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Can J Neurol Sci 2021 Apr 13:1-8. Epub 2021 Apr 13.

J Neuroophthalmol 2021 Mar 30. Epub 2021 Mar 30.

Servicio de Oftalmología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid. Servicio de Oftalmología, Hospital Clínico San Carlos, Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain. Red Temática de Investigación Cooperativa en Salud (RETICS), Oftared, Instituto de Salud Carlos III, Madrid.

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

Surv Ophthalmol 2021 Mar 26. Epub 2021 Mar 26.

Departments of Ophthalmology, Neurology and Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida.

Cerebrospinal fluid (CSF) diversion or shunting procedures are the most commonly performed surgery for the treatment of hydrocephalus and are often employed in the management of elevated intracranial pressure due to a variety of diseases. Despite their popularity however, approximately 50% of shunts fail within the first two years, and several revisions are required within the first decade after placement. Ophthalmologists may encounter patients with a CSF shunt to evaluate for concerns of vision loss or diplopia and to determine if papilledema is present. Read More

Taiwan J Ophthalmol 2021 Jan-Mar;11(1):86-88. Epub 2020 Nov 19.

Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA.

Perineural spread (PNS) to cranial nerves (CNs) by cutaneous malignancies is difficult to diagnose given the indolent course and often late or absent findings on brain imaging. A 68-year-old white man with multiple cranial neuropathies secondary to PNS by squamous cell carcinoma had negative high-quality neuroimaging for 5.25 years. Read More

Taiwan J Ophthalmol 2021 Jan-Mar;11(1):25-38. Epub 2020 Dec 2.

Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States.

Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that results in isolated raised intracranial pressure. Classic symptoms and signs of IIH include headache, papilledema, diplopia from sixth nerve palsy and divergence insufficiency, and pulsatile tinnitus. Atypical presentations include: (1) highly asymmetric or even unilateral papilledema, and IIH without papilledema; (2) ocular motor disturbances from third nerve palsy, fourth nerve palsy, internuclear ophthalmoplegia, diffuse ophthalmoplegia, and skew deviation; (3) olfactory dysfunction; (4) trigeminal nerve dysfunction; (5) facial nerve dysfunction; (6) hearing loss and vestibular dysfunction; (7) lower cranial nerve dysfunction including deviated uvula, torticollis, and tongue weakness; (8) spontaneous skull base cerebrospinal fluid leak; and (9) seizures. Read More

J Med Case Rep 2021 Mar 26;15(1):167. Epub 2021 Mar 26.

School of Medicine, Capital Medical University, Beijing, China.

Background: Patients with Marfan syndrome commonly require spinal deformity surgery. The purpose of this case report is to present a rare thoracotomy complication. We present the management of such a patient. Read More

Neuroophthalmology 2021 3;45(1):48-51. Epub 2020 Sep 3.

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

Cavernomas or cavernous malformations are the most common clinically significant vascular anomalies, accounting for 8-15% of all brain and spinal vascular malformations. While there are several articles in the literature on cavernomas, most cases report haemorrhage from these lesions as the cause of cranial nerve palsies. We report a rare case of multiple intracranial cavernomas in the brain and pons causing an isolated compressive sixth nerve palsy. Read More

JAMA Ophthalmol 2021 Mar 17;139(3):e204104. Epub 2021 Mar 17.

Department of Ophthalmology, Weill Cornell Medical College, New York, New York.

J Pediatr Endocrinol Metab 2021 Mar 14;34(3):395-399. Epub 2020 Dec 14.

Department of Paediatric Endocrinology, Variety Children Hospital, King's College Hospital NHS Foundation Trust, London, UK.

Objectives: IgG4-related hypophysitis is a novel clinical disease entity, which is typically seen in the sixth decade of life and is typically complicated by hypopituitarism. We describe an adolescent female with IgG4-related hypophysitis with normal pituitary function and summarize the relevant literature.

Case Presentation: A 11. Read More

J Binocul Vis Ocul Motil 2021 Mar 5:1-5. Epub 2021 Mar 5.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

: To evaluate the outcome of augmented superior rectus transposition (SRT) with medial rectus (MR) recession in patients with Duane Retraction Syndrome (DRS) and sixth nerve palsy.: Twenty four patients (16 DRS and 8 sixth nerve palsy) that underwent the procedure were included. The superior rectus muscle was secured, detached, and re-attached to the sclera along the spiral of Tilaux, adjacent to lateral rectus insertion. Read More

J Pediatr 2021 03;230:125

Department of Pediatric Research, University of Oslo, Oslo, Norway; Ann and Robert H. Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine, Chicago, Illinois.

J Neuroophthalmol 2021 Feb 19. Epub 2021 Feb 19.

