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Journal of Neurological Surgery. Part... Aug 2020The orbit is a paired, transversely oval, and cone-shaped osseous cavity bounded and formed by the anterior and middle cranial base as well as the viscerocranium. Its...
The orbit is a paired, transversely oval, and cone-shaped osseous cavity bounded and formed by the anterior and middle cranial base as well as the viscerocranium. Its main contents are the anterior part of the visual system, globe and optic nerve, and the associated neural, vascular, muscular, glandular, and ligamentous structures required for oculomotion, lacrimation, accommodation, and sensation. A complex stream of afferent and efferent information passes through the orbit, which necessitates a direct communication with the anterior and middle cranial fossae, the pterygopalatine and infratemporal fossae, as well as the aerated adjacent frontal, sphenoidal, and maxillary sinuses and the nasal cavity. This article provides a detailed illustration and description of the microsurgical anatomy of the orbit, with a focus on the intrinsically complex spatial relationships around the annular tendon and the superior orbital fissure, the transition from cavernous sinus to the orbital apex. Sparse reference will be made to surgical approaches, their indications or limitations, since they are addressed elsewhere in this special issue. Instead, an attempt has been made to highlight anatomical structures and elucidate concepts most relevant to safe and effective transcranial, transfacial, transorbital, or transnasal surgery of orbital, periorbital, and skull base pathologies.
PubMed: 33072474
DOI: 10.1055/s-0040-1715096 -
Acta Ophthalmologica Jun 2014To investigate the clinical features of all patients with acute-onset diplopia presenting to the ophthalmology department.
PURPOSE
To investigate the clinical features of all patients with acute-onset diplopia presenting to the ophthalmology department.
METHODS
The notes of every patient who presented with acute onset (<4-week duration) diplopia to the ophthalmology clinic over a 2-year period were reviewed. Data regarding clinical features, underlying aetiology, past medical history, investigations and outcomes were extracted.
RESULTS
One hundred and forty-nine patients presented with 53.7% having an isolated third, fourth or sixth nerve palsy, 10.7% a mechanical cause, 10.1% a dysfunction of higher control, 8.1% decompensation of a pre-existing heterophoria, 6.7% idiopathic, 5.4% causes of monocular diplopia and 5.3% another diagnosis. Neuroradiological investigation identified that <5% of patients had a serious underlying pathology, which required immediate management; 80.5% had a diagnosis and underlying aetiology, which were obvious at presentation based only on clinical information and evaluation.
CONCLUSIONS
Acute onset diplopia is an uncommon and challenging presentation for the ophthalmologist to manage. These results demonstrate that the aetiology is commonly identifiable at the first presentation based on clinical evaluation, only a small percentage require urgent radiological investigation and a small minority of cases are likely to have serious emergent pathology.
Topics: Abducens Nerve Diseases; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Demyelinating Diseases; Diplopia; Female; Humans; Male; Middle Aged; Oculomotor Nerve Diseases; Retrospective Studies; Trochlear Nerve Diseases; Young Adult
PubMed: 23387838
DOI: 10.1111/aos.12062 -
Neurological Sciences : Official... Nov 2020COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy,... (Review)
Review
COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.
Topics: Adolescent; Aged; Betacoronavirus; COVID-19; Coronavirus Infections; Female; Humans; Male; Middle Aged; Neuromuscular Diseases; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32935156
DOI: 10.1007/s10072-020-04708-8 -
American Journal of Ophthalmology Oct 2022We evaluated patients with hypertropia compatible with a diagnosis of superior oblique (SO) palsy to ascertain whether the 3-step test (3ST) can distinguish SO atrophy...
PURPOSE
We evaluated patients with hypertropia compatible with a diagnosis of superior oblique (SO) palsy to ascertain whether the 3-step test (3ST) can distinguish SO atrophy characteristic of trochlear nerve pathology from masquerading conditions.
DESIGN
Prospective cross-sectional study.
METHODS
In an academic practice, we performed quasi-coronal plane, surface coil magnetic resonance imaging in 83 patients clinically diagnosed with SO palsy. We evaluated alignment, SO cross-sectional area, SO contractility, and rectus muscle pulley positions.
