Nerve Palsy In Children Research Articles

Ophthalmoplegia With Migraine in Adults: Is It Ophthalmoplegic Migraine?

Ophthalmoplegic migraine (OM) is a rare disorder characterized by recurrent oculomotor nerve palsy in children, following migraine headaches. We report 62 adults, seen consecutively, who developed acute ophthalmoplegia with severe attacks of migraine over a 10-year (1996-2005) period. An overwhelming majority of these patients had an antecedent worsening in severity of migraine headaches, before the ophthalmoplegic attack. Sixty-two patients, aged 15-68 years, with an acute attack of OM underwent detailed clinical, biochemical, and neuroradiological evaluation. There were 62 patients with 86 attacks of OM. Whereas 48 patients had a single attack, 14 had 2 or more attacks, fulfilling the International Headache Society criteria for probable and definite OM, respectively. At presentation, isolated abducens, oculomotor, and trochlear nerve involvements were seen in 35 (56.5%), 21 (33.9%), and 5 (8.1%) patients, respectively. One patient had simultaneous involvement of 3rd and 6th nerves. Fifty-one (82.3%) patients exhibited an antecedent worsening in severity of migraine, before developing ophthalmoplegia during (59/95.2%) or within 24 hours (3/4.8%) of a severe migraine attack, respectively. Detailed biochemistry and cranial neuroimaging were normal. No case had any nerve enhancement. Use of steroids hastened recovery (P < .05). We conclude: (1) OM in adults is characterized by single attacks of ophthalmoplegia in a great majority of patients; and (2) 6th nerve involvement occurs commonly. Our results indicate that moving OM to the chapter on cranial neuralgias in the second edition of the International Headache Classification may be premature, since nerve palsy occurred during a severe migraine attack in all patients.

Recurrent isolated sixth nerve palsy after consecutive annual influenza vaccinations in a child

Recurrent sixth nerve palsy in children in the absence of structural or other neurological abnormality is a rare occurrence. We report the case of recurrent isolated sixth (abducens) nerve palsy after consecutive annual influenza vaccinations in an otherwise-healthy 2-year-old boy. Investigations including magnetic resonance imaging of the brain and orbits after each episode failed to reveal any abnormality. The temporal relation to the immunizations supports but does not prove that the influenza immunization regimen was responsible.

Phrenic nerve palsy in children associated with confirmed intrathoracic tuberculosis: Diagnosis and clinical course

In this descriptive retrospective cases series of eight cases phrenic nerve palsy in children caused by tuberculosis lymph gland infiltration of the phrenic nerve. The lymph gland enlargement was in all cases caused by culture confirmed Mycobacterium tuberculosis. The phrenic nerve palsy was on the left side in all eight cases with the presenting feature a raised diaphragm on chest radiography that was accompanied by consolidation of the left upper lobe (88%) The diagnosis of phrenic nerve palsy was confirmed by fluoroscopy of the chest. On computer tomography the outstanding features were left sided hilar and paratracheal lymph gland enlargement with displacement of the mediastinum to the right. Mediastinal displacement lead to anterior displacement of the descending aorta, which further compressed the left main bronchus. Two children had accompanying respiratory failure requiring assisted ventilation and in two additional cases the airway compression was so severe that glandular enucleation of the enlarged glands was indicated. Of the eight children five remained symptomatic after completion of TB treatment to which steroids were added for the initial month. Diaphragmatic plication was indicated in all five cases. On clinical follow-up two children had repeated respiratory tract infections secondary to underlying lung damage while the other six remained asymptomatic.

Benign recurrent sixth (abducens) nerve palsies in children

Sixth nerve palsy can occur as a result of elevated intracranial pressure, neoplasm or trauma. Reports from tertiary centres indicate that between 5% and 16% of referred cases have no...

Congenital clubfoot with concomitant peroneal nerve palsy in children

We investigated the prognosis and clinical importance of concomitant peroneal nerve palsy in congenital clubfoot. Six children (6 feet) with concomitant peroneal nerve dysfunction treated by various means and with no other related syndrome or neuromuscular disorder were studied. Their clinical outcomes and their parents' satisfaction with the outcome were assessed. Patients' average age at initial diagnosis was 5.1 months (range, 2 weeks to 13 months). The average length of follow-up was 67.4 months (range, 1-11 years). Nerve conduction velocity tests and electromyography were performed in six patients; serial cast correction, followed by application of an orthosis and periodic observation, was followed in two patients; and additional surgical correction was done in four patients whose deformity was not corrected by casting and an orthosis. None of the six patients recovered from peroneal nerve palsy and their parents reported a low level of satisfaction with the outcome of the treatment. It is important to detect the rare combination of peroneal nerve palsy and clubfoot, and to explain the poor prognosis to patients' parents before treatment.

