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Weinert MC, Bal S, Heidary G, Gaier ED. Aberrant regeneration of accommodation in pediatric inferior division oculomotor palsy. J AAPOS 2024; 28:103917. [PMID: 38588860 PMCID: PMC11156551 DOI: 10.1016/j.jaapos.2024.103917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/05/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024]
Abstract
Aberrant regeneration occurs in forms of oculomotor motor nerve palsy and frequently involves the pupil, but the incidence and functional impact of ciliary muscle involvement in pediatric patients is sparsely reported in the literature. A 4-year-old girl presented with inflammatory oculomotor motor nerve paresis affecting the inferior division. Initial treatment focused on her inability to accommodate through her physiologic +2.5 D hyperopia and the prevention and treatment of amblyopia. She subsequently developed aberrant regeneration of the pupil, with miosis on adduction. Following eye muscle surgery for residual exotropia and hypertropia, her dry refraction was noted to be more myopic in the affected eye on adduction, mirroring aberrant pupillary constriction. Recognition of pediatric aberrant regeneration of accommodation may influence surgical planning for oculomotor nerve palsy and/or management of amblyopia.
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Affiliation(s)
| | - Sila Bal
- Department of Ophthalmology, University of Utah, Salt Lake City
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Eric D Gaier
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts.
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Shetty S, Aguiar M, Shah G, Mohan M, Vijayalakshmi P, Janani R. Surgical management of oculomotor nerve palsy: a comparison of lateral rectus deactivation combined with either medial rectus resection or medial rectus fixation to the medial palpebral ligament. J AAPOS 2024; 28:103871. [PMID: 38460596 DOI: 10.1016/j.jaapos.2024.103871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/03/2023] [Accepted: 12/14/2023] [Indexed: 03/11/2024]
Abstract
PURPOSE To analyze and compare the outcome of two different surgical procedures in patients with complete oculomotor nerve palsy with large-angle exotropia. METHODS The medical records of patients with total oculomotor nerve palsy and large-angle exotropia operated on at a single center from January 2006 to June 2020 were reviewed retrospectively. One group underwent lateral rectus deactivation with medial rectus resection (resection group); the other group underwent lateral rectus deactivation with medial rectus fixation to the medial palpebral ligament (fixation group). Surgical outcomes on the first postoperative day and at 6 months postoperatively were analyzed, including alignment and postoperative complications. All statistical analyses were performed using STATA version 14. A P value of <0.05 was considered significant. RESULTS A total of 35 patients were included. There was a trend toward greater surgical success in the fixation group (93%) than in the resection group (65%), but these results were not statistically significant. Postoperative exotropic drifts were noted in both the procedures but tended to be more with patients in the resection group. Postoperative complications were noted only in the fixation group. CONCLUSIONS Lateral rectus deactivation with medial rectus fixation to the medial palpebral ligament requires more time and greater surgical expertise but appears to better prevent postoperative exotropic drift compared with lateral rectus deactivation combined with medial rectus resection.
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Affiliation(s)
- Shashikant Shetty
- Department of Paediatric Ophthalmology and Adult Strabismus, Aravind Eye Hospital, Madurai, India.
| | - Marushka Aguiar
- Department of Paediatric Ophthalmology and Adult Strabismus, Aravind Eye Hospital, Madurai, India
| | - Gargi Shah
- Consultant Siddhant eye clinic, Mumbai, India
| | | | - P Vijayalakshmi
- Vision Rehabilation Centre, Aravind Eye Hospital, Madurai, India
| | - R Janani
- Department of Paediatric Ophthalmology and Adult Strabismus, Aravind Eye Hospital, Madurai, India
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Oke I, Lorenz B, Basiakos S, Gokyigit B, Laurent E, Tsai CB, Orge F, Heidary G, Tjeerd de Faber J, Jeddawi L, Sadiq MA, Strominger M, Dodd MMU, Shah AS, Dagi LR. Aberrant regeneration in an international registry of patients with 3rd-nerve palsy. Eur J Ophthalmol 2023; 33:2154-2161. [PMID: 37265190 DOI: 10.1177/11206721231161377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
BACKGROUND/AIMS To describe the patterns of pre-operative aberrant regeneration and motility outcomes reported in an international registry of patients with 3rd-nerve palsy treated with nasal transposition of the split lateral rectus muscle (NTSLR). METHODS This cross-sectional study used data from an international, multicentre registry of patients with 3rd-nerve palsy treated with NTSLR. Patients with aberrant regeneration were identified, and patterns of innervation described. Demographics and postoperative success defined as horizontal alignment ≤15 PD were compared based on the presence, and type, of aberrant regeneration using Wilcoxon rank sum and Fisher's exact tests. RESULTS Aberrant regeneration was reported in 16% (21/129) of patients. Age at diagnosis, sex, and aetiology of palsy were not significantly associated with aberrant regeneration. Abnormal movements were triggered by adduction in 52% (11/21), infraduction in 23% (5/21), and supraduction in 23% (5/21) of cases. Presentation patterns involved rectus muscle innervation in 29% (6/21) and levator muscle innervation in 71% (15/21) of cases. Although patients with aberrant regeneration had similar probability of success in comparison to those without following NTLSR (76% vs. 69%, p = 0.5), those with abnormal innervation of a rectus muscle had a lower success rate than those with abnormal innervation of the levator palpebrae superioris muscle (17% vs. 93%; p = 0.002). CONCLUSION Successful treatment of a 3rd nerve palsy with NTSLR was not influenced by aberrant regeneration involving the levator muscle. Alternative surgical interventions should be considered when aberrant regeneration alters rectus muscle function given its adverse impact on motor outcomes with NTSLR.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Birgit Lorenz
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen, Germany
| | - Sotirios Basiakos
- Department of Ophthalmology, Justus Liebig University Giessen, Universitaetsklinikum Giessen and Marburg GmbH, Giessen, Germany
| | - Birsen Gokyigit
- Pediatric Ophthalmology and Strabismus Department, Prof Dr N Reşat Belger Beyoglu Education and Research Eye Hospital, Istanbul, Turkey
| | - Erick Laurent
- Centre d'Ophtalmologie du Lez et Clinique St Jean, Montpellier, France
| | - Chong-Bin Tsai
- Department of Ophthalmology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Faruk Orge
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Laila Jeddawi
- Pediatric Ophthalmology Division, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Mohammad Ali Sadiq
- Institute of Ophthalmology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Mitchell Strominger
- Department of Ophthalmology, University of Nevada Reno School of Medicine, Renown Medical Center, Reno, NV, USA
