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.

Case Report and Literature Review: Isolated Trochlear Nerve Palsy due to Herpes Zoster Infection.

Introduction: Trochlear nerve palsy (TNP) is a common cause of vertical diplopia resulting from superior oblique muscle weakness. While herpes zoster is a well-documented cause of cranial neuropathies, reports of TNP associated with herpes zoster infection remain limited. Case Presentation: We report a case of a 65-year-old patient with typical herpes zoster ophthalmicus on the left side of his face with subsequent corneal endotheliitis and isolated TNP. The MRI revealed a faint enhancement at the cavernous sinus on the same side as the TNP. Cerebrospinal fluid detected human herpesvirus 3, confirming the diagnosis. An intravenous antiviral was administered for 14 days with prolonged maintenance to prevent recurrence. Oral corticosteroids were also used as an adjuvant to reduce inflammation. After treatment, the uveitis subsided, and the vertical diplopia recovered partially. TNP from herpes zoster is a rare presentation. The underlying pathogenic mechanisms, including potential direct viral invasion, inflammatory responses, and possible vasculopathy affecting the trochlear nerve, are explored. Conclusion: TNP can be a rare neuro-ophthalmic complication of herpes zoster infection. Clinicians should maintain a high index of suspicion when assessing patients with cranial neuropathies in the context of herpes zoster. Prompt antiviral therapy and supportive measures can aid in the resolution of symptoms and alleviate potential long-term sequelae.

Orbital apex syndrome due to herpes zoster infection in a patient with chronic kidney disease: A case report.

We report the case of an 89-year-old man with typical herpes zoster ophthalmicus on the left side of his face with delayed clinical presentation of orbital apex syndrome. After treatment with intravenous antiviral agents and corticosteroids, the patient fully recovered. Clinical suspicion should be concerned in immunocompromised cases.

COVID-19 Vaccine-Induced Expansion of Pituitary Adenoma: A Case Report.

A pituitary adenoma is an insidious and slow-growing neoplasm of the pituitary gland. No definitive aggravating factors have currently been reported for pituitary adenoma enlargement. Our case demonstrates that the coronavirus disease 2019 (COVID-19) vaccine may be one of the risk factors aggravating tumor expansion. A 60-year-old woman experienced visual loss in her left eye for three days. Eight days before presentation or five days before visual loss, she received the fourth dose of the COVID-19 vaccine. The visual field showed bitemporal superior quadrantanopic scotoma, prominent on the left side. Neuroimaging revealed pituitary macroadenoma with a compressive effect on the optic chiasm. After diagnosis, endocrine work-up and tumor removal were successfully performed. Her vision and perimetry significantly improved. The COVID-19 vaccine is a candidate factor that might exacerbate pituitary gland enlargement. Additional data are essential to validate and establish the connection between the vaccine and this potential effect.

Concurrent Intracranial Hypertension and Bilateral Optic Neuritis in a Patient With Systemic Lupus Erythematosus: A Case Report.

Systemic lupus erythematosus (SLE) involves dysregulation of the immune system, consequently affecting multiple organ systems, including the cardiovascular, neuropsychiatric, renal, and musculoskeletal systems. Optic neuritis and intracranial hypertension are conditions that rarely occur in SLE, and their coexistence has not been reported to date. Herein, we report the first case of a patient who was diagnosed with SLE complicated by concurrent intracranial hypertension and bilateral optic neuritis. An 11-year-old Thai girl had a low-grade fever, discoid rash, oral ulcer, chronic headache, and fluctuating diplopia. She experienced bilateral vision loss just before presentation. She was diagnosed with juvenile SLE. We believe that her headache, which was probably a symptom of optic disc edema, was due to intracranial hypertension. Furthermore, she exhibited vision loss and color vision deficit and was diagnosed with bilateral optic neuritis. Her condition improved on treatment with corticosteroids (intravenous pulse methylprednisolone for 3 days, followed by 1 mg/kg/day oral prednisolone tapered over 3 months). The occurrence of optic neuritis and intracranial hypertension during an active SLE inflammation and a rapid response to high-dose corticosteroids support the fact that SLE was the etiology of these neuropsychiatric conditions. Early diagnosis and prompt treatment in such cases can lead to favorable outcomes.

Transient visual field loss after COVID-19 vaccination: Experienced by ophthalmologist, case report.

PURPOSE: The first reported case of bilateral transient visual field defect, experienced by an ophthalmologist, which developed shortly after COVID-19 vaccination (CoronaVac, Sinovac Biotech Ltd., Beijing, China) and confirmed by computerized automated perimetry. OBSERVATION: The patient is a 42-year-old Thai ophthalmologist. He developed blurred vision within an hour after the second dose of COVID-19 vaccination. We described his self-observed of sequential symptoms, chronologic events, and management steps. The visual field of left congruous hemianopia with respect to vertical midline was detected with computerized automated perimetry. The possible mechanism could be related to an acute vasospasm of the artery in the postchiasmatic visual pathway, triggered by COVID-19 vaccine, Corona Vac. CONCLUSION AND IMPORTANCE: With increasing use of the COVID-19 vaccine in the near future, it would be prudent for medical staff and ophthalmologists to be considered and aware of this associated condition.