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Kim MS, Choi J, Kim JH, Kim JS, Lee JH. Clinical Features for Patients Presenting with Diplopia. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.11.1772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin Choi
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Hoon Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Suk Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Joo Hwa Lee
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Dotan G, Rosenfeld E, Stolovitch C, Kesler A. The role of neuroimaging in the evaluation process of children with isolated sixth nerve palsy. Childs Nerv Syst 2013; 29:89-92. [PMID: 23001023 DOI: 10.1007/s00381-012-1929-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 09/08/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to assess the role of neuroimaging in identifying the etiology of pediatric isolated sixth nerve palsy (SNP). METHODS A retrospective cohort study was conducted of all patients younger than 18 years of age with an isolated SNP seen at our medical center between 2003 and 2011. RESULTS Sixteen children (nine girls; mean age, 4.5 years) with isolated SNP were identified during an 8-year period. Only cases with normal optic disk appearance and otherwise normal neurological examination were included into this study. Thus, 12 other children with SNP were excluded: ten children with papilledema, one child who developed a SNP following a resection of a brain tumor, and one with hydrocephalus and a shunt malfunction. All cases of isolated SNP were unilateral (ten left eyes). The most common cause for the SNP in these children was a tumor that was found in five patients. Other etiologies encountered in decreasing frequencies were: benign recurrent SNP (in four children), postviral or vaccination (in three children), and one case each of post trauma, Chiari malformation, congenital, and undetermined. Children who were found to have a tumor (9.9 ± 5.5 years) were significantly older (P = 0.019) than children who did not have a tumor (2.1 ± 1.8 years). CONCLUSIONS Isolated SNP can be the presentation of a brain tumor in children, and therefore, early neuroimaging of the brain is recommended, especially in older children.
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Affiliation(s)
- Gad Dotan
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Abstract
We review the supranuclear control centers and pathways leading to individual cranial nerve nuclei in the brainstem. We discuss horizontal and vertical gaze and their abnormalities, and review the cranial nerves which subserve eye movements, III, IV, VI, including their clinical testing. We highlight the sites at which these nerves are clinically affected, which often result in characteristic associated features with neurological localizing value. Differential diagnoses of cranial nerve palsies including Duane and Möbius syndromes are also described. Lastly, we discuss the nature of childhood neuromuscular junction disorders such as myasthenia gravis, as well as disorders of the muscle itself (chronic progressive external ophthalmoplegia (CPEO), thyroid orbitopathy).
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Affiliation(s)
- Atchareeya Wiwatwongwana
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
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54
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Kim MS, Choi J, Jung JH. Bilateral Abducens Nerve Palsy in Pediatric Patients with Epstein-Barr Virus Encephalitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.8.1303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jin Choi
- Department of Ophthalmology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jae Ho Jung
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
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Olusanya B, Tinley C, Grotte R. Paralytic Strabismus in South African Black and Mixed Race Children – A 15-year Clinic-based Review. Ophthalmic Epidemiol 2012; 19:396-400. [DOI: 10.3109/09286586.2012.717675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kim E, Kim JH, Hwang JM, Choi BS, Jung C. MR imaging of congenital or developmental neuropathic strabismus: common and uncommon findings. AJNR Am J Neuroradiol 2012; 33:2056-61. [PMID: 22595903 DOI: 10.3174/ajnr.a3136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution MR imaging enables direct imaging of the ocular motor nerves. The aim of this study was to assess the various causes of congenital or developmental neuropathic strabismus by using high-resolution MR imaging. MATERIALS AND METHODS High-resolution MR imaging was performed to evaluate the ocular motor nerves (CNIII, CNIV, CNVI) in 247 consecutive patients with suspected congenital or developmental neuropathic strabismus. These MR images, along with those obtained from conventional MR imaging of the brain and the orbit, were evaluated. RESULTS MR imaging abnormalities were found in 112 patients: ocular motor nerve abnormalities in 98 patients (88%), orbital abnormalities in 9 patients (8%), and brain abnormalities in 5 patients (4%). Ocular motor nerve abnormalities were CNIV aplasia (63%), CNVI aplasia or hypoplasia (21%), CNIII aplasia or hypoplasia (3%), and combined CNIII aplasia and CNVI hypoplasia (1%). Orbital abnormalities were EOM hypoplasia (7%), EOM hypertrophy (1%), and fibrotic mass (1%). Brain abnormalities were periventricular leukomalacia (4%) and periventricular heterotopia (1%). CONCLUSIONS Various MR imaging abnormalities were associated with congenital and developmental neuropathic strabismus. The most common abnormality was CNIV aplasia.
