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Choi DD, Park KA, Han K, Oh SY. Dynamic Changes in Metabolic Status Are Associated With Risk of Ocular Motor Cranial Nerve Palsies. J Neuroophthalmol 2024; 44:386-393. [PMID: 37651183 DOI: 10.1097/wno.0000000000001978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND To investigate whether recovery from or development of metabolic syndrome (MetS) in a population is associated with an altered risk for ocular motor cranial nerve palsy (CNP). METHODS This cohort study included 4,233,273 adults without a history of ocular motor cranial nerve palsy (ocular motor CNP) who underwent 2 consecutive biennial health screenings provided by the Korean National Health Insurance System between 2009 and 2011. They were followed up until December 31, 2018. Participants were categorized into a MetS-free, MetS-developed, MetS-recovered, or MetS-chronic group. A multivariable Cox proportional hazard regression model was used. Model 3 was adjusted for age, sex, smoking status, alcohol consumption, and physical activity. RESULTS Compared with the MetS-free group, the MetS-chronic group had the highest risk of ocular motor CNP (hazard ratio [HR]: 1.424; 95% confidential interval [CI]: 1.294-1.567, Model 3), followed by the MetS-developed group (HR: 1.198, 95% CI: 1.069-1.343), and the MetS-recovered group (HR: 1.168, 95% CI: 1.026-1.311) after adjusting for potential confounders. The hazard ratio of ocular motor CNP in men with chronic MetS was 1.566 (95% CI, 1.394-1.761) while that of women with chronic MetS was 1.191 (95% CI, 1.005-1.411). Among age groups, those in their 30s and 40s showed the highest association between dynamic MetS status and ocular motor CNP. CONCLUSIONS In our study, recovering from MetS was associated with a reduced risk of ocular motor CNP compared with chronic MetS, suggesting that ocular motor CNP risk could be managed by changing MetS status.
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Affiliation(s)
- Daye Diana Choi
- Department of Ophthalmology (DDC), Kim's Eye Hospital, Seoul, Korea; Department of Ophthalmology (K-APKH, SYO), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Department of Statistics (K-APKH), Soong Sil University, Seoul, Korea
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Ozobu I, Salter E, Salter S, Peng D, Sherbaf A, Ravinutala A, Liu AK. Isolated Self-Limited Right Oculomotor Nerve Palsy With Positive Asialo-GM1 Antibody After SARS-CoV-2 mRNA Vaccination. Cureus 2024; 16:e65045. [PMID: 39035598 PMCID: PMC11260434 DOI: 10.7759/cureus.65045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2024] [Indexed: 07/23/2024] Open
Abstract
mRNA vaccines have been a critical tool in combating the current coronavirus disease 2019 (COVID-19) pandemic and demonstrated a high safety profile. However, rare cases of isolated oculomotor nerve palsy following vaccination have been reported. These few reported cases can be divided into two groups based on symptom onset: immediate and delayed. While most reported cases involving Pfizer and Moderna vaccines occurred within the first few days of vaccination, a few cases with delayed onset have also been described. We present a unique case of a patient experiencing isolated, unilateral oculomotor nerve palsy 14 days after receiving a Moderna booster shot. Notably, our case and a previously reported case of 17-day onset case share the interesting finding of positive ganglioside antibodies. This not only highlights the potential for unusual occurrences following COVID-19 vaccination but also opens up avenues for exploring the underlying mechanisms behind these events.
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Affiliation(s)
| | - Ethan Salter
- Neurology, Adventist Health White Memorial, Los Angeles, USA
| | - Sophia Salter
- Neurology, Adventist Health White Memorial, Los Angeles, USA
| | - Davin Peng
- Neurology, Adventist Health White Memorial, Los Angeles, USA
| | - Arash Sherbaf
- Internal Medicine, Adventist Health White Memorial, Los Angeles, USA
| | - Arvind Ravinutala
- Internal Medicine, Adventist Health White Memorial, Los Angeles, USA
| | - Antonio K Liu
- Neurology, Adventist Health White Memorial, Los Angeles, USA
- Neurology, Loma Linda University School of Medicine, Loma Linda, USA
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Choi DD, Cheon DY, Park K, Han K, Jung J, Oh SY. Age-Related Risk of Stroke Following Ocular Motor Cranial Nerve Palsy. J Am Heart Assoc 2024; 13:e033437. [PMID: 38879451 PMCID: PMC11255764 DOI: 10.1161/jaha.123.033437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/16/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND This cohort study aims to examine the relationship between the occurrence of cranial nerve palsy (CNP) affecting the third, fourth, or sixth cranial nerve and the subsequent risk of stroke, with a particular focus on the modulating effect of age on this association. METHODS AND RESULTS We established a cohort of individuals diagnosed with third, fourth, or sixth CNP who underwent national health screening within 2 years of diagnosis from 2010 to 2017. A control group was matched by sex and age at a ratio of 1:5. Participants were followed until December 31, 2019. We use multivariable Cox proportional hazards regression analyses to assess the association between ocular motor CNP and subsequent stroke stratified by age. Covariates including lifestyle, health behavior, underlying comorbidities, and Charlson comorbidity index score were also adjusted. Compared with the control group, the ocular motor CNP group had a higher risk of stroke after adjusting for potential confounders (hazard ratio [HR], 1.23 [95% CI,, 1.08-1.39]). The risk of stroke increased by 8.91 times in individuals with ocular motor CNP who were in their 30s (HR, 8.91 [95% CI, 1.63-48.66]). The risk increased by 2.49 times in those who were in their 40s, 1.78 times in those who were in their 50s, and 1.32 times in those who were in their 60s (HRs, 2.49, 1.78, and 1.32 [95% CI, 1.39-4.45, 1.31-2.42, and 1.08-1.62], respectively). However, for those who were in their 20s, 70s, or 80s, the incidence of stroke did not significantly increase. CONCLUSIONS Our study establishes an association between ocular motor CNP and an increased risk of stroke, particularly in young adults.
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Affiliation(s)
| | - Dae Young Cheon
- Division of Cardiology, Department of Internal MedicineHallym University Dongtan Sacred Heart HospitalHwaseongKorea
| | - Kyung‐Ah Park
- Department of Ophthalmology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
| | - Kyung‐Do Han
- Department of StatisticsSoong Sil UniversitySeoulKorea
| | - Jin‐Hyung Jung
- Department of BiostatisticsThe Catholic University College of MedicineSeoulKorea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulKorea
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Du C, Lu C, Li G, Deng D, Chen W. Electroacupuncture for oculomotor nerve palsy after chemotherapy: A case report. Medicine (Baltimore) 2024; 103:e38547. [PMID: 38875429 PMCID: PMC11175888 DOI: 10.1097/md.0000000000038547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
INTRODUCTION Oculomotor nerve palsy (ONP) is often discovered in the ophthalmology department, manifested as ptosis with the same side, eyeball in the fixed external booth, or accompanied by limited inward, upward, and downward movements. The present case report described the effect of electroacupuncture (EA) on a breast cancer patient with ONP after chemotherapy. PATIENT CONCERNS A 56-year-old breast cancer patient presented with severe ptosis and fixed right eye exotropia. Besides, it is challenging to perform the movement inward, upward, and downward, and with obvious diplopia. DIAGNOSES The breast cancer patient was diagnosed with ONP, chemotherapy history. INTERVENTIONS The patient was introduced to acupuncture department to receiving EA treatment. OUTCOMES After 12 times of EA treatments, the symptom of ptosis was significantly improved, and the right upper eyelid can lift autonomously as same as the left eye. Besides, the patient's right lateral eye could move freely, and the symptoms of double vision disappeared. CONCLUSION The case suggests that EA may be an effective alternative treatment for ONP.
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Affiliation(s)
- Chun Du
- Tianshui and Wulin Street Community Health Service Center of Gongshu District, Hangzhou, China
| | - Chao Lu
- Department of Traditional Chinese Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Guangliang Li
- Department of Breast Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Dehou Deng
- Department of Traditional Chinese Medicine, Zhejiang Cancer Hospital, Hangzhou, China
| | - Weiji Chen
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, China
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Kim H, Kim H, Choi J, Yang HK, Hwang J, Kim J. Etiological distribution of isolated oculomotor nerve palsy: analysis of 633 patients and literature review. Eur J Neurol 2024; 31:e16261. [PMID: 38411317 PMCID: PMC11235800 DOI: 10.1111/ene.16261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND PURPOSE The etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of isolated oculomotor nerve palsy by recruiting patients from all departments in a referral-based university hospital. METHODS The medical records of 672 patients who had a confirmed diagnosis of isolated oculomotor nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020 were reviewed. A proportion of the etiology of isolated oculomotor nerve palsy was also compared with that of patients pooled from the previous studies that were searched on PubMed in May 2022. RESULTS The most common etiology was microvascular (n = 168, 26.5%), followed by vascular anomalies (n = 110, 17.4%), neoplastic (n = 86, 13.6%), inflammatory (n = 79, 12.5%), idiopathic (n = 60, 9.5%) and traumatic (n = 53, 8.4%). Neurologists were mainly involved in the management of microvascular and inflammatory oculomotor nerve palsies whilst ophthalmologists mainly participated in the care of idiopathic, neoplastic and traumatic palsies. Neurosurgeons mostly took care of oculomotor nerve palsy due to vascular anomalies. CONCLUSIONS The proportion of etiologies of isolated oculomotor nerve palsy may differ according to the specialties involved in the management. The results of previous studies on the etiological distribution of isolated oculomotor nerve palsy should be interpreted with this consideration.