| | - Mary-Magdalene Ugo Dodd
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Zhang KX, Varma H, Cao Y, Shah VS. Split-Tendon Medial Transposition of Lateral Rectus for Pediatric Complete Oculomotor Palsy. J Neuroophthalmol 2023; 43:254-260. [PMID: 36342135 PMCID: PMC10166200 DOI: 10.1097/wno.0000000000001731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Split-tendon medial transposition of lateral rectus (STMTLR) for complete oculomotor palsy can correct large angles of exotropia in adults, but outcomes are variable, and complications are frequent. Only a few pediatric cases have been reported, and further insight is needed to assess the child's alignment outcomes and ability for postsurgical gain of function. The aim of our study is to report the outcomes of this surgical procedure in pediatric cases of complete oculomotor palsy. METHODS A retrospective review of outcomes was conducted on 5 consecutive patients with complete oculomotor palsy treated with STMTLR by a single surgeon (V.S.S.) between 2015 and 2021 at tertiary referral centers. Primary outcome was postoperative horizontal alignment, and secondary outcome was demonstration of gain-of-function activity in the field of action of the paretic medial rectus muscle. RESULTS Five cases of pediatric complete oculomotor palsy underwent surgical treatment with STMTLR. Subjects averaged 5.3 years old (range 10 months-16 years). Two were female. Etiologies were heterogeneous, and all presented with unilateral (n = 2) or bilateral complete oculomotor palsy with exodeviations ranging from 45 to >120 prism diopters. Two subjects had bilateral disease secondary to military tuberculosis with CNS involvement. A third subject presented iatrogenically with complete bilateral third nerve palsies secondary to removal of a nongerminomatous germ cell tumor (NGGCT) of the pineal gland. The 2 remaining subjects had monocular involvement in their right eye, 1 from compressive neuropathy after a cavernoma midbrain hemorrhage, and 1 from a congenital right oculomotor palsy. All patients were observed to have stable ocular alignment for a period of at least 6 months before surgery. Unilateral STMTLR was performed in all cases except the subject with NGGCT, in which bilateral STMTLR was performed. Measurement of alignment permanence out to 1-3 years postop resulted in an average correction of 40.83 prism diopters (range 37.5-45 prism diopters) per operated eye. Four of 5 subjects regained limited but active adduction eye movements, and the 2 unilateral cases demonstrated improved convergence. None of the subjects experienced significant complications. CONCLUSIONS STMTLR was a safe and effective approach for the surgical correction of complete pediatric oculomotor palsy in our case series. In addition, pediatric patients may benefit from STMTLR with immediate gain-of-function activity in the transposed lateral rectus muscle, which supports the hypothesis that children have a dynamic and adaptive neuroplasticity of visual target selection that predominates established agonist/antagonist neural signaling.
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Khan QA, Adnan S, Ahmad N, Mumtaz H, Verma R, shahi A, Shahi A, Iram S, Baqi A. Idiopathic unilateral third nerve palsy with pupillary sparring in 10-year-old child -a case report. Ann Med Surg (Lond) 2022; 82:104723. [PMID: 36268400 PMCID: PMC9577865 DOI: 10.1016/j.amsu.2022.104723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance Aneurysm, diabetes mellitus, central nervous system (CNS) infections, pituitary tumors, and ischemia alterations are all potential causes of unilateral oculomotor nerve palsy, a common clinical disease. Case presentation A 10-year-old child presented with right eyelid ptosis and restricted eye movements associated with diplopia and pain in the right eye. Brain imaging and laboratory tests revealed no obstruction, infection, or hypercoagulable state. The condition was labeled as idiopathic. A patient was diagnosed with ptosis through a sling procedure and after 2 and 4 weeks of follow-up was told he had mild anemia. The patient was prescribed ferrous sulfate 8mg once daily for 4 months and his condition improved. Clinical discussion Surgery can correct the appearance of crossed eyes, but it seldom restores or significantly improves binocular function. Amblyopia and the loss of binocular vision can occur in children with third nerve palsy due to the excessive angle of incitant strabismus and the resulting ptosis. Conclusion Patients with idiopathic third nerve palsy must be informed of their prognosis so that they can make an informed decision about whether or not to undergo surgery. Clinical examination is the only way to identify a child's condition and proper investigations and a full history of prenatal and antenatal courses are required. Clinical examination is the only way to identify a child with idiopathic third nerve palsy. Proper investigations and a full history of prenatal and antenatal courses are required to exclude congenital and acquired reasons. Patients must be informed of their prognosis so that they can make an informed decision about whether or not to go through with the procedure.
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Falsaperla R, Presti S, Lo Bianco M, Catanzaro S, Marino S, Ruggieri M. Diagnostic controversies in recurrent painful ophthalmoplegic neuropathy: single case report with a systematic review. Ital J Pediatr 2022; 48:82. [PMID: 35659705 PMCID: PMC9164546 DOI: 10.1186/s13052-022-01274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Ophthalmoplegic migraine, renamed "Recurrent Painful Ophthalmoplegic Neuropathy" (RPON) in 2013 by the International Headache Society is a rare neurologic disorder characterized by recurrent attacks of ophthalmoplegia associated to ipsilateral headache. The etiology is still unknown. Typical magnetic resonance imaging findings show a focal nerve thickening and contrast enhancement. In the majority of cases, there is a full recovery within days or weeks. There is no evidence supporting a specific treatment. The review defines the characteristics of the recurrent painful ophthalmoplegic neuropathy in patients within 2 years of age underlying the importance of the role of magnetic resonance imaging even in presence of the first attack. Thus, an emblematic case report is presented. Case presentation The authors present a case of third cranial nerve paresis in a 17-month-old male child, presenting a neuroradiological pattern highly suggestive of schwannoma, aneurism or recurrent painful ophthalmoplegic neuropathy. Thus, a review of the literature with the pediatric casuistry of recurrent painful ophthalmoplegic neuropathy occurred within 2 years of age focusing on diagnostic considerations is presented. The authors highlight the importance to consider recurrent painful ophthalmoplegic neuropathy in presence of magnetic resonance imaging findings and clinical symptoms referable to aneurysm or schwannoma. Thus, the review defines the characteristics and the neuroradiological findings at the first RPON attack occurred under 2 years of age. Conclusion Although two attacks are necessary, the review strongly suggests to consider recurrent painful ophthalmoplegic neuropathy even at the first attack, in presence of described characteristics and the aforementioned magnetic resonance imaging findings.