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Affiliation(s)
- E Kim
- Departments of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Korea
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Merino P, Gómez de Liaño P, Villalobo JMC, Franco G, Gómez de Liaño R. Etiology and treatment of pediatric sixth nerve palsy. J AAPOS 2010; 14:502-5. [PMID: 21168073 DOI: 10.1016/j.jaapos.2010.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 08/20/2010] [Accepted: 09/19/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the causes and treatment of sixth (abducens) nerve palsy in a series of pediatric patients. METHODS This was a 14-year retrospective study of sixth nerve palsy in children under 14 years of age. Outcomes studied included horizontal deviation, degree of limitation of abduction, and head turn. Patients were treated with botulinum toxin injection at the time of diagnosis; surgery was indicated if treatment with botulinum toxin was unsuccessful. Success was defined as final deviation of orthotropia with no head turn or diplopia. RESULTS Sixth nerve palsy was diagnosed in 15 patients (10 boys; mean age, 4.1 years) between 1995 and 2008. Involvement was bilateral in 2 cases and unilateral in 13 (7 right eyes). Causes included neoplasm (4 cases), trauma (2), idiopathic (3), congenital (2), viral (2), and inflammatory (1). Neoplastic causes were associated with other neurologic signs. Recovery was spontaneous in 5 cases (2 idiopathic, 1 traumatic, 1 congenital, and 1 inflammatory). Botulinum toxin was successful in 7 of 10 patients treated, with follow-up surgery required in the remaining 3 cases. The final result was good in all cases. In all 15 patients, mean time from diagnosis to resolution was 39 months (range, 5 to 170 months). CONCLUSIONS Neoplasms were the most frequent cause of sixth nerve palsy in our patient population. Recovery was spontaneous in one third of the patients. Most required treatment with botulinum toxin, which was successful in most cases. Surgery was successful after a single procedure.
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Affiliation(s)
- Pilar Merino
- Hospital General, Universitario Gregorio Marañón, Madrid, Spain.
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58
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Clival epidural hematoma in traumatic sixth cranial nerve palsies combined with cervical injuries. J Neuroophthalmol 2010; 30:18-25. [PMID: 20182201 DOI: 10.1097/wno.0b013e3181ce14ae] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Eight patients sustained a combination of clival epidural hematoma, traumatic sixth cranial nerve palsy (6 NP), and occipitocervical injury. This combination of features has been sparsely described. Whether the hematoma, which represents tectorial membrane injury, is merely a marker for 6 NP and occipitocervical injury or is causative is unresolved, but this imaging finding should alert examiners who note traumatic 6 NP to the need for detailed cervical imaging, as surgical stabilization of this region may be critical to prevent future spinal cord dysfunction.
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Malloy KA, Chigbu DI. Ocular manifestations uncover chronic subdural hematoma secondary to abuse. ACTA ACUST UNITED AC 2010; 81:61-70. [PMID: 20152779 DOI: 10.1016/j.optm.2009.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 09/18/2009] [Accepted: 10/08/2009] [Indexed: 02/09/2023]
Abstract
BACKGROUND An abduction deficit or cranial nerve VI palsy can have many potential etiologies. However, a cranial nerve VI palsy in the setting of disc edema suggests increased intracranial pressure, requiring emergent work-up. CASE REPORT An 18-year-old woman presented with significant headaches and horizontal diplopia, which she claimed began after giving birth 3 months prior. Her examination found a right cranial nerve VI palsy and mild disc edema of the left eye. This combination of findings was suggestive of increased intracranial pressure. Emergent workup uncovered a large chronic subdural hematoma requiring immediate neurosurgical intervention. She ultimately admitted to being abused by her partner. CONCLUSION Diplopia and disc edema in a young, nonoverweight patient with an altered mental state is very concerning. Meningitis and complications of spinal anesthesia, although rare, need to be considered in patients who have recently given birth. However, other causes of increased intracranial pressure, including subdural hemorrhage secondary to trauma, also have to be considered, even if the patient denies any history of trauma. Abused patients often deny trauma.