Baylor College of Medicine (NR, AGL), Houston, Texas; Department of Ophthalmology (PM, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; The Houston Methodist Research Institute (AGL), Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology (AGL), Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York; and Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas.

Abstract: The most common etiology of an isolated abducens nerve palsy in an older adult with vasculopathic risk factors is presumed microvascular ischemia. Because the diagnosis of microvascular ischemia in this setting would not alter patient management, there is debate as to whether further workup is warranted under these circumstances. In this report, we describe a fascicular sixth nerve palsy as the initial presenting sign of metastatic ovarian carcinoma, and we highlight the importance of considering additional workup in select cases of isolated abducens nerve palsies. Read More

Cureus 2021 Jan 20;13(1):e12805. Epub 2021 Jan 20.

Emergency, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, SAU.

Sixth cranial nerve palsy is uncommon but a well-recognized consequence of head trauma. Although few cases documented traumatic persistent bilateral sixth nerve palsy, a transient episode is extremely rare and not reported before. We report an unusual case of transient bilateral abducens nerve palsy after minor head trauma, which was completely resolved without any intervention after 20 min. Read More

Case Rep Infect Dis 2021 13;2021:6699536. Epub 2021 Feb 13.

Lyme Disease Research Center, Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

We describe a patient with fever and myalgia who did not have COVID-19 but instead had Lyme disease. We propose that the co-occurrence of COVID-19 and Lyme disease during the spring of 2020 resulted in a delayed diagnosis of Lyme disease due to COVID-19 pandemic-related changes in healthcare workflow and diagnostic reasoning. This delayed diagnosis of Lyme disease in the patient we describe resulted in disseminated infection and sixth nerve palsy. Read More

Acta Neurochir (Wien) 2021 Feb 8. Epub 2021 Feb 8.

Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.

Background: Petroclival meningiomas (PC MNGs) and anterior petrous meningiomas (AP MNGs) have similar locations. However, these are different tumors clearly divided by the trigeminal nerve. There has never been a study on the comparison of the surgical outcomes of these two meningiomas. Read More

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

Oper Neurosurg (Hagerstown) 2021 Mar;20(4):E303

Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.

Meningiomas arising from Dorello's canal1-3 are a rare disease entity often resulting in an unclear diagnosis even at the time of surgery.4,5 We present a case of a 63-yr-old man who presented with a sixth nerve palsy. He was found to have a lesion in the region of Meckel's cave on neuroimaging studies. Read More

BMC Ophthalmol 2021 Jan 20;21(1):50. Epub 2021 Jan 20.

Ophthalmology Department, Benha University, Benha, Egypt.

Background: Superior rectus muscle transposition (SRT) is one of the proposed transposition techniques in the management of defective ocular abduction secondary to chronic sixth nerve palsy and esotropic Duane retraction syndrome (Eso-DRS). The aim of the current study is to report the outcomes of augmented SRT in treatment of Eso-DRS and chronic sixth nerve palsy.

Methods: a retrospective review of medical records of patients with Eso-DRS and complete chronic sixth nerve palsy who were treated by augmented full tendon SRT combined with medial rectus recession (MRc) when intraoperative forced duction test yielded a significant contracture. Read More

J Neurovirol 2021 02 18;27(1):171-177. Epub 2021 Jan 18.

NEUROCOVID-RIO Group-Research Group On Neurological Syndromes Associated With SARS-CoV-2, Rio de Janeiro, Brazil.

The complete features of the neurological complications of coronavirus disease 2019 (COVID-19) still need to be elucidated, including associated cranial nerve involvement. In the present study we describe cranial nerve lesions seen in magnetic resonance imaging (MRI) of six cases of confirmed COVID-19, involving the olfactory bulb, optic nerve, abducens nerve, and facial nerve. Cranial nerve involvement was associated with COVID-19, but whether by direct viral invasion or autoimmunity needs to be clarified. Read More

J Int Med Res 2021 Jan;49(1):300060520986702

Department of Neurology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China.

Our aim was to explore the clinical characteristics and diagnostic methods of benign abducens nerve palsy in children. The clinical and laboratory characteristics, treatment approach, and prognosis of two children with benign abducens nerve palsy were retrospectively evaluated. The main clinical symptoms of the two children were limited binocular movement accompanied by double vision, and the positive physical signs were limited binocular abduction accompanied by diplopia. Read More

J Neuroophthalmol 2021 Jan 4;Publish Ahead of Print. Epub 2021 Jan 4.

