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BMJ Case Rep 2022 May 17;15(5). Epub 2022 May 17.

Neurology, Meitra Hospital, Calicut, India.

We present a unique case of biopsy-proven necrotising sarcoidosis involving the central nervous system in a man in his 40s. The patient presented with a 2-week history of right-sided headache and diplopia. He had right trochlear and abducens nerve palsy, sensory blunting over V1 and V2 segment of right trigeminal sensory nerve and right sensory neural hearing loss. Read More

J AAPOS 2022 May 9. Epub 2022 May 9.

Pediatric Ophthalmology and Strabismus Department, Institute of Ocular Microsurgery (IMO), Barcelona, Spain.

We present the case report of a patient who presented with intermittent diplopia and left hypertropia associated with an apparent left superior oblique palsy. After dissociation with cover testing, he showed conjugate rhythmic vertical eye movements present in all gazes, thought to represent rapid rhythmically alternating fixation. The vertical rhythmic movement resolved after strabismus surgery. Read More

Medicine (Baltimore) 2022 Mar;101(11)

Department of Ophthalmology, Samsung Changwon Hospital, SungkyunkwanUniversity School of Medicine, Changwon, Korea.

Abstract: The objective of this study was to investigate the difference in clinical features according to age and factors affecting recovery of acquired sixth cranial nerve (CN6) palsy.A total of 156 patients with acute CN6 palsy between March 2016 and August 2021 who were followed up for at least 3 months were included in this study. Etiology, rate of recovery, and factors associated with recovery were retrospectively investigated. Read More

Cureus 2022 Feb 20;14(2):e22408. Epub 2022 Feb 20.

Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA.

Pituitary apoplexy (PA) is an expansion of a pituitary adenoma due to infarction or hemorrhage of the gland. The term apoplexy usually describes larger bleeds leading to a sudden onset of symptoms. Although it is a rare condition, it can be a life-threatening emergency. Read More

BMC Ophthalmol 2022 Mar 16;22(1):126. Epub 2022 Mar 16.

Department of Ophthalmology, College of Medicine, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.

Background: To investigate preoperative clinical features and postoperative results according to the correspondence between excyclotorsion and the paretic eye in patients with congenital unilateral superior oblique palsy (USOP).

Methods: A retrospective review of medical charts was performed. The patients were divided into the accordance (ocular excyclotorsion in the paretic eye) and disaccordance (ocular excyclotorsion in the non-paretic eye) groups. Read More

BMC Endocr Disord 2022 Mar 14;22(1):65. Epub 2022 Mar 14.

The First Department of Medicine, Wakayama Medical University, Wakayama, Japan.

Background: Early diagnosis of lymphoma involving the central nervous system is sometimes difficult but emergent to avoid the delay of therapeutic initiation. Pituitary insufficiencies are usually associated with lymphoma in the pituitary gland. There have been no cases of lymphoma originating from extra pituitary gland with hypopituitarism that simultaneously presenting unilateral upper cranial nerve palsies and ophthalmalgia. Read More

J AAPOS 2022 04 5;26(2):89-91. Epub 2022 Feb 5.

Department of Pediatric Ophthalmology, Strabismus and Neuro-ophthalmology, Dr Shroff's Charity Eye Hospital, New Delhi, India.

Congenital superior oblique (SO) palsy is often associated with anomalies of its tendon, increased tendon laxity being the most common. Rarely, the tendon lies in an abnormal location nasal to the superior rectus (SR) muscle, either attaching to the sclera or to Tenon's capsule. We describe a case of a child who presented with abnormal head posture and exotropia. Read More

Int Cancer Conf J 2022 Jan 27;11(1):75-80. Epub 2021 Nov 27.

Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, 7-172, Yatsuyamada, Koriyama, Fukushima 963-8052 Japan.

Sphenoid sinus malignancies are rare diseases. Secondary hypopituitarism associated with sphenoid sinus malignancy is not well known. A 41-year-old male complained of right ptosis. Read More

Indian J Ophthalmol 2022 Feb;70(2):609-612

Department of Paediatric Ophthalmology and Strabismus, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India.

Purpose: We aimed to study the success of prism in regard to diplopia resolution score and associated factors in patients presenting with symptomatic diplopia arising from various etiologies.

Methods: In this descriptive, retrospective study diplopia resolution among 31 patients who were prescribed prism were analyzed.

Results: Fifty-four patients were evaluated for diplopia and 31 were included for the study done over 3 years. Read More

Korean J Ophthalmol 2022 Jan 24. Epub 2022 Jan 24.

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.

Purpose: This study evaluated the prognosis of patients with traumatic unilateral superior oblique palsy (SOP) and clinical factors associated with spontaneous resolution.

Methods: Medical records of patients with traumatic unilateral SOP who visited two hospitals (*** and *** Hospital) between January 2015 and June 2020 were reviewed retrospectively. When traumatic unilateral SOP did not recover within at least 1 year of follow-up, no spontaneous resolution was considered. Read More

Brain Sci 2021 Nov 6;11(11). Epub 2021 Nov 6.

