RESUMO
BACKGROUND: Abducens nerve palsy is the most common isolated ocular cranial nerve palsy. In adults, nontraumatic etiologies of isolated sixth cranial nerve palsy can include vascular disease, inflammation, tumors, and a prior history of infection. CASE PRESENTATION: We present a case of a 52-year-old Asian male who developed acute abducens nerve palsy after vaccination with the AstraZeneca coronavirus disease 2019 vaccine. A complete workup including magnetic resonance imaging of the brain and orbits revealed no abnormalities. The patient experienced a gradual recovery over 10 weeks through alternative eye patching. The abducens nerve palsy is postulated to be correlated with the coronavirus disease 2019 vaccine. CONCLUSION: Despite the recognized efficacy and cost benefits of coronavirus disease 2019 vaccines, clinicians should be aware of the possible association between cranial nerve palsies and coronavirus disease 2019 vaccines.
Assuntos
Doenças do Nervo Abducente , COVID-19 , Humanos , Doenças do Nervo Abducente/etiologia , Masculino , Pessoa de Meia-Idade , COVID-19/complicações , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Imageamento por Ressonância Magnética , SARS-CoV-2 , Vacinação/efeitos adversosRESUMO
INTRODUCTION: In this report, we describe a rare case of a cranial nerve VI palsy secondary to herpes zoster infection with polyneuropathic involvement. CASE PRESENTATION: An 82-year-old male was seen by ophthalmology for acute onset of double vision. Fourteen days before presenting, he was diagnosed with herpes zoster ophthalmicus. He was suspected to have zoster polyneuropathy also involving cranial nerve IX and X given a sore throat that began prior to the characteristic trigeminal dermatomal rash. He was diagnosed with cranial nerve VI palsy secondary to herpes zoster infection. DISCUSSION: Ophthalmic complications of herpes zoster ophthalmicus are many; however, extraocular nerve palsies secondary to herpes zoster infection and zoster polyneuropathy are documented infrequently in the literature. CONCLUSIONS: Extraocular muscle palsies are a rare complication of herpes zoster infection. This case reviews the most current literature surrounding this condition and discusses the significance of polyneuropathic involvement in varicella zoster virus reactivation.
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Doenças do Nervo Abducente , Herpes Zoster Oftálmico , Humanos , Masculino , Herpes Zoster Oftálmico/complicações , Herpes Zoster Oftálmico/tratamento farmacológico , Herpes Zoster Oftálmico/diagnóstico , Idoso de 80 Anos ou mais , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/virologia , Antivirais/uso terapêutico , Diagnóstico DiferencialRESUMO
Multiple myeloma is a plasma cell neoplasm, which may present as a solitary plasmacytoma and, uncommonly, as an extramedullary plasmacytoma. Intracranial plasmacytomas may manifest in central nervous system involvement as cranial nerve palsies. Cranial nerve six palsy is the most common in cases of malignancy. However, isolated abducens palsy presenting as multiple myeloma recurrence is very uncommon. Here, we detail two cases in which intracranial plasmacytoma lesions were present within the region of the Dorello canal, resulting in acute isolated unilateral diplopia from disease recurrence in the absence of systemic marrow involvement.
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Doenças do Nervo Abducente , Imageamento por Ressonância Magnética , Mieloma Múltiplo , Recidiva Local de Neoplasia , Humanos , Doenças do Nervo Abducente/etiologia , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Idoso , Diagnóstico Diferencial , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/complicações , Plasmocitoma/patologia , Feminino , Diplopia/etiologia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/complicaçõesAssuntos
Sincinesia , Humanos , Sincinesia/fisiopatologia , Ponte/diagnóstico por imagem , Ponte/patologia , Masculino , Doenças Desmielinizantes/fisiopatologia , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/patologia , Imageamento por Ressonância Magnética , Feminino , Doenças do Nervo Abducente/fisiopatologia , Pessoa de Meia-IdadeRESUMO
Pseudoaneurysm of the internal carotid artery caused by skull base osteomyelitis (SBO) is a lethal condition seen in immunocompromised patients, predominantly those with diabetes mellitus. Cranial nerve involvement is a common complication and generally indicates a poor prognosis. We report the case of a 62-year-old diabetic patient who presented with isolated sixth cranial nerve palsy. She had uncontrolled blood sugar levels and high erythrocyte sedimentation rate, and she suffered from pyelonephritis. Neuroimaging detected SBO with multiple secondary mycotic pseudoaneurysms prominent at the petrocavernous junction. Ischemia is the most common etiology for an isolated abducens nerve palsy, but in certain cases neuroimaging is warranted to prevent life-threatening complications. This case highlights the importance and urgency of identifying and managing such conditions.