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Affiliation(s)
- Raffaele Falsaperla
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy.,Unit of Neonatal Intensive Care and Neonatology, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy
| | - Santiago Presti
- Department of Clinical and Experimental Medicine, Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.
| | - Manuela Lo Bianco
- Department of Clinical and Experimental Medicine, Pediatrics Postgraduate Residency Program, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | | | - Silvia Marino
- Unit of Pediatrics and Pediatric Emergency, University Hospital "Policlinico Rodolico-San Marco", Catania, Italy
| | - Martino Ruggieri
- Department of Clinical and Experimental Medicine, Unit of Rare Diseases of the Nervous System in Childhood, Section of Paediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
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Wen Y, Shen T, Yan J. Larger Than Larger: Huge Amounts of Recession-Resection Surgery for Third Nerve Palsy. J Pediatr Ophthalmol Strabismus 2022; 60:184-194. [PMID: 35758195 DOI: 10.3928/01913913-20220428-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the characteristics and management outcomes of strabismus surgery in patients with third cranial nerve palsy and identify factors associated with long-term outcomes. METHODS A 10-year retrospective study of patients with third cranial nerve palsy who underwent strabismus surgery was performed at Zhongshan Ophthalmic Center, Sun Yat-sen University, China, between August 2010 and January 2021. Clinical characteristics and factors associated with long-term outcomes were evaluated. Success of surgery was defined as esotropia of 15 prism diopters (PD) or less at postoperative day 1 (POD1) or any deviation of 10 PD or less at postoperative month 2 (POM2) or later. RESULTS A total of 91 patients were included, with a mean age of 24.02 ± 15.38 years (range: 2 to 64 years). Forty-one patients (45.1%) were diagnosed as having complete palsy. Congenital palsy accounted for 40.7% (n = 37). Mean follow-up time was 2.50 ± 1.78 years (range: 8 months to 8 years). One-step surgery was performed in 78.0% of cases (n = 71), a staging procedure in 7.7% (n = 7), and reoperations in 14.3% (n = 13). Most patients had supra-maximal recession and resection of the horizontal rectus muscle with additional techniques, including horizontal rectus transposition, superior oblique transposition, traction sutures, and fixation of the globe. The mean surgical dosage performed on the horizontal rectus muscle was 18.52 ± 5.69 mm (range: 8 to 35 mm). Success rates at postoperative month 8 (POM8) were 69.0% (49 of 71) in the one-step surgery group, 57.1% (4 of 7) in the staging surgery group, and 46.2% (6 of 13) in the reoperation group. Preoperative horizontal deviation (odds ratio [OR]: 1.07, 95% CI: 1.02 to 1.13, P = .011), horizontal deviation at POD1 (OR: 0.86, 95% CI: 0.76 to 0.97, P = .016), and horizontal deviation at POM2 (OR: 1.53, 95% CI: 1.18 to 1.98, P = .001) were associated with the outcomes at POM8. Patients with partial palsy had a higher success rate than those with complete palsy (76.0% vs 51.2%, P = .014). CONCLUSIONS Supra-maximal recession and resection with additional techniques yields satisfying surgical results in patients with third nerve palsy when a larger surgical dose is performed for an initial overcorrection for 15 to 25 PD at POD1. The cases with complete palsy showing a larger deviation were prone to failure. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].
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Müther M, Bruns AK, Fortmann T, Brentrup A, Grenzebach U, Stummer W. Symptomatic Oculomotor Nerve Cyst in a 3-Year-Old Child: Case Report With Emphasis on Surgical Management. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Third nerve palsies in the pediatric population are most commonly caused by trauma, tumors, or vascular abnormalities. Cystic oculomotor nerve neuropathies, however, are rare. We report the case of a symptomatic cyst along and within the oculomotor nerve, which has not been described previously.
CLINICAL PRESENTATION
Here, we report a case of a 3-yr-old girl presenting with a progressive painless oculomotor nerve palsy. A magnetic resonance imaging revealed a cystic formation along the cisternal and cavernous course of the nerve. Due to lack of alternative treatment options, surgery was offered. Intraoperative direct nerve stimulation allowed for identification of a non-functional part of the cyst wall and open fenestration and biopsy were executed. Histopathology revealed neuritis. Serology was negative for various pathogens. The oculomotor palsy rapidly resolved. At a follow-up 5 yr after surgery, the girl is asymptomatic and the cisternal part of the cyst remains collapsed.
CONCLUSION
This is the first report of a symptomatic cyst along and within the oculomotor nerve treated effectively with open fenestration and decompression highlighting the importance of intraoperative neuromonitoring in cranial nerve surgery. Uncertainty remains regarding the etiology of this disease.
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Affiliation(s)
- Michael Müther
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Ann-Katrin Bruns
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Hospital, Hamm, Germany
| | - Angela Brentrup
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Ulrike Grenzebach
- Department of Ophthalmology, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
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Usta G, Karaca U, Keskinbora HK, Gonen T. Paralytic Strabismus in Turkish Children Examined at Three Tertiary Care Services: A Retrospective Cohort Study. J Pediatr Ophthalmol Strabismus 2021; 58:282-286. [PMID: 34180285 DOI: 10.3928/01913913-20210122-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the etiology and distribution of pediatric ocular motor nerve palsy manifesting as paralytic strabismus. METHODS The authors retrospectively examined the medical files of patients younger than 18 years who were suspected to have strabismus between January 1999 and June 2012 in three Turkish clinics and followed up for at least 6 months. Patients with paralytic strabismus were stratified according to age, sex, affected cranial nerve, and etiology (congenital, traumatic, neoplastic, post-viral, vascular, undetermined, or other), and compared the proportions between groups. RESULTS Paralytic strabismus was observed in 33 of 1,263 patients (2.6%), with a mean age of 5.9 ± 4.4 years (range: 6 months to 16 years). Seventeen patients (51.5%) were boys and 16 (48.5%) were girls. Twelve patients (36.4%) had congenital paralytic strabismus, and 21 patients (63.6%) had acquired strabismus. The most prevalent cause of acquired paralytic strabismus was trauma in 11 patients (52.4%), undetermined in 6 patients (28.6%), post-viral cranial nerve paralysis in 3 patients (14.3%), and a history of hydrocephalus in 1 patient (9.1%). The fourth cranial nerve was the most frequently affected (45.5% [15 of 33]), followed by the sixth (39.4% [13 of 33]) and the third (15.2% [5 of 33]). CONCLUSIONS Evaluating the incidence and etiology of paralytic strabismus in children in a clinical setting may improve disease management and reduce unnecessary invasive examinations. This study will assist clinicians in understanding the clinic-based distribution of pediatric paralytic strabismus. [J Pediatr Ophthalmol Strabismus. 2021;58(5):282-286.].