Neurology Department, Larkin Community Hospital, South Miami, FL 33143, USA.

Parinaud's syndrome involves dysfunction of the structures of the dorsal midbrain. We investigated the pathophysiology related to the signs and symptoms to better understand the symptoms of Parinaud's syndrome: diplopia, blurred vision, visual field defects, ptosis, squint, and ataxia, and Parinaud's main signs of upward gaze paralysis, upper eyelid retraction, convergence retraction nystagmus (CRN), and pseudo-Argyll Robertson pupils. In upward gaze palsy, three structures are disrupted: the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), interstitial nucleus of Cajal (iNC), and the posterior commissure. Read More

J AAPOS 2021 12 18;25(6):338.e1-338.e6. Epub 2021 Nov 18.

The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

Background: Adjustable bilateral Harada-Ito procedures have been described, sometimes with asymmetric adjustment used to correct vertical misalignment when coexisting with torsional strabismus. We investigated the causes of significant postoperative torsional incomitance noted in some patients undergoing these procedures.

Methods: The medical records of patients who underwent bilateral Harada-Ito procedures for bilateral trochlear nerve palsy between 1980 and 2018 were reviewed retrospectively. Read More

J Neuroophthalmol 2021 Dec;41(4):e824-e825

Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, Alabama.

J Neuroophthalmol 2021 Dec;41(4):e823-e824

School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama.

Strabismus 2021 12 17;29(4):243-251. Epub 2021 Nov 17.

Department of Ophthalmology, University of California, Los Angeles.

While most cases of superior oblique (SO) hypofunction represent contractile weakness due to denervation, sometimes the lesion is exclusively in the tendon. This study sought to distinguish the pattern of incomitant strabismus caused by deficiency of SO oculorotary force caused by tendon abnormalities versus that of neurogenic palsy. Clinical and magnetic resonance imaging (MRI) findings of 7 cases of unilateral SO tendon interruption or extirpation were compared with 11 cases of age matched unilateral SO palsy having intact tendons. Read More

J Neuroophthalmol 2022 Mar 8;42(1):e240-e247. Epub 2021 Oct 8.

Department of Ophthalmology and Stein Eye Institute, Bioengineering Department, Department of Neurology, University of California, Los Angeles, California.

Background: Ivanir and Trobe have claimed that hypertropia (HT) that is greater in upgaze than downgaze, or equal to it, is characteristic of decompensated congenital superior oblique (SO) palsy and never present in ischemic, traumatic, or tumorous SO palsy. The reliability of this claim was tested in patients with SO palsy confirmed by MRI demonstration of subnormal ipsilesional SO size.

Methods: Quasi-coronal, surface coil MRI was performed in target-controlled central gaze to identify patients with a unilateral reduction in SO cross section indicative of palsy. Read More

J Neuroophthalmol 2021 Aug 18. Epub 2021 Aug 18.

Department of Ophthalmology and Vision Sciences (EK, EAM), University of Toronto, Toronto, Canada; Department of Ophthalmology (EAM), Toronto Western Hospital, University Health Network, Toronto, Canada; and Department of Ophthalmology (EAM), Mount Sinai Hospital, Sinai Health System, Toronto, Canada.

Neuro-Behce disease (NBD) has a predilection for affecting the parenchyma of the upper brainstem; however, involvement of the fourth nerve nucleus or fascicle by NBD has not been previously described. We report a case of a young man with acute right fourth nerve palsy and history of Behcet disease with an enhancing lesion in the left caudal midbrain corresponding to the left trochlear nerve nucleus/fascicle. This is the first described case of NBD producing nuclear/fascicular fourth nerve palsy. Read More

BMJ Neurol Open 2021 6;3(2):e000174. Epub 2021 Sep 6.

Radiology, Allen Hospital, Waterloo, Iowa, USA.

Objective: To present a case of two identical twins presenting concurrently with symptoms and subsequent initial diagnosis of neuromyelitis optica spectrum disorder (NMOSD).

Methods: Clinical, laboratory and MRI findings for both twins were reviewed and presented here.

Results: Twin A presented with right eye pain and subsequent blurred vision in right eye. Read More

Pan Afr Med J 2021;39:156. Epub 2021 Jun 29.

Service Universitaire des Urgences et de Réanimation Médicale, Hôpital Régional de Zaghouan, Faculté de Médecine de Tunis, Tunis, Tunisie.

J Neurol 2022 Apr 19;269(4):2140-2148. Epub 2021 Sep 19.

Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.

Background: Ocular motor nerve palsies (OMNP) frequently cause patients to present in an emergency room. In the following study, we report the differential diagnosis of OMNP by use of magnetic resonance imaging (MRI) and CSF examination as a standard.

Method: We performed a data analysis of N = 502 patients who presented with oculomotor, trochlear, and/or abducens nerve palsy in the emergency room of the Department of Neurology, University of Ulm, between January 2006 and December 2019. Read More

JNMA J Nepal Med Assoc 2021 Jul 1;59(238):604-607. Epub 2021 Jul 1.

Department of Neurology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.