Assuntos
Doenças do Nervo Abducente , Falso Aneurisma , Micoses , Osteomielite , Feminino , Humanos , Pessoa de Meia-Idade , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/complicações , Base do Crânio , Osteomielite/complicações , Neuroimagem/efeitos adversos , Micoses/complicaçõesRESUMO
The three classic symptoms of carotid cavernous fistula (CCF) are pulsating exophthalmos, bruit and conjunctival chemosis. Here, we present a clinical case of isolated abducens nerve palsy due to a high-flow CCF in an 84-year-old woman, without the typical congestive orbito-ocular features. It was a diagnostic challenge because, for patients older than 50 years with cardiovascular risk factors, ischaemic mononeuropathy is the most frequent aetiology. This case illustrates the least common type of CCF that can be easily misdiagnosed. Physicians should consider fistula as a possible diagnosis in a patient with isolated abducens nerve palsy even without the classic triad.
Assuntos
Doenças do Nervo Abducente , Fístula Carótido-Cavernosa , Erros de Diagnóstico , Humanos , Fístula Carótido-Cavernosa/diagnóstico , Feminino , Idoso de 80 Anos ou mais , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/diagnósticoRESUMO
Purpose: To report patients who first presented with various ocular manifestations and eventually ascertained to have underlying dengue. Methods: A prospective study was conducted at multiple tertiary eye-care centers in India from 2012 to 2022. Cases reporting initially with ocular features along with fever/past history of fever over the last two weeks or with clinical features of dengue were selected. After an ophthalmological examination, patients underwent complete serological and biochemical analysis and those with reduced platelet counts were evaluated for dengue. Results: Out of 564 cases, 15 patients were verified to be afflicted with dengue eventually. A rising trend of cases was seen every year and out of 15 cases, eight cases were reported during the Covid-19 pandemic (from 2020 to 2022), but were COVID-negative. 9 cases presented with acute redness followed by diminished vision. Seven cases presented a history of fever over the last few days and one had traveled from dengue endemic area. The various ocular presentations included subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth-nerve palsy, and vitreous hemorrhage. On serological examination, all 15 patients were detected to have low platelets. All cases responded well with supportive treatment and the ocular features subsided in all within a couple of weeks with good visual recovery. Conclusion: In a tropical nation, such as India, with endemic dengue zones and increasing figures of dengue lately, ophthalmologists must include dengue fever among the differential diagnoses in various ocular presentations like subconjunctival hemorrhage, viral keratitis, anterior uveitis, sixth nerve palsy, and vitreous hemorrhage. Abbreviations: DHF = dengue hemorrhagic fever, PCR = polymerase chain reaction, RT-PCR = real-time automated reverse transcriptase (RT-PCR), SD = standard deviation, MAC-ELIS = IgM antibodies capture enzyme-linked immunosorbent assay, RE = right eye, LE = left eye, CECT = Contrast-enhanced computed tomography.
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Doenças do Nervo Abducente , Dengue , Infecções Oculares Virais , Ceratite , Uveíte Anterior , Humanos , Hemorragia Vítrea , Pandemias , Estudos Prospectivos , Infecções Oculares Virais/diagnóstico , Infecções Oculares Virais/epidemiologia , Dengue/complicações , Dengue/diagnóstico , Dengue/epidemiologiaRESUMO
The modified Nishida muscle transposition procedure, in which one-third of each vertical rectus muscle belly is sutured onto the sclera in the infero- and superotemporal quadrants without either tenotomy of the vertical rectus muscles or splitting of the vertical rectus muscle is an effective treatment for abducens nerve palsy. We report a case of inferior rectus muscle aplasia treated using the modified Nishida procedure to transpose both horizontal rectus muscles inferiorly combined with superior rectus tenotomy.
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Músculos Oculomotores , Procedimentos Cirúrgicos Oftalmológicos , Tenotomia , Humanos , Músculos Oculomotores/cirurgia , Tenotomia/métodos , Procedimentos Cirúrgicos Oftalmológicos/métodos , Masculino , Doenças do Nervo Abducente/cirurgia , Visão Binocular/fisiologia , Técnicas de Sutura , Feminino , Movimentos Oculares/fisiologiaRESUMO
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 1st June 2022 to 30th 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.
