3rd Nerve Palsy Research Articles

Demographic Characteristics and Causes of Acquired Non-senile Ptosis: Experience at a Tertiary Oculoplastic Center

Purpose: To determine the demographic characteristics and causes of acquired, non-senile ptosis in patients presenting to an oculoplastic clinic of a tertiary care centre.
 Study Design: Observational case series.
 Place and Duration of Study: Lady Reading Hospital, from January 2016 to December 2017.
 Methods: Twenty eight patients were fulfilling the inclusion criteria were recruited in the study. Detailed history with complete examination and investigations like electromyography, acetylcholine receptor antibody test and CT/MRI brain were performed when required. Cause of each ptosis was determined and the relative proportions were calculated.
 Results: There were 28 cases with acquired, non-senile ptosis. Fifty seven percent were males while females were 42.9%. Patients were divided into four age groups. Most of the patients were in age group of 42–62 years. Eyelid/orbit tumor and Chronic progressive external ophthalmoplegia (CPEO) was seen in 3.6% and 7.1% patients of < 20 years of age respectively. Myasthenia gravis and thyroid related pseudoptosis was common in patients of 21-41 years. In patients with age 42-62 years, Pseudoptosis due to thyroid disorder was the commonest. In patients with age more than 63 years, 3rd nerve palsy, eyelid/orbital mass and Myasthenia gravis was seen. Third nerve palsy and Pseudoptosis secondary to thyroid and eyelid/orbit mass were more common in males while Myasthenia gravis was more common in females. CPEO was equally seen in both genders with p = 0.575.
 Conclusion: Thyroid related eyelid pseudoptosis of the contralateral eye was the commonest cause in this case series.
 Key Words: Blepharoptosis, Third nerve palsy, Myasthenia gravis.

A Case of Idiopathic Orbital Inflammation And Third Nerve Palsy: Interesting Case

Purpose: This case is a unique presentation of idiopathic orbital inflammation and 3rd nerve palsy (superior division involvement).

Modified Orbitozygomatic Approach for Resecting a Parasellar Tumor in a Single Institution

BackgroundModified orbitozygomatic craniotomy is characterized by simplicity and wide exposure. The purpose of the present study was to describe a modified orbitozygomatic approach without resecting the zygomatic arch for large parasellar tumor surgeries.MethodsBetween April 2016 and December 2019, seven patients with parasellar tumor underwent surgiest with a modified orbitozygomatic approach. Surgical procedures, clinical outcomes, and complications were analyzed.ResultsThis study included 3 meningiomas, 2 pituitary adenomas, 1 chondrosarcoma, and 1 schwannoma. Modified orbitozygomatic craniotomy provides a wider surgical freedom in the opticocarotid and prechiasmatic cistern than frontotemporal craniotomy without orbitotomy, Total, subtotal, and partial resections were achieved for 3, 2, and 2 patients, respectively. Reasons for partial resections were tight adhesion to the carotid artery and encasing of the carotid artery. Permanent morbidities developed in one patient with 3rd nerve palsy and one patient with hemiparesis.ConclusionModified orbitozygomatic approach can provide the shortest access to the interpeduncular cistern with a minimum brain retraction. Surgeons who experience surgical challenge during the conventional approach for parasellar tumor resection are recommended to learn the modified orbitozygomatic approach.

Nasopharyngeal B-cell lymphoma with pan-hypopituitarism and oculomotor nerve palsy: a case report and review of the literature