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Affiliation(s)
- Hyun‐Jae Kim
- Department of NeurologyChungbuk National University HospitalCheongjuRepublic of Korea
| | - Hyo‐Jung Kim
- Biomedical Research InstituteSeoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Jeong‐Yoon Choi
- Department of NeurologySeoul National University College of MedicineSeoulRepublic of Korea
- Dizziness Center, Clinical Neuroscience Center, Department of NeurologySeoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Jeong‐Min Hwang
- Department of Ophthalmology, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
| | - Ji‐Soo Kim
- Department of NeurologySeoul National University College of MedicineSeoulRepublic of Korea
- Dizziness Center, Clinical Neuroscience Center, Department of NeurologySeoul National University Bundang HospitalSeongnamRepublic of Korea
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Lee D, Han K, Rhiu S, Jung JH, Park KA, Oh SY. Cranial Nerve Palsy and Risk of Kidney Cancer: A Nationwide Population-Based Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:913. [PMID: 38929530 PMCID: PMC11206143 DOI: 10.3390/medicina60060913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/26/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objective: Understanding whether cranial nerve palsy (CNP) acts as an independent risk factor for kidney cancer could have important implications for patient care, early detection, and potentially the development of preventive strategies for this type of cancer in individuals with CNP. This study aimed to examine the risk of kidney cancer following the onset of ocular motor CNP and assess whether CNP could be considered an independent risk factor for kidney cancer. Materials and Methods: A population-based cohort study was conducted using data from the National Sample Cohort (NSC) database of Korea's National Health Insurance Service which was collected from 2010 to 2017. Follow-up was until kidney cancer development, death, or 31 December 2018. Cox proportional hazard regression analysis was performed to determine hazard ratios (HRs) for kidney cancer according to CNP status. Participants aged 20 years or more diagnosed with CNP from 2010 to 2017 were included. Exclusions comprised individuals with specific pre-existing conditions, inability to match a control group, and missing data, among others. CNP patients were age-sex matched in a 1:5 ratio with control cases. The primary outcome was incidence of kidney cancer during the follow-up period. Results: This study comprised 118,686 participants: 19,781 in the CNP group, and 98,905 in the control group. Compared to the control group, participants with CNP had a higher risk of kidney cancer (adjusted HR in model 4, 1.599 [95% CI, 1.116-2.29]). After a 3-year lag period, the CNP group had a significantly higher risk (adjusted HR in model 4, 1.987 [95% CI, 1.252-3.154]). Conclusions: Ocular motor CNP may be an independent risk factor for kidney cancer, as indicated by a higher incidence of kidney cancer in CNP patients. Further research is needed to elucidate the underlying mechanisms and explore potential preventive measures for kidney cancer in patients with ocular motor CNP.
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Affiliation(s)
- Dongyoung Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.L.)
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Soolienah Rhiu
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwaseong 18450, Republic of Korea
| | - Jin-hyung Jung
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.L.)
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (D.L.)
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Zhang J, Wang S, Jiang Y, Zhang Y. Oculomotor Nerve Palsy Induced by a Cerebral Developmental Venous Anomaly: A Case Report and Comprehensive Review. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943363. [PMID: 38762752 PMCID: PMC11117436 DOI: 10.12659/ajcr.943363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/02/2024] [Accepted: 03/18/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Symptoms caused by developmental venous anomalies (DVAs) are usually mild and unspecific. Despite the benign nature of DVAs, they can occasionally be symptomatic. CASE REPORT A 67-year-old woman presented with sudden diplopia and left eyelid ptosis for 10 days. A neurologic examination revealed left complete oculomotor nerve palsy. Other neurologic deficits, including eye pain or pulsatile tinnitus, were not detected. Furthermore, the visual acuity was normal. Additionally, no retinal hemorrhage, venous dilatation, or fundus tortuosity were observed. No ischemia lesions or neoplasms were observed in MRI, and no widening or enhancement of the cavernous sinus was detected in post-contrast T1-weighted images, but magnetic resonance tomography cerebral angiography (MRTA) detected an offending vessel compressing the left oculomotor nerve in the fossa interpeduncular. We hypothesized that oculomotor nerve palsy (ONP) was caused by an abnormal arterial structure. However, digital subtraction angiography (DSA) revealed no aneurysm or abnormal arterial structure in the arterial phase, while a tortuous and dilated collecting vein was detected in the venous phase, connecting the left temporal lobe to the left cavernous sinus. This indicated a typical caput medusae appearance, suggesting the mechanism of oculomotor palsy caused by compressive impairment of the DVA. The patient refused microvascular decompression surgery, and ONP persisted after 30 days. Management was conservative, with spontaneous resolution at 60 days and no recurrence during the 2-year follow-up. CONCLUSIONS ONP is rarely caused by DVAs, which are easily ignored due to their benign nature. Cerebral vein examinations are advised for patients exhibiting clinical symptoms of unknown etiology.
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Affiliation(s)
- Jianying Zhang
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, PR China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Sisi Wang
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, PR China
| | - Ying Jiang
- Department of Neurology, Changzhou First People’s Hospital, Changzhou, Jiangsu, PR China
| | - Yue Zhang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China
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Khalili MR, Roshanshad A, Vardanjani HM. Botulinum Toxin Injection for the Treatment of Third, Fourth, and Sixth Nerve Palsy: A Meta-Analysis. J Pediatr Ophthalmol Strabismus 2024; 61:160-171. [PMID: 38112391 DOI: 10.3928/01913913-20231120-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
The efficacy of botulinum toxin injection for the treatment of third, fourth, and sixth nerve palsy was evaluated. PubMed, Scopus, EMBASE, Web of Science, and Google Scholar databases were searched. Data about the duration of palsy (acute vs chronic), cause of the palsy, type of toxin used, mean dose, and other background characteristics were collected. Outcome variables were success rate (defined by alleviation of diplopia or reduction in eye deviation) and standardized mean difference of prism diopter and abduction deficit before and after injection. The Joanna Briggs Institute checklist was implemented for the risk of bias assessment. The analysis included 38 articles, comprising 643 patients. The overall treatment success rate in acute and chronic nerve palsy was 79% and 33%, respectively. The success rate was not significantly different between different subgroups of age, type of botulinum toxin, pre-injection prism diopter, etiology of the palsy, duration of follow-up, and mean dose of botulinum toxin injection. However, in both acute and chronic palsy, diabetes etiology was accompanied by the highest success rate. Overall symptomatic response to botulinum injection was 84% (95% CI: 67% to 96%), whereas functional response was observed in 64% (95% CI: 47% to 79%) of the patients. The odds ratio for the success rate of treatment of palsies with botulinum toxin versus expectant management was 2.67 (95% CI: 1.12 to 6.36) for acute palsy and 0.87 (95% CI: 0.17 to 4.42) for chronic palsy. Botulinum toxin can be used for the treatment of acute third, fourth, and sixth nerve palsy, especially in patients with acute palsy and more severe tropia. [J Pediatr Ophthalmol Strabismus. 2024;61(3):160-171.].
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Xu G, He K, Ye X, Ning S, Zhang Q. Acupuncture therapy for isolated ischemic oculomotor nerve palsy: A case report. Medicine (Baltimore) 2024; 103:e37850. [PMID: 38640311 PMCID: PMC11029924 DOI: 10.1097/md.0000000000037850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Isolated ischemic oculomotor nerve palsy as a type of ophthalmic disease is rarely observed in clinical practice. Quality of life is frequently impacted by isolated ischemic oculomotor nerve palsy due to its lack of treatment options and long-term visual impairment. We describe an acupuncture-treated instance of isolated ischemic oculomotor paralysis. METHODS Acupoints including Jingming (BL 1), Chengqi (ST 1), Cuanzhu (BL 2), and Sizhukong (TE 23) on the right side, and bilateral Fengchi (GB 20), Waiguan (TE 5), Hegu (LI 4), and Zulinqi (GB 41) were selected for needling. Each treatment lasted for 30 minutes, once every other day. Acupuncture treatment was administered for a total of 11 times. RESULTS Acupuncture is a promising treatment option for isolated ischemic oculomotor nerve palsy. CONCLUSIONS Ischemic oculomotor nerve paralysis can affect the quality of life of patients. Acupuncture intervention can promote the recovery of the disease is a very effective treatment measure.
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Affiliation(s)
- Guan Xu
- Zhejiang Chinese Medical University, Hangzhou, China
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Kelin He
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiao Ye
- Confucius Institute, University of Coimbra, Coimbra, Portugal
| | - Songhao Ning
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Quanai Zhang
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Sanchez J, DeLosSantos H, Dandamudi M, Freddo L, Macchiavello GA. A Case Report of Shingles Vaccine as a Cause of Third Nerve Palsy: A Novel Etiology. Cureus 2024; 16:e59086. [PMID: 38803709 PMCID: PMC11128331 DOI: 10.7759/cureus.59086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Vaccines are biological preparations widely used to provide acquired immunity against various life-threatening organisms and prevent severe complications of different infections. Vaccines typically demonstrate a high level of safety with minimal adverse effects. Nevertheless, it is crucial to enhance awareness when a potential new side effect emerges, as exemplified in the case discussed ahead. Despite the rarity of independent third nerve palsy occurrences, its association with the zoster vaccine remains unprecedented.
