MyMedR

Fulltext Nasal cause of sixth cranial nerve palsy

Irfan M

Malays Fam Physician, 2013;8(3):54.

PMID: 25893063

Matched MeSH terms: Abducens Nerve Diseases

Fulltext Rhinocerebral mucormycosis with isolated sixth nerve palsy in an immunocompetent patient

Jain S, Kumar S, Kaushal A

Med J Malaysia, 2011 Oct;66(4):376-8.

PMID: 22299566

We report a case of rhinocerebral mucormycosis in a 31 year old immunocompetent female presenting initially like acute rhinosinusitis with nasal stuffiness, severe headache, vomiting who soon developed isolated right lateral rectus palsy. Computed tomography (CT) scan of the Post-Nasal Spaces(PNS) showed an ill defined expansile heterogenous density mass in the sphenoid with extension into the ethmoids, nasal cavity, optic canal, superior orbital fissure, clivus and right temporal lobe with signal void in Magnetic Resonance Imaging (MRI). The debris and polypoid mucosa obtained on nasal endoscopy revealed mucormycosis on histopathologic examination. The patient was managed with urgent surgical debridement and medical management.

Matched MeSH terms: Abducens Nerve Diseases/etiology*

Bilateral optic perineuritis and left abducens nerve palsy in a toddler

Chew-Ean T, Othman K, Ghani SA, Shatriah I

Can J Ophthalmol, 2018 10;53(5):e211-e212.

PMID: 30340747 DOI: 10.1016/j.jcjo.2017.11.011

Matched MeSH terms: Abducens Nerve Diseases/complications*; Abducens Nerve Diseases/diagnosis; Abducens Nerve Diseases/drug therapy

Lateral rectus myositis mimicking an abducens nerve palsy in a pregnant woman

Haslinda AR, Shatriah I, Azhany Y, Nik-Ahmad-Zuky NL, Yunus R

Ophthalmic Plast Reconstr Surg, 2013 3 28;30(1):e13-5.

PMID: 23531952 DOI: 10.1097/IOP.0b013e31828957ae

Myositis is a rare unknown inflammatory disorder of the skeletal muscle tissue. Generalized inflammatory myopathies, polymyositis, and dermatomyositis have been reported during pregnancy. Isolated orbital myositis in pregnancy has not been previously described in the literature. The authors report a case of left isolated orbital myositis in a primigravida at 38 weeks gestation affecting the patient's left lateral rectus muscle. MRI of the orbit was consistent with the diagnosis. She showed remarkable clinical improvement with oral corticosteroids therapy.

Matched MeSH terms: Abducens Nerve Diseases/diagnosis*; Abducens Nerve Diseases/drug therapy

Fulltext Ptosis due to cavernous sinus syndrome as a rare presentation of advanced breast metastasis in a patient with delayed diagnosis

Khaw K, Ramli N, Rahmat K

Malays Fam Physician, 2012;7(1):31-3.

PMID: 25606243 MyJurnal

Complications of breast cancer metastasis may be the first manifestation of the disease. We report a rare case of left eye ptosis secondary to cavernous sinus syndrome in a 34-year-old lady due to refusal of proper medical treatment for metastatic breast cancer. The delay in seeking medical treatment was attributed to her use of Traditional Chinese Medicine (TCM).

Matched MeSH terms: Abducens Nerve Diseases

Fulltext Isolated unilateral sixth cranial nerve palsy: A rare presentation of dengue fever

Mazliha M, Boo YL, Chin PW

Malays Fam Physician, 2016;11(1):25-26.

PMID: 28461846 MyJurnal

Dengue fever is a common mosquito-borne viral infection endemic in tropical and subtropical countries. Neurological manifestations in dengue infection are relatively uncommon, and include encephalitis, encephalopathy, neuromuscular disorders and neuro-ocular disorders. Cranial mononeuropathy is a rare manifestation of dengue infection. A 40-year-old man was diagnosed with isolated, unilateral sixth cranial nerve palsy complicating dengue infection. The patient was managed accordingly, and full ocular recovery was observed. This was the first reported case of isolated sixth cranial nerve palsy associated with dengue fever in Malaysia. It is important for clinicians to consider dengue as a differential diagnosis in patients presenting with fever and sixth cranial nerve palsy.

Matched MeSH terms: Abducens Nerve Diseases

Fulltext A rare case of traumatic bilateral sixth cranial nerve palsy

Hamidon, B.B., Md Shariful, H.S., Nasaruddin, M.Z.

International Medical Journal Malaysia, 2012;11(2):50-52.

MyJurnal

Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.

