1
|
Abuhammad A, Nassar O, Tomizi MG, Alfroukh K, Abuturki A. Case of Lemierre's Syndrome Presenting With Neuro-Ophthalmologic Complications That Worsened After Stopping Corticosteroids. Cureus 2024; 16:e53640. [PMID: 38449947 PMCID: PMC10917393 DOI: 10.7759/cureus.53640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Lemierre's syndrome (LS) is a rare disorder that manifests as septic internal jugular thrombophlebitis following a recent oropharyngeal infection. This article details a unique case of LS, where the patient presented to the emergency room with complaints of vomiting, headache, diplopia, and left eye pain. Due to a history of sore throat, headache, neck pain, fever, and nausea five days prior to admission, the patient was initially treated with amoxicillin/clavulanate for suspected tonsillitis. A positive meningeal sign and elevated temperature were observed during the clinical examination. Lumbar puncture (LP) was deferred based on imaging indicating potential increased intracranial pressure (ICP). Nevertheless, the patient received vancomycin, ceftriaxone, and dexamethasone as an initial course of treatment for presumed bacterial meningitis. Significant improvement was observed within the first four days of admission, with no subsequent episodes of fever, nausea, or headache. However, upon discontinuation of corticosteroid therapy, the patient experienced severe headaches and frequent vomiting. An urgent brain CT scan confirmed the extension of the left internal jugular vein (IJV) thrombosis to the ipsilateral sigmoid sinuses. Metronidazole and anticoagulant medication were initiated upon LS diagnosis. There is a paucity of discussions on corticosteroid use in LS, with no definitive statistics in the current literature. This case underscores the importance of recognizing and effectively managing interconnected clinical manifestations.
Collapse
Affiliation(s)
| | - Osayd Nassar
- Department of Internal Medicine, Al-Ahli Hospital, Hebron, PSE
| | | | | | | |
Collapse
|
2
|
Poshattiwar RS, Acharya S, Shukla S, Kumar S. Neurological Manifestations of Connective Tissue Disorders. Cureus 2023; 15:e47108. [PMID: 38022020 PMCID: PMC10646945 DOI: 10.7759/cureus.47108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Connective tissue disorders (CTD) are a group of disorders affecting the connective tissues. Usually the musculoskeletal and the vascular system is impacted. Along with these systems, the nervous system is also involved in CTD, which leads to various neurological manifestations. The pathophysiology of neurological complications of CTD is caused by various factors and is complicated. Disturbed immune complexes, chronic inflammation, and autoimmunity in which the body attacks its cells are considered to be responsible for the neurological complications of CTD. Additionally, the vascular symptoms that lead to decreased blood flow to the brain are also responsible for the neurological manifestations of CTD in diseases like systemic lupus erythematosus (SLE). In SLE, vessel wall integrity is compromised, which may lead to decreased blood flow leading to neurological complications. CTD can manifest a variety of neurological complications. These neurological complications can be classified into symptoms affecting the peripheral nervous system, central nervous system, and the autonomic nervous system. Some of the common neurological complications of CTD are headaches, seizures, ataxia, neuropathies leading to cranial nerve palsies, myelopathies, tremors, encephalitis, and cerebral infarction. Cranial nerve palsies can disturb sensations, vision, hearing, and mastication. Neuropsychiatric symptoms are also commonly observed in CTD. Cognitive dysfunction can be caused due to neuropsychiatric problems. Some of the cognitive dysfunctions are lack of concentration, memory loss, confusion, and coma. In this review, we will address various neurological manifestations of CTD.
Collapse
Affiliation(s)
- Riddhi S Poshattiwar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| |
Collapse
|
3
|
Muacevic A, Adler JR, AlMaghrabi SJ, Mozahim NF, Mozahim SF, Alsubaie SA, Alsehly AA, Alshuaibi RO, Alotaibi LA, Qashgari FS. Cranial Nerve Impairment Associated With COVID-19 Infections: A Systematic Review. Cureus 2022; 14:e31997. [PMID: 36589199 PMCID: PMC9798034 DOI: 10.7759/cureus.31997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 pandemic has created huge economic and healthcare burdens. In most cases, the virus affects the lungs and causes respiratory symptoms. Additionally, its impact on the cranial nerves remains unclear. We thus aimed to investigate cranial nerve dysfunction in patients with COVID-19 infection. We conducted a systematic literature search of relevant and eligible literature in five databases: PubMed, Web of Science, Medline, EBSCO, and Google Scholar. Our sample included 21 case reports, one case series with 29 patients, and one analytical study with 135 cases. Participant ages ranged from 23 months to 72 years (mean age of 47.5 ± 19.02). The mean time from respiratory symptoms to the onset of neurological signs was (9.6 ± 7.4) days, and the mean recovery time was (16.3 ± 15.3) days. Cranial nerve impairment associated with COVID-19 infection has affected a large population, from infants to the elderly. Facial and abducent nerves were the most commonly affected cranial nerves with reported good prognosis or complete recovery within a few days to weeks. Olfactory dysfunctions were widely detected among COVID-19 patients.