Assuntos
Doenças do Nervo Abducente , Mpox , Feminino , Masculino , Humanos , Hospitalização , Tempo de Internação , Reino Unido/epidemiologiaAssuntos
Doenças do Nervo Abducente , Arterite de Takayasu , Humanos , Angiografia Digital , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico por imagem , Angiografia por Ressonância Magnética , Doenças do Nervo Abducente/diagnóstico por imagem , Doenças do Nervo Abducente/etiologiaAssuntos
Hipertrofia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Humanos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico por imagem , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/patologia , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Síndromes de Compressão Nervosa/complicações , Masculino , Doenças do Nervo Abducente/etiologia , Feminino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To investigate the prevalence and risk of new-onset abducens nerve palsy and acute-onset diplopia following mRNA COVID-19 vaccination. METHODS: In this retrospective, population-based study, patient data from the COVID-19 Research Network of TriNetX was searched via the TriNetX Analytics platform for patients who received specific vaccinations based on Common Procedural Technology codes. We recorded instances of newly diagnosed abducens nerve palsy and diplopia within 21 days following each vaccination event. RESULTS: Of the 3,545,224 patients (mean age at vaccination, 46.2 ± 21.3 years) who received the mRNA COVID-19 vaccine, 12 (<0.0001%) patients had a new diagnosis of abducens nerve palsy and 453 (0.013%) had acute-onset diplopia within 21 days of first dose of COVID-19 vaccination. After propensity score matching, the relative risk for new abducens nerve palsy diagnosis after the first dose of COVID-19 vaccination was not significantly different from that after influenza (RR, 0.77), Tdap (RR, 1.0), or the second dose of the COVID-19 vaccinations (RR, 1.00). Furthermore, there was a lower risk of abducens nerve palsy diagnosis after the first dose of the COVID-19 vaccination compared with the risk after COVID-19 infection (RR, 0.15). CONCLUSIONS: The risk of a new abducens nerve palsy diagnosis following the first dose of the COVID-19 vaccine is lower than the risk associated with COVID-19 infection itself. There is no evidence to suggest a causal relationship between COVID-19 vaccination and the development of abducens nerve palsy.
Assuntos
Doenças do Nervo Abducente , Vacinas contra COVID-19 , COVID-19 , Humanos , Doenças do Nervo Abducente/induzido quimicamente , COVID-19/complicações , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Diplopia/induzido quimicamente , Estudos Retrospectivos , Vacinação/efeitos adversosRESUMO
OBJECTIVE: Carotid cavernous fistulas (CCFs) represent uncommon and anomalous communications between the carotid artery and the cavernous sinus. MATERIALS AND METHODS: Case report RESULTS: We present the clinical details and successful management of a previously healthy 44-year-old patient who presented with one-month worsening headache, bilateral abducens palsy and conjunctival injection. Imaging modalities including magnetic resonance imaging (MRI) with contrast and digital subtraction angiography (DSA) facilitated the diagnosis of CCF. The patient underwent endovascular coiling of the CCF, leading to neurological recovery and symptom remission. CONCLUSION: This case highlights the importance of promptly CCF diagnosis in patients with multiple cranial nerve palsies and conjunctival hyperemia. Moreover, it emphasizes the efficacy of endovascular coiling in achieving symptom remission.
Assuntos
Doenças do Nervo Abducente , Fístula Carótido-Cavernosa , Seio Cavernoso , Embolização Terapêutica , Hiperemia , Humanos , Adulto , Fístula Carótido-Cavernosa/complicações , Fístula Carótido-Cavernosa/diagnóstico por imagem , Hiperemia/diagnóstico por imagem , Hiperemia/complicações , Seio Cavernoso/diagnóstico por imagem , Doenças do Nervo Abducente/diagnóstico por imagem , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/terapia , Artérias Carótidas , Embolização Terapêutica/efeitos adversosRESUMO
BACKGROUND With the advent of antibiotics, petrous apicitis (PA), inflammation of the petrous temporal bone, has become a rare complication of otitis media. Even more uncommon is Gradenigo syndrome (GS), a result of PA, characterized by a triad of otitis media or purulent otorrhea, pain within the regions innervated by the first and second division of the trigeminal nerve, and ipsilateral abducens nerve palsy. Recent literature has demonstrated increasing reports of Fusobacterium necrophorum isolated in cases of GS. CASE REPORT A 21-year-old man presented with otalgia, reduced hearing, and severe headache. Examination revealed right-sided purulent otorrhea, anesthesia within the trigeminal nerve distribution, and an ipsilateral abducens nerve palsy. F. necrophorum was isolated from an ear swab and a blood culture. Computed tomography and magnetic resonance imaging (MRI) demonstrated otomastoiditis, PA, cavernous sinus thrombosis, and severe stenosis of the petrous internal carotid artery. He was treated with intravenous benzylpenicillin, underwent a mastoidectomy and insertion of a ventilation tube, and was started on a 3-month course of dabigatran. Interval MRI showed improved internal carotid artery caliber, persistent petrous apex inflammation, and normal appearance of both cavernous sinuses. Follow-up clinical review noted persistent abducens and trigeminal nerve dysfunction. CONCLUSIONS We identified 190 cases of PA; of these, 80 presented with the classic Gradenigo triad. Fusobacterium sp. were cultured in 10% of GS cases, making them the most frequent isolates. Due to the fastidious nature of F. necrophorum, it may be underrepresented in the historical literature, and we recommend that empiric antibiotics cover anaerobic organisms.
