93 results match your criteria onset sixth-nerve


Acute-onset binocular diplopia in neurological unit: Aetiological factors and diagnostic assessment.

Acta Neurol Scand 2021 Mar 31. Epub 2021 Mar 31.

Department of Human Neurosciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.

Objectives: To investigate the aetiology of acute-onset binocular diplopia (AOBD) in neurological units and identify the key diagnostic procedures in this setting.

Materials And Methods: Clinico-demographic data from patients hospitalized for AOBD from 2008 to 2019 were retrospectively reviewed. AOBD due to an underlying neurological disorder known to cause diplopia was addressed as secondary diplopia. Read More

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Visual acuity loss and sixth nerve palsy as the only manifestations of slit ventricle syndrome.

Arch Soc Esp Oftalmol 2021 Jan 18. Epub 2021 Jan 18.

Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, España.

The case is presented of a girl diagnosed with obstructive hydrocephalus due to pilomyxoid astrocytoma, which required a ventriculoperitoneal shunt (VPS) at the age of 5 years and 10 months. Two months later, magnetic resonance imaging of the brain did not show ventriculomegaly or other signs of increased intracranial pressure. At the age of 6 years and 2 months, a rapid onset of bilateral visual acuity loss developed and she was diagnosed with slit ventricle syndrome. Read More

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January 2021

Unilateral lateral rectus palsy: an unusual presentation of pineal epidermoid cyst.

Pan Afr Med J 2020 6;36:252. Epub 2020 Aug 6.

Department of Paediatrics, Kasturba Medical College, MAHE University, Manipal, India.

An 11-year-old boy presenting with sudden onset double vision, headache and neck pain was found to have left lateral rectus palsy, papilledema and neck rigidity. An initial diagnosis of benign intracranial hypertension was considered. However, magnetic resonance imaging (MRI) of the brain surprisingly discovered the pineal gland cyst. Read More

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January 2021

Diplopia as the presenting feature of acute lymphoblastic leukemia.

Am J Ophthalmol Case Rep 2020 Dec 17;20:100931. Epub 2020 Sep 17.

Neuro Ophthalmology Department, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, Tamilnadu, India.

Purpose: To report a rare case of acute lymphoblastic leukemia presenting with diplopia to an ophthalmologist.

Observations: A 29-year-old male patient presented to ophthalmology department with sudden onset of binocular diplopia in left gaze. Magnetic resonance imaging of brain and orbits revealed a thickened left medial rectus, with enhancement of right sixth nerve, bilateral third and fifth nerves. Read More

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December 2020

Idiopathic intracranial hypertension: Update on diagnosis and management.

Clin Med (Lond) 2020 07;20(4):384-388

University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK and University of Birmingham, Edgbaston, UK

Idiopathic intracranial hypertension is a condition of raised intracranial pressure of unknown cause. Features include new onset headache, which is frequently non-specific; papilloedema is present, visual disturbances are common; and there may be sixth nerve palsy. Diagnosis includes brain imaging with venography to exclude structural causes and venous sinus thrombosis. Read More

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Intracranial Involvement in Multiple Myeloma Presenting as a Cranial Nerve Palsy.

J Hematol 2019 Mar 30;8(1):29-33. Epub 2019 Mar 30.

Department of Haematology, University Hospital Limerick, Limerick, Ireland.

Multiple myeloma (MM) is characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Neurological complications in MM most frequently occur due to spinal cord compression by bony lesions, paraprotein-related neuropathy, hypercalcemia, hyperviscosity, or amyloidosis. Intracranial involvement is a rare complication of MM occurring in only 1% of patients. Read More

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Acute Sixth Nerve Palsy and Retinal Hemorrhages as the Presenting Features of Acute Lymphoblastic Leukemia.