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Affiliation(s)
- Jorge Sanchez
- Internal Medicine, St. Barnabas Hospital Health System, Bronx, USA
| | | | | | - Lorenza Freddo
- Neurology, St. Barnabas Hospital Health System, Bronx, USA
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Sas LK, Chronopoulos A, Boujan T, Krastel H, Hattenbach LO. [Neurovascular conflict as a rare cause of internal and external ophthalmoplegia]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02017-5. [PMID: 38456996 DOI: 10.1007/s00347-024-02017-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Affiliation(s)
- L K Sas
- Klinik für Augenheilkunde, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Deutschland
| | - A Chronopoulos
- Klinik für Augenheilkunde, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Deutschland.
| | - T Boujan
- Zentralinstitut für Diagnostische und Interventionelle Radiologie, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Deutschland
| | - H Krastel
- Universitäts-Augenklinik, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Deutschland
| | - L-O Hattenbach
- Klinik für Augenheilkunde, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Deutschland
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Pellerano FM, Messilaty MS, Chin SS, Parnes GJ, Akbar NA, Agarwal V, Mbekeani JN. Isolated Third Nerve Palsy as the Initial Manifestation of a Large Clival Chordoma. J Neuroophthalmol 2024; 44:e117-e119. [PMID: 36562553 DOI: 10.1097/wno.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Fernando M Pellerano
- Department of Ophthalmology (FMP), Indiana University School of Medicine, Indianapolis, Indiana; Departments of Surgery (Ophthalmology) (MSM, JNM), and Radiology (GJP), Jacobi Medical Center, Bronx, New York; Department of Pathology (SSC), Montefiore Medical Center, Bronx, New York; Departments of Otorhinolaryngology (NAA, VA) and Neurosurgery (VA), Montefiore Medical Center, Bronx, New York; and Department of Ophthalmology and Visual Sciences (JNM), Albert Einstein College of Medicine, Bronx, New York
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Kim J, Han K, Jung JH, Park KA, Oh SY. Early-Onset Ocular Motor Cranial Neuropathy Is a Strong Predictor of Dementia: A Nationwide, Population-Based Cohort Study. Ophthalmology 2024; 131:288-301. [PMID: 37832727 DOI: 10.1016/j.ophtha.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE To assess the risk of dementia in individuals with newly diagnosed ocular motor cranial neuropathy (OMCN). DESIGN A nationwide, population-based cohort study using authenticated data from the Korean National Health Insurance Service (KNHIS). PARTICIPANTS This study included 60 781 patients with OMCN who received a diagnosis between 2010 and 2017 and were followed up through 2018, with an average follow-up of 3.37 ± 2.21 years with a 1-year lag. After excluding patients with disease related to oculomotor dysfunction preceding the OMCN diagnosis, a total of 52 076 patients with OMCN were established. Of these, 23 642 patients who had participated in the National Health Screening Program (NHSP) within 2 years before the OMCN diagnosis were included. After applying the exclusion criteria, the final cohort comprised 19 243 patients and 96 215 age and sex-matched control participants without OMCN. METHODS We identified patients with newly diagnosed OMCN in the KNHIS database and collected participant characteristics from the health checkup records of the NHSP. The study end point was determined by the first claim with a dementia diagnostic code and antidementia medications. The association of OMCN with dementia risk was examined using Cox proportional hazards regression analysis, adjusting for potential confounding factors. MAIN OUTCOME MEASURES The main outcome measures were hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VaD) development in patients with OMCN relative to those without OMCN. RESULTS Patients with newly diagnosed OMCN demonstrated higher metabolic comorbidities than those without OMCN. New OMCN was associated with an elevated risk of ACD (HR, 1.203; 95% CI, 1.113-1.300), AD (HR, 1.137; 95% CI, 1.041-1.243), and VaD (HR, 1.583; 95% CI, 1.286-1.948), independent of potential confounding factors. The younger age groups exhibited a stronger association between OMCN and ACD (HR, 8.690 [< 50 years] vs. 1.192 [≥ 50 years]; P = 0.0004; HR, 2.517 [< 65 years] vs. 1.099 [≥ 65 years]; P < 0.0001). CONCLUSIONS This nationwide population-based study assessed the association between OMCN and dementia risk. Our results demonstrated a robust relationship between OMCN and the risk of dementia, particularly in the younger population. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jaeryung Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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14
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Srimanan W, Panyakorn S. 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. Clin Ophthalmol 2024; 18:441-450. [PMID: 38352051 PMCID: PMC10863467 DOI: 10.2147/opth.s449127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
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.
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Affiliation(s)
- Worapot Srimanan
- Ophthalmology Division, Phramongkutklao Hospital, Bangkok, Thailand
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15
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Hankinson J, Shuaib A. Surgical management of oculomotor nerve palsy - a review of the literature. Eur J Ophthalmol 2024:11206721241229758. [PMID: 38303488 DOI: 10.1177/11206721241229758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
We aim to review the surgical management techniques available for patients with oculomotor nerve (OMN) palsy, compare and contrast the approaches and subsequent outcomes. A search of the literature was carried out to yield all papers relevant to the topic, and a wide spectrum of surgical techniques were identified. These included: muscle shortening and lengthening procedures, muscle transposition, globe fixation and ptosis surgery. Patients often require a synergistic combination of these techniques. Strabismus surgery for OMN palsy can be approached through a variety of different techniques to improve the quality of life, independence and aesthetics for the patient.
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Affiliation(s)
- Jake Hankinson
- Barts and The London School of Medicine and Dentistry, London, UK
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16
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Hao W, Yingzi M. Acupuncture treated oculomotor nerve palsy with diabetes mellitus: A case reported. Explore (NY) 2023; 19:718-720. [PMID: 36806384 DOI: 10.1016/j.explore.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
The incidence of diabetes mellitus is increasing rapidly, and this condition often results in severe complications. One such complication, diabetic oculomotor nerve palsy (ONP), that can lead to significant impairment of visual function is increasingly recognized. However, there are few reports in the literature on the treatment of diabetic ONP. In the present case, the use of needling a selection of local and distal acupoints showed promising results for the treatment of diabetic ONP. We also present a brief literature review related to this case.
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Affiliation(s)
- Wang Hao
- Department of Acupuncture-Moxibustion, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, Beijing 100039, China
| | - Ma Yingzi
- Guangning Community Health Service Center of Beijing, Beijing 100041, China.
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17
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Zhao B, Bhatti MT, Fang C, Hodge DO, Holmes JM, Mohney BG, Chen JJ. Vascular Risk Factors in Isolated Microvascular Ischemic Third Nerve Palsy: A Population-Based Study. J Neuroophthalmol 2023; 43:248-253. [PMID: 36730253 PMCID: PMC10643043 DOI: 10.1097/wno.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Although presumed microvascular third nerve palsies (TNP) have been associated with vascular risk factors and/or stroke, these associations have not been explored in a population-based cohort. The purpose of this population-based case-control study was to determine whether these factors are associated with TNPs that had been classified as isolated microvascular ischemic events and determine future risk of mortality. METHODS Participants were subjects >18 years old with new onset of isolated TNP attributed to presumed microvascular ischemia (n = 55) while residing in Olmsted County, Minnesota, from January 1, 1978 to December 31, 2014. Control subjects (n = 55) were randomly selected from the same population and matched for gender, age, and length of medical follow-up. We identified all cases of new-onset isolated presumed microvascular ischemic TNP using the Rochester Epidemiology Project, a record-linkage system of medical records for all patient-physician encounters in Olmsted County, Minnesota. All medical records of cases and controls were reviewed for potential risk factors, including diabetes mellitus, diabetic retinopathy, hypertension, hyperlipidemia, smoking, and symptomatic ischemic stroke. Multivariable and univariate logistic regression analyses were used to compare the prevalence of potential risk factors between microvascular ischemic cases and controls according to the number of subjects, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Kaplan-Meier curves were used to compare mortality between cases and controls. RESULTS The annual incidence of microvascular ischemic TNP was 1.7 per 100,000. Univariate analysis demonstrated that hypertension ( P < 0.001; OR, 4.80; 95% CI, 2.11-11.58), diabetes mellitus ( P < 0.001; OR, 6.55; 95% CI, 2.72-17.32), diabetic retinopathy ( P = 0.014; OR, 13.50; 95% CI, 2.48-251.55), coronary artery disease ( P = 0.047; OR, 2.27; 95% CI, 1.02-5.18), and symptomatic ischemic stroke ( P = 0.039; OR, 3.56; 95% CI, 1.07-11.85) all occurred more frequently in patients with microvascular ischemic TNP than controls. In multivariate analysis, only hypertension (OR of 4.14, 95% CI, 1.61-10.65, P < 0.001) and diabetes (OR of 4.12, 95% CI, 1.43-11.92, P = 0.003) remained independently statistically significant. There was numerically higher mortality in microvascular cases than in controls, but it did not reach statistical significance. CONCLUSIONS There are multiple cardiovascular diseases that are associated with isolated microvascular ischemic TNP, including hypertension, coronary artery disease, diabetes mellitus, diabetic retinopathy, and symptomatic ischemic stroke. Given that the main drivers of this association seem to be diabetes and hypertension, patients with microvascular ischemic TNP should be evaluated for these conditions.
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Affiliation(s)
- Bingying Zhao
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - M. Tariq Bhatti
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Chengbo Fang
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - David O. Hodge
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL, USA
| | - Jonathan M. Holmes
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
- Department of Ophthalmology, University of Arizona, Tucson, AZ, USA
| | - Brian G. Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - John J. Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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18
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Papadopoulou M, Tzortsou S, Chatzi I, Baltogiannis C. Oculomotor nerve palsy as an extraintestinal manifestation of Crohn's disease. BMJ Case Rep 2023; 16:e254456. [PMID: 37202111 PMCID: PMC10201219 DOI: 10.1136/bcr-2022-254456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) may present with extraintestinal manifestations. Neurological symptoms associated with IBD are infrequent. Thus, any unexplained neurological symptom that occurs in patients with IBD should raise the suspicion of a link between the two disorders. We report a case of a man in his 60s, who was diagnosed with Crohn's disease and developed ptosis and diplopia. Neurological examination revealed oculomotor nerve palsy, sparing the pupil. MRI and magnetic resonance angiography of the brain were insignificant and no other cause was determined. He was treated with oral corticosteroids and symptoms gradually subsided. Cranial nerve palsies associated with IBD have been rarely reported. They usually involve the optic and acoustic nerve and are attributed to a common dysimmune base. This is the first reported case of oculomotor nerve palsy (III cranial nerve) associated with IBD. Clinicians treating patients with IBD should be alert for unusual neurological complications and treat them appropriately.