BackgroundPrimary nasopharyngeal lymphoma (NPL) is a very rare tumor of Waldeyer ring (WR) lymphoid tissue. It is challenging to differentiate lymphoma infiltration of pituitary from a pituitary adenoma, meningioma infiltration, and other sellar lesions to plan a suitable treatment strategy. We presented for the first time a unique case of NPL with an unusual presentation of oculomotor nerve palsy associated with pan-pituitary involvement in a diabetic patient.Case presentationA 64-year old diabetic woman with no previous history of malignancy presented with intermittent diplopia for about the last nine months. Severe headache, left eye ptosis and hypoglycemic episodes were added to her symptoms after a while. Further complaints include generalized weakness, loss of appetite, generalized musculoskeletal pain, and 6–7 kg weight loss within six months. Her family history was unremarkable. Physical examinations of eyes indicated left eye 3rd, 4th, and 6th nerve palsy. But, she was not anisocoric, and the pupillary reflexes were normal on both eyes. No lymphadenopathy, organomegaly and other abnormalities were found. Magnetic resonance imaging (MRI) showed a heterogeneous enhancement in the seller and suprasellar regions, enlargement of the stalk, parasellar dural enhancement and thickening of the sphenoid sinus without bone erosion. Also, both cavernous sinuses were infiltrated and both internal carotid arteries were encased by the neoplastic lesion. It suggested an infiltrative neoplastic lesion which compressed the cranial nerves. Pituitary hormone levels assessment indicated a pan-hypopituitarism. Following nasopharyngeal mucosal biopsy, the immunohistochemistry (IHC) findings revealed a low-grade non-Hodgkin’s B-cell lymphoma. Systemic workup, including cerebrospinal fluid (CSF) studies, bone marrow aspiration, chest and abdominopelvic high-resolution computed tomography (HRCT) indicated no other involvement by the lymphoma. After chemotherapy courses, central adrenal insufficiency, partial central diabetes incipidious (CDI) and central hypothyroidism have been resolved. To our best knowledge, we found 17 cases of NPL with cranial nerve palsy, 1 case of NPL with pan-hypopituitarism and no NPL case with both cranial nerve palsy and pituitary dysfunction.ConclusionsThe incidence of cranial neuropathy in patients with diabetes should not merely be attributed to diabetic neuropathy without further evaluation.

Misdiagnosis of Third Nerve Palsy.

This study identifies the diagnostic errors leading to misdiagnosis of 3rd nerve palsy and to aid clinicians in making this diagnosis. The objective of this article is to determine the incidence of misdiagnosis of 3rd cranial nerve palsy (3rd nerve palsy) among providers referring to a tertiary care neuro-ophthalmology clinic and to characterize diagnostic errors that led to an incorrect diagnosis. This was a retrospective clinic-based multicenter cross-sectional study of office encounters at 2 institutions from January 1, 2014, to January 1, 2017. All encounters with scheduling comments containing variations of "3rd nerve palsy" were reviewed. Patients with a documented referral diagnosis of new 3rd nerve palsy were included in the study. Examination findings, including extraocular movement examination, external lid examination, and pupil examination, were collected. The final diagnosis was determined by a neuro-ophthalmologist. The Diagnosis Error Evaluation and Research (DEER) taxonomy tool was used to categorize the causes of misdiagnosis. Seventy-eight patients referred were for a new diagnosis of 3rd nerve palsy. The main outcome measure was the type of diagnostic error that led to incorrect diagnoses using the DEER criteria as determined by 2 independent reviewers. Secondary outcomes were rates of misdiagnosis, misdiagnosis rate by referring specialty, and examination findings associated with incorrect diagnoses. Of 78 patients referred with a suspected diagnosis of 3rd nerve palsy, 21.8% were determined to have an alternate diagnosis. The most common error in misdiagnosed cases was failure to correctly interpret the physical examination. Ophthalmologists were the most common referring provider for 3rd nerve palsy, and optometrists had the highest overdiagnosis rate of 3rd nerve palsy. Misdiagnosis of 3rd nerve palsy was common. Performance and interpretation of the physical examination were the most common factors leading to misdiagnosis of 3rd nerve palsy.