J Neuroophthalmol 2021 Mar;41(1):e131-e133

Division of Neuro-Ophthalmology (MA, ADH), Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Ophthalmology (MA), King Abdulaziz Medical City, Riyadh, Saudi Arabia; and Department of Pathology (MAV), Johns Hopkins University School of Medicine, Baltimore, Maryland.

Abstract: A 36-year-old apparently healthy man presented with acute onset of diplopia. Examination demonstrated left sixth nerve palsy with 3 retinal hemorrhages noted in one eye. Gadolinium-enhanced high-resolution skull base MRI revealed left sixth nerve enhancement involving the cisternal segment. Read More

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Acquired Ocular Motor Palsy: Current Demographic and Etiological Profile.

Asia Pac J Ophthalmol (Phila) 2020 Jan-Feb;9(1):25-28

Strabismus and Neuro-Ophthalmology Services, Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India.

Purpose: To describe the clinical, demographic, and etiological profile of patients of acquired ocular motor palsy presenting in a tertiary eye care center.

Design: A retrospective hospital record-based study was conducted in patients of paralytic strabismus presenting from April 2016 to December 2017.

Methods: Data included demographic and clinical details, diagnosis, underlying etiology, imaging, laboratory reports, and the outcome. Read More

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October 2020

Sixth nerve palsy in sporadic Burkitt Lymphoma.

Am J Ophthalmol Case Rep 2019 Dec 31;16:100565. Epub 2019 Oct 31.

School of Medicine (SY), (Department of Ophthalmology (AGL), Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.

Purpose: To describe a unique presentation of Central Nervous System Burkitt Lymphoma.

Observations: A 59-year-old male presented with new onset binocular horizontal diplopia five days after initial presentation with abdominal distension, weight loss, and night sweats. He was diagnosed with Burkitt Lymphoma with base of skull metastasis that was initially visible only on PET scan and subsequently resolved with chemotherapy. Read More

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December 2019

Insidious onset of headache, diplopia and Horner's syndrome: a rare case of petrous bone osteomyelitis.

BMJ Case Rep 2019 Sep 18;12(9). Epub 2019 Sep 18.

Diabetes and Endocrine, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.

We present an unusual case of skull base osteomyelitis in an 88-year-old woman. She presented with gradual onset unilateral headache and diplopia. On examination, there was evidence of a left-sided Horner's and ipsilateral sixth nerve palsy. Read More

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September 2019

Botulinum toxin A in the early treatment of sixth nerve palsy in type 2 diabetes.

Indian J Ophthalmol 2019 07;67(7):1133-1136

Department of Paediatric Ophthalmology, Aravind Eye Hospital, Coimbatore, Tamil Nadu, India.

Purpose: Our study aims at evaluating the efficacy and safety of botulinum toxin A in the early treatment of sixth nerve palsy in type 2 diabetic patients.

Methods: This study is a prospective and interventional clinical case series of patients presenting with acute onset of sixth cranial nerve palsy, who received injection botulinum toxin A.

Results: Thirty-one cases were included in the study. Read More

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The Role of Botulinum Toxin in the Treatment of Strabismus.

Semin Ophthalmol 2019 8;34(4):198-204. Epub 2019 Jun 8.

b Department of Ophthalmology , Harvard Medical School , Boston , MA , USA.

: To perform a systematic review of the application of botulinum toxin A (BTA) in the management of strabismus in the adult and pediatric populations. : A systematic literature search was performed using the Medline database. : In 1989, with the FDA approval of botulinum toxin (onabotulinum toxin A, or BTA) for the treatment of strabismus, patients were provided with an alternative to surgical recession. Read More

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Yellow fever vaccine-associated neurological disease: it is not just the silver generation at risk.

BMJ Case Rep 2019 May 13;12(5). Epub 2019 May 13.

West of Scotland Specialist Virology Centre, NHS Greater Glasgow and Clyde, Glasgow, UK.