Matched MeSH terms: Abducens Nerve Diseases

Fulltext Extensive dural sinus thrombosis and bilateral lateral rectus palsy as an uncommon complication of chronic suppurative otitis media

Balasubramanian A, Mohamad I, Sidek D

BMJ Case Rep, 2013;2013.

PMID: 23355565 DOI: 10.1136/bcr-2012-007414

Dural venous sinus thrombosis, especially of the sigmoid sinus, is a known but uncommon intracranial extradural complication of chronic suppurative otitis media. Even rarer is the simultaneous occurrence of bilateral abducens palsy in the same patient. We report the case of an adolescent male who presented with signs of raised intracranial pressure, diplopia and bilateral lateral rectus palsy associated with a history of left ear discharge and neck swelling. Extensive dural sinus thrombosis extending right up to the left internal jugular vein was confirmed on CT imaging. The patient was successfully treated with thrombolytic agents and antibiotic therapy. The pathophysiology of the concurrent complications is discussed.

Matched MeSH terms: Abducens Nerve Diseases/etiology*

Co-occurrence of acute ophthalmoplegia (without ataxia) and idiopathic intracranial hypertension

Yeak J, Zahari M, Singh S, Mohamad NF

Eur J Ophthalmol, 2019 Jul;29(4):NP1-NP4.

PMID: 30280587 DOI: 10.1177/1120672118803532

BACKGROUND: Acute ophthalmoparesis without ataxia was designated as 'atypical Miller Fisher syndrome' as it presents with progressive, relatively symmetrical ophthalmoplegia, but without ataxia nor limb weakness, in the presence of anti-GQ1b antibody. Idiopathic intracranial hypertension is characterized by signs of raised intracranial pressure occurring in the absence of cerebral pathology, with normal composition of cerebrospinal fluid and a raised opening pressure of more than 20 cmH2O during lumbar puncture. We aim to report a rare case of acute ophthalmoplegia with co-occurrence of raised intracranial pressure.

CASE DESCRIPTION: A 28-year-old gentleman with body mass index of 34.3 was referred to us for management of double vision of 2 weeks duration. His symptom started after a brief episode of upper respiratory tract infection. His best corrected visual acuity was 6/6 OU. He had bilateral sixth nerve palsy worse on the left eye and bilateral hypometric saccade. His deep tendon reflexes were found to be hyporeflexic in all four limbs. No sensory or motor power deficit was detected, and his gait was normal. Plantar reflexes were downwards bilaterally and cerebellar examination was normal. Both optic discs developed hyperaemia and swelling. Magnetic resonance imaging of brain was normal and lumbar puncture revealed an opening pressure of 50 cmH2O. Anti-GQ1b IgG and anti-GT1a IgG antibody were tested positive.

CONCLUSION: Acute ophthalmoparesis without ataxia can present with co-occurrence of raised intracranial pressure. It is important to have a full fundoscopic assessment to look for papilloedema in patients presenting with Miller Fisher syndrome or acute ophthalmoparesis without ataxia.

Matched MeSH terms: Abducens Nerve Diseases/diagnosis

Herpes Zoster Ophthalmicus with Orbital Apex Syndrome-Difference in Outcomes and Literature Review

Lim JJ, Ong YM, Wan Zalina MZ, Choo MM

Ocul Immunol Inflamm, 2018;26(2):187-193.

PMID: 28622058 DOI: 10.1080/09273948.2017.1327604

Matched MeSH terms: Abducens Nerve Diseases/diagnosis; Abducens Nerve Diseases/drug therapy; Abducens Nerve Diseases/virology

Fulltext Diplopia in a post-splenectomy Thalassemic patient

Neoh, Pei Fang, Tai, Evelyn L.M., Liza Sharmini A.T.

Journal of Biomedical and Clinical Sciences, 2017;2(2):26-28.

MyJurnal

We report a case of cavernous sinus thrombosis in a post-splenectomy male with underlying Haemoglobin E Thalassemia major. A 35-year-old man presented with a first episode of sudden onset of diplopia on lateral gaze for 1 week. He had no other ocular and systemic symptoms. There was no history of trauma or recent infection. However, he admitted that he was not compliant to his oral penicillin V and aspirin, which was prescribed to all post splenectomy patients. Unaided visual acuity in both eyes was 6/6. On examination, there was limited abduction over the left eye, suggestive of left lateral rectus palsy. Full blood count revealed leucocytosis with thrombocytosis. Magnetic resonance imaging, magnetic resonance angiography and magnetic resonance venography of the brain showed bulging of the left cavernous sinus, with a persistent focal filling defect, in keeping with left cavernous sinus thrombosis (CST). He was diagnosed with left isolated sixth nerve palsy secondary to aseptic cavernous sinus thrombosis with pro-thrombotic state post-splenectomy. He was started on subcutaneous fondaparinux and oral warfarin. His diplopia fully resolved after 1 month of treatment with complete resolution of CST on computed tomography venogram.