Tolosa-Hunt Syndrome is a rare disease characterized by painful ophthalmoplegia affecting third, fourth, and/or sixth cranial nerve caused by non-specific inflammation in the cavernous sinus or superior orbital fissure of unknown etiology. We presented a 67-year-old female with Tolosa-Hunt Syndrome. She had a right-sided headache and periorbital pain with double vision. Read More

J Neuroophthalmol 2022 Mar 26;42(1):e394-e395. Epub 2021 Jul 26.

Departments of Ophthalmology (CPF, AJV, CEF) and Neurological Surgery (CEF), University of Washington School of Medicine, Seattle, Washington.

Neurol Med Chir (Tokyo) 2021 Oct 28;61(10):591-597. Epub 2021 Jul 28.

Department of Neurosurgery, School of Medicine, Fujita Health University.

Schwannomas of the trochlear nerve are relatively rare, and most patients present with preoperative diplopia because of trochlear nerve palsy. We describe the case of a 61-year-old male patient with a trochlear nerve schwannoma and no pre- and postoperative diplopia, despite his trochlear nerve being cut during the operation. We aimed to investigate the frequency of postoperative diplopia associated with intraoperative trochlear nerve disturbance by reviewing previous case reports, wherein postoperative diplopia did not occur after the trochlear nerve was cut intraoperatively. Read More

Ophthalmology 2021 08;128(8):1179

University of Alabama School of Medicine, Birmingham, Alabama.

J Neuroophthalmol 2021 12;41(4):e612-e618

Department of Ophthalmology (MSK, GPJ, KL), University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Biostatistics (SS, UH), Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Department of Ophthalmology (GLT), University of Basel, Basel, Switzerland; and Institute of Molecular and Clinical Ophthalmology Basel (GLT), Basel, Switzerland.

Background: The purpose of the study is to evaluate the agreement of the foveopapillary angle (FPA) on conventional fundus photography (c-FPA) with the FPA on scanning laser ophthalmoscopy (SLO) imaging (SLO-FPA) in patients with fourth nerve palsy and healthy controls (HCs).

Methods: The FPA was measured in both eyes of 25 patients and 25 HCs in synedra View (c-FPA) and with the integrated algorithm of the Heidelberg Spectralis OCT (SLO-FPA). The primary endpoint was the agreement of both measurements. Read More

J Binocul Vis Ocul Motil 2021 Jul-Sep;71(3):83-89. Epub 2021 Jun 7.

Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.

: To evaluate the effect of augmented inferior oblique recession (recession +5 mm loop) on the vertical deviation in primary position (PP) and the inferior oblique overaction (IOOA) in patients with unilateral congenital or acquired superior oblique palsy.: The medical records of patients who underwent unilateral inferior oblique recession with 5 mm loop during 2012 and 2019 were retrospectively reviewed. All patients had small to moderate manifest or intermittent hypertropia in PP and overaction of the inferior oblique muscle of +2 or +3 in lateral gaze. Read More

Annu Rev Vis Sci 2021 09 3;7:827-850. Epub 2021 Jun 3.

Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA; email:

Abnormalities in cranial motor nerve development cause paralytic strabismus syndromes, collectively referred to as congenital cranial dysinnervation disorders, in which patients cannot fully move their eyes. These disorders can arise through one of two mechanisms: () defective motor neuron specification, usually by loss of a transcription factor necessary for brainstem patterning, or () axon growth and guidance abnormalities of the oculomotor, trochlear, and abducens nerves. This review focuses on our current understanding of axon guidance mechanisms in the cranial motor nerves and how disease-causing mutations disrupt axon targeting. Read More

Optom Vis Sci 2021 06;98(6):543-546

Perry Point VA Medical Center, Perry Point, Maryland.

Significance: Cranial nerve IV palsy is the most common cranial nerve affected in both pediatric and adult patients with vertical and/or torsional diplopia. The condition has multiple known etiologies, including schwannoma, which is rarely reported in the literature. Schwannoma should be considered when the most common etiologies have been ruled out. Read More

Reg Anesth Pain Med 2021 11 26;46(11):1002-1005. Epub 2021 May 26.

Department of Anesthesiology and Pain Medicine, Amsterdam UMC location AMC, Amsterdam, The Netherlands.

Background: Trigeminal neuralgia (TN) has the highest incidence of disorders causing facial pain. TN is provoked by benign stimuli, like shaving, leading to severe, short-lasting pain. Patients are initially treated using antiepileptic drugs; however, multiple invasive options are available when conservative treatment proves insufficient. Read More

Int Ophthalmol 2021 Oct 20;41(10):3437-3442. Epub 2021 May 20.

Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.

Purpose: To identify the etiologies of isolated fourth cranial nerve palsy in Ramathibodi hospital, Thailand.

Methods: Patients diagnosed with isolated fourth nerve palsy from January 1, 2009, through July 31, 2020 in Ramathibodi Hospital, were included in this retrospective, observational case series. The demographic data of patients, age at presentation, the etiologies of isolated fourth nerve palsy and neuroimaging results (if indicated) were recorded. Read More