A 35-year-old man presented to his optician with sudden onset diplopia and a 1-week history of headaches. He was noted to have sixth nerve palsy. The following day he was admitted to hospital with confusion and expressive dysphasia. Read More

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Petroclival Meningioma Presenting With an Ipsilateral Sixth Nerve Palsy and a Contralateral Homonymous Quadrantanopia: A Unique and Topographically Localizing Syndrome.

J Neuroophthalmol 2019 Sep;39(3):405-407

Department of Ophthalmology & Visual Sciences (AS, LJL, AGL), University of Texas Medical Branch, Galveston, Texas; Department of Ophthalmology (AV, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Ophthalmology (AGL), Baylor College of Medicine, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Section of Ophthalmology (AGL), University of Texas MD Anderson Cancer Center, Houston, Texas; and Department of Ophthalmology (AGL), University of Iowa Hospitals and Clinics, Iowa City, Iowa.

An 84-year-old woman reported onset of headaches, diplopia, and blurred vision. On examination, she was found to have a left sixth nerve palsy and an incongruous right homonymous hemianopia. Brain MRI demonstrated a left petroclival meningioma, causing this unusual combination of clinical findings. Read More

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September 2019

Causes and surgical treatment of diplopia and strabismus secondary to myasthenia gravis.

Arch Soc Esp Oftalmol 2019 Mar 20;94(3):107-113. Epub 2018 Dec 20.

Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, España.

Objective: To present a report of the ocular motility disorders, treatment and outcomes of myasthenia gravis (MG).

Material And Method: A retrospective study was performed on the data of patients with MG. An evaluation was made using mean age, gender, initial diagnosis, ocular deviation, time of onset of clinical characteristics, treatment and results. Read More

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Ophthalmological findings in neuroborreliosis - a prospective study performed in western Sweden.

Acta Ophthalmol 2019 Feb 26;97(1):44-52. Epub 2018 Aug 26.

Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.

Purpose: To evaluate and follow-up ophthalmological findings in individuals diagnosed with neuroborreliosis, confirmed by cerebrospinal fluid (CSF) analysis.

Methods: Twenty-four individuals (13 males), mean age 43.5 ± 18. Read More

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February 2019

Jugular Tubercle Meningioma with Hemorrhagic Conversion Mimicking a Ruptured Thrombosed Giant Vertebrobasilar Aneurysm.

World Neurosurg 2018 Nov 27;119:108-112. Epub 2018 Jul 27.

Department of Neurosurgery, University of Miami/Jackson Memorial Hospital, Miami, Florida, USA.

Background: Hemorrhagic meningiomas, although relatively uncommon, represent a distinct clinical entity. In some cases, these meningiomas can closely mimic a thrombosed aneurysm. We present a case of a jugular tubercle meningioma whose radiographic and clinical picture initially suggested a ruptured, thrombosed vertebrobasilar aneurysm. Read More

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November 2018

May the Inferior Petrosal Sinus Recanalization During Endovascular Treatment for Carotid-Cavernous Fistulas Increase the Risk of Sixth Nerve Palsy?

World Neurosurg 2018 Aug 3;116:e246-e251. Epub 2018 May 3.

Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France.

Background: Sixth nerve palsy is a common complication of endovascular treatment for carotid-cavernous fistulas (CCF). Two hypotheses are evoked: the spontaneous venous congestion into the cavernous sinus and the direct compression of the nerve by the embolic agent into the cavernous sinus. Nevertheless, the evidence is still uncertain. Read More

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Facial Weakness, Diplopia, and Fever in a 31-Year-Old: An Atypical Case of Tuberculous Meningitis.

Cureus 2017 Dec 7;9(12):e1918. Epub 2017 Dec 7.

Department of Medicine, Northwell Long Island Jewish Medical Center, New York, United States.