Sixth nerve palsies in children. Presentation of four cases

The etiology of the sixth nerve palsy in children includes multiple causes, being the acquired ones the most frequent. Due to the importance of the adequate management and possible implications of this pathology, four patients are presented for analysis and discussion.

Comparison of Facial Nerve Paralysis in Adults and Children

PurposeFacial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults.Materials and MethodsWe retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005.ResultsThe most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma.ConclusionThese results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different.

P162: Etiology and Outcome of Pediatric Facial Nerve Palsy

Objective: Characterize the demographics, etiologies, treatment and outcome of children presenting with facial paresis at two tertiary care pediatric hospitals. Study Design and Setting: Retrospective chart review. Children 0 18 years old admitted for facial nerve palsy between April 1989 and April 2005 were identified and pertinent information was recorded from their medical records. The facial palsy severity was scored using the House-Brackmann grading scale. Results: 280 cases of facial nerve paralysis were identified. Etiologies of facial nerve palsy were otologic infections (n = 56), congenital (n= 43), neoplasms (n=40), forceps use at birth (n=28), Bell’s palsy (n= 22), post-operative complication (n=16) and trauma (n=16). Other etiologies were found in the 59 remaining patients. Outcome varied between 100% complete recovery for forceps trauma cases to 23% complete recovery in postoperative complication cases. Conclusion: This represents the largest case series on facial nerve palsy in children. The etiologies of facial palsy in children are different from the ones reported in adults and are associated with a more favourable outcome. A better understanding of this condition and its various etiologies is necessary to obtain an accurate diagnosis and adjust the treatment accordingly. Results Summary of results by etiology

Arachnoid Cyst Resulting in Sixth Nerve Palsy in a Child

A 2 year old presented with incomitant esotropia and abduction deficit consistent with sixth nerve palsy. Neuroimaging revealed an arachnoid cyst on the left. Neurosurgical shunting followed by strabismus surgery relieved the abduction deficit and esotropia. An arachnoid cyst may be a rare cause of acquired sixth nerve palsy and strabismus in children.

Acute facial nerve palsy in children: How often is it Lyme borreliosis?

Acute facial nerve palsy in children may be caused by infection by Borrelia burgdorferi, but the incidence of facial nerve palsy and the proportion of facial nerve palsy caused by Lyme borreliosis may vary considerably between areas. Furthermore, it is not well known how often facial nerve palsy caused by Lyme borreliosis is associated with meningitis. In this population-based study, children admitted for acute facial nerve palsy to Stavanger University Hospital during 9 y from 1996 to 2004 were investigated by a standard protocol including a lumbar puncture. A total of 115 children with facial nerve palsy were included, giving an annual incidence of 21 per 100,000 children. 75 (65%) of these were diagnosed as Lyme borreliosis, with all cases occurring from May to November. Lymphocytic meningitis was present in all but 1 of the children with facial nerve palsy caused by Lyme borreliosis where a lumbar puncture was performed (n = 73). In this endemic area for Borrelia burgdorferi, acute facial nerve palsy in children was common. The majority of cases were caused by Lyme borreliosis, and nearly all of these were associated with lymphocytic meningitis.