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Affiliation(s)
- Marianna Papadopoulou
- Department of Physiotherapy, University of West Attica, Egaleo, Greece
- Department of Neurology, Hygeias Melathron, Athens, Greece
| | - Sofia Tzortsou
- Department of Neurology, Hygeias Melathron, Athens, Greece
| | - Ioanna Chatzi
- Department of Neurology, Hygeias Melathron, Athens, Greece
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19
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Iwasaki M, Nishizawa T, Iida E, Arioka H. Third cranial nerve palsy due to COVID-19 infection. BMJ Case Rep 2023; 16:16/5/e255142. [PMID: 37137545 PMCID: PMC10163548 DOI: 10.1136/bcr-2023-255142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
We report a case of a previously healthy man in his 40s who presented with mild SARS-CoV-2 infection (COVID-19) concomitant with acute onset of left third cranial nerve palsy with restricted supraduction, adduction and infraduction. Our patient did not present any history of hypertension, hyperlipidaemia, diabetes mellitus or smoking. The patient recovered spontaneously without any antiviral treatment. To our knowledge, this is the second report of third cranial nerve palsy spontaneously resolved without any risk factors of vascular disease, specific image findings, nor any possible causes other than COVID-19. In addition, we reviewed 10 other cases of third cranial nerve palsy associated with COVID-19, which suggested that the aetiology varies greatly. As a clinician, it is important to recognise COVID-19 as a differential diagnosis for third cranial nerve palsy. Finally, we aimed to encapsulate the aetiologies and the prognosis of the third cranial nerve palsy associated with COVID-19.
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Affiliation(s)
- Monika Iwasaki
- Department of General Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Toshinori Nishizawa
- Department of General Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Eiki Iida
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
| | - Hiroko Arioka
- Department of General Internal Medicine, St. Luke's International Hospital, Chuo-ku, Tokyo, Japan
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20
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Park KA, Jeon H, Choi DG, Jung JH, Shin HJ, Lee BJ, Moon Y, Lee SY, Lee DC, Cho SY, Kim SJ, Oh SY, Moon S, Oh SY, Choi DD, Choi MY, Kim WJ, Kim US, Lee HJ, Kim Y. Ocular motility disorders following coronavirus disease-19 vaccination. Graefes Arch Clin Exp Ophthalmol 2023; 261:1127-1139. [PMID: 36383278 PMCID: PMC9667443 DOI: 10.1007/s00417-022-05888-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/31/2022] [Accepted: 10/25/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe clinical manifestations and short-term prognosis of ocular motility disorders following coronavirus disease-2019 (COVID-19) vaccination. METHODS Ocular motility disorders were diagnosed by clinical assessment, high-resolution magnetic resonance imaging, and laboratory testing. Clinical manifestations, short-term prognosis, and rate of complete recovery were analyzed. RESULTS Sixty-three patients (37 males, 26 females) with a mean age of 61.6 ± 13.3 years (range, 22-81 years) were included in this study. Among 61 applicable patients with sufficient information regarding medical histories, 38 (62.3%) had one or more significant underlying past medical histories including vasculopathic risk factors. The interval between initial symptoms and vaccination was 8.6 ± 8.2 (range, 0-28) days. Forty-two (66.7%), 14 (22.2%), and 7 (11.1%) patients developed symptoms after the first, second, and third vaccinations, respectively. One case of internuclear ophthalmoplegia, 52 cases of cranial nerve palsy, two cases of myasthenia gravis, six cases of orbital diseases (such as myositis, thyroid eye disease, and IgG-related orbital myopathy), and two cases of comitant vertical strabismus with acute onset diplopia were found. Among 42 patients with follow-up data (duration: 62.1 ± 40.3 days), complete improvement, partial improvement, no improvement, and exacerbation were shown in 20, 15, 3, and 4 patients, respectively. CONCLUSION This study provided various clinical features of ocular motility disorders following COVID-19 vaccination. The majority of cases had a mild clinical course while some cases showed a progressive nature. Close follow-up and further studies are needed to elucidate the underlying mechanisms and long-term prognosis.
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Affiliation(s)
- Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeshin Jeon
- Department of Ophthalmology, Pusan National University Collage of Medicine and Biomedical Research Institute, Busan, Korea
| | - Dong Gyu Choi
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, College of Medicine Hallym University, Seoul, Korea.
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jin Shin
- Department of Ophthalmology, Konkuk University Hospital, Seoul, Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Se-Youp Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Dong Cheol Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Soon Young Cho
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sunghyuk Moon
- Department of Ophthalmology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Shin Yeop Oh
- Department of Ophthalmology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Daye Diana Choi
- Department of Ophthalmology, Kim's Eye Hospital, Seoul, Korea
| | - Mi Young Choi
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Won Jae Kim
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ungsoo Samuel Kim
- Department of Ophthalmology, Chung-Ang University, Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University College of Medicine, Jeonju, Korea
| | - Yikyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Omiya M, Nishiguchi S, Moriya H, Akazawa K, Nagahiro T, Seto M. Aseptic meningitis after amenamevir treatment for herpes zoster ophthalmicus with oculomotor nerve palsy in a patient taking immunosuppressant. J Infect Chemother 2023; 29:519-522. [PMID: 36708771 DOI: 10.1016/j.jiac.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 01/26/2023]
Abstract
A 79-year-old woman presented with vomiting after being prescribed amenamevir by her primary care physician. She had a medical history of rheumatoid arthritis and was administered prednisolone and methotrexate. She was finally diagnosed with herpes zoster ophthalmicus and aseptic meningitis, and intravenous antiviral therapy was initiated. However, the patient developed oculomotor nerve palsy on the 11th day of hospitalization. In this case, there was a time lag between the administration of antiviral drugs and clinical improvement. Our case suggests the necessity of selecting antivirals, especially in high-risk cases of CNS complications, to avoid the low intracerebral transferability of antiviral drugs, including amenamevir.
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Affiliation(s)
- Moeko Omiya
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan.
| | - Sho Nishiguchi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hidekazu Moriya
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Kenichiro Akazawa
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Takanori Nagahiro
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Masami Seto
- Department of General Medicine, Shonan Kamakura General Hospital, Kamakura, Japan
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22
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Wang R, Gao Y, Wu S, Cai X, Yu T, Wang L. Research hotspots and trends of oculomotor nerve palsy from 2001 to 2021 based on web of science: A bibliometric analysis. Front Neurol 2023; 14:1112070. [PMID: 36908629 PMCID: PMC9992801 DOI: 10.3389/fneur.2023.1112070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
Background Oculomotor nerve palsy (ONP) is a clinically occurring neurological disorder. Due to the complex anatomy and long travel distances of the oculomotor nerve, the causes of ONP vary and manifest in various ways. With continued interest in this area, it has become necessary to conduct a bibliometric study in ONP. This work aims to synthesize and visually identify current research themes and future trends in ONP through a literature-based analysis. Method Articles and reviews on ONP published from 2002 to 2021 were derived from the Web of Science Core Collection (WoSCC) database. We generated visual images and performed quantitative and qualitative analysis through an online bibliometric tool, Citespace and VOSviewer software. Results A total of 1,205 published articles were included in this analysis. The annual number of this area's publications is showing an overall upward trend, with the number of citations increasing every year, reaching 2,698 by 2021. The United States (367) and Japan (116) dominated the list with the most numerous articles published. The University of California Los Angeles in the USA is the institution that published the highest number of articles (47). Engle EC (23) and the JOURNAL OF NEUROSURGERY (46) are the most influential authors and journals in this field. The co-occurrence network analysis divided the keywords into five main research themes, which mainly include clinical manifestations of ONP, aneurysms, cerebral neurological symptoms, diseases with ONP as a complication, and other neurological disorders. Conclusion This study is the first comprehensive and systematic bibliometric analysis of the current state of global ONP research over the past 20 years. We organized current hotspots and expected trends and provided key information for exploring potential research frontiers in ONP.
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Affiliation(s)
- Runze Wang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yang Gao
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - ShanHong Wu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaojun Cai
- Endocrinology Department, Heilongjiang Academy of Sciences of Traditional Chinese Medicine, Harbin, China
| | - TianYang Yu
- Heilongjiang University of Chinese Medicine, Harbin, China.,Acupuncture Department, Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Liyuan Wang
- Heilongjiang University of Chinese Medicine, Harbin, China.,Ophthalmology Department, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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23
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Baek SM, Lee SB, Yoo EA, Na YI, Lee KJ. Isolated Oculomotor Nerve Palsy After Temporoparietal Lobar Hemorrhage With a Mass Effect: A Case Report. BRAIN & NEUROREHABILITATION 2023; 16:e1. [PMID: 37033009 PMCID: PMC10079481 DOI: 10.12786/bn.2023.16.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 04/05/2023] Open
Abstract
We report a case of a patient who presented with ipsilateral oculomotor nerve palsy after a spontaneous left temporoparietal lobar hemorrhage with mass effect. Primary symptomatology included ipsilateral ptosis, dilated fixed pupil, and a lack of superior and medial movement with limited inferior left eye movements. Brain imaging revealed compression of the left upper midbrain due to subtentorial herniation of the hemorrhage, and susceptibility-weighted images sequences showed cerebral microbleed in the left midbrain substantia nigra. Based on our observation from this case, physicians should consider temporoparietal lobar hemorrhage with mass effect as an attributable factor in the etiologic cause of ipsilateral oculomotor nerve palsy.