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Affiliation(s)
- Kelly A Malloy
- Pennsylvania College of Optometry, at Salus University, Elkins Park, Pennsylvania.
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Choi BS, Kim JH, Jung C, Hwang JM. High-resolution 3D MR imaging of the trochlear nerve. AJNR Am J Neuroradiol 2010; 31:1076-9. [PMID: 20093316 DOI: 10.3174/ajnr.a1992] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The cisternal segment of the trochlear nerve is difficult to identify reliably by routine MR imaging. We investigated the visibility and anatomic features of the trochlear nerve by using high-resolution 3D-bTFE imaging in healthy subjects. MATERIALS AND METHODS This study was conducted with 32 healthy subjects without ocular movement disorders. For us to visualize the cisternal segment of the trochlear nerve, all subjects underwent 3D-bTFE imaging at 3T with 2 different resolutions: conventional resolution (voxel size, 0.67 x 0.45 x 1.4 mm) and high resolution (voxel size, 0.3 x 0.3 x 0.25 mm). Visibility of the trochlear nerve was graded with the use of a qualitative scale of certainty as follows: definite, probable, and indeterminate. The diameter of the trochlear nerve was measured. RESULTS On conventional-resolution images, the visibility of the trochlear nerve was definite in 3 nerves, probable in 12 nerves, and indeterminate in 49 nerves. On high-resolution images, visibility was definite in 63 nerves and probable in 1 nerve. The mean diameter of the trochlear nerve was 0.54 mm (range, 0.35-0.96 mm). CONCLUSIONS The trochlear nerve was visualized 100% of the time on high-resolution imaging with a voxel smaller than the nerve diameter. High-resolution imaging should have an important role in investigating the pathogenic mechanism of neuropathic strabismus, such as congenital superior oblique palsy.
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Affiliation(s)
- B S Choi
- Department of Radiology, Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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61
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Barton JJS. OCULAR MOTOR NERVES AND INTERNUCLEAR CAUSES. Continuum (Minneap Minn) 2009. [DOI: 10.1212/01.con.0000348837.10856.4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Sturm V, Schöffler C. Long-term follow-up of children with benign abducens nerve palsy. Eye (Lond) 2009; 24:74-8. [PMID: 19218985 DOI: 10.1038/eye.2009.22] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Benign abducens nerve palsy is rare in childhood. Diagnosis is made by exclusion, and the severe underlying pathologies have to be ruled out. The aim of our study was to present the largest single-center series of patients with the longest period of follow-up to confirm the benign nature of this entity. PATIENTS AND METHODS We carried out a retrospective study of 12 consecutive children with benign abducens nerve palsy. All children underwent a careful orthoptic and ophthalmic examination during acute presentation and follow-up. RESULTS Painless palsies were associated with a preceding infection or immunization in five patients. The left eye was affected in nine children and no bilateral case was found. No sex differences were seen. Recovery was observed within 6 months in all cases, and ipsilateral recurrences occurred in three children. Three children required strabismus surgery. None of the patients developed long-term recurrences or neurological abnormalities during a mean follow-up of more than 9 years. CONCLUSIONS Our data support earlier findings, such as painless and predominately left-sided occurrence, spontaneous recovery within 6 months, and ipsilateral recurrence. In contrast to much of the literature, we did not find a female preponderance. Exclusion of severe causes and close follow-up is mandatory for these patients. As none of the patients developed long-term recurrences or neurological sequelae, this entity can be regarded as a benign condition without malignant associations or complications.