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Sudhakar P. Commentary: Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile. Indian J Ophthalmol 2021; 69:1148-1149. [PMID: 33913848 PMCID: PMC8186591 DOI: 10.4103/ijo.ijo_3437_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Padmaja Sudhakar
- Assistant Professor of Ophthalmology and Neurology, University of Kentucky, 740 S. Limestone, Lexington, KY, USA
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Chung SA, Han MR. Pupil-Involving Oculomotor Nerve Palsy Following Tonsillectomy and Adenoidectomy. J Pediatr Ophthalmol Strabismus 2019; 56:e76-e78. [PMID: 31821512 DOI: 10.3928/01913913-20190917-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/25/2019] [Indexed: 11/20/2022]
Abstract
Ocular complications of adenotonsillectomy are rare. The authors describe a 6-year-old boy who developed mydrasis and limitations of supraduction and infraduction after adenotonsillectomy. This was attributed to the hemorrhagic compression of the nerve in the cavernous sinus. This is the first report of pupil-involving oculomotor nerve palsy following adenotonsillectomy. [J Pediatr Ophthalmol Strabismus. 2019;56:e76-e78.].
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Merino P, Gutierrez C, de Liaño PG, Srur M. Long term outcomes of strabismus surgery for third nerve palsy. JOURNAL OF OPTOMETRY 2019; 12:186-191. [PMID: 30600170 PMCID: PMC6612019 DOI: 10.1016/j.optom.2018.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/10/2018] [Accepted: 10/27/2018] [Indexed: 06/09/2023]
Abstract
PURPOSE To report long-term outcomes of strabismus surgery for treatment of third nerve palsy. METHODS We performed a 15-year retrospective study of patients who had undergone surgery. We analyzed preoperative mean deviation (at 6 months, 1 year after surgery, and at the end of follow-up), type of surgery, and factors predicting outcomes. A final deviation <10 prism diopters (pd) was considered a good esthetic outcome, and no diplopia in the primary position at the end of follow-up was considered a good functional outcome. RESULTS Surgery was performed in 31 cases. Mean age was 36.27 years (women, 51.6%). Total and complete third nerve palsy was recorded in 22.6% and acquired palsy in 80.6%. Mean preoperative horizontal deviation (HD) in primary position was 40.24pd (near) and 44.29 (distance) and 14.33pd in vertical deviation (VD). Mean final HD was 8.94pd (near) and 11.35pd (distance), and mean final VD was 6.13. One surgery was performed in 68.9%. A favorable esthetic outcome was obtained in 64.5% and a successful functional outcome in 72.2%. Statistically significant differences were found between near HD (p=0.019) and distance HD (p=0.035) at 1 year compared with the end of follow-up and between VD at 6 months and 1 year after surgery (p=0.03). Mean follow-up was 6.05 years. No specific factors predicted a successful outcome. CONCLUSIONS Esthetic and functional results were similar. No predictors of successful outcome were identified. HD was better 1 year after surgery, and VD improved during follow-up.
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Affiliation(s)
- Pilar Merino
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain.
| | - Carlota Gutierrez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
| | - Pilar Gómez de Liaño
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
| | - Marcela Srur
- Hospital General Universitario Gregorio Marañón, Madrid, Spain; Ocular Motility Section, Department of Ophthalmology, Hospital Gregorio Marañón, Madrid, Spain
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Park KA, Oh SY, Min JH, Kim BJ, Kim Y. Acquired onset of third, fourth, and sixth cranial nerve palsies in children and adolescents. Eye (Lond) 2019; 33:965-973. [PMID: 30760897 DOI: 10.1038/s41433-019-0353-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 09/10/2018] [Accepted: 10/17/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To describe the causes of third, fourth, and sixth cranial nerve palsies in children and adolescents. METHODS In this retrospective case series, a total of 66 patients aged 0-19 years with third, fourth, and sixth cranial nerve palsies seen in strabismus and neuro-ophthalmic practice from 2010 to 2017 were included. Causes of palsies were determined based on clinical assessment, high-resolution magnetic resonance imaging (MRI), and laboratory work-up. RESULTS Thirty-five patients had sixth cranial nerve palsy, 14 patients had third cranial nerve palsy (7 partial, 7 complete), 13 patients had fourth cranial nerve palsy, and 4 patients had combined cranial nerve palsies in this study. Neoplasia involving central nervous system was one of the most common causes of third, fourth, and sixth cranial nerve palsies both in children (age: 0-14 years) and adolescents (age: 15-19 years) (20% and 31%, respectively). Overall, neoplasia (23%) was the most common cause of acute third, fourth, and sixth cranial nerve palsies, followed by idiopathic cause (14%), inflammation (11%), and non-aneurysmal vascular contact (11%). Neoplasia was also the most common cause of sixth and third cranial nerve palsies (25% and 29%, respectively). The most common cause of fourth cranial nerve palsy was late decompensation in congenital fourth cranial nerve palsy (46%). CONCLUSIONS A substantial proportion of pediatric and juvenile patients had serious pathologies for third, fourth, and sixth cranial nerve palsies. If nerve palsies are indicated, prompt diagnosis of etiologies using high-resolution MRI with contrast and laboratory work-up are important for this disease population.
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Affiliation(s)
- Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yikyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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14
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Incomitant Strabismus and Principles of Its Management. Strabismus 2019. [DOI: 10.1007/978-981-13-1126-0_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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16
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A cohort study on acute ocular motility disorders in pediatric emergency department. Ital J Pediatr 2018; 44:62. [PMID: 29843812 PMCID: PMC5975436 DOI: 10.1186/s13052-018-0502-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 05/21/2018] [Indexed: 12/02/2022] Open
Abstract
Background Acute ocular motility disorders (OMDs) in children admitted to Emergency Department (ED) represents a not so rare condition with a wide spectrum of different etiologies. The emergency physician must be skilled in rapidly identifying patients with potentially life threatening (LT) forms, requiring further diagnostic procedures. The aim of the study was to assess characteristics of children with acute Ocular Motility Disorders (OMDs), and to identify “red flags” for recognition of underlying life-threatening (LT) conditions. Methods A retrospective cohort study evaluated children (2 months-17 years) admitted to a tertiary Emergency Department in 2009–2014. A subgroup analysis was performed comparing children with and without LT conditions. Results Of 192 visits for OMDs, the isolated strabismus occurred most frequently (55.6%), followed by pupil disorders (31.8%), ptosis (5.2%) and combined OMDs (11.5%). The majority of acute OMDs involved no underlying LT conditions (n = 136) and most of them were infants or toddlers (50%). In a multivariable analysis, LT conditions included especially children over 6 years of age, increasing the odds ratio by 2% for each months of age (p = 0.009). LT etiologies were 16 times more likely in combined OMDs (p = 0.018), were over 13 times more likely to report associated extra-ocular signs/symptoms (p = 0.017) and over 50 times more likely to report co-morbidity (p = 0.017). Conclusion OMDs are not an uncommon presentation at ED. Although most of them involve non-LT conditions, the ED physician should consider potential “red flags” for appropriate management of children such as age > 6 years, combined OMDs, extra-ocular symptoms and co-morbidity.