RESULTS
A total of 57 patients with mean age 39 years (SD = 21 years) had unilateral SO palsy manifested by SO atrophy (22 congenital and 35 acquired). There was normal SO size in 26 patients with an average age of 39 years (SD =16 years) considered masquerades (8 congenital and 18 acquired). Maximum palsied SO cross-section averaged 9.5 ± 3.8 mm, less than 18.4 ± 3.9 mm contralaterally (P < 10). In masquerades, maximum hypertropic SO cross-section was 20.7 ± 3.1 mm, which was not different from the hypotropic SO or the contralesional muscle in SO palsy. Head tilt testing in masquerades was indistinguishable from SO palsy. In SO palsy, central hypertropia averaged 13.2 ± 9.4Δ, increasing to 21.1 ± 14.0Δ in ipsilateral tilt, and decreasing to 4.3 ± 5.3Δ in contralateral tilt. In masquerades, central hypertropia averaged 13.1 ± 8.7Δ, and was 17.7 ± 11.1Δ in ipsilateral and decreasing to 4.9 ± 5.1Δ in contralateral tilt. Upright hypertropia was larger at 17.7 ± 9.9Δ in congenital than 12.0 ± 8.4Δ in acquired SO palsy (P = 0025) but was indistinguishable from congenital masquerades. Contractile change in SO cross-section was bilaterally similar in masquerades. Relevant coordinates of rectus pulleys were similar bilaterally in masquerades.
CONCLUSIONS
The 3ST pattern characteristic of unilateral SO palsy may be mimicked in all respects by masquerades.
Topics: Adult; Atrophy; Cross-Sectional Studies; Humans; Oculomotor Muscles; Paralysis; Prospective Studies; Strabismus; Trochlear Nerve Diseases
PubMed: 35618024
DOI: 10.1016/j.ajo.2022.05.017 -
Indian Journal of Ophthalmology Aug 2022The Parks 3-step test is an important test in the diagnosis of a single cyclovertical muscle palsy.
BACKGROUND
The Parks 3-step test is an important test in the diagnosis of a single cyclovertical muscle palsy.
PURPOSE
This video is presented to provide a simplified and easy understanding of the Parks 3-step test for post-graduate residents.
SYNOPSIS
The video contains a description of the steps to perform a 3-step test, the results of the test in a case of superior oblique palsy, the conditions that mimic a positive 3-step test, and how to identify these mimicking conditions.
HIGHLIGHTS
This is a simple demonstration of a classic clinical diagnostic procedure.
ONLINE VIDEO LINK
https://youtu.be/1wpjwe19c0E.
Topics: Exercise Test; Humans; Oculomotor Muscles; Paralysis; Strabismus; Trochlear Nerve Diseases
PubMed: 35919015
DOI: 10.4103/ijo.IJO_714_22 -
Annual Review of Vision Science Sep 2021Abnormalities in cranial motor nerve development cause paralytic strabismus syndromes, collectively referred to as congenital cranial dysinnervation disorders, in which... (Review)
Review
Abnormalities in cranial motor nerve development cause paralytic strabismus syndromes, collectively referred to as congenital cranial dysinnervation disorders, in which patients cannot fully move their eyes. These disorders can arise through one of two mechanisms: () defective motor neuron specification, usually by loss of a transcription factor necessary for brainstem patterning, or () axon growth and guidance abnormalities of the oculomotor, trochlear, and abducens nerves. This review focuses on our current understanding of axon guidance mechanisms in the cranial motor nerves and how disease-causing mutations disrupt axon targeting. Abnormalities of axon growth and guidance are often limited to a single nerve or subdivision, even when the causative gene is ubiquitously expressed. Additionally, when one nerve is absent, its normal target muscles attract other motor neurons. Study of these disorders highlights the complexities of axon guidance and how each population of neurons uses a unique but overlapping set of axon guidance pathways.
Topics: Axons; Cranial Nerve Diseases; Eye Movements; Humans; Motor Neurons; Strabismus
PubMed: 34081534
DOI: 10.1146/annurev-vision-093019-114307