Matched MeSH terms: Abducens Nerve Diseases

Fulltext Post dental extraction basal skull osteomyelitis with cranial nerve palsy

Tan, Ciang Sang, Haiza Hani Hamidon, Zainah Shaikh Hedra

Malaysian Journal of Paediatrics and Child Health, 2016;22(101):0-0.

MyJurnal

Background: A 9 year old boy presented with history of persistent headache and recurrent vomiting for 1 month post dental extraction. CT brain was performed for the possibility of space occupying lesion but it was normal. Subsequently, he was treated as migraine after exclusion of meningitis and intracranial lesion. Unfortunately, he developed 3rd, 4th and 6th cranial nerve palsy two weeks later. Repeated CT brain showed subtle finding and inconclusive. MRI brain performed at the time showed features suggestive of basal skull osteomyelitis with congestion of right orbit and optic nerve swelling. Case was referred to Paediatric Neurologist and he was diagnosed to have cranial nerve palsy secondary to basal skull osteomyelitis, post dental extraction.

Conclusion: Dental procedure is common among children, however basal skull osteomyelitis with cranial nerve palsy is a rare complication. Adequate treatment of dental infection post dental procedure is important to prevent this complication.

Matched MeSH terms: Abducens Nerve Diseases

Late clinical and magnetic resonance imaging follow up of Nipah virus infection

Lim CC, Lee WL, Leo YS, Lee KE, Chan KP, Ling AE, et al.

J Neurol Neurosurg Psychiatry, 2003 Jan;74(1):131-3.

PMID: 12486285

The Nipah virus is a newly identified paramyxovirus responsible for an outbreak of fatal encephalitis in Malaysia and Singapore. This paper reports the follow up clinical and magnetic resonance imaging findings in 22 affected subjects. Of 13 patients with encephalitis, one died, one was lost to follow up, and seven recovered. Among the four remaining patients, one had residual sixth nerve palsy, another suffered from severe clinical depression, and a third patient had evidence of retinal artery occlusion. One patient with delayed onset Horner syndrome had a single lesion in the cervical spinal cord. The brain magnetic resonance findings were stable or improved in nine patients over 18 months of follow up. Among a second group of nine asymptomatic seropositive abattoir workers, magnetic resonance examination in seven subjects revealed discrete small lesions in the brain; similar to those detected in encephalitis patients. These findings suggest that in addition to encephalitis, the newly discovered Nipah virus affects the spinal cord and the retina. Late clinical and radiological findings can occur in Nipah virus infections as with other paramyxoviruses.

Matched MeSH terms: Abducens Nerve Diseases/epidemiology

Fulltext Leptomeningeal Carcinomatosis With Optic Nerve Metastasis Secondary to Breast Cancer

Chew C, Wan Hitam WH, Ahmad Tajudin LS

Cureus, 2021 Mar 31;13(3):e14200.

PMID: 33936906 DOI: 10.7759/cureus.14200

Leptomeningeal carcinomatosis (LC) and optic nerve metastasis are uncommon occurrences in breast cancer. We report a rare case of LC with optic nerve infiltration secondary to breast cancer. A 45-year-old lady who was a known case of treated right breast carcinoma six years ago presented with a blurring of vision in both eyes, floaters, and diplopia for one month. She also had recurrent attacks of seizure-like episodes, headache, and vomiting. Examination revealed high blood pressure with tachycardia. Her right eye visual acuity was counting fingers at two feet and 6/36 in the left eye. She had right abducens nerve palsy. Fundoscopy showed bilateral optic disc swelling with pre-retinal, flame-shaped haemorrhages and macular oedema. CT scan of brain and orbit was normal. She was admitted for further investigations. While in the ward, her vision deteriorated further. Her visual acuity in both eyes was at the level of no perception to light. She also developed bilateral abducens nerve palsy and right facial nerve palsy. Subsequently, she started having bilateral hearing loss. There were few episodes of fluctuations in conscious awareness. MRI brain showed mild hydrocephalus. Both optic nerves were thickened and enhanced on T1-weighted and post-gadolinium. Lumbar puncture was performed. There was high opening pressure. Cerebrospinal fluid cytology showed the presence of malignant cells. Family members opted for palliative care in view of poor prognosis. Unfortunately, she succumbed after a month's stay in hospital. Diagnosis of LC and optic nerve infiltration presents a formidable challenge to clinicians especially in the early stages where neuroimaging appears normal and lumbar puncture has high false negatives. Multiple high-volume taps are advised if clinical suspicion of LC is high.

Matched MeSH terms: Abducens Nerve Diseases

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