Tendon elongation with bovine pericardium in strabismus surgery\u2014indications beyond Graves\u2019 orbitopathy

BackgroundFor some patients with complex ocular motility disorders, conventional strabismus surgery is insufficient. Surgery with tendon elongation allows correction of larger angles and maintains a sufficient arc of contact for rectus muscles. This study reports results for tendon elongation with bovine pericardium (Tutopatch®) in indications other than Graves’ orbitopathy in which it is already widely used.MethodsWe reviewed the records of all patients who underwent surgery with Tutopatch® in our institution. Angles of squint and head postures were analyzed preoperatively, on the first postoperative day, and in the long term (median 9 weeks after the operation). Patients with Graves’ orbitopathy were excluded.ResultsFrom 2011 to 2018, the procedures on 58 eyes of 54 patients (35 females, median age 35 years (3–75)) met the inclusion criteria. Horizontal rectus muscle surgery (53 eyes) was conducted on patients with residual strabismus (13), Duane’s retraction syndrome with eso- (type I: 16)/exodeviation (type II: 2, type III: 1), 6th (7)/3rd nerve palsy (7), Möbius syndrome (2), congenital fibrosis of the extraocular muscles type 3A (CFEOM3A, TUBB3 mutation) (4), and orbital apex syndrome (1). Vertical rectus muscle surgery (5 eyes) was conducted on patients with myasthenia (1), vertical tropia after orbital floor fracture (1), CFEOM1 (2), and Parry-Romberg syndrome (1). 42 eyes had prior eye muscle surgery (1–5 procedures, median 1). Out of 45 patients with postoperative long-term data, 43 showed an angle reduction. Fifty-one percent had an angle of 10Δ (prism diopter) or less, one had a significant over-effect, and 10 had revision surgery. For the heterogeneous group of residual eso- and exotropias, the median absolute horizontal angle was reduced from 35Δ (16 to 45Δ) to 9Δ (0 to 40Δ), for Duane’s retraction syndrome from 27.5Δ (9 to 40Δ) to 7Δ (0 to 40Δ), and for sixth and third nerve palsies from 43Δ (20 to 75Δ) to 18Δ (4 to 40Δ). For 3 patients with vertical rectus muscle surgery, the median absolute vertical angle was reduced from 30Δ (20 to 45Δ) to 4Δ (1 to 22Δ). The motility range was shifted in the direction contrary to the elongated muscle in all subgroups. A considerable reduction of the excursion into the field of action of the elongated muscle had to be registered.ConclusionsStrabismus surgery with bovine pericardium introduces new surgical options for complicated revisions and for rare and complex oculomotor dysfunctions. Yet, it has to be recognized that this type of surgery aiming at maximum effects, despite preservation or restitution of the arc of contact, leads to reduction of the excursion into the field of action of the elongated muscle. Furthermore, dose finding can be difficult depending on the underlying pathology and more than one intervention might be necessary for optimal results.

Satisfacción de la cirugía de estrabismo basada en la opinión de cirujanos expertos

PurposeTo assess the perception of strabismus surgeons in Spain regarding patient satisfaction after surgery, by analysing the types of strabismus with the most satisfied patients, as well as the causes of dissatisfaction. MethodsA survey was carried out among the members of the Spanish Strabology Society who were over 50 years of age, active in Spain, with more than 20 years of surgical experience, and whose main surgical activity was strabismus. The questionnaire consisted of 18 questions about the perception of patient satisfaction according to the type of strabismus, patient age, as well as the most frequent cause of dissatisfaction after surgery. ResultsThe questionnaires were completed by a total of 29 surgeons, with a mean of 31 years of surgical experience. The most frequent cause of perceived dissatisfaction was residual strabismus. No differences were found in the satisfaction index between children and adults. The surgery that was considered to produce greater satisfaction was endotropia, followed by decompensated 4th nerve palsy, and exotropia, while 3rd nerve palsy was the cause of the most dissatisfaction. ConclusionsAccording to strabismus surgeons, endotropia is the most satisfactory surgery for the patient, followed by exotropia, vertical strabismus, and traumatic paralysis of the 4th cranial nerve.

Parálisis oculomotoras en el contexto de una reactivación del virus varicela-zóster: a propósito de 4 casos

Varicella zoster virus (VZV) infection has a high prevalence worldwide. Within the multiple ophthalmologic manifestations that VZV can cause, sudden diplopia is among them. A review is presented of four clinical cases of 3rd and 4th oculomotor nerve palsies in herpes zoster ophthalmicus. A review is also presented of the physiopathology and most important clinical manifestations. Imaging tests are essential in order to rule out complications. Systemic antiviral administration is the correct treatment.

