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Klin Monbl Augenheilkd 2021 Apr 30;238(4):499-503. Epub 2021 Apr 30.

Strabologie et ophtalmologie pédiatrique, Université de Lausanne, Hôpital ophtalmique Jules-Gonin, Fondation Asile des aveugles, Lausanne, Schweiz.

Purpose: The rectus inferior myopexy is often used in vertical incomitant deviations without significant deviation in primary position. We analysed the long-term results in different pathologies.

Methods: Retrospective study of patients operated on rectus inferior myopexy between 1984 and 2018. Read More

J Int Med Res 2021 Apr;49(4):3000605211008292

Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.

Trochlear palsy often results from traumatic, congenital and microvascular disorders. An intra-axial lesion as a cause of trochlear palsy is uncommon. Moreover, it usually accompanies other neurological deficits. Read More

J Binocul Vis Ocul Motil 2021 Apr-Jun;71(2):50-54. Epub 2021 Apr 15.

Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.

: To describe a patient who presented with right unilateral white-eyed posteriorly-draining carotid-cavernous fistulas (CCF) causing an isolated, acute-onset trochlear nerve palsy with atypical progression to a contralateral left red-eyed anteriorly-draining CCF associated with orbital congestion.: A 74-year-old female presented with an acute onset incomitant right hypertropia consistent with the clinical diagnosis of a superior oblique palsy. Initial workup including MRI was normal. Read More

Dis Mon 2021 May 1;67(5):101132. Epub 2021 Mar 1.

Cook County Health and Hospital Systems USA. Electronic address:

J Neurosurg 2021 Feb 19:1-10. Epub 2021 Feb 19.

Objective: Petroclival meningiomas (PCMs) remain difficult to remove, and radical tumor resection continues to pose a relatively high risk of neurological morbidity in patients with these lesions because of the proximity of the tumor to neurovascular structures. The anterior and posterior combined (APC) transpetrosal approach allows resection of a large petroclival lesion with minimal retraction of the temporal lobe. However, this approach is thought to be complex and time-consuming. Read More

J AAPOS 2021 Feb 16. Epub 2021 Feb 16.

Royal Free Hospital London, United Kingdom.

Purpose: To compare the effectiveness of inferior oblique myectomy and anterior transposition for correction of hypertropia in trochlear nerve palsy.

Methods: This retrospective study compares the surgical outcome of 40 patients with hypertropia secondary to trochlear nerve palsy who underwent either a unilateral myectomy or anterior transposition of the inferior oblique muscle. The primary outcome measure was the change in vertical deviation in primary gaze. Read More

J Neurol 2021 Feb 4. Epub 2021 Feb 4.

National Hospital for Neurology and Neurosurgery, Queen Square. Department of Clinical and Motor Neurosciences, University College London, London, UK.

The evaluation of central vestibular syndromes, especially in the acute setting, can pose a challenge even for the most experienced clinician. Of particular importance is the evaluation of ocular torsion and nystagmus, which can be sensitive for central vestibular pathology, but easily missed by the untrained eye. We present two cases of acute vestibular syndrome of central origin in which the use of magnified fundoscopy at the bedside aided the precise anatomical diagnosis to inform appropriate further management. Read More

J Ophthalmol 2020 17;2020:9476749. Epub 2020 Dec 17.

Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.

Methods: A total of 287 consecutive patients diagnosed with congenital SOP and 82 control subjects were included. Congenital SOP patients were grouped according to the presence (present group) or absence (absent group) of the trochlear nerve using thin-section high-resolution MRI of cranial nerves. We developed a computer-aided detection (CAD) system that could automatically analyze objective indices of facial asymmetry using frontal face photographs. Read More

J Nippon Med Sch 2021 Jan 16. Epub 2021 Jan 16.

Department of Neurology, Shioda Hospital.

Ischemic stroke is a very rare etiology in cases of isolated trochlear nerve palsy, and no reports of ipsilateral trochlear nerve palsy caused by unilateral stroke have so far been published. However, we now report a case of isolated trochlear nerve palsy due to ipsilateral dorsal small midbrain infarction in a 70-year-old woman who presented with acute onset of diplopia. There were no other clinical manifestations, but brain magnetic resonance imaging revealed a small ischemic lesion in the right dorsal midbrain, showing that isolated trochlear nerve palsy can be caused by stroke. Read More

BMJ Case Rep 2020 Dec 21;13(12). Epub 2020 Dec 21.

Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Post-traumatic direct carotid-cavernous fistulas may develop in patients with a closed head injury. The classical presentation is the Dandy's triad-chemosis, pulsatile proptosis and orbital bruit. Associated findings may include orbital pain, dilated episcleral corkscrew vessels, vision deficit and cranial nerve palsies. Read More

Oper Neurosurg (Hagerstown) 2021 Jan;20(2):E91-E97

Department of Neurological Surgery, CHI St. Vincent Arkansas Neuroscience Institute, Sherwood, Arkansas.