McGovern Medical School (BP), Houston, Texas; Department of Ophthalmology (SHB, NB, AGL), Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas; Department of Neurology (MON), Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas; Departments of Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; Department of Ophthalmology (AGL), University of Texas Medical Branch, Galveston, Texas; MD Anderson Cancer Center (AGL), University of Texas, Houston, Texas; and Department of Ophthalmology (AGL), the University of Iowa Hospitals and Clinics, Iowa City, Iowa.

Abstract: Mollaret meningitis (MM) refers to benign recurrent aseptic meningitis usually following herpes simplex virus 2 (HSV-2) infection. Neuro-ophthalmic manifestations associated with MM are rarely reported. We present a case of recurrent HSV-2 meningitis with the neuro-ophthalmic presentation of papilledema and sixth nerve palsy. Read More

J Neuroophthalmol 2021 Mar;41(1):114-118

Division of Neuro-Ophthalmology (VPD, KAAD, BKC), Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts; and Departments of Radiology (OR), Pathology (SNC), and Neurology (BKC), Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.

Abstract: A 44-year-old woman presented with 2 painful and self-limited episodes of binocular horizontal diplopia within 1 year that at the beginning were thought to be secondary to microvascular insult. Her medical history was significant for Cushing syndrome status post transsphenoidal resection with bilateral adrenalectomy 4 years prior, hypertension, and diabetes mellitus. Neuro-ophthalmic evaluation was significant for left abduction deficit and incomitant esotropia consistent with left abducens nerve palsy. Read More

J Fr Ophtalmol 2021 Mar 29;44(3):e133-e134. Epub 2020 Dec 29.

Department of Ophthalmology, Complejo Hospitalario de Navarra, Irunlarrea 3, 31008 Pamplona, Spain.

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

Obstet Med 2020 Dec 31;13(4):195-197. Epub 2019 Jan 31.

Department of Radio-Diagnosis, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India.

Pregnant women presenting with isolated cranial palsies are uncommon. Isolated sixth nerve (abducens nerve) palsy can occur for a variety of reasons and neuroimaging is often performed to identify an underlying cause. We report a case of a woman in her third pregnancy with preeclampsia who presented with an isolated sixth nerve palsy. Read More

HNO 2020 Dec 17. Epub 2020 Dec 17.

Klinik und Poliklinik für Hals‑, Nasen- und Ohrenkrankheiten, plastische und ästhetische Operationen, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Deutschland.

Neuroophthalmology 2020 1;44(6):399-402. Epub 2020 May 1.

Faculty of Medicine Department of Neurology, Ankara University, Ankara, Turkey.

The classically affected cranial nerve from intracranial hypertension is the sixth nerve. Carcinomatous meningitis can cause persistent or progressive cranial nerve palsies by infiltrating them in the subarachnoid space. Here we present a rare case of episodic, short-lasting, and unilateral oculomotor nerve palsy associated with carcinomatous meningitis and intracranial hypertension in a 44-year-old woman diagnosed with metastatic lung adenocarcinoma. Read More

Pediatr Neurol 2021 02 22;115:48-49. Epub 2020 Nov 22.

NewYork-Presbyterian Hospital, New York, New York; Division of Child Neurology, Department of Neurology, Columbia University Irving Medical Center, New York, New York. Electronic address:

Neurology 2021 02 14;96(6):e866-e875. Epub 2020 Dec 14.

From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (A.V., S.M.-C., B.J., G.P., V.R., V.D., D.P., F.D., J.H.) and Neuro-Cognition and Neuro-Ophthalmology Department (V.D., C.T.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team, NeuroMyoGene Institute (A.V., S.M.-C., B.J., G.P., V.R., V.D., F.D., J.H.), INSERM U1217/CNRS UMR5310; University Claude Bernard Lyon 1 (A.V., S.M.-C., B.J., G.P., V.R., V.D., F.D., J.H., C.T.), Université de Lyon, Lyon, France; Dermatology Department (F.S.), Centre Hospitalier de Valence; Neurology Department (M.E.), Centre Hospitalier de Libourne; Team ImpAct (C.T.), Lyon Neuroscience Research Center, INSERM U1028 CNRS UMR5292; and Neurology Department 2-Mazarin (D.P.), Centre de Recherche de l'Institut du Cerveau et de la Moelle Epiniere Groupe, Hospitalier Pitie-Salpetriere et Universite Pierre et Marie Curie-Paris 6, AP-HP, France.

Objective: To describe the spectrum, treatment, and outcome of cranial nerve disorders associated with immune checkpoint inhibitor (Cn-ICI).

Methods: This nationwide retrospective cohort study on Cn-ICI (2015-2019) was conducted using the database of the French Refence Center. In addition, a systematic review of the literature (MEDLINE, Scopus, and Web of Science) for records published between 2010 and 2019 was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the search terms cranial nerve or neuropathy or palsy and immune checkpoint inhibitors. Read More