MON-262 A Case of the Suprasellar Atypical Teratoid Rhabdoid Tumor (ATRT) Presenting in an Adult Treated with Intrathecal Chemotherapy

Background: Atypical teratoid rhabdoid tumors (ATRTs) are highly malignant tumors that usually present as a posterior fossa mass in children less than 3 years old. Only 38 cases have been reported in adults. They are also typically located in the supratentorial region. In none of the reported cases of suprasellar ATRT in the adult, intrathecal chemotherapy (via ommaya) has been used. Clinical case: A 70-year-old woman presented with a severe headache and magnetic resonance imaging (MRI) revealed a suprasellar mass measuring 2.9 x 2.1 x 3.0 cm. Shortly after her presentation, she developed an acute 3rd nerve palsy, and repeat MRI found dramatic interval growth. A transsphenoidal approach for biopsy/resection was attempted, but the lesion was not accessible via this corridor. She then underwent a right frontotemporal craniotomy and subsequently developed panhypopituitarism, including diabetes insipidus. Pathology revealed poorly differentiated malignant cells. Immunohistochemistry was positive for synaptophysin, Epithelial Membrane Antigen (EMA), Tumor protein p53, and negative for integrase interactor 1 (INI-1 antibody) with loss of expression in tumor nuclei with positive internal control in endothelial cells. These findings confirmed the diagnosis of ATRT. The Ki-67 index was 60% consistent with a highly proliferative tumor. One month later, she developed acute mental status change. Repeat computed tomography, and MRI showed recurrence of the tumor at the same location with new leptomeningeal enhancement involving the left facial nerve. Multimodal treatment was instituted, consisting of intraventricular/intrathecal chemotherapy with etoposide and topotecan plus fractionated external beam cranial irradiation (30 Gy in 10 fractions). She continued to deteriorate, and following consultation with her family, she was transferred to hospice care and died six months following her initial surgery. Conclusion: This is the first case of adult suprasellar ATRT that has been treated with intrathecal chemotherapy. There is no consensus on the best combination of chemotherapy, and often the St. Jude’s protocol used in the treatment of pediatric ATRT is used. In line with the biological behavior reported for this tumor in children and adults in different locations, the tumor was very aggressive, resulting in the patient’s death only after 6 months from the diagnosis despite aggressive surgical and medical treatment. Reference: 1. Athale, U. H., J. Duckworth, I. Odame, and R. Barr. 2009. Childhood atypical teratoid rhabdoid tumor of the central nervous system: a meta‐analysis of observational studies. J. Pediatr. Hematol. Oncol. 31:651-663. 2. Shonka N, Armstrong T (2011) Atypical teratoid/rhabdoid tumors in adults: A case report and treatment-focused review. J Clin Med Res 3: 85-92.

An atypical presentation of giant cell arteritis without headache

We describe an unusual case of giant cell arteritis initially manifesting as insidiously progressive spastic quadriparesis, widespread muscle wasting and fasciculations in the absence of headache, followed by a complete left pupil-involving 3rd nerve palsy 10 months later. MRI and CSF analysis revealed evidence of intracranial involvement with established white matter lesions and intrathecal oligoclonal bands, respectively, whilst whole body FDG-PET demonstrated isolated uptake within the descending aorta. The temporal arteries were clinically and radiologically unremarkable but biopsy showed transmural inflammation and multinucleate giant cells. A rapid, complete and sustained improvement followed steroid therapy.

Central Nervous System Burkitt Lymphoma Presenting as Atypical Guillain-Barre Syndrome.

A previously healthy 25-year-old man presented with a 3-weeks history of frontal headache, right-sided ptosis and binocular horizontal diplopia. The diagnosis of right 3rd nerve palsy was made. Magnetic Resonance Imaging/angiography (MRI/A) of the brain was interpreted as normal. Two days later, right facial droop and weakness developed along with lower back pain, paresthesias of both legs and left leg weakness. On exam, he had bilateral upper lid ptosis, bilateral adduction deficits and areflexia of the left patella with bilaterally decreased ankle reflexes. It was concluded that he now has bilateral partial pupil-sparing left 3rd nerve palsies and right peripheral 7th nerve palsy.