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Affiliation(s)
- V Sturm
- Department of Ophthalmology, University Hospital of Hamburg, Hamburg, Germany.
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64
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Moster ML. Paresis of Isolated and Multiple Cranial Nerves and Painful Ophthalmoplegia. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Akagi T, Miyamoto K, Kashii S, Yoshimura N. Cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy. Jpn J Ophthalmol 2008; 52:32-5. [DOI: 10.1007/s10384-007-0489-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 09/13/2007] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW The aim of this article is to evaluate and review the scientific literature on pediatric ocular trauma from the past several years. Recent advancements have recognized mechanisms of injury that may be unique to children, require different treatment course than adults, and raise multiple public health concerns. RECENT FINDINGS Epidemiologic studies have shown that ocular trauma is a major cause of monocular blindness and potential disability in children worldwide. The mechanisms of injury are quite variable and often found under mundane circumstances. Orbital fractures in children are more likely to cause entrapment of orbital contents due to the structure of orbital bones at an early age and require earlier surgical repair. The management of traumatic hyphema responds well to outpatient care and topical aminocaproic acid. The management of traumatic cataracts has been enhanced with new iris-fixated lens implants. Endophthalmitis after ocular trauma carries a significantly worse prognosis, which may be reduced by early referral and intervention. SUMMARY This review broadens our understanding of the mechanisms, treatment, and prognostic indicators in pediatric ocular trauma. This will allow improved clinical care of these injuries.
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Affiliation(s)
- Jonathan H Salvin
- Division of Ophthalmology, Nemours/Alfred I. DuPont Hospital for Children, Jefferson Medical College, Wilmington, Delaware 19899, USA.
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Malloy KA. Prostate cancer metastasis to clivus causing cranial nerve VI palsy. ACTA ACUST UNITED AC 2007; 78:55-62. [PMID: 17258159 DOI: 10.1016/j.optm.2006.08.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 07/13/2006] [Accepted: 08/02/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND An abduction deficit can have many potential etiologies. Clinical testing can help distinguish a neurogenic from a restrictive process. For any patient with a current or past history of cancer, even in the setting of vasculopathic risk factors, a further workup is necessary to rule out a metastatic process. CASE REPORT A 66-year-old man reported sudden blurry vision but did not describe a definite diplopia. Clinical evaluation found left cranial nerve (CN) VI palsy. Although he did have vasculopathic risk factors, neuroimaging found prostate cancer metastasis to the mid to left clivus, extending to the left cavernous sinus region as well as a smaller metastasis to the left temporal lobe. The patient underwent radiation treatment with improvement in his clinical presentation and symptoms. His prostate cancer was subsequently treated more aggressively, and 2 years later, despite spinal metastases, he was doing relatively well. CONCLUSION Prostate cancer commonly metastasizes, with a high propensity to invade bone. CN VI runs along the midline-structured bony clivus, between the pons and the cavernous sinuses. Therefore, a metastatic lesion to the clivus can be responsible for unilateral or bilateral CN VI palsy. In men, a common primary site of cancer metastasis to the clivus is the prostate. Eye doctors must look closely for evidence of even subtle abduction deficits in all patients with a history of prostate cancer. Early detection can lead to improved medical treatment and extended life expectancy.
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Affiliation(s)
- Kelly A Malloy
- Pennsylvania College of Optometry, Elkins Park, Pennsylvania 19027, USA.