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17
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Eom HD, Kwon YK, Son BJ, Chun BY. Periosteal Fixation Applied to Patients with Large-angle Paralytic Strabismus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.3.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hee Dong Eom
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
| | - Young Ki Kwon
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
| | - Byeong Jae Son
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
| | - Bo Young Chun
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Ophthalmology, Kyungpook National University Hospital, Daegu, Korea
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18
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Nasser O, Hertle RW, Purt B, Martin S. Transposition of Both Oblique Muscles Combined With Lateral Rectus Botulinum Toxin Injection and Globe Fixation Suture in the Treatment of Congenital Cranial Nerve III Palsy. J Pediatr Ophthalmol Strabismus 2017; 54:e13-e17. [PMID: 28453162 DOI: 10.3928/01913913-20170201-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 12/12/2016] [Indexed: 11/20/2022]
Abstract
The authors report a new technique to treat complete cranial nerve III palsy. A 15-year-old girl underwent botulinum toxin injection into the lateral rectus muscle, nasal transposition of both the superior and inferior oblique muscles to the medial rectus insertion, and absorbable suture globe fixation to the nasal orbital periosteum. Six months postoperatively, her primary position eye deviation was within 12 prism diopters of orthotropia with limitation of ductions in all directions. [J Pediatr Ophthalmol Strabismus. 2017;54:e13-e17].
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Cui V, Kouliev T. Isolated oculomotor nerve palsy resulting from acute traumatic tentorial subdural hematoma. Open Access Emerg Med 2016; 8:97-101. [PMID: 27843362 PMCID: PMC5098763 DOI: 10.2147/oaem.s117687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acute subdural hematoma (SDH) resulting from head trauma is a potentially life-threatening condition that requires expedient diagnosis and intervention to ensure optimal patient outcomes. Rapidly expanding or large hematomas, elevated intracranial pressure, and associated complications of brain herniation are associated with high mortality rates and poor recovery of neurological function. However, smaller bleeds (clot thickness <10 mm) or hematomas occurring in infrequent locations, such as the tentorium cerebelli, may be difficult to recognize and patients may present with unusual or subtle signs and symptoms, including isolated cranial nerve palsies. Knowledge of neuroanatomy supported by modern neuroimaging can greatly aid in recognition and diagnosis of such lesions. In this report, we present a case of isolated oculomotor nerve palsy resulting from compressive tentorial SDH following blunt head trauma, review the literature concerning similar cases, and make recommendations regarding the diagnosis of SDH in patients presenting with isolated cranial nerve palsies.
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Affiliation(s)
- Victoria Cui
- Washington University School of Medicine, St Louis, MO, USA
| | - Timur Kouliev
- Emergency Department, Beijing United Family Hospital, Beijing, China
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20
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Abstract
Visual disturbances resulting from acute nerve paralysis of the muscles controlling eye movements can be challenging to evaluate in the pediatric population. Children may not be capable of describing symptoms or providing an adequate history. Therefore, it is important to have an understanding of the anatomical course of the extraocular cranial nerves and clinical manifestations of their dysfunction. We report 2 cases of extraocular cranial nerve palsies and, in addition to an anatomical review, discuss the common etiologies of paralysis and the importance of ophthalmological and neurological follow-up to ensure optimal long-term visual function.
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21
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Wan MJ, VanderVeen DK. Eye disorders in newborn infants (excluding retinopathy of prematurity). Arch Dis Child Fetal Neonatal Ed 2015; 100:F264-9. [PMID: 25395469 DOI: 10.1136/archdischild-2014-306215] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/22/2014] [Indexed: 01/01/2023]
Abstract
A screening eye examination is an essential part of the newborn assessment. The detection of many ocular disorders in newborn infants can be achieved through careful observation of the infant's visual behaviour and the use of a direct ophthalmoscope to assess the ocular structures and check the red reflex. Early diagnosis and subspecialty referral can have a critical impact on the prognosis for many ocular conditions, including potentially blinding but treatable conditions such as congenital cataracts, life-threatening malignancies such as retinoblastoma and harbingers of disease elsewhere such as sporadic aniridia and its association with the development of Wilms tumour.
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Affiliation(s)
- Michael J Wan
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Deborah K VanderVeen
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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22
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Traumatic oculomotor nerve palsy. Arch Plast Surg 2015; 42:250-2. [PMID: 25798404 PMCID: PMC4366714 DOI: 10.5999/aps.2015.42.2.250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/08/2022] Open
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Bagheri A, Borhani M, Tavakoli M, Salehirad S. Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period. J Ophthalmic Vis Res 2015; 9:343-9. [PMID: 25667737 PMCID: PMC4307654 DOI: 10.4103/2008-322x.143375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 02/17/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose: To evaluate the demographics and management outcomes of strabismus surgery in patients with third cranial nerve palsy. Methods: This retrospective study includes subjects with third cranial nerve palsy. We evaluated age, sex, laterality, severity of involvement, etiology, frequency of clinical findings, and types and results of treatments. Results: 52 patients including 29 male and 23 female subjects with mean age of 21.1±15.5 years were studied between January 1999 and January 2009. Etiologies of third nerve palsy included congenital in 16 (30.8%), trauma in 26 (50%) and other causes in 10 (19.2%) patients. In 24 patients (46.2%), the palsy was complete. The most common type of strabismus was exotropia associated with hypotropia (40%). Medical treatment was used in 25 (48%) and surgical treatment in 46 (88.4%) subjects. One time strabismus surgery was performed in 30 (65.2%), 2 times in 11 (24%) and 3 times in 5 (10.8%) subjects. The most common operation was large horizontal recession and resection in 78.2% of cases. Mean horizontal deviation in primary position was 66±29 prism diopters (PD) before surgery decreasing to 21±19, 13±12 and 6±8 PD after first, second and third surgery, respectively. Corresponding figures for mean vertical deviation were 13±15, 7±12, 4±6 and 1±2 PD, respectively. Abnormal head posture was 10-30° in 11 (21.1%) cases before treatment which completely resolved after surgery. Conclusion: Surgical management of strabismus in patients with third nerve palsy is difficult and challenging, however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.
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Affiliation(s)
- Abbas Bagheri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Borhani
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Tavakoli
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahram Salehirad
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Cranial nerve palsies in childhood. Eye (Lond) 2015; 29:246-51. [PMID: 25572578 DOI: 10.1038/eye.2014.292] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/24/2014] [Indexed: 11/08/2022] Open
Abstract
We review ocular motor cranial nerve palsies in childhood and highlight many of the features that differentiate these from their occurrence in adulthood. The clinical characteristics of cranial nerve palsies in childhood are affected by the child's impressive ability to repair and regenerate after injury. Thus, aberrant regeneration is very common after congenital III palsy; Duane syndrome, the result of early repair after congenital VI palsy, is invariably associated with retraction of the globe in adduction related to the innervation of the lateral rectus by the III nerve causing co-contraction in adduction. Clinical features that may be of concern in adulthood may not be relevant in childhood; whereas the presence of mydriasis in III palsy suggests a compressive aetiology in adults, this is not the case in children. However, the frequency of associated CNS abnormalities in III palsy and the risk of tumour in VI palsy can be indications for early neuroimaging depending on presenting features elicited through a careful history and clinical examination. The latter should include the neighbouring cranial nerves. We discuss the impact of our evolving knowledge of congenital cranial dysinnervation syndromes on this field.