3rd Nerve Palsy After Microsurgical Clipping of Basilar Top Aneurysm

Oculomotor nerve is the third cranial nerve that enters the orbit through the superior orbital fissure and controls muscles that drive most movements of the eye and raise the eyelid.

Dengue Encephalitis with Unilateral 3rd Nerve Palsy

Dengue Encephalitis with Unilateral 3rd Nerve Palsy

PB1763 CNS INVOLVEMENT AT PRESENTATION IN AML: A RETROSPECTIVE CASE SERIES

Background:Central nervous system involvement at present in Acute Myeloid Leukemia is uncommon. When it occurs, the course is less predictable and prognostication and therapy guidelines are less lucid than with acute lymphoblastic leukemia.Aims:To review the clinical profile, presentation, imaging findings, CSF positivity, management, and outcomes of AML patients with CNS involvement at the time of initial presentation.Methods:We retrospectively collected the clinicopathological profile, management and outcome data of AML patients with CNS involvement over the past 5 years at our Institute. Patients with CNS involvement by CSF positivity or direct CNS or spinal cord involvement were included. It is our policy to perform CNS evaluation at presentation in all Pediatric AML or with symptoms suggestive of CNS involvement e.g. paraparesis, seizures, proptosis.Patients with paraspinal masses causing cord compressions, intra cranial bleed, intraretinal bleed, CNS involvement at relapse, or possible CNS involvement but without either CSF or imaging confirmation were excluded.Results:Eight patients fulfilled our inclusion criteria. Of these 4 were adults and 4 were pediatric patients (<18 years age). Only 1 (12.5%) amongst these was a female. Cytogenetics were t(8:21), t(8:21) +8, t(8:21) +8 +19, AML with t(9:22) in 1 patient each with rest 50% patients having normal cytogenetics.CSF analysis was positive for malignant cells in 3 patients, not done in 1 (because patient was very sick) and negative in the rest. Imaging was not done in 2 patients who were CSF positive with no focal neurological deficits, and was normal in 1 patient with 3rd cranial nerve palsy. Leptomeningeal involvement was present in 2 patients, cavernous sinus and falx cerebri involvement in 1, paravertebral deposits and cord enhancement in 1, and paravertebral and infratemporal deposits in another.All patients were treated with 3+7 induction followed by HIDAC with IT therapy with each cycle and 2 patients received RT as well. Ph positive AML was taken up for transplant after 2nd induction with HIDAC and is currently undergoing the same. 1 patient was not given chemotherapy because she had severe fungal pneumonia and expired.Six out of the 7 treated patients showed near complete resolution of CNS symptoms/imaging findings after chemotherapy. 1 patient with paraplegia had persisting spinal cord lesions despite 2 induction chemotherapies, IT and RT. Four patients relapsed – one CNS relapse, two CNS and BM relapse and 1 patient had BM relapse in the background of persisting CNS disease. Currently only 3 patients are alive, one of whom is undergoing Allogenic HSCT.Summary/Conclusion:CNS involvement in AML is rare at presentation. Presentation can vary from asymptomatic CSF positivity, to isolated cranial nerve involvement to paraplegia and recurrent seizures. Screening and Management protocols are not clearly defined. NCCN recommends screening before first consolidation in patients with monocytic differentiation, Mixed phenotypic acute leukemia, WBC >40000at diagnosis, extra medullary disease or high risk APML. For major neurological signs imaging should be performed. If no signs or symptoms then CSF should be done. Treatment with standard AML chemotherapy with IT/RT seems to have short term effects only. Overall prognosis in this group of patients seems poor with a high rate of relapse and mortality. Larger studies are required to address relevant questions such as high risk patients who should be screened, indications of performing CSF analysis and imaging, and adequate management.image