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Dubnov-Raz G, Merlob P, Geva-Dayan K, Blumenthal D, Finkelstein Y. Increased rate of major birth malformations in infants with neonatal “asymmetric crying face”: A hospital-based cohort study. Am J Med Genet A 2007; 143:305-10. [PMID: 17256788 DOI: 10.1002/ajmg.a.31551] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Asymmetric crying face (ACF) is a minor anomaly found in 3-8 per 1,000 births, which may be associated with other anomalies. Previous studies on this topic included small groups of selected subjects, resulting in large variations in findings. The aim of this study was to examine the characteristics and associated anomalies of newborn infants with ACF compared with the general population of newborn infants. The study included newborn infants delivered between 1993 and 2003 at the Department of Neonatology of Rabin Medical Center, Israel. Charts of all newborns diagnosed with ACF were reviewed for obstetric and neonatal details, then compared with non-ACF newborns. ACF was diagnosed in 258 of 67,289 newborns (0.38%), with left-side predominance (77%). Major malformations were found in 7% of ACF infants, 3.5-fold higher than in the total Israeli population. Mild anomalies were present in 15% of the ACF group, and deformations in 4.6%. There was a higher rate of forceps deliveries in the ACF group (RR = 2.73, 95% CI = 1.37-5.42). ACF was more prevalent among females, and the male:female ratio was lower in the ACF group (0.86 vs. 1.06, P = 0.05). The rate of low-birth-weight infants was 3.9% among ACF infants and 9.6% in the control group (RR = 0.41, 95% CI = 0.23-0.76). No significant between-group difference was found for rates of primiparity, macrosomia, prematurity, postmaturity, or size-for-gestational-age. Thus, ACF is associated with a high rate of major malformations. This should prompt clinicians to seek for additional birth defects in ACF infants.
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Affiliation(s)
- Gal Dubnov-Raz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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69
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Abstract
A 22-year-old woman presents with headache and an acquired cranial nerve VI palsy. The differential diagnosis and work-up were negative. The causes of cranial nerve VI palsy in young patients are discussed. Follow-up for patients in this age group is also discussed.
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Affiliation(s)
- Molly E Gilbert
- Neuro-ophthalmology Service, Wills Eye Hospital,Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Comer RM, Dawson E, Plant G, Acheson JF, Lee JP. Causes and outcomes for patients presenting with diplopia to an eye casualty department. Eye (Lond) 2006; 21:413-8. [PMID: 16732215 DOI: 10.1038/sj.eye.6702415] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the causes and outcomes for patients presenting with diplopia to an eye casualty department. METHODS Patients presenting with diplopia as a principal symptom, who were referred to the Orthoptic Department from Moorfields Eye Casualty over a 12-month period, were retrospectively investigated. RESULTS One hundred and seventy-one patients were identified with complete records in 165 cases. There were 99 men and 66 women with an age range of 5-88 years. Monocular diplopia accounted for 19 cases (11.5%), whereas 146 patients (88.5%) had binocular diplopia. Cranial nerve palsies were the most common cause of binocular diplopia accounting for 98 (67%) of cases. Isolated sixth nerve palsy was the largest diagnostic group (n=45). Microvascular disease (hypertension or diabetes mellitus, or both) was present in 59% of patients with cranial nerve palsies, and of this group, 87% resolved spontaneously by 5 months rising to 95% by 12 months. CONCLUSION Patients with clinically isolated single cranial nerve palsies associated with diabetes or hypertension are likely to recover spontaneously within 5 months and initially require observation only. However, patients with unexplained binocular diplopia and those who progress or fail to recover should be investigated to establish the underlying aetiology and managed as appropriate.
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Affiliation(s)
- R M Comer
- Department of Paediatric, Moorfields Eye Hospital, London, UK.