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25
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Apparent Inferior Rectus Palsy with Gaze-Dependent Sensory Adaptations. Optom Vis Sci 2014; 91:e140-4. [DOI: 10.1097/opx.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Inoue N, Watanabe H, Okamura K, Sakaki M, Kageji T, Nagahiro S, Kagami S. Atypical teratoid rhabdoid tumor in the cavernous sinus of a toddler presenting with oculomotor nerve palsy. Childs Nerv Syst 2014; 30:1463-6. [PMID: 24682530 PMCID: PMC4102773 DOI: 10.1007/s00381-014-2407-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Atypical teratoid rhabdoid tumor (ATRT) is a rare, highly malignant, and aggressive tumor of infancy. Although the prognosis of ATRT has been extremely poor, recently, the first prospective study for ATRT demonstrated improvement of prognosis. On the other hands, oculomotor nerve palsy is rare in children and the most frequent etiology is congenital. To our knowledge, only a few ATRT cases presenting with oculomotor nerve palsy have been reported, but ATRT originating from the cavernous sinus (CS) has not yet been reported. CASE REPORT An 18-month-old girl with right oculomotor nerve palsy was admitted, and a small mass in the right CS was detected with brain MRI. Although she received steroid pulse therapy and antimicrobial therapy, the mass continued to enlarge. One month after admission, the mass was partially resected and diagnosed as ATRT. Multimodal therapy including anthracycline-based chemotherapy, intrathecal therapy, and cranial irradiation was performed. Twenty-nine months after resection, she was alive without tumor relapse, but the oculomotor nerve palsy persisted. CONCLUSION This is the first reported case of ATRT located in the CS presenting with oculomotor nerve palsy. This case was successfully treated with partial removal of the tumor, a new chemotherapy regimen for ATRT and cranial X-ray irradiation.
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Affiliation(s)
- Nami Inoue
- Department of Pediatrics, The University of Tokushima Graduate School, Tokushima, Japan,
| | - Hiroyoshi Watanabe
- Department of Pediatrics, The University of Tokushima Graduate School, Tokushima, Japan
| | - Kazumi Okamura
- Department of Pediatrics, The University of Tokushima Graduate School, Tokushima, Japan
| | - Mika Sakaki
- Department of Pathology, The University of Tokushima Graduate School, Tokushima, Japan
| | - Teruyoshi Kageji
- Department of Neurosurgery, The University of Tokushima Graduate School, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, The University of Tokushima Graduate School, Tokushima, Japan
| | - Shoji Kagami
- Department of Pediatrics, The University of Tokushima Graduate School, Tokushima, Japan
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Abstract
PURPOSE OF REVIEW To provide clinically relevant information regarding the evaluation and current treatment options for oculomotor nerve palsies. We survey recent literature and provide some insights into these studies. RECENT FINDINGS Recent case reports highlight emerging new causes of oculomotor cranial nerve palsies, including sellar chordoma, odontogenic abscess, nonaneurysmal subarachnoid hemorrhage, polycythemia, sphenoiditis, neurobrucellosis, interpeduncular fossa lipoma, metastatic pancreatic cancer, leukemia, and lymphoma. Surgical studies have focused on modifications and innovations regarding strabismus surgery for this condition. New globe fixation procedures may include fixation to the medial orbital wall by precaruncular and retrocaruncular approaches, apically based orbital bone periosteal flap fixation and the suture/T-plate anchoring platform system. SUMMARY Management of oculomotor nerve palsy depends in part upon the underlying cause and anatomical location of the lesion. Careful clinical evaluation and appropriate imaging can identify a definitive cause in most cases. Surgical options depend on the number, extent, and severity of the muscles involved as well as the presence or absence of signs of aberrant regeneration. The clinician should also address issues that arise due to involvement of the pupil and accommodation. Strabismus surgery can be challenging but also rewarding with appropriate selection and staging of procedures.
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28
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Louis M, Goga D, François P, Laure B. [Ptosis secondary to cavernous sinus meningioma]. J Fr Ophtalmol 2013; 36:e197-200. [PMID: 23932584 DOI: 10.1016/j.jfo.2013.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/16/2013] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Meningiomas of the cavernous sinus are often the cause of neuro-ophthalmologic manifestations. Fifty percent of affected patients present with ptosis. We report a case of ptosis acquired during the first year of life due to oculomotor nerve palsy secondary to a cavernous sinus meningioma. We then discuss the causes of third cranial nerve palsy and treatment options for ptosis associated with CN III palsy. OBSERVATION A fifteen-year-old female patient presented with ptosis due to a third cranial nerve palsy appearing within the first year of life. Magnetic resonance imaging (MRI) revealed a cavernous sinus meningioma. The ptosis was treated by frontalis suspension using autologous temporalis fascia. The meningioma required regular follow-up. DISCUSSION Ptosis due to third cranial nerve palsy is rare in children. The most common etiologies are congenital and represent 33 to 40% of cases in various studies. Other etiologies are traumatic, tumoral, vascular and infectious. The cause needs to be found by imaging over the entire course of the nerve. Cavernous sinus meningioma is one cause of third cranial nerve palsy. The surgical treatment of ptosis due to third cranial nerve palsy is levator resection or frontalis suspension with a strip of fascia lata or temporalis fascia.
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Affiliation(s)
- M Louis
- Service de chirurgie maxillo-faciale et plastique de la face, CHU Trousseau, route de Loches, 37044 Tours cedex, France.
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29
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Abstract
We review the supranuclear control centers and pathways leading to individual cranial nerve nuclei in the brainstem. We discuss horizontal and vertical gaze and their abnormalities, and review the cranial nerves which subserve eye movements, III, IV, VI, including their clinical testing. We highlight the sites at which these nerves are clinically affected, which often result in characteristic associated features with neurological localizing value. Differential diagnoses of cranial nerve palsies including Duane and Möbius syndromes are also described. Lastly, we discuss the nature of childhood neuromuscular junction disorders such as myasthenia gravis, as well as disorders of the muscle itself (chronic progressive external ophthalmoplegia (CPEO), thyroid orbitopathy).