SUN-596 A Rare Case of Metastatic Medullary Thyroid Carcinoma to Pituitary Gland

Background: Metastasis to the hypothalamus & pituitary gland account for 1-2% of sellar masses. Pituitary metastasis of medullary thyroid carcinoma (MTC) accounts for only 6 published cases in the literature. Imaging alone cannot diagnose metastasis & requires resection for histochemical identification. We describe a case of metastatic MTC presenting with 3rd nerve palsy & pituitary lesion. Case Presentation: 63 y.o. man with 1-month history of bilateral retro-orbital headache, diplopia & left eye ptosis presented to the hospital for second evaluation. He had history of MTC (5 x 3 x 2.5 cm), h/o thyroidectomy 5 years prior & known metastatic non-progressive lung lesions on CT. Medications included levothyroxine & citalopram. He had no personal or family history of MEN syndromes. 2 weeks prior he went to another hospital for same complaints. Initial MRI of head found a parasellar 1.6 cm mass extending to sella. Neurosurgery did not recommend intervention at that time. At our hospital, dedicated pituitary MRI this time showed a primary intrasellar lesion displacing normal pituitary gland, without bony erosion, favoring a pituitary macroadenoma with bilateral cavernous sinus invasion. No optic optic chiasm involvement was noted. Calcitonin level was 2582 pg/mL (1580 pg/mL 10 months ago), CEA 17.0 ng/mL [<3.0 ng/mL]. Hormonal workup did not indicate functional adenoma - instead showed partial hypopituitarism, with LH 1.0 mIU/mL [1.24-8.62 mIU/mL], FSH 2.90 mIU/mL, am free testosterone 7.9 pg/mL [35 - 155 pg/mL], total testosterone 522 ng/dL [250-1100 ng/dL], TSH 0.059 [ 0.28-3.89 uIU/mL], free T4 0.72 ng/dL [0.58-1.64 ng/dL], IGF-1 230 [41-279 ng/mL], am cortisol of 8.4 mcg/dL [6.7-22.7 mcg/dL]. Ophthalmology consult revealed CN III palsy with left ptosis, without visual field deficits, indicating mass compression of CN III. Due to persistent headache, 2nd neurosurgical opinion was sought & transphenoidal resection performed. Initial frozen section suggested pituitary adenoma. Gross pathology demonstrated calcitonin, chromogranin A & synaptophysin immunoreactive cells consistent with metastatic MTC. Post operative MRI demonstrated only small residual right sellar & cavernous component. Daily local conventional fractionated radiation was started with Rad/Onc. Tyrosine kinase inhibitor therapy will be considered after post-radiation MRI & genetic testing for RET mutations. Discussion: Our patient’s clinical presentation of severe headache & rapid onset of diplopia was not consistent with pituitary adenoma, and the MRI result was a confounder. Conclusion: Although pituitary metastasis is rare, it should be considered in the differential in the appropriate clinical context. For MTC, active surveillance with imaging and biochemical markers is critical for management. Doubling time of calcitonin <1 year and rising CEA levels should prompt suspicion for disease progression.

TP1-2 Treatment of dural and direct caroticocavernous fistulas via the transorbital approach

ObjectivesTo analyse the outcome of this novel approach in patients with Caroticocavernous fistulas (CCFs) and to compare it with the commonly used transvenous pathway.DesignRetrospective analysis of patients with CCFs treated using the transorbital approach.Subjects10 patients were identified following review of inpatient databases and collection of information for those treated offsite.MethodsAnalysis of Angiography findings and follow up imaging alongwith review of outcomes from patient records (Using TO approach, coils were used over liquid embolic due to risk of reflux of liquid from perforators).ResultsNo failure to puncture No orbital hematoma requiring drainage/canthotomy Occlusion rate 100% Commonest symptoms of eye pain and proptosis (all subjects) with chemosis, opthalmoplegia and reduced visual acuity (fairly common) in the patients studied improved significantly post the TO procedure with transient 3rd and 4th Nerve palsy being the only complication.ConclusionsTransorbital approcah (TO) is a safer, acceptable alternative to the catheter transveous approaches for CCFs (dural and direct) With greater numbers and experience, TO could be considered as a 1 st line approach.