Tuberculous meningitis (TBM) is an infection of the central nervous system (CNS) meninges that carries high morbidity and mortality. It is important to recognize, as patients may present with atypical symptoms. We describe the case of a 31-year-old man with a history of diabetes who presented with a sub-acute onset of right-sided facial weakness and right gaze difficulty with diplopia. Read More

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December 2017

[Efficacy of Vertical Muscle Transpositions with and without Simultaneous Rectus Muscle Recession for Unilateral Sixth Nerve Palsy].

Klin Monbl Augenheilkd 2018 Oct 20;235(10):1096-1104. Epub 2017 Nov 20.

Zentrum für Augenheilkunde, Universitätskliniken Köln, Köln.

Background: We report results of a modified vertical muscle transposition procedure according to the Hummelsheim principle - with and without simultaneous rectus muscle recession - for unilateral sixth nerve palsy. We examine the influence of the duration of the palsy, preoperative angle of squint and preoperative abductive capacity on surgical results of the procedures.

Patients And Methods: Retrospective study of 29 consecutive patients with unilateral abducens nerve palsy who underwent surgery between 2001 and 2012. Read More

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October 2018

Early Onset Sixth-Nerve Palsy with Eccentric Fixation.

Am Orthopt J 2017 Jan;67(1):72-79

From the Eye Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania;

Purpose: To report four cases of early onset sixth-nerve palsy all of whom had eccentric fixation.

Methods: A retrospective case note review was undertaken of all cases presenting to the senior author's private and NHS practice with early onset sixth palsy between 2006 and 2012. As well as demographic information, details of ophthalmic, orthoptic, electrophysiological examinations, and radiological investigations that were extracted from the records. Read More

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January 2017

Complete ophthalmoplegia, complete ptosis and dilated pupil due to internal carotid artery dissection: as the first manifestation of Takayasu arteritis.

BMC Cardiovasc Disord 2017 07 25;17(1):201. Epub 2017 Jul 25.

National Hospital, Colombo, Sri Lanka.

Background: Takayasu arteritis is a rare, chronic large vessel vasculitis involving the aorta and its primary branches. As the disease progresses, the active inflammation of large vessels leads to dilation, narrowing and occlusion of the arteries. Arterial dissection is due to separation of the layers of the arterial wall resulting in a false lumen, where blood seeps into the vessel wall. Read More

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Binocular diplopia in a tertiary hospital: Aetiology, diagnosis and treatment.

Arch Soc Esp Oftalmol 2017 Dec 15;92(12):565-570. Epub 2017 Jul 15.

Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, España.

Objective: To study the causes, diagnosis and treatment in a case series of binocular diplopia.

Material And Method: A retrospective chart review was performed on patients seen in the Diplopia Unit of a tertiary centre during a one-year period. Diplopia was classified as: acute≤1 month since onset; subacute (1-6 months); and chronic (>6 months). Read More

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December 2017

Botulinum toxin for the treatment of strabismus.

Cochrane Database Syst Rev 2017 03 2;3:CD006499. Epub 2017 Mar 2.

Department of Ophthalmology, Aintree University Hospitals NHS Foundation Trust, Lower Lane, Liverpool, UK, L9 7AL.

Background: The use of botulinum toxin as an investigative and treatment modality for strabismus is well reported in the medical literature. However, it is unclear how effective it is in comparison to other treatment options for strabismus.

Objectives: The primary objective was to examine the efficacy of botulinum toxin therapy in the treatment of strabismus compared with alternative conservative or surgical treatment options. Read More

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Ocular myasthenia gravis in a person with tetraplegia presenting challenges in diagnosis and management.

Spinal Cord Ser Cases 2016 7;2:15037. Epub 2016 Apr 7.

New South Wales Spinal Outreach Service, Royal Rehab , Sydney, NSW, Australia.

We report the first case of ocular myasthenia gravis (OMG) in a patient with complete tetraplegia, highlighting diagnostic and management challenges. Spinal multidisciplinary rural clinic and specialised inpatient Spinal Cord Injury Unit, NSW, Australia. A 61-year-old man with established C5 AIS A tetraplegia, presented with sudden onset of diplopia and bilateral ptosis, later diagnosed as OMG, in context of other complex co-morbidities, including a cervical cord syrinx, obstructive sleep apnoea and labile blood pressure. Read More

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Unilateral sixth nerve palsy.