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Doenças do Nervo Abducente , Otite Média , Petrosite , Masculino , Humanos , Adulto Jovem , Adulto , Petrosite/complicações , Fusobacterium necrophorum , Otite Média/complicações , Doenças do Nervo Abducente/complicações , Doenças do Nervo Abducente/diagnóstico , Inflamação , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: This case report describes a 34-year-old woman who developed diplopia and strabismus 2 weeks after a vaginal delivery and epidural anesthesia. CASE REPORT: A 34-year-old women presented to the emergency department (ED) with continued headache and new-onset diplopia after having undergone epidural anesthesia for a vaginal delivery 2 weeks prior. During that time, she underwent two blood patches, rested supine, drank additional fluids, and consumed caffeinated products for her spinal headache. When she developed double vision from a cranial nerve VI palsy, she returned to the ED. At that time, she had a third blood patch performed, and she was evaluated by a neurologist. The medical team felt the cranial nerve VI palsy was due to the downward pull of the brain and stretching of the nerve. Magnetic resonance imaging and neurosurgical closure of the dura were considered as the next steps in treatment; however, they were not performed after being declined by the patient. All symptoms were resolved over the next 3 weeks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case illustrates the uncommon complication of a cranial nerve VI palsy from a persistent cerebrospinal fluid leak after a dural puncture. Emergency physicians must be aware that diplopia can be a rare presenting symptom after patients undergo a lumbar puncture. Furthermore, emergency physicians should be aware of the multiple treatment options available. Knowledge of the timeline of resolution of the diplopia is necessary to make shared decisions with our patients about escalating care.
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Doenças do Nervo Abducente , Anestesia Epidural , Humanos , Feminino , Adulto , Diplopia/etiologia , Diplopia/terapia , Placa de Sangue Epidural/efeitos adversos , Placa de Sangue Epidural/métodos , Anestesia Epidural/efeitos adversos , Doenças do Nervo Abducente/etiologia , Cefaleia/etiologia , Paralisia , Nervos CranianosRESUMO
Ocular neuromyotonia (ONM) is an infrequent disorder characterised by recurrent episodes of binocular diplopia caused by paroxysmal contraction of one or several extraocular muscles innervated by the same cranial nerve. It can be triggered spontaneously or caused by prolonged contraction of specific eye muscle(s) and is usually related to a local intracranial radiotherapy antecedent. We report the case of a 46-year-old woman who developed intermittent episodes of binocular diplopia eight years after radiotherapy for a nasopharyngeal carcinoma. After a complete neuro-ophthalmic assessment we diagnosed the case as an abducens nerve neuromyotonia. Although it is infrequent, radiotherapy to the nasopharynx is a possible cause of ONM, due to the proximity to the base of the skull and extraocular motor nerve pathways, especially that of the VI cranial nerve, as is the case presented in this article, about a patient whose history is a nasopharyngeal carcinoma treated with local radiotherapy.