Brainstem tuberculoma: A delayed IRIS

We describe a twenty six years old lady with tuberculous meningitis who developed new onset left ptosis and binocular diplopia with features of left fascicular 3rd nerve palsy after 9 months of anti tubercular therapy (ATT) and imaging revealed new onset tuberculoma in the mid-brain. Tuberculoma responded to steroids while continuing ATT. Formation of new tuberculoma as a part of immune reconstitution inflammatory syndrome (IRIS) is possible even after prolonged therapy of 9 months, which responded well to only steroids without altering ATT.

Outcome of medial sphenoidal wing meningioma surgery

Abstract Background: Sphenoid wing meningiomas among difficult surgery tumours due to involvement of important structures like optic nerve, cavernous sinus or carotid artery. Objective: to evaluate outcome and prognostic factors in patients with medial sphenoid wing meningiomas after microsurgery in a series of 47 patients with medial sphenoid wing meningioma. Method: This paper includes analysis of 47 patients &amp; their data who underwent surgical management for meningiomas involving the medial sphenoid wing in the period between Jan 2008 and February 2016 at Mansoura university hospital. Results: The most of patients were suffering from visual impairment (59.6%), followed by headaches (38.2%). Total tumor resection were achieved in 23 cases, incomplete in 19 cases and partial resection in 5 cases. Visual acuity improved or stable in 57.4% of the patients. Preoperative neurological deficit remains unchanged postoperative in 35 cases while improved in 4 cases. 8 cases developed permanent 3rd Nerve palsy. Tumor recurrence was in 7 patients. Conclusion: There are many factors influence the prognosis of inner sphenoid wing meningioma including the extent of surgical resection, cavernous sinus invasion, present or absent of peritumoral edema, vascularity of the tumor, size of the tumor, presence or absence of arachnoid plane between the tumor and surrounding neurovascular structures and preoperative neurological condition

A Case Report of Rare Acute Ischemic Stroke Due to Meningeal Irritation

Stroke is a rapidly developing symptom or sign of loss of cerebral function secondary to interruption of the blood supply due to a thrombus or hemorrhage. These diseased vessels are usually affected by well-recognized risk factors, but in some cases other rare conditions may be related to stroke development. Herein, we introduce one of these rare stroke conditions in a 37-year-old previously healthy male who presented to the emergency department with misleading symptoms and signs of reduced level of consciousness, isolated medical 3rd nerve palsy and possible drug overdose. A thorough neurological examination and investigation demonstrated a case of acute ischemic stroke as a consequence of meningeal irritation with an underlying inflammatory response. The patient was treated simultaneously for both conditions and responded dramatically with full recovery upon discharge. Thus, consideration of acute stroke in patients with no previous known risk factors is highly recommended especially with unusual neurological findings.

Men as victims of intimate partner violence - a case report

Intimate partner violence (IPV) is an important worldwide problem. Several studies on IPV found equivalent rates of assault perpetrated by men and women. The victim was a 30 years old three wheel driver, married with two children. He was assaulted by his wife with a club over the head and was admitted to the Teaching Hospital Karapitiya. A CT scan of the brain revealed a left parieto-occipital large extra dural haemorrhage (EDH), left parietal skull fracture with midline shift of 2cm and cerebral oedema. Left tempero-parietal craniotomy and evacuation of EDH was done. On examination, apart from the surgical incision, he had a sutured laceration 8cm in length over the left side of the head. Left sided 3rd cranial nerve palsy was also present. The idea of women being violent is a hard thing for many people to believe as it goes against the stereotype of the passive and helpless female. This, in spite of the fact that women are known to be more likely than men to commit child abuse and child murder. Findings of this case suggest that women use IPV against their male partners. Given the potentially serious physical and mental health consequences this can have, particularly for victims, research in this area needs to move beyond the argument over who perpetrates more IPV and who suffers more as a consequence of IPV.