Collapse
|
4
|
Manea MM, Dragoș D, Enache I, Sirbu AG, Tuta S. Multiple cranial nerve palsies following COVID-19 vaccination-Case report. Acta Neurol Scand 2022; 145:257-259. [PMID: 34725821 PMCID: PMC8653229 DOI: 10.1111/ane.13548] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/15/2021] [Accepted: 10/24/2021] [Indexed: 12/17/2022]
Abstract
Background The novel COVID‐19 vaccines have side effects that require efficient and close monitoring. Aims of the Study To examine whether the Pfizer‐BioNTech vaccine is associated with multiple cranial neuropathy. Methods We report the case of a 29‐year‐old male patient with no notable history who presented with left oculomotor, abducens, trigeminal and facial palsies 6 days after receiving the first dose of the Pfizer‐BioNTech COVID‐19 vaccine. Results Gadolinium‐enhanced MRI of the brain revealed enhancement in the left facial, trigeminal and oculomotor nerves, which persisted upon repeated examination. The cerebrospinal fluid analysis showed no sign of inflammation, both initially and after 1 month from the start of the patient's symptoms. Other causes were excluded by laboratory tests. The patient received high doses of corticosteroids, with improvement of symptoms. Conclusions In our case, the most probable etiology of the patient's multiple cranial neuropathy is the Pfizer‐BioNTech vaccine, which highlights the need for prolonged surveillance of COVID‐19 vaccine neurological complications.
Collapse
Affiliation(s)
- Maria Mirabela Manea
- Carol Davila University of Medicine and Pharmacy Bucharest Romania
- Neurology Department National Institute of Neurology and Neurovascular Diseases Bucharest Romania
| | - Dorin Dragoș
- Carol Davila University of Medicine and Pharmacy Bucharest Romania
- Internal Medicine Department Emergency University Hospital Bucharest Romania
| | - Iulia Enache
- Neurology Department National Institute of Neurology and Neurovascular Diseases Bucharest Romania
| | - Adrian George Sirbu
- Neurology Department National Institute of Neurology and Neurovascular Diseases Bucharest Romania
- MEDINST Centre Bucharest Romania
| | - Sorin Tuta
- Carol Davila University of Medicine and Pharmacy Bucharest Romania
- Neurology Department National Institute of Neurology and Neurovascular Diseases Bucharest Romania
| |
Collapse
|
5
|
Thomas K, Ocran C, Monterastelli A, Sadun AA, Cockerham KP. Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners. Clin Pract 2021; 11:919-32. [PMID: 34940005 DOI: 10.3390/clinpract11040106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/28/2021] [Accepted: 11/19/2021] [Indexed: 01/13/2023] Open
Abstract
Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment.
Collapse
|
6
|
Al Saad M, Rimawi A, Saadeh A, Shehadeh A. Mucormycosis with extensive cranial nerve involvement as the first presentation of diabetes mellitus: A case report. Qatar Med J 2021; 2021:61. [PMID: 34888198 PMCID: PMC8627576 DOI: 10.5339/qmj.2021.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 09/12/2021] [Indexed: 11/21/2022] Open
Abstract
Mucormycosis, a rare fungal infection, mainly affects individuals with diabetes mellitus and those who were immunocompromised and has a high mortality rate. Its most common presentation is similar to that of acute bacterial sinusitis with symptoms of nasal congestion, headache, and fever. The involvement of multiple cranial nerves in mucormycosis was rarely reported in the literature and indicates severe disease. Herein, we report the case of a 56-year-old man who was referred to the ophthalmology outpatient clinic for facial nerve palsy. He was treated with systemic steroids for 10 days with no improvement. On examination, he had a loss of vision and a frozen orbit due to involvement of cranial nerves II, III, IV, V, VI, and VII. An extensive workup revealed a hemoglobin A1C of 10%. However, he was never diagnosed with diabetes mellitus previously and denied any of the classical symptoms of diabetes mellitus. He underwent ethmoidectomy, maxillectomy, and drainage of an intraorbital abscess after appropriate imaging studies. Histopathology confirmed the diagnosis of mucormycosis, and the patient was started on systemic amphotericin B. This case emphasizes the importance of screening for diabetes mellitus. Early recognition of underlying diabetes mellitus in this patient may have prevented the development of mucormycosis along with its devastating complications.