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Affiliation(s)
- Seung-Min Baek
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
| | - Seung-Bok Lee
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
- Yeonsei Enabling Science Technology & Clinical Research Center, Yonsei University, Wonju, Korea
| | - Eun-Ae Yoo
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
- Department of Radiology, Presbyterian Medical Center, Jeonju, Korea
| | - Yeong-il Na
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
| | - Kwang-Jae Lee
- Department of Physical Medicine and Rehabilitation, Presbyterian Medical Center, Jeonju, Korea
- Medical Device Clinical Trial Center, Presbyterian Medical Center, Jeonju, Korea
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24
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Hong JP, Lee SU, Yu S, Kim JS. Pseudo-pupil sparing oculomotor nerve palsy in cavernous-carotid fistula. J Neurol 2023; 270:552-554. [PMID: 35976435 DOI: 10.1007/s00415-022-11332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Jun-Pyo Hong
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea.,Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea
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25
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Chronopoulos A, Consigli A, Heim J, Schutz JS, Becker M, Krastel H, Hattenbach LO. Isolated Internal Ophthalmoplegia from Posterior Cerebral Artery Neurovascular Conflict. Case Rep Ophthalmol 2023; 14:104-110. [PMID: 36968808 PMCID: PMC10035546 DOI: 10.1159/000529231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/09/2023] [Indexed: 03/29/2023] Open
Abstract
We report a rare case of recurrent isolated internal ophthalmoplegia attributed to oculomotor nerve (CN III) compression by the posterior cerebral artery (PCA). A 30-year-old female patient presented with recurrent right-sided headaches, right periorbital pain, and slight anisocoria. Slit-lamp examination revealed normal anterior and posterior segments except for vermiform movements of the right pupil with a temporal hyporeactive flat area. Tonic pupils were ruled out with pilocarpine 0.1% testing. Suspecting an internal ophthalmoplegia, magnetic resonance imaging was ordered which demonstrated the right CN III indented by the PCA, fulfilling the criteria of a neurovascular conflict. The evaluation of unilateral mydriasis from internal ophthalmoplegia should prompt neuroimaging with exclusion of aneurysmal or compressive lesions. CN III palsy can rarely be caused by vascular anatomical variants because of the proximity of the posterior intracranial circulation and CN III. Newer, more precise imaging techniques will better help characterize neurovascular conflicts presenting as cranial nerve palsies.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Andrea Consigli
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Julia Heim
- Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - James S. Schutz
- Department of Ophthalmology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Minerva Becker
- Division of Radiology, Department of Diagnostics, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Hermann Krastel
- Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
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26
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Kritzinger J, Micieli JA. Enhancement of the Third Cranial Nerve due to Microvascular Ischemia: Case Report. Case Rep Ophthalmol 2023; 14:87-92. [PMID: 36879795 PMCID: PMC9984938 DOI: 10.1159/000529669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Third nerve palsy (3NP) commonly results from a microvascular ischemic insult. Typically, computed tomography or magnetic resonance angiography is performed to rule out a posterior communicating artery aneurysm. If this is normal and the pupil is spared, patients are often observed with the expectation of spontaneous improvement within 3 months. Oculomotor nerve enhancement on MRI with contrast in the context of microvascular 3NP is not well recognized. Here, we report third nerve enhancement in a case of a 67-year-old woman with diabetes and other vascular risk factors who presented with left eye ptosis and a limitation of extraocular eye movements consistent with 3NP. She underwent an extensive inflammatory workup that was negative and the diagnosis of a microvascular 3NP was made. A spontaneous recovery was achieved within 3 months, and she did not receive any treatment. She remained clinically well, although increased T2 signal in the oculomotor nerve persisted after 10 months. While the exact mechanism remains unknown, it is likely that microvascular ischemic insults lead to intrinsic changes of the third nerve that may result in enhancement and persistent T2 signal. Additional workup for inflammatory causes of 3NP may not be required when enhancement of the oculomotor nerve is seen in the right clinical context. Further study is required to understand why enhancement is a rarely reported finding in patients with microvascular ischemic 3NP.
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Affiliation(s)
- Justin Kritzinger
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jonathan A Micieli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Kensington Vision and Research Center, Toronto, ON, Canada
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Cheng N. A Conflicting Case of Ophthalmoparesis. JAMA Neurol 2022; 79:2796659. [PMID: 36190712 DOI: 10.1001/jamaneurol.2022.3149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A 37-year-old man with no known medical or drug history presented with an insidious onset of left-eye ptosis. He did not complain of headaches, facial numbness, dysarthria, facial droop, dysphagia, limb weakness or numbness. What is your diagnosis?
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Affiliation(s)
- Newman Cheng
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore
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Shree R, Mahesh KV, Balaini N, Goel A. Oculomotor Cranial Neuropathies: Diagnosis and Management. Ann Indian Acad Neurol 2022; 25:S70-S82. [PMID: 36589037 PMCID: PMC9795710 DOI: 10.4103/aian.aian_167_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/02/2022] [Indexed: 01/04/2023] Open
Abstract
Ocular nerve palsies are among the most common cranial neuropathies in neurological practice. Nerves can get affected anywhere along their path from the brainstem to the orbit. There can be isolated involvement of multiple cranial nerves together. The etiologies differ according to the type of presentation. The steps toward the diagnosis need to be strategically planned and must be based on clinical localization. It is crucial to make proper localization to plan further investigations and thus treatment of the etiology. This review covers the approach toward the diagnosis, etiologies involved, and management of ocular cranial neuropathies.
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Affiliation(s)
- Ritu Shree
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,Address for correspondence: Dr. Ritu Shree, Level-1, Block-A, Room number: 11, Nehru Hospital, PGIMER, Chandigarh - 160 012, India. E-mail:
| | - Karthik Vinay Mahesh
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neeraj Balaini
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Abeer Goel
- Department of Neurology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Cui YY, Wang B, Jiang B, Zhao SH. Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm. Int J Ophthalmol 2022; 15:1316-1321. [PMID: 36017047 DOI: 10.18240/ijo.2022.08.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/14/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To explore the risk factors of oculomotor nerve palsy (ONP) in patients with intracranial aneurysm (IA) and develop a nomogram model for predicting ONP of IA patients. METHODS A total of 329 IA patients were included. Logistic regression analysis was applied to identify independent factors, which were then integrated into the nomogram model. The performance of the nomogram model was evaluated by calibration curve, receiver operating curve (ROC), and decision curve analysis. RESULTS Univariate and multivariate logistic regression analysis indicated posterior communicating artery (PCoA) aneurysm [hazard ratio (HR)=17.13, P<0.001] and aneurysm diameter (HR=1.31, P<0.001) were independent risk factors of ONP in IA patients. Based on the results of logistic regression analysis, a nomogram model for predicting the ONP in IA patients was constructed. The calibration curve indicated the nomogram had a good agreement between the predictions and observations. The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve (AUC) of 0.863. The decision curve analysis showed that the nomogram was powerful in the clinical decision. PCoA aneurysm (HR=3.38, P=0.015) was identified to be the only independent risk factor for ONP severity. CONCLUSION PCoA aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients. The nomogram established is performed reliably and accurately for predicting ONP. PCoA aneurysm is the only independent risk factor for ONP severity.
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Affiliation(s)
- Yuan-Yue Cui
- Department of Ophthalmology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Bin Wang
- Department of Neurosurgery, Peking University International Hospital, Beijing 102206, China
| | - Bo Jiang
- Department of Ophthalmolohy, Anhui No.2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Shi-Hong Zhao
- Nanjing Aier Eye Hospital, Aier School of Ophthalmology, Central South University, Changsha 410015, Hunan Pronvince, China.,Department of Ophthalmology, the First Affiliated Hospital, Naval Military Medical University, Shanghai 200433, China
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Shrestha R, Bishokarma S, Rayamajhi S, Shrestha S, Lamichhane S, Shrestha P, Thulung S. Pituitary apoplexy presenting as isolated third cranial nerve palsy: case series. J Surg Case Rep 2022; 2022:rjac386. [PMID: 36017525 PMCID: PMC9398505 DOI: 10.1093/jscr/rjac386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/07/2022] [Indexed: 11/14/2022] Open
Abstract
Pituitary apoplexy (PA) is caused by a sudden increase in pressure in the pituitary region due to acute hemorrhage, infarction or necrosis. PA can also be caused by restricting blood supply to the nerve due to compression of the internal carotid artery. Acute third cranial nerve palsy (third CN) secondary to PA is a rare medical emergency caused by bleeding within a growing mass within the sella turcica. We presented two cases of PA with isolated third CN palsy treated with transsphenoidal pituitary decompression. PA is therefore an important differential diagnosis to consider in patients with isolated third nerve palsy. The prognosis for isolated third nerve palsy in PA appeared successful, with variable recovery from medical and surgical intervention.