Background: Securing proximal control in complex paraclinoid aneurysm surgery through traditional techniques may be challenging and risky in certain situations. Advancements of anatomical knowledge of the cavernous sinus (CS) and hemostasis have made it more accessible as a surgical option.

Objective: To describe the technique of temporary clipping of the horizontal segment of the intracavernous internal carotid artery (IC-ICA) in preparation for permanent clipping of complex paraclinoid aneurysms. Read More

J Neuroophthalmol 2021 Mar;41(1):e7-e15

Section of Radiology (Nivedita Agarwal), Hospital Santa Maria del Carmine, Rovereto, Italy; Division of Neuroradiology (Nivedita Agarwal, RHW), Department of Radiology. University of Utah, Salt Lake City, Utah; Department of Neurosurgery (AKA, GLG), the Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Neuro-ophthalmology (TJM), Department of Ophthalmology, the Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Neuroradiology (MK), Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois; Department of Neuroradiology (LLM), Cedimagem/Alliar Diagnostic Center, Juiz de Fora, Brazil; Department of Radiology (AFC), Le Bonheur Children's Hospital, the University of Tennessee Health Sciences Center, Memphis, Tennessee; Department of Opththalmology (LCD), St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Otolaryngology Head and Neck Surgery (MI), the Johns Hopkins School of Medicine, Baltimore, Maryland; Division of Neuroradiology (Nafi Aygun), Department of Radiology, the Johns Hopkins School of Medicine, Baltimore, Maryland; and Division of Neuroradiology (AMB), Department of Radiology, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Background: The trochlear nerve (the fourth cranial nerve) is the only cranial nerve that arises from the dorsal aspect of the midbrain. The nerve has a lengthy course making it highly susceptible to injury. It is also the smallest cranial nerve and is often difficult to identify on neuroimaging. Read More

Ear Nose Throat J 2020 Oct 9:145561320963676. Epub 2020 Oct 9.

Department of Otorhinolaryngology-Head and Neck Surgery, 13013Osaka University Graduate School of Medicine, Osaka, Japan.

Skull base metastatic tumors are rare. Breast cancer in particular can cause bone metastases after a long period of time. A 70-year-old woman presented with multiple cranial nerve palsy. Read More

Medicine (Baltimore) 2020 Oct;99(40):e22304

Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Centro Neurolesi Bonino-Pulejo, Messina, Italy.

Rationale: Treatment of chronic neuropathic pain in the head and face regions presents a challenge for pain specialists due to the lack of reliable medical and surgical approaches.

Patient Concerns: A 62-year-old patient came to our attention for an intense facial pain secondary to a lesion of the right trigeminal nerve (all branches) due to a petroclival meningioma.

Diagnoses: The patient also presented with gait impairment as well as a deficit of the right facial, auditory, trochlear and abducens cranial nerves. Read More

J AAPOS 2020 10 22;24(5):268.e1-268.e7. Epub 2020 Sep 22.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Purpose: To report the results of adjustable graded augmentation of superior rectus transposition, a novel modification of superior rectus transposition (SRT) designed to reduce postoperative vertical or torsional diplopia.

Methods: The medical records of patients who underwent adjustable graded augmentation of SRT with or without adjustable medial rectus recession (MRc) from February 2017 to December 2019 were reviewed retrospectively. A Mendez ring was used to monitor torsional change after transposition of the superior rectus muscle to the lateral rectus muscle and after sequential placement of 2 or 3 augmentation sutures by superior rectus-lateral rectus loop myopexy. Read More

J AAPOS 2020 10 18;24(5):272.e1-272.e4. Epub 2020 Sep 18.

Department of Ophthalmology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.

Purpose: To investigate the angle of deviation in various gaze positions as a risk factor for overcorrection of moderate-angle unilateral trochlear nerve palsies treated with two-muscle surgery.

Methods: The medical records of consecutive patients with presumed unilateral moderate-angle trochlear nerve palsy who underwent two-muscle surgery were retrospectively reviewed. Patients with overcorrection, defined as reversal of hyperdeviation by prism alternate cover testing at distance (straight ahead) or near measured at 6 weeks, were compared to non-overcorrected patients for their preoperative torsion and ocular alignment at near and distance. Read More

J AAPOS 2020 10 18;24(5):285.e1-285.e6. Epub 2020 Sep 18.

Department of Pediatrics, Pediatric and Perinatal Pathology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Purpose: To investigate the correlation between clinical characteristics and histopathological and immunohistochemical features of inferior oblique muscles in patients with primary and secondary inferior oblique overaction.

Methods: Inferior oblique muscle specimens of patients who underwent inferior oblique-weakening procedures for primary or secondary inferior oblique overaction were recruited. Subjects were mainly divided into two groups, each of which was further divided into two subgroups: group 1 included patients with primary inferior oblique overaction (subgroups, infantile esotropia vs acquired V-pattern esotropia), and group 2 included patients with secondary inferior oblique overaction (subgroups, congenital vs acquired trochlear nerve palsy). Read More

Neurol Sci 2020 Nov 15;41(11):3039-3056. Epub 2020 Sep 15.

Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, 226014, India.

COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. Read More

J Stroke Cerebrovasc Dis 2020 Oct 8;29(10):105105. Epub 2020 Jul 8.

Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea. Electronic address:

Heat stroke is a life-threatening disease characterized by hyperthermia and neurological dysfunction. The central nervous system is highly sensitive to hyperthermia, which causes neurological complications due to the involvement of the cerebellum, basal ganglia, anterior horn cells, and peripheral nerves. Several studies reported about clinical symptoms and brain image findings of heat stroke. Read More

J Neurovirol 2020 12 10;26(6):970-972. Epub 2020 Sep 10.

Department of Ophthalmology, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain.

Since COVID-19 was first reported, different neurological complications have been acknowledged, but their description is constantly evolving. We report a case of concurrent tonic pupil and trochlear nerve palsy in this context. A 62-year-old man reported a 5-day history of binocular vertical diplopia and blurred vision in his left eye, noticing that his left pupil was dilated. Read More

Acta Neurochir (Wien) 2021 04 8;163(4):1037-1043. Epub 2020 Sep 8.

Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.

Background: Separation of the vertebrobasilar artery (VBA) from the trigeminal nerve root in microvascular decompression (MVD) is technically challenging. This study aimed to review the clinical features of VBA involvement in trigeminal neuralgia and evaluate surgical decompression techniques in the long term.

Methods: We retrospectively reviewed the surgical outcomes of 26 patients (4. Read More

Arq Neuropsiquiatr 2020 Jun;78(6):385-386

Hospital Alemão Oswaldo Cruz, Departamento de Neurorradiologia, São Paulo SP, Brazil.

Clin Exp Optom 2021 Mar;104(2):255-257

Advanced Care Ocular Disease Service, Southern College of Optometry, Memphis, Tennessee, USA.

Korean J Ophthalmol 2020 06;34(3):256-258

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

Clin Exp Optom 2021 Jan;104(1):132-134

Advanced Care Ocular Disease Service, Southern College of Optometry , Memphis, Tennessee, USA.

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):18-26

Departments of Ophthalmology.

Purpose: Advances in surgical approaches have improved access for total or near-total resection of spheno-orbital meningiomas (SOM). Herein, the outcomes of multidisciplinary resection and reconstruction of SOM via frontotemporal orbitozygomatic craniotomy at a single institution are evaluated.

Methods: A retrospective chart review was performed of all patients with SOM who underwent joint neurosurgical and oculofacial plastic resection via frontotemporal orbitozygomatic craniotomy between January 1999 and December 2018. Read More

J Clin Med 2020 Mar 30;9(4). Epub 2020 Mar 30.

Department of Neurology, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei 105, Taiwan.

Varicella-zoster virus (VZV) infection can cause chickenpox and herpes zoster. It sometimes involves cranial nerves, and rarely, it can involve multiple cranial nerves. We aimed to study clinical presentations of cranial nerve involvement in herpes zoster infection. Read More

Zhonghua Yan Ke Za Zhi 2020 Mar;56(3):166-170

Tianjin Eye Hospital, Tianjin Key Lab. of Ophthalmology and Visual Science, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology of Tianjin Medical University, Tianjin Eye Institute, Tianjin 300020, China.

There are many pathogenic factors of strabismus. In addition to the changes of alignment and ocular movement, there may be abnormal pathways and development of extraocular muscles, abnormalities of orbital and intraorbital connective tissue, paralysis of cranial nerves (oculomotor nerve, trochlear nerve, and abductor nerve), and nuclear and supranuclear lesions, accompanied by other cerebral dysplasia sometimes. In recent years, advances in imaging technology and its application in the professional field of strabismus have made it possible to clearly observe the eye, orbital, intracranial, and innervation changes, which is helpful to clarify the etiology of strabismus and extraocular muscle-related diseases, and to provide a basis for the diagnosis and treatment of strabismus. Read More

World Neurosurg 2020 06 5;138:153-157. Epub 2020 Mar 5.

Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. Electronic address:

Background: Pituitary apoplexy is an acute clinical syndrome caused by infarction and/or hemorrhage of pituitary adenoma, which typically presents with severe headache, visual deterioration, and endocrine abnormalities. However, temporal lobe seizure (and temporal lobe epilepsy) has not been viewed as a symptom of pituitary apoplexy in the literature.

Case Description: To elucidate further such a rare complication of temporal lobe seizure, we describe here the rare clinical manifestations of a 55-year-old previously healthy man with pituitary apoplexy harboring headache, combined palsies involving cranial nerves III to VI, endocrinologic disturbances, and temporal lobe seizure. Read More