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Affiliation(s)
- Atchareeya Wiwatwongwana
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; Division of Pediatric Ophthalmology and Strabismus, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
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Olusanya B, Tinley C, Grotte R. Paralytic Strabismus in South African Black and Mixed Race Children – A 15-year Clinic-based Review. Ophthalmic Epidemiol 2012; 19:396-400. [DOI: 10.3109/09286586.2012.717675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tuli SY, Kelly M, Giordano B, Fillipps DJ, Tuli SS. Blepharoptosis: assessment and management. J Pediatr Health Care 2012; 26:149-54. [PMID: 22360934 DOI: 10.1016/j.pedhc.2011.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/02/2011] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Sanjeev Y Tuli
- Division of Ambulatory Pediatrics, Department of Pediatrics, University of Florida, Gainesville, FL, USA.
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Abstract
Oculomotor nerve palsy is a rare finding in children and, when reported, is most frequently either congenital or acquired from postnatal trauma, infection, aneurysm, or migraine. Intracranial lipomas also represent an uncommon finding in children, and although their development is not completely understood, they are now thought to be congenital in nature. Here, we describe the case of a 23-month-old boy presenting to the emergency department with left-sided, complete, pupil-involving oculomotor nerve palsy. On magnetic resonance imaging, he was found to have an intracranial lipoma of the left interpeduncular fossa. The patient had gradual and spontaneous improvement of symptoms, with complete resolution reported at the 4-month follow-up visit. However, a second magnetic resonance image at 6 months revealed that the lipoma did not change in size. To our knowledge, intracranial lipomas have been previously reported as a possible cause of partial oculomotor nerve palsy in only one adult and have never been reported in a child. In addition, we did not find any reports of intracranial lipomas as a cause of complete, pupil-involving oculomotor palsy, although they are known to cause other cranial nerve pathology. We conclude that intracranial lipomas, although rare, should be considered in the differential diagnosis for oculomotor nerve palsy in children. Further investigation is needed to determine the true incidence of this association.
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Neurobrucellosis developing unilateral oculomotor nerve paralysis. Am J Emerg Med 2012; 30:2085.e5-7. [PMID: 22244219 DOI: 10.1016/j.ajem.2011.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 12/02/2011] [Indexed: 11/22/2022] Open
Abstract
Brucellosis is a zoonotic infectious disease that is common around the world. Its clinical course demonstrates great diversity as it can affect all organs and systems. However, the central nervous system is rarely affected in the pediatric population. Neurobrucellosis is most frequently observed with meningitis and has numerous complications, including meningocephalitis, myelitis, cranial nerve paralyses, radiculopathy, and neuropathy. Neurobrucellosis affects the second, third, sixth, seventh, and eighth cranial nerves. Involvement of the oculomotor nerves is a very rare complication in neurobrucellosis although several adult cases have been reported. In this article, we present the case of a 9-year-old girl who developed unilateral nerve paralysis as a secondary complication of neurobrucellosis and recovered without sequel after treatment. This case is notable because it is a very rare, the first within the pediatric population. Our article emphasizes that neurobrucellosis should be considered among the distinguishing diagnoses in every case that is admitted for nerve paralysis in regions where Brucella infection is endemic.
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Turner SJ, Dexter MA, Smith JEH, Ouvrier R. Primary nerve repair following resection of a neurenteric cyst of the oculomotor nerve. J Neurosurg Pediatr 2012; 9:45-8. [PMID: 22208320 DOI: 10.3171/2011.10.peds10548] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Neurenteric cysts are rare congenital lesions of endodermal origin occurring in the spinal canal and infrequently in the posterior cranial fossa. The authors report the case of a 3-year-old child who presented with a recurrent third cranial nerve palsy. Magnetic resonance imaging showed a large cystic mass lesion in the ambient cistern on the right side, with compression of the anterolateral aspect of the brainstem. The patient underwent a craniotomy, complete excision, and a primary third cranial nerve repair. While there have been 3 reported cases of neurenteric cysts arising from the oculomotor nerve, this is the first documented case with a primary nerve repair.
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Affiliation(s)
- Scott J Turner
- Department of Neurosurgery, Westmead Hospital, New South Wales, Australia.
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35
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Abstract
Neurologists are frequently consulted because of a pupillary abnormality. An unequal size of the pupils, an unusual shape, white colored pupils, or a poorly reactive pupil are common reasons for referral. A directed history and careful observation of the iris and pupil movements can bear out ocular pathology such as congenital or structural anomalies as the cause of abnormal pupils. Thereafter, it is important to evaluate the neurologic causes of anisocoria and poor pupil function. The first part of this article emphasizes pupillary abnormalities frequently encountered in infants and children and discusses some of the more common acquired iris structural defects. The second part focuses on evaluation of lesions in the neural pathways that result in pupillary dysfunction, with particular attention to those conditions having neurologic, systemic, or visual implications.
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Affiliation(s)
- Pierre-François Kaeser
- University Ophthalmology Service, Hôpital Ophtalmique Jules Gonin, Avenue de France 15, Lausanne 1004, Switzerland
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36
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Liu GT, Volpe NJ, Galetta SL. Eye movement disorders. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cabrejas L, Hurtado-Ceña FJ, Tejedor J. Predictive factors of surgical outcome in oculomotor nerve palsy. J AAPOS 2009; 13:481-4. [PMID: 19840728 DOI: 10.1016/j.jaapos.2009.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2009] [Revised: 08/13/2009] [Accepted: 08/14/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the outcomes and predictive factors of surgical treatment of oculomotor nerve palsy. METHODS Records of patients requiring eye muscle surgery for oculomotor nerve palsy in our institution were retrospectively reviewed. Age, sex, etiology, deviation, completeness of involvement, time between onset and surgery, botulinum toxin treatment, and number of surgical procedures were recorded as potential predictive factors. Muscle function, presence of diplopia, and torticollis were also recorded. The main outcome measure was motor function. Secondary outcome measures were presence of diplopia, torticollis, and limitation of muscle function. RESULTS Surgery was required in 22 patients, of whom motor success was obtained in 14 (63.6%). Frequency of diplopia and torticollis were significantly reduced by surgery. After multivariate regression analysis, longer time between onset and surgery (p = 0.03) and larger initial deviation (p = 0.05) were significantly associated with poorer postsurgical results in terms of motor function. CONCLUSIONS Longer time from onset to surgery and larger eye deviation are negative prognostic factors of postsurgical motor success for oculomotor nerve palsy.