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Affiliation(s)
- Ramesh Shrestha
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences , Kathmandu 44600, Nepal
| | - Suresh Bishokarma
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences , Kathmandu 44600, Nepal
| | - Sushil Rayamajhi
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences , Kathmandu 44600, Nepal
| | - Sunita Shrestha
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences , Kathmandu 44600, Nepal
| | - Saurav Lamichhane
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences , Kathmandu 44600, Nepal
| | - Pratyush Shrestha
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences , Kathmandu 44600, Nepal
| | - Suraj Thulung
- Department of Neurosurgery, Upendra Devkota Memorial National Institute of Neurological and Allied Sciences , Kathmandu 44600, Nepal
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Hattori K, Matsuda N, Yoshizawa M, Ugawa Y, Kanai K. [Oculomotor nerve palsy with preserved pupillary reaction in two cases of neurolymphomatosis]. Rinsho Shinkeigaku 2022; 62:552-557. [PMID: 35753787 DOI: 10.5692/clinicalneurol.cn-001727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Case 1: A 64-year-old woman with acute ptosis and diplopia was admitted to our hospital. She had right oculomotor nerve palsy with preserved pupillary reaction without any other neurological deficits. MRI showed abnormal enhancement in the right oculomotor nerve. An ovarian tumor was detected on CT examination, and was pathologically diagnosed as diffuse large B-cell lymphoma (DLBCL). Cerebrospinal fluid cytology disclosed malignant lymphoma cells. Based on the above findings, we concluded that she had neurolymphomatosis (NL) of the right oculomotor nerve. Case 2: A 63-year-old woman was admitted to our hospital due to weakness of the bilateral lower extremities and gait disturbance. Lumbar MRI showed enhanced lesions in the cauda equina, and we diagnosed her as having DLBCL based on bone marrow aspiration study. She later developed right oculomotor nerve palsy with preserved pupillary reaction together with the right abducens and hypoglossal nerve palsies, which were caused by NL. Our cases suggest that oculomotor nerve palsy with preserved pupillary reaction can be a clinical feature of NL. Although NL mainly affects the subperinerium, as parasympathetic fibers are located in the periphery of the oculomotor nerve and supplied by pia matar blood vessels, patients with NL may shows this clinical feature.
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Affiliation(s)
| | | | | | - Yoshikazu Ugawa
- Department of Human Neurophysiology, Fukushima Medical University
| | - Kazuaki Kanai
- Department of Neurology, Fukushima Medical University
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Association between migraine and risk of ocular motor cranial nerve palsy. Sci Rep 2022; 12:10512. [PMID: 35732687 PMCID: PMC9217919 DOI: 10.1038/s41598-022-14621-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/09/2022] [Indexed: 11/20/2022] Open
Abstract
To assess association between migraines and development of ocular motor cranial nerve palsy (CNP) and finding risk factors using the National Sample Cohort database from the Korea National Health Insurance Service. Data was analyzed from 4,234,341 medical screening examinees aged 20–90 years in 2009. Cox proportional hazard regression analysis was used to the adjusted hazard ratios (HR) for ocular motor CNP according to presence of migraine. Subgroup analysis was performed to evaluate effect of other factors on association of migraine with ocular motor CNP. A total of 5806 participants (0.14% of subjects) developed ocular motor CNP and were assigned to CNP group, 4,048,018 were assigned to control group, with an average of 8.22 ± 0.93 years of follow-up. Incidence of ocular motor CNP increased in migraine group compared to control. After adjusting potential confounding variables, HR for ocular motor CNP was 1.166 (confidence interval [CI] 1.013–1.343) in migraine group. Subgroups of relatively younger age less than 65 years (HR = 1.267, 95% CI 1.067–1.504), male gender (HR = 1.228, 95% CI 1.000–1.122), smokers (HR 1.426, 95% CI 1.127–1.803), and diabetes mellitus patients (HR = 1.378, 95% CI 1.045–1.378) showed a stronger association between migraines and development of ocular motor CNP. Our population-based cohort study demonstrated a significant association between presence of migraines and incidence of ocular motor CNP. Especially, relatively younger age, males, smokers, and diabetes patients with migraines could have a higher risk of developing ocular motor CNP.
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Chan AX, Chang A, Do JL, Koo SJ, Lin G, Welsbie DS. Polymorphous low-grade adenocarcinoma with cavernous sinus involvement presenting as third nerve palsy. Am J Ophthalmol Case Rep 2022; 26:101460. [PMID: 35313474 PMCID: PMC8933825 DOI: 10.1016/j.ajoc.2022.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Polymorphous low-grade adenocarcinoma is a tumor of the salivary glands that typically localizes within the oral cavity. We present a case of isolated third cranial nerve palsy as the initial presentation of polymorphous low-grade adenocarcinoma involving the left cavernous sinus in a patient status post glaucoma surgery. Observations A 68-year-old woman status post glaucoma drainage device implantation in her left eye presented with an isolated left third nerve palsy ten weeks postoperatively. Differential diagnoses included microvascular ischemic neuropathy, postoperative ptosis, and compressive mass. MRI revealed a left cavernous sinus mass, and subsequent excisional biopsy revealed a diagnosis of polymorphous low-grade adenocarcinoma. Conclusions There are few cases reporting polymorphous low-grade adenocarcinoma originating from and extending beyond the nasopharynx. This report emphasizes an unexpected neuro-ophthalmic manifestation of this salivary gland tumor.
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Nichols KK, Malloy KA, Karpecki PM, Bacharach J, Douglas RS, Foster S, Gromacki SJ, Whitley WO. Topical Review: An Update of Diagnostic and Management Algorithms for Acquired Blepharoptosis. Optom Vis Sci 2022; 99:230-240. [PMID: 35058403 DOI: 10.1097/opx.0000000000001868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE Acquired ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is likely underdiagnosed and undertreated. Given the evolving understanding of the condition and expanding therapeutic options, this review reappraised published evidence and clinical experience regarding diagnosis and treatment of acquired ptosis.The authors met over two structured virtual working sessions to review current evidence and develop timely recommendations for acquired ptosis identification, differential diagnosis, characterization, and treatment selection. Diagnostic algorithms, plus management and referral guidelines, are presented. Eyelid evaluation and, when needed, ptosis diagnostic workup are essential in the comprehensive eye examination. Acquired ptosis can be efficiently identified via patient questionnaire, history, and photograph review combined with assessment of eyelid position and symmetry using established methods. When ptosis is present, it is essential to evaluate onset, symptoms, pupil diameter, and extraocular muscle function to identify or rule out serious underlying conditions. If signs of serious underlying etiology are present, immediate referral/follow-up testing is required. After ruling out serious underlying causes, masquerade conditions, and pseudoptosis, pharmacologic or surgical treatment should be selected based on the clinical evidence. Effectively managing acquired ptosis requires practice-wide commitment to thorough eyelid evaluation, accurate diagnosis, and adoption of new treatment modalities. Aided by evolving pharmacologic therapeutic options, shifting from a "detect and refer" to a "diagnose and manage" approach can support identification and treatment of more patients with acquired ptosis, particularly mild-to-moderate cases.
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Affiliation(s)
| | - Kelly A Malloy
- The Eye Institute of the Pennsylvania College of Optometry, Salus University, Philadelphia, Pennsylvania
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Choi DD, Han K, Park KA, Oh SY. Association of Obesity and Incidence of Third, Fourth, and Sixth Cranial Nerve Palsies. Am J Ophthalmol 2022; 235:258-270. [PMID: 34543662 DOI: 10.1016/j.ajo.2021.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess the association between obesity and the development of third, fourth, and sixth cranial nerve palsy (CNP). METHODS We analyzed a cohort of 4,067,842 adults aged between 20 and 90 years who underwent health checkups within the National Health Insurance Service between January 1 and December 31, 2009. The participants were followed until December 31, 2017. Cox proportional hazards regression analysis was used to determine the adjusted hazard ratios (HRs) for CNP. Model 3 (the main analysis model) was adjusted for age, sex, smoking status, alcohol consumption, and physical activity. Model 4 was additionally adjusted for hypertension, dyslipidemia, and diabetes mellitus in the setting of model 3. RESULTS A total of 5,835 individuals were diagnosed with CNP during the follow-up period (7.3 years). General obesity (body mass index [BMI] ≥25 kg/m2) was associated with an increased risk of CNP compared to individuals without general obesity (model 3, HR 1.248, 95% CI 1.184-1.315; model 4, HR 1.162, 95% CI 1.102-1.227). Abdominal obesity (waist circumference [WC] ≥90 cm in men and ≥85 cm in women) also showed an increased HR compared to individuals without abdominal obesity (model 3, 1.239, 95% CI 1.170-1.313; model 4, HR 1.127, 95% CI 1.062-1.196). Compared to the group without either type of obesity, the group with only abdominal obesity (model 3, HR 1.167, 95% CI 1.035-1.317), the group with only general obesity (HR 1.19, 95% CI 1.14-1.24), and the group with both obesity types (HR 1.317, 95% CI 1.236-1.404) showed increased HRs for CNP. CONCLUSION Based on our population-based cohort study, both general and abdominal obesity increased the risk of CNP. Also, the combination of general and abdominal obesity may further increase the risk of CNP.
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Affiliation(s)
- Daye Diana Choi
- From the Department of Ophthalmology, Kim's Eye Hospital, Seoul, Republic of Korea (D.D.C.)
| | - Kyungdo Han
- Department of Statistics, Soongsil University, Seoul, Republic of Korea (K.H.).
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.P. and S.Y.O.).
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (K.P. and S.Y.O.).
