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Acute Abducens Nerve Paralysis in the Pediatric Emergency Department: Analysis of 14 Patients: Erratum. Pediatr Emerg Care 2021; 37:190. [PMID: 33651764 DOI: 10.1097/pec.0000000000002408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Zhang T, Tang J. Two cases of benign abducens nerve palsy in children and their long-term follow-up. J Int Med Res 2021; 49:300060520986702. [PMID: 33445999 PMCID: PMC7812401 DOI: 10.1177/0300060520986702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Our aim was to explore the clinical characteristics and diagnostic methods of benign abducens nerve palsy in children. The clinical and laboratory characteristics, treatment approach, and prognosis of two children with benign abducens nerve palsy were retrospectively evaluated. The main clinical symptoms of the two children were limited binocular movement accompanied by double vision, and the positive physical signs were limited binocular abduction accompanied by diplopia. No abnormalities were found in laboratory examinations or in imaging of the head, chest, and abdomen. Both children were treated with B vitamins, methylprednisolone, and gamma globulin, and the clinical symptoms disappeared within 3 months of starting treatment. The cause of benign abducens nerve palsy in children is unknown, but may be related to immune factors. In the two cases presented here, the patients recovered after treatment with immunomodulators.
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Affiliation(s)
- Tong Zhang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Xuzhou Children's Hospital, Xuzhou, Jiangsu Province, China
| | - Jihong Tang
- Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Knoflach K, Holzapfel E, Roser T, Rudolph L, Paolini M, Muenchhoff M, Osterman A, Griese M, Kappler M, von Both U. Case Report: Unilateral Sixth Cranial Nerve Palsy Associated With COVID-19 in a 2-year-old Child. Front Pediatr 2021; 9:756014. [PMID: 34976891 PMCID: PMC8718702 DOI: 10.3389/fped.2021.756014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
Children have been described to show neurological symptoms in acute coronavirus disease 2019 (COVID-19) and multisystemic inflammatory syndrome in children (MIS-C). We present a 2-year-old boy's clinical course of unilateral acute sixth nerve palsy in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Onset of the palsy in the otherwise healthy boy occurred seven days after symptoms attributed to acute infection had subsided respectively 3 weeks after onset of respiratory symptoms. SARS-CoV-2 specific IgG was detected in serum as well as in cerebrospinal fluid. The patient showed a prolonged but self-limiting course with a full recovery after three and a half months. This case illustrates in a detailed chronological sequence that sixth cranial nerve involvement may occur as post-infectious, self-limiting complication of pediatric SARS-CoV-2-infection thus expanding the neurological spectrum of symptoms for children with COVID-19. Clinicians should be aware of the possibility of post-infectious sixth nerve palsy related to SARS-CoV-2-infection particularly in view of recent respiratory tract infection or confirmed cases of SARS-CoV-2-infection amongst the patient's close contacts.
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Affiliation(s)
- Katrin Knoflach
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Eva Holzapfel
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Timo Roser
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Lieselotte Rudolph
- Department of Ophthalmology, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Marco Paolini
- Department of Radiology, University Hospital Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Maximilian Muenchhoff
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, Ludwig-Maximilians-University (LMU), Munich, Germany.,German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Andreas Osterman
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, Ludwig-Maximilians-University (LMU), Munich, Germany.,German Center for Infection Research, Partner Site Munich, Munich, Germany
| | - Matthias Griese
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.,German Center for Lung Research (DZL), Partner Site Munich, Munich, Germany
| | - Matthias Kappler
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Ulrich von Both
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany.,German Center for Infection Research, Partner Site Munich, Munich, Germany
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Benign Recurrent Sixth Nerve Palsy in a Child. Case Rep Ophthalmol Med 2017; 2017:8276256. [PMID: 29445557 PMCID: PMC5763058 DOI: 10.1155/2017/8276256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 12/16/2017] [Indexed: 11/17/2022] Open
Abstract
Benign recurrent sixth nerve palsy in children is rare. It typically occurs following viral illness or immunization, and prognosis is usually excellent. However, it is always a diagnosis of exclusion given the more serious alternative causes. Therefore, a thorough examination with brain imaging is recommended. The authors report a child with six recurrent episodes of isolated benign sixth nerve palsy.
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Emiroglu M, Alkan G, Kartal A, Cimen D. Abducens nerve palsy in a girl with incomplete Kawasaki disease. Rheumatol Int 2016; 36:1181-3. [PMID: 27329470 DOI: 10.1007/s00296-016-3515-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/15/2016] [Indexed: 11/29/2022]
Abstract
Kawasaki disease (KD) is a systemic vasculitis that can involve the nervous system, including the cranial nerves. Central nervous system findings, especially irritability, lethargy, and aseptic meningitis, occur in 1-30 % of KD patients (1). Cranial nerve palsies are seen rarely, and abducens nerve palsy has been reported in only three children. We describe a 2.5-year-old girl with incomplete KD who developed transient abducens nerve palsy after intravenous immunoglobulin (IVIG) treatment.
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Affiliation(s)
- Melike Emiroglu
- Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Alaeddin Keykubat Campus, 42075, Selcuklu, Konya, Turkey.
| | - Gulsum Alkan
- Department of Pediatric Infectious Diseases, Selcuk University Faculty of Medicine, Alaeddin Keykubat Campus, 42075, Selcuklu, Konya, Turkey
| | - Ayse Kartal
- Department of Pediatric Neurology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Derya Cimen
- Department of Pediatric Cardiology, Selcuk University Faculty of Medicine, Konya, Turkey
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Tan LA, Kasliwal MK, Munoz LF. Ventriculoperitoneal Shunt Failure Presenting as Isolated Unilateral Abducens Nerve Palsy. J Emerg Med 2015; 50:e31-2. [PMID: 26432084 DOI: 10.1016/j.jemermed.2015.06.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/02/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Lee A Tan
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Manish K Kasliwal
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Lorenzo F Munoz
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
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