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Isolated Sixth Cranial Nerve Palsy in Patients with Pituitary Apoplexy

Atallah O, Badary A, Sanker V, Awuah WA, Ergen A, Kandasamy R, et al.

J Neurol Surg A Cent Eur Neurosurg, 2024 Nov 08.
PMID: 39515376 DOI: 10.1055/s-0044-1791973

BACKGROUND: Pituitary apoplexy is an acute clinical syndrome constituted by headache, visual impairment, ophthalmoplegia, and altered mental status. Abducens nerve palsy due to pituitary apoplexy is a significant clinical manifestation in pituitary apoplexy cases.This study aims to investigate the rare occurrence of isolated sixth cranial nerve palsy in patients with pituitary apoplexy, a condition characterized by sudden hemorrhagic or ischemic infarction of the pituitary gland.
METHODS: A search was conducted on major databases, including PubMed, Web of Science, and ScienceDirect, to identify cases of isolated sixth cranial nerve palsy in patients with pituitary apoplexy. Only six cases were found in the available literature. Descriptive statistics were used to summarize the data, and relevant clinical features were compared between the cases.
RESULTS: Among the six identified cases, isolated sixth cranial nerve palsy in patients with pituitary apoplexy predominantly affected middle-aged adults, with a prominent male preponderance. Clinical manifestations included acute-onset diplopia and headache, with the most common radiologic finding being pituitary gland enlargement or hemorrhage. Laboratory investigations revealed hormonal dysregulation in some cases. Treatment approaches varied and included conservative management and surgical intervention. Outcomes were generally favorable, with most patients experiencing partial or complete resolution of their cranial nerve palsy.
CONCLUSION: Isolated sixth cranial nerve palsy in patients in the context of pituitary apoplexy is an exceptionally rare occurrence, with only six documented cases in the available literature. Further research and case reporting are essential to better understand this rare clinical entity and guide optimal management strategies.
The molecular landscape of neurological disorders: insights from single-cell RNA sequencing in neurology and neurosurgery

Awuah WA, Ahluwalia A, Ghosh S, Roy S, Tan JK, Adebusoye FT, et al.

Eur J Med Res, 2023 Nov 16;28(1):529.
PMID: 37974227 DOI: 10.1186/s40001-023-01504-w

Single-cell ribonucleic acid sequencing (scRNA-seq) has emerged as a transformative technology in neurological and neurosurgical research, revolutionising our comprehension of complex neurological disorders. In brain tumours, scRNA-seq has provided valuable insights into cancer heterogeneity, the tumour microenvironment, treatment resistance, and invasion patterns. It has also elucidated the brain tri-lineage cancer hierarchy and addressed limitations of current models. Neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, and amyotrophic lateral sclerosis have been molecularly subtyped, dysregulated pathways have been identified, and potential therapeutic targets have been revealed using scRNA-seq. In epilepsy, scRNA-seq has explored the cellular and molecular heterogeneity underlying the condition, uncovering unique glial subpopulations and dysregulation of the immune system. ScRNA-seq has characterised distinct cellular constituents and responses to spinal cord injury in spinal cord diseases, as well as provided molecular signatures of various cell types and identified interactions involved in vascular remodelling. Furthermore, scRNA-seq has shed light on the molecular complexities of cerebrovascular diseases, such as stroke, providing insights into specific genes, cell-specific expression patterns, and potential therapeutic interventions. This review highlights the potential of scRNA-seq in guiding precision medicine approaches, identifying clinical biomarkers, and facilitating therapeutic discovery. However, challenges related to data analysis, standardisation, sample acquisition, scalability, and cost-effectiveness need to be addressed. Despite these challenges, scRNA-seq has the potential to transform clinical practice in neurological and neurosurgical research by providing personalised insights and improving patient outcomes.

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