Oculomotor nerve palsy in childhood

Background: The management of children with oculomotor nerve palsy is complicated by their variable presentation, amblyopia, potential loss of binocularity, and associated neurological disease. Our purpose was to evaluate the causes, neurological associations, treatment, and sensorimotor outcomes of a group of children who developed oculomotor nerve palsy Methods: We identified 18 children aged 14 years or younger, of whom 13 (72%) were less than 8 years old, through a retrospective record review of all children with oculomotor nerve palsy seen between January 1995 and January 2001 by one of the authors (C.J.L). Results: Congenital-onset oculomotor nerve palsy was the most frequent presentation, followed by traumatic, neoplastic, vascular, and migrainous or parainfectious etiologies. Pupil sparing was seen in I patient with neoplastic etiology. Primary aberrant regeneration was the presenting sign in a child with neurofibromatosis type 2. Amblyopia developed in 7 (39%) children and was successfully treated in 5 of the 7 (71%). Stereopsis was maintained in 6 (33%) children of whom 2 were within the amblyogenic age group. Six (33%) patients underwent strabismus surgery, and 3 of them (50%) achieved orthotropia and maintained stereopsis. Interpretation: Children with oculomotor nerve palsy require neuroimaging. Their pupillary signs, unlike those of adults, are not helpful in differentiating compressive etiologies from other causes. Good visual acuity was obtained in children within the amblyogenic age group with appropriate occlusion therapy. Stereopsis was uncommon in children who developed third nerve palsy during the amblyogenic period; preservation of stereopsis was dependent either on rapid and complete recovery, or on the child’s adoption of a compensatory head position.

Transient phrenic nerve palsy after cardiac operation in infants

Objective The aims of this study were to prove the presence of transient phrenic nerve palsy in children after cardiac surgery by successive recordings of diaphragmatic action potentials (DAPs), and to decide the indication of diaphragmatic plication in infants with postoperative phrenic nerve palsy. Methods The DAPs were recorded from 11 infants (age 0–54 months) under artificial ventilation after cardiac surgery. The successive DAP recordings were performed within 3–4 days (0W), 1 week (1W) and 2 weeks (2W) after operation to make a final decision for diaphragmatic plication to wean artificial ventilation. Results The patients were divided into 3 groups according to the DAP changes in successive recordings, namely, patients with normal DAPs at 0W, patients with transient depression of DAPs at 0W followed by recovery to normal DAPs by 1W and/or 2W, and patients with persistent depression of DAPs of the affected side necessitating plication of hemidiaphragm. Conclusions In infants with phrenic nerve palsy after cardiothoracic surgery, persistently abnormal DAPs in repeated electrophysiologic examinations for at least 2 weeks after surgery are a useful guidance to support clinical and radiological evidence for an indication of diaphragmatic plication.

260 Long-lasting polyneuropathy and psychiatric disorders in thallium poisoning. Study of six cases

Lyme neuroborreliosis is a frequent cause of facial nerve palsy in children, isolated oculomotor nerve palsy due to Borrelia-associated nervous system infection however is rarely seen. Here we report a case of isolated oculomotor nerve palsy due to a nervous system infection with Borrelia burgdorferi in childhood and restitutio in integrum after intravenous antibiotic therapy.

Isolated hypoglossal nerve palsy in a 14-year-old girl

Isolated hypoglossal nerve palsy is rare, but occasionally it appears as the initial or solitary sign of an intracranial or extracranial space-occupying lesion or a vascular abnormality of the internal carotid artery. We present a 14-year-old girl who, following an upper respiratory tract infection, presented with isolated right hypoglossal nerve palsy. Anti-streptolysin O titre was increased to >1280 suggesting a preceding streptococcal infection. Magnetic resonance imaging of the brain did not show any intracranial or extracranial abnormality. She had a partial improvement at 3 months. This case emphasizes the value of recognizing the existence of benign self-limiting, post-infectious causes of isolated hypoglossal nerve palsies in children.

小児の反回神経麻痺

Recurrent laryngeal nerve paralysis in children is a relatively rare disease. Its clinical features in children are considered dissimilar to those in adults. Here we present 11 cases of children with recurrent laryngeal nerve paralysis and discuss the manner of treatment for this disease. Clinical features compared and found to differ with those in adults are summarized as follows : 1) congenital paralysis is the most common cause, 2) bilateral paralysis is frequent, 3) congenital systemic abnormalities are frequently combined, 4) respiratory disorder is the most critical symptom especially in infants, 5) vocal cord movement ordinarily recovers in a few years especially in patients with congenital paralysis. Management strategies should be focused on the maintenance of a safe and stable airway and the acquisition of intelligible speech. Less traumatic laterofixation of the vocal cord by Ejnell's procedure is a preferable surgical treatment for prolonged respiratory disorder due to bilateral laryngeal paralysis.

