the 12-month follow-up. A peritumoral edema caused by a highly proliferative PC MNG with an elevated MIB-1 index (≥4%) is associated with postoperative abducens nerve deficits.
Topics: Abducens Nerve; Abducens Nerve Diseases; Humans; Meningeal Neoplasms; Meningioma; Morbidity; Paralysis; Retrospective Studies
PubMed: 35877258
DOI: 10.3390/curroncol29070398 -
Turkish Neurosurgery Oct 2010The microanatomy of the abducens nerve (AN) is important for clinical reasons and surgical approaches as it is located in the petroclival region. The incidence of...
AIM
The microanatomy of the abducens nerve (AN) is important for clinical reasons and surgical approaches as it is located in the petroclival region. The incidence of branching and duplication of the abducens nerve are unknown and mechanisms relating to paralysis of the nerve in indirect conditions are yet to be clarified.
MATERIAL AND METHODS
Microanatomical details (anatomical observations and morphometric measurements) of the AN were obtained from 20 cadaveric skull bases (40 specimens).
RESULTS
55% of the intracranial abducens nerves had branching, with type 2 and 3 branching occurring in 10%. The nerve coursed below the petrosphenoidal ligament in all but one, and was located at the lateral third below the ligament in 82.5% of the specimens. The mean AN diameter was 1.3±0.2 mm, and the mean diameter of the dural entrance pore was 1.8±0.3 mm, the right being significantly larger than the left. The mean distance of the AN from the posterior clinoid process was 8.4±2.5 mm and from the petrous apex 3.6±2.1 mm.
CONCLUSION
Branching of the AN was present in a significant number of specimens; the branching pattern at the cavernous segment may be called "pseudobranching". The AN is at risk for paresis in indirect conditions because of its angles and fixations on its course.
Topics: Abducens Nerve; Cadaver; Cavernous Sinus; Cranial Fossa, Posterior; Humans; Microdissection; Skull Base
PubMed: 20963693
DOI: 10.5137/1019-5149.JTN.3303-10.1 -
Cureus Jul 2023A healthy 28-year-old lady, para 1, presented to the emergency department with persistent frontal headache, nausea, and vomiting following an emergency cesarean...
A healthy 28-year-old lady, para 1, presented to the emergency department with persistent frontal headache, nausea, and vomiting following an emergency cesarean section four days ago. She experienced difficulties with six failed attempts of spinal anesthesia intrapartum before conversion to general anesthesia. A 25-gauge Whitacre needle was utilized for administering spinal anesthesia under a sitting position. The anesthetist noticed a loss of resistance upon needle insertion, but only a negligible amount of cerebrospinal fluid was obtained upon removing the stylet. The patient underwent an emergency cesarean section due to fetal distress, and she was not in labor during the attempts of spinal anesthesia. Otherwise, the cesarean section lasted for an hour and was uneventful. No intrapartum eclampsia or pre-eclampsia. She was diagnosed with post-dural puncture headache, and her symptoms improved after receiving intravenous hydration, oral caffeine, and non-steroidal anti-inflammatory drug (NSAIDs). However, on the sixth day after the spinal anesthesia, she suddenly developed double vision. Examination showed bilateral visual acuity was measured at 6/7.5. No proptosis or ptosis was noted. The relative afferent pupillary defect was negative with no anisocoria. Both eyes were orthophoria with normal head posture. Extraocular muscles revealed a right abduction restriction of -1 with the patient complaining of binocular horizontal diplopia at the right gaze, consistent with right abducens nerve palsy. Systemic neurological findings were normal, and imaging results were unremarkable. Diagnosis of right abducens nerve palsy post-dural puncture was made clinically. The patient was keen on conservative management instead of blood patch therapy. Hence, she was treated supportively via uni-ocular patching to relieve diplopia. Spontaneous complete recovery of the right abducens nerve palsy was observed after three weeks. Cranial nerve palsy is a rare complication reported following spinal anesthesia, with the abducens nerve being the commonest nerve involved. Although it is not always benign, the presented case showed spontaneous complete recovery of the right abducens nerve palsy after three weeks. Awareness of this uncommon complication will avoid unnecessary distress and investigative burden to both the patient and the doctor.
PubMed: 37539413
DOI: 10.7759/cureus.41298