Am J Emerg Med 2017 Jun 12;35(6):934.e1-934.e2. Epub 2016 Dec 12.

Tehran University of Medical Sciences, Department of Emergency Medicine, Sina Hospital, Hasan Abad Square, Imam Khomeini Ave, Tehran, Iran. Electronic address:

Background: The diagnosis of cerebral venous sinus thrombosis still remains a real challenge. Seizure, unusual headache with sudden onset, unexplained persistently unilateral vascular headache and neurologic deficit-which is difficult to be attributed to a vascular territory are some of the suggestive symptoms.

Case: An isolated sixth nerve palsy is discussed as a rare presentation for cerebral venous thrombosis. Read More

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Isolated diplopia associated with calcineurin inhibitor therapy in a patient with idiopathic membranous nephropathy: a case report.

BMC Nephrol 2016 08 19;17(1):116. Epub 2016 Aug 19.

Department of Nephrology, University of Florida, 655 W 8th St, Jacksonville, FL, 32209, USA.

Background: Neurotoxicity is a common side effect of treatment with calcineurin inhibitors. Tremors are frequently reported as the most common manifestation. Variable presentations can include headaches, seizures, visual hallucinations or blindness. Read More

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Lyme neuroborreliosis: a treatable cause of acute ocular motor disturbances in children.

Br J Ophthalmol 2015 Oct 13;99(10):1401-4. Epub 2015 Apr 13.

Department of Ophthalmology, Nordsjællands Hospital Hillerød, Hillerød, Denmark Department of Ophthalmology, Copenhagen University Hospital Glostrup, Glostrup, Denmark.

Background: Lyme neuroborreliosis (LNB) designates central nervous system involvement caused by the tick-borne spirochaete Borrelia burgdorferi (Bb). The present study describes a spectrum of acquired ocular motor disorders in children with LNB.

Methods: Six paediatric patients (age 3-15 years) with ocular motor symptoms as first manifestations of LNB evaluated by a paediatrician and ophthalmologist are presented. Read More

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October 2015

Risk factors and prognosis of isolated ischemic third, fourth, or sixth cranial nerve palsies in the Korean population.

J Neuroophthalmol 2015 Mar;35(1):37-40

Department of Ophthalmology, Chosun University College of Medicine, Gwangju, Korea.

Background: To investigate the risk factors and prognosis for ischemic third, fourth, and sixth cranial nerve palsies in a Korean population.

Methods: A pair-matched case-control study of 54 Korean patients who were diagnosed with ischemic third, fourth, or sixth cranial nerve palsies was performed to evaluate their risk factors. Using conditional logistic regression analysis, prevalence of potential risk factors in patients and controls, included diabetes mellitus, hypertension, hyperlipidemia, ischemic heart disease, left ventricular hypertrophy (LVH), and smoking were examined retrospectively. Read More

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Ocular Neuromyotonia Noted after Recent Botulinum Toxin Injection for Sixth Nerve Palsy Following Resection of a Posterior Fossa Skull Base Meningioma.

Neuroophthalmology 2015 Feb 24;39(1):39-41. Epub 2014 Nov 24.

University of Miami Miller School of MedicineMiami, FloridaUSA; Bascom Palmer Eye Institute Miami, FloridaUSA.

A 56-year-old female complained of diplopia immediately after surgical excision of a recurrent left skull base tuberculum meningioma. She was found to have a left sixth nerve palsy, which was subsequently treated with botulinum toxin injection to the medial rectus muscle. Three months post injection, the patient had partial recovery of the sixth nerve palsy and new-onset ocular neuromyotonia. Read More

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February 2015