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Rose LVT, Elder JE. Management of congenital elevation deficiency due to congenital third nerve palsy and monocular elevation deficiency. Clin Exp Ophthalmol 2008; 35:840-6. [PMID: 18173413 DOI: 10.1111/j.1442-9071.2007.01613.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To document the presentation and management of congenital III nerve palsy and monocular elevation deficiency to single ophthalmologist over a 14-year period. Surgical management was reviewed and visual outcome was analysed. METHODS A retrospective study was conducted of all patients presenting during a period between 1992 and 2006 to the private practice of a paediatric ophthalmologist, with either congenital III or monocular elevation deficiency. For patients requiring surgical intervention pre- and post-surgical data were documented and analysed. RESULTS A total of 19 congenital III and 13 monocular elevation deficiency patients were identified. There were eight surgical patients in each congenital III nerve palsy group and in the monocular elevation deficiency group. The congenital III group had a preoperative mean exotropia for near of -36 prism dioptres (PD) compared with postoperative mean exotropia for near -16 PD. Preoperative mean hypotropia for near of -19 PD was improved to postoperative mean hypotropia of -5 PD. The monocular elevation deficiency group had preoperative mean esotropia for near of +6 PD compared with postoperative mean exotropia for near -5 PD. Preoperative mean hypotropia for near of -15 PD was improved to postoperative mean hypotropia of -7 PD. At last follow up both groups had a majority of mild or no amblyopia noted. CONCLUSION Superficially, congenital III and monocular elevation deficiency may appear similar, both frequently having ptosis and hypotropia as features. Careful clinical assessment of the horizontal alignment and the result of forced duction testing will usually allow them to be distinguished. Congenital III more frequently requires surgery for exotropia as well as surgery for hypotropia and monocular elevation deficiency more often requires surgery just for hypotropia. The ptosis surgery is similar for either diagnosis in this study. Significant cosmetic improvement, as well as excellent visual acuity outcomes can be achieved.
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Affiliation(s)
- Loreto V T Rose
- Department of Ophthalmology, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Abstract
PURPOSE OF REVIEW To provide clinically relevant information regarding the diagnosis, etiology, work-up and treatment of third cranial nerve palsies, while incorporating information from current publications and providing our opinions on these studies. RECENT FINDINGS In the past year, an important study focused on the confirmation of current neuro-imaging guidelines for third cranial nerve palsies. Recent case reports have highlighted etiologies such as giant cell arteritis, trauma, neuro-syphilis and demyelination secondary to infliximab and multiple sclerosis. Surgically, newer studies have focused on globe-tethering procedures for correcting strabismus and the use of frontalis suspension for correcting ptosis. Improved imaging technology with high-resolution magnetic resonance imaging (hr-MRI) allows for direct visualization of the entire nerve path and the affected muscles. SUMMARY Management of a third nerve palsy depends upon localization of the causative lesion and determination of the underlying etiology. Once these issues are addressed, strabismus surgery can be both challenging and rewarding in these complex patients.
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Affiliation(s)
- Tammy Yanovitch
- Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina 27710, USA
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Salman MS, Froese N, Shuckett P, Wrogemann J, Eisenstat DD. Claude syndrome 'plus' in an adolescent. Can J Neurol Sci 2006; 33:430-2. [PMID: 17168175 DOI: 10.1017/s031716710000545x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Werner M, Bhatti MT, Vaishnav H, Pincus DW, Eskin T, Yachnis AT. Isolated anisocoria from an endodermal cyst of the third cranial nerve mimicking an Adie's tonic pupil. J Pediatr Ophthalmol Strabismus 2005; 42:176-9. [PMID: 15977871 DOI: 10.3928/01913913-20050501-06] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present only the second reported case in the literature of a neuroenteric cyst involving the third cranial nerve. Our case is highlighted by the initial presentation of an isolated anisocoria, initially believed to represent an Adie's tonic pupil as interpreted by pharmacologic testing. False-positive results may occur with the dilute pilocarpine test.
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Affiliation(s)
- Mark Werner
- Department of Ophthalmology, University of Florida College of Medicine, Box 100284 JHMHSC, Gainesville, FL 32610-0284, USA
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Velez FG, Thacker N, Britt MT, Alcorn D, Foster RS, Rosenbaum AL. Rectus muscle orbital wall fixation: a reversible profound weakening procedure. J AAPOS 2004; 8:473-80. [PMID: 15492742 DOI: 10.1016/j.jaapos.2004.06.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Surgical treatment of third nerve palsy, sensory exotropia and strabismus secondary to anomalous innervation of the rectus muscles, frequently require large rectus muscle recessions in an attempt to maintain alignment in the primary position and reduce the effects of misinnervation. The aim of this study was to describe and evaluate the results of inactivation of a rectus muscle by its attachment to the adjacent orbital wall. METHODS Seven subjects diagnosed with third-nerve palsy (three cases), Duane syndrome (two cases), sensory exotropia (one case), and congenital aberrant innervation of vertical rectus muscles (one case) underwent rectus muscle inactivation by orbital wall fixation. The rectus muscle was disinserted from the globe and reattached to the adjacent orbital periosteum using non-absorbable sutures. This surgery was performed on the lateral rectus muscle in six subjects, and surgery was performed on both ipsilateral vertical rectus muscles in one. RESULTS Postoperatively four of six patients were aligned within 12 prism diopters of orthotropia in primary position. All patients had improvement of the anomalous head posture. In Duane syndrome, lateral rectus inactivation markedly reduced co-contraction and globe retraction. No overcorrections resulted. CONCLUSION A rectus muscle may be functionally inactivated when its insertion is attached to the orbital periosteum. Advantages of this procedure over extirpation and free tenotomy include permanent disinsertion of the muscle from globe and reversibility.
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Lee AG, Hayman LA, Brazis PW. The evaluation of isolated third nerve palsy revisited: an update on the evolving role of magnetic resonance, computed tomography, and catheter angiography. Surv Ophthalmol 2002; 47:137-57. [PMID: 11918895 DOI: 10.1016/s0039-6257(01)00303-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The evaluation and management of the neurologically isolated third nerve palsy continues to evolve. The major concern for the clinician confronted with a patient with a third nerve palsy has been the exclusion of an intracranial aneurysm. The evolution of new imaging techniques, such as computed tomography angiography and magnetic resonance angiography, have provided new imaging options for clinicians. This article reviews the pertinent recent literature on the use of these imaging studies in evaluating the patient with a third nerve palsy.
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Affiliation(s)
- Andrew G Lee
- Department of Ophthalmology, The University of Iowa Hospital, Iowa City, IA 52242, USA
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Abstract
Strabismus surgery may restore limited binocular function and improve cosmesis in patients with paralytic strabismus. Evaluation of the amount of residual function of the affected extraocular muscles is essential to determine which surgical procedure will yield the best results. Standard muscle resection techniques are effective for patients who have paretic extraocular muscles with residual function. Muscle transposition procedures are indicated for patients with total paralysis of an extraocular muscle. Autogenous and alloplastic materials may be required to fix the eye in primary position in patients with total paralysis of multiple extraocular muscles. This article discusses the recent literature regarding the evaluation and management of patients with paralytic strabismus. Current concepts regarding extraocular muscle transposition and the use of autogenous materials are emphasized.
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Affiliation(s)
- P H Phillips
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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