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Shew W, Wang MTM, Danesh-Meyer HV. Stroke risk after ocular cranial nerve palsy - A systematic review and meta-analysis. J Clin Neurosci 2022; 98:168-174. [PMID: 35182847 DOI: 10.1016/j.jocn.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/17/2021] [Accepted: 12/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Isolated ischemic ocular cranial nerve palsies (OCNP) involving the 3rd, 4th and 6th cranial nerves (CN) are prevalent conditions in ophthalmic practice. However, it is not clearly established whether such patients are at increased risk of stroke after onset of OCNPs. METHODS Medline, PubMed, Embase and Cochrane Central registers were systematically searched for eligible studies comparing isolated ischemic OCNPs against matched controls on the subsequent development of stroke with at least two years of follow up. Case reports and series were excluded. Appropriate studies were entered for meta-analysis to determine hazard ratios. Search and data extraction was completed on 22 Feb 2021. Random effect models were used to generate pooled hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Three studies were suitable for meta-analysis (total n = 2,756 OCNP cases and 21,239 matched controls). The meta-analysis demonstrated a hazard ratio of 5.96 (4.20-8.46 95% CI) of subsequent stroke after isolated OCNP within the first year. The hazard ratio reduced to 3.27 (2.61-4.10 95% CI) after five years although remains raised at 2.49 (1.53-4.06 95% CI) up to 12 years. The highest risk was demonstrated with 3rd cranial nerve palsies. Two additional studies assessed the risk of stroke with newly diagnosed diabetics and compared OCNPs against lacunar stroke. These studies did not demonstrate a significant increased risk of stroke, although they may be statistically underpowered. CONCLUSION Ischemic OCNPs represent a significant risk factor for development of subsequent stroke in a similar magnitude to transient ischemic attack within the first year.
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Affiliation(s)
- William Shew
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
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Bal J, Bruneau M, Berhouma M, Cornelius JF, Cavallo LM, Daniel RT, Froelich S, Jouanneau E, Meling TR, Messerer M, Roche PH, Schroeder HWS, Tatagiba M, Zazpe I, Paraskevopoulos D. Management of non-vestibular schwannomas in adult patients: a systematic review and consensus statement on behalf of the EANS skull base section. Part I: oculomotor and other rare non-vestibular schwannomas (I, II, III, IV, VI). Acta Neurochir (Wien) 2022; 164:285-297. [PMID: 34755208 DOI: 10.1007/s00701-021-05048-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Non-vestibular schwannomas are relatively rare, with trigeminal and jugular foramen schwannomas being the most common. This is a heterogeneous group which requires detailed investigation and careful consideration to management strategy. The optimal management for these tumours remains unclear, and there are several controversies. The aim of this paper is to provide insight into the main principles defining management and surgical strategy, in order to formulate a series of recommendations. METHODS A task force was created by the EANS skull base section along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumours on a European perspective. To achieve this, the task force performed an extensive systematic review in this field and had discussions within the group. This article is the first of a three-part series describing non-vestibular schwannomas (I, II, III, IV, VI). RESULTS A summary of literature evidence was proposed after discussion within the EANS skull base section. The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological assessments, optimal surgical and radiotherapy strategies and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the treatment of non-vestibular schwannomas. For each of these tumours, the management of these patients is complex, and for those which are symptomatic tumours, the paradigm is shifting towards the compromise between function preservation and progression-free survival.
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Affiliation(s)
- Jarnail Bal
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Michael Bruneau
- Department of Neurosurgery, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Moncef Berhouma
- Neuro-Oncologic and Vascular Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Jan F Cornelius
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Luigi M Cavallo
- Department of Neurosurgery, University Hospital of Naples Federico II, Napoli, Italy
| | - Roy T Daniel
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | | | - Emmanuel Jouanneau
- Skull Base and Pituitary Neurosurgical Department, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | | | - Mahmoud Messerer
- Department of Neurosurgery, Lausanne University Hospital and University of Lausanne, 42 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Pierre-Hugues Roche
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Idoya Zazpe
- Department of Neurosurgery, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK.
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Isolated third cranial nerve palsies-modern management principles. Eye (Lond) 2022; 36:232-233. [PMID: 33323979 PMCID: PMC8727561 DOI: 10.1038/s41433-020-01349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023] Open
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Oculomotor Nerve Palsy. Neuroophthalmology 2022. [DOI: 10.1007/978-981-19-4668-4_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Chung JE, Schroeder RM, Wilson B, Van Stavern GP, Stunkel L. Failure to Obtain Urgent Arterial Imaging in Acute Third Nerve Palsies. J Neuroophthalmol 2021; 41:537-541. [PMID: 34334757 DOI: 10.1097/wno.0000000000001337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Isolated third nerve palsy may indicate an expanding posterior communicating artery aneurysm, thus necessitating urgent arterial imaging. This study aims to assess the rate and duration of delays in arterial imaging for new isolated third nerve palsies, identify potential causes of delay, and evaluate instances of delay-related patient harm. METHODS In this cross-sectional study, we retrospectively reviewed 110 patient charts (aged 18 years and older) seen between November 2012 and June 2020 at the neuro-ophthalmology clinic and by the inpatient ophthalmology consultation service at a tertiary institution. All patients were referred for suspicion of or had a final diagnosis of third nerve palsy. Demographics, referral encounter details, physical examination findings, final diagnoses, timing of arterial imaging, etiologies of third nerve palsy, and details of patient harm were collected. RESULTS Of the 110 included patients, 62 (56.4%) were women, 88 (80%) were white, and the mean age was 61.8 ± 14.6 years. Forty (36.4%) patients received arterial imaging urgently. Patients suspected of third nerve palsy were not more likely to be sent for urgent evaluation (P = 0.29) or arterial imaging (P = 0.082) than patients in whom the referring doctor did not suspect palsy. Seventy-eight of 95 (82%) patients with a final diagnosis of third nerve palsy were correctly identified by referring providers. Of the 20 patients without any arterial imaging before neuro-ophthalmology consultation, there was a median delay of 24 days from symptom onset to imaging, and a median delay of 12.5 days between first medical contact for their symptoms and imaging. One patient was harmed as a result of delayed imaging. CONCLUSIONS Third nerve palsies were typically identified correctly, but referring providers failed to recognize the urgency of arterial imaging to rule out an aneurysmal etiology. Raising awareness of the urgency of arterial imaging may improve patient safety.
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Affiliation(s)
- Jennifer E Chung
- Washington University in St. Louis School of Medicine (JEC), St. Louis, Missouri; Department of Ophthalmology (RMS), Indiana University School of Medicine, Indianapolis, Indiana; and Departments of Ophthalmology and Visual Sciences (BW, GPVS, LS) and Neurology (GPVS, LS), Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Hyland SJ, Kavi TR, Smith NR, Lin J, Catton MD. Transient Bilateral Ophthalmoplegia: A Case of a Forgotten Anesthetic Medication Effect. Cureus 2021; 13:e18802. [PMID: 34804664 PMCID: PMC8592781 DOI: 10.7759/cureus.18802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/05/2022] Open
Abstract
A 58-year-old woman was found to have bilateral ptosis and downward gaze deviation immediately after elective shoulder surgery with general anesthesia and supraclavicular nerve block. A code stroke was activated due to concern for the neurologic process, but neuroimaging did not reveal acute changes or vascular abnormality. Her symptoms gradually resolved in the following hours with supportive care and were ultimately deemed to be related to anesthetic and transdermal scopolamine exposures layered upon her underlying comorbidities. Transient bilateral ophthalmoplegia after general anesthetics has been previously described; drug effect should be considered in the differential of this alarming presentation, which can mimic acute stroke and/or Horner syndrome.
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Affiliation(s)
- Sara J Hyland
- Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, USA
| | - Tapan R Kavi
- Department of Neurocritical Care, OhioHealth Riverside Methodist Hospital, Columbus, USA
| | - Nicole R Smith
- Department of Hospital Medicine, OhioHealth Grant Medical Center, Columbus, USA
| | - Jacky Lin
- Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, USA
| | - Mark D Catton
- Department of Anesthesia, OhioHealth Grant Medical Center, Columbus, USA
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Kim J, Han K, Yoo J, Park KA, Oh SY. Liver enzymes and risk of ocular motor cranial nerve palsy: a nationwide population-based study. Neurol Sci 2021; 43:3395-3405. [PMID: 34811598 DOI: 10.1007/s10072-021-05735-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/03/2021] [Indexed: 01/09/2023]
Abstract
This study aimed to assess the associations between liver enzymes including γ-glutamyl transferase (GGT) and the development of ocular motor cranial nerve palsy (CNP) using the National Sample Cohort database from Korea's National Health Insurance Service. We analyzed data from 4,233,273 medical screening examinees aged 20 years or more in 2009. Study participants were followed up until December 31, 2018. A Cox proportional hazard regression analysis was performed for quartiles of liver enzymes to determine the linkage between each value and ocular motor CNP using quartile 1 as a reference after adjusting for potential confounders. A total of 5,807 (0.14%) patients developed ocular motor CNP during the follow-up period of 8.22 ± 0.94 years. The incidence of ocular motor CNP gradually increased as the GGT levels increased. The highest quartile of the GGT group had hazard ratio (HR) of 1.245 (95% confidence interval [CI], 1.136-1.365). Regarding alanine aminotransferase (ALT), the highest quartile of the ALT group had HR of 1.141 (95% CI, 1.049-1.241). However, the incidence of ocular motor CNP did not gradually increase as the ALT levels increased. The coexistence of the increased level of GGT, metabolic syndrome, and obesity showed a stronger association with ocular motor CNP development (HR, 1.331; 95% CI, 1.173, 1.511) compared to having a single factor or two factors. In conclusion, our population-based cohort study demonstrated a significant association between serum GGT level and the incidence of ocular motor CNP, suggesting that GGT could be a new clinical marker for predicting the occurrence of ocular motor CNP.