Botulinum toxin for sixth nerve palsies in children with brain tumors

Purpose: Sixth nerve palsies in children with brain tumors have a low rate of spontaneous recovery. Botulinum toxin has been used to treat sixth nerve palsies. In this study, we review outcomes for children with brain tumors and sixth nerve palsies, some of whom were treated with botulinum toxin. Methods: To determine whether botulinum toxin effected the outcome of children with sixth nerve palsies and brain tumors, a retrospective review of charts was conducted for patients identified as having brain tumors and sixth nerve palsies after evaluation at the St Jude Children's Research Hospital Eye Clinic between 1992 and 1999. Of 48 charts identified, 19 met our inclusion criteria, having a record of brain tumor associated with sixth nerve palsy and 2 or more eye clinic visits at least 6 months apart. Children were considered recovered if they had an esotropia of less than 10 PD in primary gaze at the last follow-up visit and did not require surgical correction. Results: Of the 19 children included in the study, 10 were managed conservatively (no botulinum toxin or surgery for at least 6 months after diagnosis). Nine children received one or more botulinum toxin injections. Two (20%) of the 10 children in the conservatively managed group recovered without surgical intervention. Two (22%) of the 9 children in the botulinum toxin treatment group recovered without surgical intervention. Conclusions: Treatment with botulinum toxin did not improve the rate of recovery in our series of children with brain tumors and sixth nerve palsies. (J AAPOS 2001;5:21-5)

Parálisis oculomotora adquirida en el adolescente

Acquired oculomotor palsy in juvenile age are most commonly due to head trauma, tumors, migraine, vasculopathies and demyelinating diseases. We document three cases of paroxysmal oculomotor nerve palsy in childhood, illustrating the main clinical symptoms, neurological examination, MR images, diagnosis, treatment and evolution. Final diagnosis were: multiple sclerosis, pineoblastoma, and craniopharyngioma. Sudden oculomotor nerve palsy occurring in youth in the absence of head trauma, viral infection or migraine access, firmly suggests a serious intracranial disease, and neuroimage studies should be quickly obtained to have an early diagnosis.

Paralytic strabismus

In the last year, published works on paralytic strabismus have concerned many topics. New advances have been made in the knowledge of epidemiology of ocular nerve palsies in children, muscular causes of paralytic strabismus, and neuroimaging management of patients with third nerve palsy who are at risk of cerebral aneurysms. The author describes reports on rare associations of oculomotor imbalances and neurologic diseases as well as atypical orbital localizations of tumors. He also discuss new neuroimaging findings in congenital superior oblique muscle palsy and new acquisitions on cyclofusion deterioration in acquired trochlear palsy.

A Pediatric Case of Ophthalmoplegic Migraine with Recurrent Oculomotor Nerve Palsy

Purpose: A young patient of ophthalmoplegic migraine with recurrent oculomotor nerve palsy is reported. Case: A 4-year-old girl came to our hospital complaining of recurrent left ptosis and double vision which completely resolved within a few days. She had a history of drowsiness after vomiting every two months. Left oculomotor nerve palsy with internal ophthalmoplegia was observed. Electroencephalography revealed mild changes, but computed tomography, single photon emission computed tomography, and cerebrovascular Doppler-ultrasound examination demonstrated no abnormalities. This oculomotor nerve palsy completely improved on the next day. Results: Thereafter, left episodic mydriasis and oculomotor nerve palsy occurred twice each. However, the frequency and symptoms of migraine were remarkably reduced by topical administration of 0.25% timolol maleate twice daily to both eyes. Conclusion: In isolated oculomotor nerve palsy in childhood, ophthalmoplegic migraine should be also considered. We emphasize that a detailed case history is very important to its diagnosis.

Neuro-ophthalmology of eye-movement disorders.

Magnetic resonance and functional brain imaging continue to expand their roles in complementing the clinical examination to localize the causes of eye-movement disorders. A retrospective review from county-based clinical practices emphasized generally benign causes of third, fourth, and sixth cranial nerve palsies in children, but a study from a tertiary referral center found a high incidence of neoplasms causing sixth-nerve palsies in children. A prospective study found that 38% of diabetic patients with third-nerve palsies had anisocoria up to 2.5 mm. An initial attempt to develop an evidence-based practice pathway for the evaluation of ocular motor nerve palsies has been developed for isolated sixth-nerve palsies in adults. In an important study of Graves hyperthyroidism, treatment with radioactive iodine was more likely than methimazole therapy alone to be associated with the appearance or worsening of ophthalmopathy. The clinical worsening of eye findings could be prevented by concurrent administration of corticosteroids for 3 months. Smoking is still a major controllable risk factor for thyroid ophthalmopathy.