Bilateral Abducens Nerve Paralysis Research Articles

Republication de : Central nystagmus and alterations in vestibular tests due to an inadvertent gentamicin administration into spinal space: A CARE case report

Gentamicin has a well-known potential for damaging the peripheral vestibular organs. However, it is considered to be innocuous to the CNS as it crosses the blood-brain barrier poorly. Here, we describe central neuro-otological abnormalities developed by a patient after deployment of gentamicin into his spinal space. A 61-year-old male unintentionally received gentamicin during spinal locoregional anesthesia for a urological procedure. During the first 48 hours the patient presented upper extremity dysmetria, dysarthria, and bilateral abducens nerve paralysis from which he recovered completely. He remained asymptomatic from day 3 to 10 after the incident. On day 11 he presented an acute vestibular syndrome. Severe bilateral vestibulopathy was confirmed by means of video head impulse testing. From day 14 onwards, he presented a persistent horizontal left-beating nystagmus, showing no variation or signs of compensation after 14 months, not responding to intensive vestibular rehabilitation or vestibular suppressant drugs. During follow-up, intercurrent gaze-evoked/direction-changing nystagmus has been recorded in various opportunities. We interpreted these findings as signs of both severe peripheral bilateral vestibulopathy and cerebellar and/or midbrain late-onset neurotoxicity, which can be explained by the intrinsic neurotoxic capability of high doses of gentamicin in the CNS.

Central nystagmus and alterations in vestibular tests due to an inadvertent gentamicin administration into spinal space: A CARE case report

IntroductionGentamicin has a well-known potential for damaging the peripheral vestibular organs. However, it is considered to be innocuous to the CNS as it crosses the blood-brain barrier poorly. Here, we describe central neuro-otological abnormalities developed by a patient after deployment of gentamicin into his spinal space. Case summaryA 61-year-old male unintentionally received gentamicin during spinal locoregional anesthesia for a urological procedure. During the first 48 hours the patient presented upper extremity dysmetria, dysarthria, and bilateral abducens nerve paralysis from which he recovered completely. He remained asymptomatic from day 3 to 10 after the incident. On day 11 he presented an acute vestibular syndrome. Severe bilateral vestibulopathy was confirmed by means of video head impulse testing. From day 14 onwards, he presented a persistent horizontal left-beating nystagmus, showing no variation or signs of compensation after 14 months, not responding to intensive vestibular rehabilitation or vestibular suppressant drugs. During follow-up, intercurrent gaze-evoked/direction-changing nystagmus has been recorded in various opportunities. DiscussionWe interpreted these findings as signs of both severe peripheral bilateral vestibulopathy and cerebellar and/or midbrain late-onset neurotoxicity, which can be explained by the intrinsic neurotoxic capability of high doses of gentamicin in the CNS.

Measuring the optic nerve sheath diameter by using ultrasonography in diagnosis and follow-up of pseudo-tumor cerebri: A case report

Introduction: The pseudo-tumor cerebri (PTC) is defined as the idiopathic or benign intracranial hypertension (IH), complaints of which cannot be explained in a different way. PTC is an exclusion diagnosis, in which the neuroophtalmopathology of IH cannot be determined. The patients with PTC may have complaints such as headache, nausea, vomiting, temporary blurred vision, and mild-level vision loss or unilateral or bilateral abducens nerve paralysis may develop. The radiological examination of patients yields normal results. In case that IH develops due to any reason, the enlargement is seen in optic nerve sheath diameter (ONSD) in the acute period. Case reports: 14 year-old patient, who has been diagnosed for PTC in our unit, optic nerve sheath diameter (ONSD) measurement and follow-up of pressure change of whom have been performed by using ultrasonography (USG) method, is presented in order to discuss the contribution of this non-invasive method to diagnosis, treatment, and observation processes. Conclusion: USG and ONSD measurement in PTC cases may be effective and reliable monitoring method as much as invasive methods.

Scedosporium apiospermum invasive sinusitis presenting as extradural abscess

IntroductionChronic invasive fungal rhinosinusitis (CIFR) is a rare entity generally observed in immunodepressed subjects. The pathogen most frequently identified is Aspergillus spp. Imaging generally reveals invasive pseudoneoplastic features. We report a case of Scedosporium apiospermum (S. apiospermum) CIFR with an atypical clinical and radiological presentation. Case reportA 72-year-old immunocompetent man presented with chronic headache, neck pain and bilateral limitation of lateral gaze. Imaging revealed an isolated left sphenoidal lesion with marked bone changes and an extradural abscess over the clivus. Large endoscopic sphenoidotomy with type II rhinopharyngectomy was performed and the diagnosis of S. apiospermum CIFR was based on histological examination and fungal culture. The patient refused all medical treatment and did not present any signs of recurrence after 1 year of follow-up. DiscussionS. apiospermum is a fungal species rarely isolated in CIFR. The present case was revealed by an atypical clinical presentation including isolated sphenoidal infection complicated by bilateral abducens nerve paralysis and extradural abscess. Imaging was also unusual, revealing features of fibrous dysplasia or bacterial osteomyelitis rather than the typical pseudoneoplastic appearance. The patient was successfully treated by surgery alone, which may therefore be sufficient treatment in immunocompetent subjects.

Primary fourth ventricular meningioma: case report and review of the literature

Primary fourth ventricle meningiomas are extremely rare, and they are defined as meningiomas arising from the choroid plexus and lying strictly within the fourth ventricle. In this report we present a 61-year-old man with progressive worsening vertigo and gait disturbance, and new onset of diplopia. Neurological examination revealed bilateral abducens nerve paralysis, horizontal nystagmus, and gait disturbance with truncal ataxia. Neuroimaging revealed a mass lesion in the fourth ventricle with brain stem compression, and obstructive hydrocephalus. The patient was operated in the prone position with suboccipital craniotomy and splitting the lower vermis. Total resection of the tumor was achieved with no intra- or post-operative complications. Histopathologic examination revealed fibroblastic type meningioma (WHO grade I).

Acquired isolated abducens nerve palsies: a retrospective study on etiology in an Iranian population

Objective: We investigated causes of abducens nerve paralysis, the side of the involvements, age, and sex distribution of causes. Background: Abducens nerve paralysis is the most common nerve palsy among ocular motor nerves, which have not been investigated in Iran yet. Material and Methods: This is a retrospective case-series study performed from April 1995 to April 2000. We investigated 50 patients who attended to the Neuro-ophthalmology Clinic in Farabi Eye Hospital and were diagnosed as acquired isolated unilateral or bilateral abducens nerve paralysis. Results: The most common causes were ischemia (44%), tumors (18%), idiopathic intracranial hypertension (14%), and multiple sclerosis (8%). The less common causes were trauma, undetermined, arteriovenous fistula, aneurysm, syphilis, and temporal arteritis. The paralysis was seen in 28 women (56%) and 22 men (44%). Seventy percent of patients were older than 40 years of age, and also peak incidence of abducens nerve paralysis was at the sixth decade of life. Conclusion: In contrast to earlier studies, in our study the most common cause of abducens nerve paralysis was ischemic cause and the undetermined cause was not a prominent cause of paralysis. Moreover, the age peak of abducens nerve paralysis was a decade earlier than a similar earlier study, which is probably due to high prevalence of diabetes mellitus as ischemic cause in our country.