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Diplopia , Síndrome de Isaacs , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Nasofaríngeas/radioterapia , Síndrome de Isaacs/etiologia , Síndrome de Isaacs/diagnóstico , Carcinoma Nasofaríngeo/radioterapia , Diplopia/etiologia , Carcinoma/radioterapia , Doenças do Nervo Abducente/etiologia , Lesões por Radiação/etiologia , Lesões por Radiação/complicações , Radioterapia/efeitos adversosRESUMO
The concurrent development of abducens nerve palsy and optic neuritis on the same side is rare. Here we presented an 82-year-old man who developed the combination of abducens nerve palsy and optic neuritis on the left side 2 months after the sixth inoculation of COVID-19 mRNA vaccine. In past history at 45 years old, he experienced subarachnoid hemorrhage and underwent surgery for the clipping of intracranial aneurysm. The patient had no systemic symptoms, such as general fatigue, fever, arthralgia, and skin rashes. Physical and neurological examinations were also unremarkable. Since the aneurysmal metal clip used at that time was not compatible with magnetic resonance imaging, he underwent computed tomographic (CT) scan of the head and showed no space-occupying lesion in the orbit, paranasal sinuses, and brain. As an old lesion, the anterior temporal lobe on the left side had low-density area with metallic artifact on the left side of the skull base, indicative of metal clipping. In 4 weeks of observation from the initial visit, he showed complete recovery of visual acuity and became capable of abducting the left eye in full degrees. We also reviewed 8 patients with the combination of abducens nerve palsy and optic neuritis in the literature to reveal that the combination of signs did occur in mild meningitis with rare infectious diseases and in association with preceding herpes zoster in the first branch of the trigeminal nerve. The course of the present patient suggested that the combination of signs might be vaccine-associated.
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Doenças do Nervo Abducente , Herpes Zoster , Neurite Óptica , Idoso de 80 Anos ou mais , Humanos , Masculino , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/diagnóstico , Vacinas contra COVID-19 , Herpes Zoster/complicações , Herpesvirus Humano 3 , Neurite Óptica/etiologiaRESUMO
Purpose: Minimally invasive and surgical spine procedures are commonplace with various risks and complications. Cranial nerve palsies, however, are infrequently encountered, particularly after procedures such as lumbar punctures, epidural anesthesia, or intrathecal injections, and are understandably worrisome for clinicians and patients as they may be interpreted as secondary to a sinister etiology. However, a less commonly considered source is a pneumocephalus which may, in rare cases, abut cranial nerves and cause a palsy as a benign and often self-resolving complication. Here, we present the case of a patient who underwent an intrathecal methotrexate infusion for newly diagnosed non-Hodgkin's T-cell lymphoma and subsequently developed an abducens nerve palsy due to pneumocephalus. We highlight the utility of various imaging modalities, treatment options, and review current literature on spinal procedures resulting in cranial nerve palsies attributable to pneumocephalus presenting as malignant etiologies.
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Doenças do Nervo Abducente , Doenças dos Nervos Cranianos , Pneumocefalia , Humanos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Doenças dos Nervos Cranianos/etiologia , Doenças dos Nervos Cranianos/complicações , Doenças do Nervo Abducente/etiologia , Doenças do Nervo Abducente/complicações , Punção Espinal/efeitos adversos , Nervos CranianosRESUMO
BACKGROUND: Various ligaments present in the skull base are of clinical and surgical importance. One among them, is the petrosphenoid ligament (PSL). PSL may ossify either in a partial or complete form and forms the roof of Dorello's canal underneath which the abducens nerve passes. Studies argued both protective and adverse effects of the ossified PSL. Hence, the incidence of PSL ossification has become a relevant subject in clinical practice to radiologists, neurologists and neurosurgeons for understanding its potential role in abducens nerve compression. MATERIALS AND METHODS: We have undertaken this study to investigate the incidence of PSL ossification from multidetector computed tomography (MDCT) images of the patients who had been referred to the Medical Imaging Department of Mubarak Al-Kabeer Hospital in Kuwait. We retrospectively assessed a total of 200 patients' head CT scans (400 petroclival regions) between January 2021 and June 2022 in which 59% were males (n = 118) and 41% were females (n = 82) aged between 18 and 91 years. RESULTS: A total of 37 patients (26 male, 11 female) aged between 18-84 years were presented with ossification of PSL. Among these 37 patients, 28 patients were presented with unilateral ossified PSL, and 9 patients were presented with bilateral ossified PSL, amounting to the total of 46 ossified PSL from 400 CT images of the petroclival regions (11.5%). The genderwise and sidewise occurrence of the PSL ossification seen in different age groups were not statistically significant (p > 0.05). Among all the ossified cases, there was no patient presented with abducens nerve palsy. CONCLUSIONS: We believe our results provide baseline data in the region for understanding PSL ossification and its impact on the abducens nerve palsy.