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Dhaliwal A, West AL, Trobe JD, Musch DC. Third, fourth, and sixth cranial nerve palsies following closed head injury. J Neuroophthalmol 2006; 26:4-10. [PMID: 16518159 DOI: 10.1097/01.wno.0000204661.48806.1d] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between the circumstances and severity of closed head injury (CHI) and the clinical and imaging features of cranial nerve 3, 4, and 6 palsies has not been rigorously addressed in a large study. METHODS Retrospective chart review of 210 consecutive patients with CHI examined at a single tertiary care center from 1987 to 2002. Patients were located by searching the ophthalmology inpatient consultation and neuro-ophthalmology outpatient databases and hospital emergency room billing codes for a diagnosis of traumatic 3, 4, or 6 cranial nerve palsy (Cranial Nerve Injury Group) and a diagnosis of CHI without traumatic 3, 4, or 6 nerve palsy (Control Group). The Cranial Nerve Injury Group was then subdivided into two groups: those with injuries to an individual cranial nerve and those with multiple (including bilateral) cranial nerve injuries. Comparisons between groups were based on age, gender, type of accident, Glasgow Coma Scale (GCS), documented loss of consciousness (LOC), type of ocular injury, presence of systemic injury, need for rehabilitation, physical therapy and cognitive scores, and imaging features. RESULTS The Cranial Nerve Injury Group had a significantly higher severity of head injury, more CT abnormalities, and worse short-term neurologic outcomes as compared with the Control Group. These trends were also found when each cranial nerve injury subgroup was compared with the Control Group. Those with cranial nerve 3 palsy had the most severe head injury; those with cranial nerve 4 palsy had an intermediate level of head injury; and those with cranial nerve 6 palsy had the lowest level of head injury. There were no consistent associations between the location of the imaging abnormalities and which cranial nerve was damaged. CONCLUSIONS CHI with palsy of an ocular motor nerve was more severe than CHI without ocular motor nerve palsy, as measured by the GCS, intracranial and skull imaging abnormalities, and a greater frequency of inpatient rehabilitation. Palsy of cranial nerve 3 was associated with relatively more severe CHI than was palsy of cranial nerves 4 or 6. The location of the imaging abnormalities did not correlate with a particular cranial nerve injury.
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Affiliation(s)
- Avninder Dhaliwal
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical Center, Ann Arbor, Michigan 48105, USA
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Tollefson MM, Mohney BG, Diehl NN, Burke JP. Incidence and types of childhood hypertropia: a population-based study. Ophthalmology 2006; 113:1142-5. [PMID: 16647125 DOI: 10.1016/j.ophtha.2006.01.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2005] [Revised: 11/26/2005] [Accepted: 01/18/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To determine the incidence and types of childhood hypertropia in a defined population. DESIGN Retrospective population-based cohort. PARTICIPANTS All pediatric (<19 years of age) residents of Olmsted County, Minnesota, diagnosed with vertical strabismus from January 1, 1985, through December 31, 1994. METHODS The medical records of all potential patients identified by the resources of the Rochester Epidemiology Project were reviewed. MAIN OUTCOME MEASURES Incidence and types of childhood hypertropia. RESULTS Forty-two cases of childhood hypertropia were identified during the 10-year period, yielding an annual age- and gender-adjusted incidence of 12.9 (95% confidence interval, 9.0-16.9) per 100000 patients younger than 19 years of age. This rate corresponds to a prevalence of approximately 0.26%, or 1 in 391, of all children younger than 19 years of age. Nearly three fourths (71.4%) of the children had a IVth cranial nerve palsy, primary inferior oblique overaction, Brown syndrome, or a vertical tropia in the setting of an abnormal central nervous system. CONCLUSIONS The incidence rates for childhood hypertropia in this population-based study are higher than published reports of prevalence. Fourth cranial nerve palsy and primary dysfunction of the inferior oblique muscle were the most common forms of vertical strabismus in this population.
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Affiliation(s)
- Megha M Tollefson
- Department of Pediatric & Adolescent Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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Jary A, Maillard L, Raffo E, Ducrocq X, Braun M, Vespignani H. Paralysie vélopalatine isolée aiguë réversible de l’enfant. Rev Neurol (Paris) 2004; 160:836-8. [PMID: 15454873 DOI: 10.1016/s0035-3787(04)71041-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Unilateral spinal and accessory palsy is uncommon in children. The main problem is the extensive exploration undertaken to achieve etiological diagnosis. OBSERVATION We report two cases of transitory, unilateral, spinal and accessory palsy, associated in one case with homolateral hemi-pharyngeal palsy, that occurred in two previously healthy children. RESULTS Few reports have been published in the literature to date. From those two cases and data of the literature, we suggest that the clinical presentation results from idiopathic peripheral nerve palsy. CONCLUSION Further case reports would be useful to confirm the benign nature of this syndrome so that complementary investigations may be limited in future cases with a similar presentation.