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Affiliation(s)
- Joonhyoung Kim
- Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
| | - Juhwan Yoo
- Department of Biomedicine and Health Science, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Garg A, Micieli JA. Importance of the "Rule of the Pupil" in the Modern Neuroimaging Era. J Neuroophthalmol 2021; 41:293-297. [PMID: 33470742 DOI: 10.1097/wno.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The "Rule of the Pupil" states that when aneurysms compress the oculomotor nerve, a dilated or sluggishly reactive pupil will result. In previous decades, when cerebral angiography was required to detect an intracranial aneurysm, the "Rule of the Pupil" was used to determine the relative risk of angiography and the likelihood of aneurysmal compression in patients with third nerve palsies (3NPs). Noninvasive imaging including computed tomography angiography (CTA) and magnetic resonance angiography has become readily accessible and can detect all aneurysms large enough to cause 3NPs. It is therefore recommended that all patients with 3NP undergo neuroimaging regardless of pupil status because the consequences of missing an aneurysm are high. The question therefore remains as to whether the "Rule of the Pupil" still has relevance in today's era of modern neuroimaging. We describe a 73-year-old man who developed a left complete, pupil-sparing 3NP and was found to have a paraclinoid meningioma in the left cavernous sinus. As compressive lesions are expected to impair the iris sphincter muscle, no intervention was recommended and his 3NP spontaneously improved within 3 months. We also describe a 54-year-old woman with diabetes and a complete 3NP with a dilated, nonreactive pupil. Initial CTA was reported as normal, but re-review of imaging revealed a posterior communicating artery aneurysm and immediate intervention to coil the aneurysm occurred. The "Rule of the Pupil" is still important in the modern neuroimaging era as demonstrated in cases of incidentally found lesions along the course of the oculomotor nerve and missed radiological findings.
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Affiliation(s)
- Anubhav Garg
- Faculty of Medicine (AG), University of Toronto, Toronto, Canada ; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada ; Division of Neurology (JAM), Department of Medicine, University of Toronto, Canada ; and Kensington Vision and Research Centre (JAM), University of Toronto, Toronto, Canada
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Larcombe SJ, Street D, Wright B. Isolated oculomotor nerve palsy secondary to acute sinusitis. J R Coll Physicians Edinb 2021; 51:143-145. [PMID: 34131670 DOI: 10.4997/jrcpe.2021.209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sinusitis is a common condition, but only very rarely accompanied by isolated cranial nerve palsies. We describe a case of a 64-year-old male with a two-day history of left-sided ptosis associated with one week of nasal congestion and frontal sinus pain. Examination revealed ptosis with left pupil mydriasis. Uncontrasted computed tomography and angiography of the head demonstrated neither intracranial vascular abnormalities nor acute lesions; however, it did show mucosal thickening in the left frontal sinus, ethmoid air cells and left maxillary sinus, indicating potential obstruction of the left ostiomeatal complex. The sinusitis was treated with intranasal steroids, xylomethazoline and nasal douching. The patient reported resolution of all symptoms, including left ptosis, within one week of therapy. This rare case of sinusitis causing ptosis is presented due to its infrequent nature, such that awareness of the differential diagnosis of cranial nerve palsy and complications of sinusitis may be improved.
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Affiliation(s)
- Stephanie Jade Larcombe
- Student Services, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK,
| | - Duncan Street
- Neurology, University Hospitals Birmingham NHS Foundation Trust, Neurology, UK
| | - Benjamin Wright
- Neurology, University Hospitals Birmingham NHS Foundation Trust, Neurology, UK
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Third Nerve Palsy Secondary to Compression by Dolichoectatic Posterior Communicating Artery. Can J Neurol Sci 2021; 49:463-464. [PMID: 34121641 DOI: 10.1017/cjn.2021.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
BACKGROUND An isolated oculomotor nerve (CN III) palsy is a diagnostic concern because of the potential for serious morbidity or life-threatening causes. We present 5 unusual causes of oculomotor nerve palsy that escaped initial diagnosis in order to raise awareness of their associated features that will facilitate correct diagnosis. METHODS This study consisted of a retrospective analysis of clinical features and imaging of 5 patients who were referred for neuro-ophthalmologic evaluation with presumed diagnosis of oculomotor nerve palsy of unknown reasons. RESULTS A complete CN III palsy and an inferior division CN III palsy were diagnosed with a schwannoma in the cavernous sinus and orbital apex portion, respectively; a middle-aged woman with aberrant regeneration was found to have a small meningioma; an adult man with ptosis was diagnosed with cyclic oculomotor paresis with spasms; and a patient after radiation was diagnosed with neuromyotonia. CONCLUSIONS Localizing the lesion of oculomotor nerve palsy and careful examination of the imaging is crucial. Aberrant regeneration, cyclic pupil changes, and past medical history of amblyopia, strabismus, or radiation are also very helpful for diagnosis.
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Zhao J, Li Y, Chang Q, Wang J, Sun H. Diabetic Oculomotor Nerve Palsy Displaying Enhancement of the Oculomotor Nerve in the Orbit and Cavernous Sinus on MRI. Eur Neurol 2021; 84:246-253. [PMID: 33975309 DOI: 10.1159/000514100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Imaging data were scarce on diabetic oculomotor nerve palsy (ONP). Our study explored the MRI features and their clinical implications for diabetic ONP. METHODS Fifty-nine patients with a clinical diagnosis of diabetic ONP were recruited from our department between January 2015 and December 2019. Orbital MRI was retrospectively analyzed, and follow-up scans were obtained for 5 patients. Based on the ocular motor nerve palsy scale, the difference in the scores on the first and last hospital days was defined as the improvement score and was used to assess the treatment effects in all. RESULTS Thirty-eight (64.41%) patients presented thickening and enhancement of the cavernous segment and inferior division of the intraorbital segment of the ipsilateral oculomotor nerve, with the cisternal segment spared in all. After complete resolution of symptoms, follow-up MRI in 5 patients revealed that the enhancement was less obvious compared with the previous images. 6 patients in the enhancement group and 4 patients in the nonenhancement group were treated with 80 mg of methylprednisolone. Significant differences were not detected in the median improvement scores between patients with and those without corticosteroid use (p = 0.240). CONCLUSION Thickening and enhancement of the unilateral oculomotor nerve were common imaging findings in diabetic ONP, and they persisted after complete resolution of symptoms in some patients. The cavernous segment and the inferior division of the intraorbital segment were simultaneously involved, and the cisternal segment was often spared. Refraining from corticosteroids was recommended even with nerve enhancement.
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Affiliation(s)
- Juan Zhao
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong Li
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qinglin Chang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Houliang Sun
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Ibrikji S, Rizk N, Sawaya R. Petrous apicitis presenting with Horner's syndrome. Acta Neurol Belg 2021; 122:1121-1122. [PMID: 33961280 DOI: 10.1007/s13760-021-01692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sidonie Ibrikji
- Neurology department, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Nesreen Rizk
- Infectious Diseases Department, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Raja Sawaya
- AUBMC, Riad El Solh, 11-0236, Beirut, 1107 2020, Lebanon.
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Almaghrabi N, Fatani Y, Saab A. Cavernous internal carotid artery aneurysm presenting with ipsilateral oculomotor nerve palsy: A case report. Radiol Case Rep 2021; 16:1339-1342. [PMID: 33897925 PMCID: PMC8056302 DOI: 10.1016/j.radcr.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 10/24/2022] Open
Abstract
The oculomotor nerve palsy is a rare neurological deficit, it is associated with numerous underlying pathologies. Including stroke, neoplasms, trauma, post-surgical inflammation, and microvascular damage from chronic disease. It can cause a set of neurological deficits, including diplopia from oculomotor nerve involvement, decreased visual acuity from optic neuropathy, facial hypoesthesia from involvement of the trigeminal nerve, and less frequently facial pain. We present a case of 52 years old female patient who presented with a history of lateral divination of the left eye associated with ipsilateral drooping of upper eyelid, visual disturbance, and pupil dysfunction. MRI and MRA were performed and in conventional sequences plus 3D FIESTA sequence and it shows a signal void structure, compressing the left oculomotor nerve after passing through left chiasmatic cistern and upon entrance to cavernous sinus. Reformatted images demonstrate that this structure arising from distal left internal carotid artery at lateral part of cavernous sinus represents a saccular aneurysm in the cavernous part of the internal carotid. Aneurysms can cause direct compression of the third cranial nerve either by the enlargement of an unruptured aneurysm or by rupture of the aneurysmal sac resulting in third cranial nerve palsy.
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Affiliation(s)
- Nizar Almaghrabi
- Radiology resident, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Yousef Fatani
- Radiology resident, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Abeer Saab
- Neuroradiology Consultant, King Abdulaziz Hospital, Makkah, Saudi Arabia
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Jia-hao Z, Richard SA, Yin-sheng D, Ming J, Yan Z. Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.9767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Contrast-induced encephalopathy (CIEP) is a rare complication after endovascular therapy. The etiology of CIEP is still a matter of debate. We present a rare occurrence of CIEP in a known hypertensive and type 2 diabetic patient after endovascular coiling of cerebral aneurysm with oculomotor nerve palsy. A 68-year old female presented with seven days history of headache and left ptosis or blepharoptosis with mild mydriasis. The headaches were localized mainly at the left side of the nose, orbit, and upper forehead while the left ptosis was associated with blurred vision. Computed tomography angiography revealed an aneurysm in between the C4 segment of the left internal carotid artery (ICA) and the bifurcation of the left posterior communicating artery. Digital subtraction angiography further confirmed the aneurysm. We used the transarterial approach to assess the aneurysm and subsequent coiling. Iohexol (Omnipaque) contrast agent was used during the endovascular procedure. The patient’s condition deteriorated into acute confusion state with cardinal symptomology of CIEP immediately after the operation. Computed tomography scan revealed cortical contrast enhancement in the vascular territory of the ICA as well as edema. Her symptomatology resolved 48 hours after treated with anticonvulsants, intracranial pressure reduction and hydration. Chronic hypertension as well as type 2 diabetics may be critical predisposing factors to CIEP. CIEP should be suspected in patients presenting with acute confusion state after endovascular therapy. Massive edema with ischemic brain changes in white matter of the brain before endovascular procedure should rise suspicion of CIEP.
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