Collapse
Affiliation(s)
- Mouna Al Saad
- Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan E-mail:
| | - Ahmad Rimawi
- School of Medicine, University of Jordan, Amman, Jordan
| | - Ahmad Saadeh
- School of Medicine, University of Jordan, Amman, Jordan
| | | |
Collapse
|
7
|
Marlow M, Edwards L, McCrickard L, Francois Watkins LK, Anderson J, Hand S, Taylor K, Dykes J, Byers P, Chatham-Stephens K. Mild Botulism From Illicitly Brewed Alcohol in a Large Prison Outbreak in Mississippi. Front Public Health 2021; 9:716615. [PMID: 34504830 PMCID: PMC8421542 DOI: 10.3389/fpubh.2021.716615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Botulism is typically described as a rapidly progressing, severe neuroparalytic disease. Foodborne botulism is transmitted through consuming food or drink that has been contaminated with botulinum toxin. During a botulism outbreak linked to illicitly brewed alcohol (also known as “hooch” or “pruno”) in a prison, 11 (35%) of 31 inmates that consumed contaminated hooch had mild illnesses. This includes 2 inmates with laboratory confirmed botulism. The most frequently reported signs and symptoms among the 11 patients with mild illness included dry mouth (91%), hoarse voice (91%), difficulty swallowing (82%), fatigue (82%), and abdominal pain (82%). Foodborne botulism is likely underdiagnosed and underreported in patients with mild illness. Botulism should be considered on the differential diagnosis for patients with cranial nerve palsies.
Collapse
Affiliation(s)
- Mariel Marlow
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Leslie Edwards
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Sheryl Hand
- Mississippi State Department of Health, Jackson, MS, United States
| | - Kathryn Taylor
- Mississippi State Department of Health, Jackson, MS, United States
| | - Janet Dykes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul Byers
- Mississippi State Department of Health, Jackson, MS, United States
| | | |
Collapse
|
8
|
Bhayana A, Bajaj SK, Misra RN, Kumaran SS. Clinicoradiological aspects of pontine tegmental cap dysplasia: Case report of a rare hindbrain malformation. Indian J Radiol Imaging 2021; 28:18-21. [PMID: 29692521 PMCID: PMC5894312 DOI: 10.4103/ijri.ijri_25_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Malformations involving the brainstem are very rare and present with a varied spectrum of clinical symptoms due to multiple cranial nerve palsies and pyramidal tract involvement. Of these, pontine tegmental cap dysplasia is a very unusual malformation, characterized by ventral pons hypoplasia and an ectopic dorsal band of tissue, projecting into the fourth ventricle, from dorsal pontine tegmentum. A 4-year-old male child, presenting with left facial nerve palsy, revealed hypoplastic ventral pons and an ectopic structure on magnetic resonance imaging (MRI). The ectopic structure was isointense to pons, arose from the left side of dorsal pontine tegmentum, at pontomedullary junction and protruded into the fourth ventricle, impinging upon the left seventh and eighth cranial nerves. Diffusion tensor imaging (DTI) depicted abnormal white matter tracts in ectopic tissue with absent transverse pontine fibres and abnormal middle and superior cerebellar peduncles. The typical MRI appearance, coupled with DTI, helped us reach an accurate diagnosis of pontine tegmental cap dysplasia, in a setting of neurological dysfunction.
Collapse
Affiliation(s)
- Aanchal Bhayana
- Department of Radiodiagnosis, Safdarjung Hospital and VM Medical College, New Delhi, India
| | - Sunil K Bajaj
- Department of Radiodiagnosis, Safdarjung Hospital and VM Medical College, New Delhi, India
| | - Ritu N Misra
- Department of Radiodiagnosis, Safdarjung Hospital and VM Medical College, New Delhi, India
| | - S Senthil Kumaran
- Department of Nuclear Medical Resonance, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Ali A, Kalla A. Multiple cranial nerve palsies in immunodeficiency subtype of Burkitt lymphoma. J Community Hosp Intern Med Perspect 2018; 8:303-306. [PMID: 30357018 PMCID: PMC6197034 DOI: 10.1080/20009666.2018.1514944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/17/2018] [Indexed: 11/03/2022] Open
Abstract
Burkitt lymphoma is a late complication of HIV, and bilateral cranial nerve palsies are extremely rare in patients with AIDS. A twenty year old Caucasian male with known congenital HIV who had been non-adherent with anti-retroviral therapy presented with multiple cranial nerve palsies and was eventually diagnosed with Burkitt lymphoma. Before chemotherapy, he was started on radiation therapy to the brain, meninges, and base of skull with the intent of improving cranial nerve palsies and preventing further neurological sequelae since the cranial nerve palsies were dense and there was concern that intrathecal chemotherapy would have less penetration than radiation. He eventually died due to overall disease burden. We hereby present what we believe is the first reported case of Burkitt lymphoma presenting with bilateral facial, vestibulocochlear, left abducens, and mandibular nerve palsies. Recognition of different presentations of Burkitt lymphoma is extremely important as it would aid in early diagnosis and initiation of both chemotherapy and anti-retroviral therapy potentially leading to improved outcomes.