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Affiliation(s)
- A Jary
- Service de Neurologie, CHU de Nancy, Hôpital Central, Nancy
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74
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Abstract
PURPOSE To examine sensory and motor outcomes of superior oblique paresis (SOP) presenting in patients < 8 years old and to ascertain whether SOP was ever the presenting manifestation of intracranial pathology. METHODS Retrospective observational case series of SOP in children < 8 years old in an outpatient university center. RESULTS Ninety-two patients with SOP presented at a median age of 3.9 years. The etiologies were likely congenital (n = 56), craniofacial anomalies (n = 12), head trauma (n = 5), postresection of brain tumors (n = 3), orbital inflammation (n = 1), prenatal stroke (n = 1), and unknown (n = 14). Twenty-six were followed-up for a median of 2.1 years and did not have surgery; 46 were followed-up for a median of 3 years and did undergo surgery. No cases of new intracranial pathology occurred during follow-up. In 42 patients observed for at least 6 months without surgery, motor status was stable or improved (each in approximately one third of cases) or deteriorated (in one fourth of cases). Motor outcomes were better (P =.01) in patients undergoing surgery (87% aligned within 5 prism diopters) than in those not undergoing surgery despite worse presenting deviations. Sensory status did not show a similar improvement with surgery. Patients presenting before age 4 had worse sensory outcomes (P =.00001) than patients presenting later. At the last examination, 4 patients had vision < 20/40 from amblyopia. CONCLUSIONS SOP in children < 8 years old was not associated with the development of new intracranial pathology. Motor alignment and sensory function were often stable, although some patients improved, and others deteriorated. With surgery, satisfactory motor outcomes were usually achieved, but sensory status often was not improved. Sensory outcomes were generally worse in patients presenting at younger ages.
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Affiliation(s)
- Kristina Tarczy-Hornoch
- Zanvyl Krieger Children's Eye Center, Wilmer Ophthalmological Institute, Johns Hopkins Hospital, Baltimore, MD, USA
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75
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Tabassi A, Salmasi AH, Sabeti A. Acquired isolated abducens nerve palsies: a retrospective study on etiology in an Iranian population. Neuroophthalmology 2004. [DOI: 10.1080/01658100490890234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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76
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Holmes JM, Leske DA, Burke JP, Hodge DO. Birth prevalence of visually significant infantile cataract in a defined U.S. population. Ophthalmic Epidemiol 2003; 10:67-74. [PMID: 12660855 DOI: 10.1076/opep.10.2.67.13894] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the birth prevalence of visually significant infantile cataract, using population-based comprehensive medical record retrieval, in a defined US population. DESIGN Retrospective, population-based, medical record retrieval. METHODS We reviewed records of all pediatric patients (0-17 years) coded as cataract during a 20-year period (1978 to 1997) using the resources of the Rochester Epidemiology Project. "Infantile cataract" was defined as a cataract diagnosed within the first year of life. "Possible infantile cataract" was defined as a cataract, diagnosed after the first year in a child born in Olmsted County, where there was no evidence of an acquired traumatic, acquired systemic, or acquired ocular etiology. Visually insignificant cataracts were excluded. RESULTS Ten incident cases of visually significant infantile cataract were identified during the 20-year study period, yielding a birth prevalence of 3.0 per 10,000 live births (95% CI: 1.5-5.6 per 10,000). Five additional cases of visually significant "possible infantile cataract" were identified, diagnosed between the ages of 2 and 8 years. Inclusion of these "possible infantile cataracts" would result in an estimate of overall birth prevalence for visually significant infantile cataract of 4.5 per 10,000 live births (95% CI: 2.5-7.5 per 10,000). CONCLUSIONS Using population-based medical record retrieval methods, we estimate the birth prevalence of visually significant infantile cataract to be 3.0 to 4.5 per 10,000. Infantile cataracts are an important cause of visual impairment in children and these data are useful in planning clinical trials and allocating health care resources.
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Affiliation(s)
- Jonathan M Holmes
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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77
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Abstract
Ocular trauma is a leading cause of visual loss in children. Understanding the fundamentals of eye trauma evaluation and management will help decrease associated ocular morbidity and visual loss. Many eye injuries are preventable and should not be viewed as random accidents. The primary care provider can help reinforce the need for protective eyewear during activities associated with ocular trauma. When evaluating infants who may have suffered child abuse, an ocular fundus examination is essential to rule out shaken infant syndrome.