Collapse
Affiliation(s)
- Abbas Ali
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Abhishek Kalla
- Department of Hematology and Oncology, Saint Agnes Hospital, Baltimore, MD, USA
| |
Collapse
|
10
|
Ho KWD, Drew PA, Chuquilin M. Merkel Cell Carcinoma with Distant Metastasis to the Clivus Causing Symptoms Mimicking Tolosa-Hunt Syndrome: A Case Report and Literature Review. Front Neurol 2017; 8:409. [PMID: 28868044 PMCID: PMC5563365 DOI: 10.3389/fneur.2017.00409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/28/2017] [Indexed: 01/03/2023] Open
Abstract
Merkel cell carcinoma (MCC) is an uncommon but highly malignant neuroendocrine tumor of the skin. MCC can metastasize, but involvement of the central nervous system is rare. Here, we report a case of rapidly progressing metastatic MCC to the clivus and bilateral cavernous sinus in an immunocompromised patient. This case is unique in that it is the first case report showing MCC metastasis to the clivus from a distant site. It also demonstrates that a MCC metastasis can masquerade with symptoms of Tolosa–Hunt syndrome. A literature review on MCC with CNS metastasis is presented.
Collapse
Affiliation(s)
- Kwo Wei David Ho
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Peter A Drew
- Department of Pathology, University of Florida, Gainesville, FL, United States
| | - Miguel Chuquilin
- Department of Neurology, University of Florida, Gainesville, FL, United States
| |
Collapse
|
11
|
Bratton ML, Hoehn ME, Morris B, Merchant TE, Gajjar A, Patel R, Kerr NC. Residual Strabismus in Children Following Improvement of Cranial Nerve Palsies Affecting Ocular Ductions. Am Orthopt J 2015; 65:87-93. [PMID: 26564932 DOI: 10.3368/aoj.65.1.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Children with brain neoplasms often develop cranial nerve palsies (CNP) affecting ocular ductions. Duction deficits may improve or resolve with treatment of their intracranial disease. However, these children may be left with residual strabismus. METHODS We identified 104 children with third, fourth, and/or sixth cranial nerve palsies who were treated for central nervous system (CNS) neoplasms. A retrospective chart review was conducted to determine the presence or absence of residual strabismus following resolution of duction deficits. RESULTS Of the 104 children with CNP secondary to an intracranial neoplasm, forty-five had improvement or resolution of their duction deficit with treatment of their CNS lesion. Of these forty-five children, one had a third cranial nerve palsy, six had fouth cranial nerve palsies (one was bilateral), thirty-seven had sixth cranial nerve palsies (thirteen were bilateral), and one had two different cranial nerve palsies in the same eye (fourth and sixth). Of the eighteen children with improved (but not resolved) duction deficits, only three (17%) experienced resolution of their strabismus. Of the twenty-seven children with resolved duction deficits, nine (33%) experienced resolution of their strabismus. For the children with residual strabismus, the average angle of strabismus before duction deficits improved or resolved was 33.2Δ; while for those children without residual strabismus, it was 20Δ. CONCLUSIONS Our findings indicated that the majority of children with improved or resolved duction deficits from CNP after treatment for CNS neoplasms are left with residual strabismus. Therefore, we suggest children with CNP secondary to CNS neoplasms need ophthalmic care after duction deficits resolve, as they are likely to have residual strabismus.
Collapse
Affiliation(s)
| | - Mary Ellen Hoehn
- From the Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health and Science Center, Memphis, Tennessee; From the Department of Oncology, St. Jude Children's Research Hospital, Memphis and
| | - Brannon Morris
- From the Department of Oncology, St. Jude Children's Research Hospital, Memphis and
| | - Thomas E Merchant
- From the Athens Neurological Associates, Athens, Georgia. This study was conducted at the University of Tennessee Health and Science Center and St. Jude Children's Research Hospital
| | - Amar Gajjar
- From the Department of Oncology, St. Jude Children's Research Hospital, Memphis and
| | - Rutviben Patel
- From the Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health and Science Center, Memphis, Tennessee
| | - Natalie C Kerr
- From the Hamilton Eye Institute, Department of Ophthalmology, University of Tennessee Health and Science Center, Memphis, Tennessee; From the Department of Oncology, St. Jude Children's Research Hospital, Memphis and
| |
Collapse
|