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Affiliation(s)
- Lawrence M Levine
- Department of Ophthalmology, University of Florida, P.O. Box 100284, Gainesville, FL 32608, USA.
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78
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Abstract
Neuropathies of the oculomotor, trochlear, and abducens nerves may present with isolated or complex neurologic findings. An understanding of the anatomy of these cranial nerves as they traverse the brainstem, basilar cisterns, and cavernous sinus on their way to the orbit can assist in localizing the suggested site of pathology and help to focus imaging protocols. Differential diagnostic possibilities for specific anatomic locations are reviewed.
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Affiliation(s)
- B Eisenkraft
- Department of Radiology, Winthrop-University Hospital, Mineola, NY 11501, USA
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79
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Van Stavern GP, Biousse V, Lynn MJ, Simon DJ, Newman NJ. Neuro-ophthalmic manifestations of head trauma. J Neuroophthalmol 2001; 21:112-7. [PMID: 11450900 DOI: 10.1097/00041327-200106000-00012] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the neuro-ophthalmic findings in a group of patients with head trauma. MATERIALS AND METHODS A retrospective chart review of all patients given a diagnosis code of head trauma in the neuroophthalmology unit at Emory University between 1991 and 1999. RESULTS A total of 326 consecutive patients were reviewed (203 [63%] men and 123 [37.0%] women). Age ranged from 2 to 86 years, with a mean of 30 years. Motor vehicle accident was the most common cause of head trauma, occurring in 195 (59.8%) patients. An abnormal neuro-ophthalmic examination was noted in 185 of 326 patients (56.7%). Loss of consciousness was not associated with any outcome, but the presence of a neuroimaging abnormality, particularly intracranial hemorrhage, was significantly associated with specific neuroophthalmic deficits. CONCLUSIONS Head trauma causes a number of neuroophthalmic manifestations. The afferent and efferent pathways are vulnerable to traumatic injury, although the efferent system is more commonly affected. Loss of consciousness may not be a reliable predictor of specific neuro-ophthalmic outcomes, but neuroimaging abnormalities may.
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Affiliation(s)
- G P Van Stavern
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
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80
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Abstract
In the last year, published works on paralytic strabismus have concerned many topics. New advances have been made in the knowledge of epidemiology of ocular nerve palsies in children, muscular causes of paralytic strabismus, and neuroimaging management of patients with third nerve palsy who are at risk of cerebral aneurysms. The author describes reports on rare associations of oculomotor imbalances and neurologic diseases as well as atypical orbital localizations of tumors. He also discuss new neuroimaging findings in congenital superior oblique muscle palsy and new acquisitions on cyclofusion deterioration in acquired trochlear palsy.
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Affiliation(s)
- C Schiavi
- 1st Eye Service, University of Bologna, School of Medicine, Italy
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81
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Abstract
Magnetic resonance and functional brain imaging continue to expand their roles in complementing the clinical examination to localize the causes of eye-movement disorders. A retrospective review from county-based clinical practices emphasized generally benign causes of third, fourth, and sixth cranial nerve palsies in children, but a study from a tertiary referral center found a high incidence of neoplasms causing sixth-nerve palsies in children. A prospective study found that 38% of diabetic patients with third-nerve palsies had anisocoria up to 2.5 mm. An initial attempt to develop an evidence-based practice pathway for the evaluation of ocular motor nerve palsies has been developed for isolated sixth-nerve palsies in adults. In an important study of Graves hyperthyroidism, treatment with radioactive iodine was more likely than methimazole therapy alone to be associated with the appearance or worsening of ophthalmopathy. The clinical worsening of eye findings could be prevented by concurrent administration of corticosteroids for 3 months. Smoking is still a major controllable risk factor for thyroid ophthalmopathy.
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Affiliation(s)
- S R Hamilton
- Neuro-ophthalmology Unit, Swedish Medical Center, Seattle, WA 98122, USA
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