Nerve Palsy In Children Research Articles

Peripheral facial nerve palsy in children in a Borrelia high-endemic area, a retrospective follow-up study.

To identify the incidence, aetiology and prognosis of acute peripheral facial nerve palsy (FNP) in children in the Borrelia high-endemic region of Stockholm. The present study identified children from 0 to 18years of age who visited a paediatric emergency department for acute peripheral FNP during a 1-year period from 2014 to 2015. Data were collected retrospectively. The Sunnybrook and House-Brackmann facial grading systems were used to measure clinical outcome. A total of 77 children were identified with FNP, an estimated incidence of 30 per 100000 children/year. Forty-five children (58%) were diagnosed with neuroborreliosis, 28 (36%) with idiopathic FNP and four (6%) with other rarer causes. Neuroborreliosis was common from June to November and mainly seen in children below 10years of age. Six patients (8%) had remaining symptoms at least 3months after onset; three had idiopathic facial palsy (IFP) and were all older than 10years, one had neuroborreliosis and two had other causes. Neuroborreliosis and IFP were the major causes of FNP during the study period. Neuroborreliosis-associated facial palsy had a seasonal variation and dominated in younger ages.

Benign abducens nerve palsy: diagnosis by exclusion

Of all the cranial nerves, the abducens nerve has the longest intracranial course hence is most common cranial nerve to be affected secondary to any potentially devastating intracranial cause. It can indicate significant underlying pathology. Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. Most of the time it will be unilateral but bilateral involvement is also well known. It can recurrent without any underlying identifiable pathology. The 6th nerve palsy is considered as benign after ruling out all possible causes. Benign causes account for just 9 to 14% of all 6th nerve palsies in children. Most of the time benign 6th nerve palsy occurs after viral infection or vaccination as an immunological reaction. In our case patient had history of pentavalent vaccination 1 month back. After thorough investigation and ruling out all possible causes it was attributed to post vaccination immunological reaction. which resolved spontaneously over 4months.

Acquired onset of third, fourth, and sixth cranial nerve palsies in children and adolescents.

To describe the causes of third, fourth, and sixth cranial nerve palsies in children and adolescents. 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. 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, and4 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%). 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.

The implementation of laser biostimulation at the early treatment stage of facial nerve palsy in children

Introduction: Peripheral-type facial nerve palsy (FNP) is called "Bell's paralysis". This is the most common type of damage to the facial nerve among children. Treatment includes the use of various types of pharmacologically assisted physical treatments. Study aim: The aim of the study is to evaluate the effectiveness of laser biostimulation in the treatment of peripheral FNP as well as the speed and sequence at which the disease symptoms subside. In addition, the relationship between the progress in physiotherapy and the patient's age were determined. Material and methods: The study included 50 patients (27 girls and 23 boys) aged 6 to 18 with FNP symptoms. Left-sided paralysis was noted in 22 of them, and right-sided in 28. All of the subjects included in the study were divided into two equal groups. In group A, treat-ment with the use of magnetic fields and electrostimulation was applied, while in group B, laser biostimulation was additionally applied. The speed and sequence of regression of symp-toms and the recovery of muscular strength were assessed. Results: In group A, in 17 of the treated children, symptoms subsided after 3 weeks. In group B, symptom relief occurred in 18 of them after 2 weeks. Due to one of the symptoms main-taining, although the symptom was not intense, 8 patients from group B continued ambulatory treatment, while 14 continued from group A. Conclusions: The early application of laser biostimulation in FNP patients leads to the rapid regression of symptoms and shortens the time of hospital treatment. Not fully shutting the eye and Bell’s symptoms were the quickest to subside. The age of the child with FNP does not affect the duration of treatment.

Pupillary and Accommodative Disorders After Idiopathic Oculomotor Nerve Palsy in Childhood: A Case Report

Pupillary and Accommodative Disorders After Idiopathic Oculomotor Nerve Palsy in Childhood: A Case Report

Treatment for supracondylar fracture of humerus with nerve palsy in children

Treatment for supracondylar fracture of humerus with nerve palsy in children

Facial nerve palsy in children: A retrospective study of 124 cases.

To report the causes and clinical evaluation of children with facial nerve palsy (FNP) admitted to an affiliated university hospital during a 5-year period (2011-2015). A total of 124 children were retrospectively categorised into two groups: idiopathic Bell's palsy (109 patients) and the second group into other FNP aetiologies (15 patients). All children received a standardised work-up and follow-up. Therapy consisted of steroid administration associated with antiviral treatment when a viral infection was suspected. All children of the first group had a full recovery under oral steroids within 2 months of treatment. From the second group, seven children (46%) had a viral infection based on serological findings, two of them were positive for neurotropic herpes viruses, and one had Ramsay Hunt syndrome; six children with infectious FNP had recurrent FNP on the ipsilateral or contralateral side. Five patients had FNP as a complication of acute otitis media; three of them (60%) had partial or full recovery postoperatively. One child developed FNP following temporal bone trauma that had an uneventful recovery with conservative treatment. One child suffered from Melkersson-Rosenthal syndrome, and another child presented with FNP associated with unilateral hemiparesis following an ischaemic cerebral infarct. Facial palsy in children is a manifestation of a heterogeneous group of causes. The most common aetiology of FNP in children in our study was idiopathic (Bell's palsy), followed by infective causes, such as acute otitis media and neurotropic herpes viruses. Therefore, treatment should be adapted to each patient depending on the underlying disease and severity of FNP.

Familial Bell's palsy: A case report

The etiology of Bell's palsy (BP) is still not defined. Familial inheritance has been found in 4–14% of cases. We describe a case of one such family affected by BP and review the current literature concerning hereditary influences. The patient case history, clinical examination and detailed family history provided by the patient. We report the case of a ten-month-old female presented with acute onset of right-sided facial muscle weakness. BP is rare in children under the age of two years. Further questioning revealed she was one of seven members with a history of BP. One of those was another children (seven-months-old) affected by BP ( Fig. 1 ). The manifestation is slightly greater in females at a 1.5 to 1 ratio. There are some described causes of facial nerve palsy in children, as it can be congenital or acquired. The literature showed the association between HLA and BP. It was postulated that familial facial palsy is an autoimmune disease with genetic predisposition, suggesting autosomal dominant inheritance with low penetrance or variable penetrance. One study of 92 patients with BP found a significant decrease in the HLA class 2 DR antigen and severely decreased levels of CD3/CD4 T cells, suggesting that it may exist resistance HLA-DR gene. Furthermore, it is described in literature that a structural abnormality of the dimension of facial canal is the most common cause of the familial facial palsy. There are few cases described about familial facial palsy in the literature. It's uncommon BP in children under two years. The familial clustering of BP is not an incidental happening, the number of related cases suggests the familial influence component. Familial facial palsy is an autoimmune disease with an HLA genetic association or anatomical abnormality of the facial canal.

Isolated Ocular Motor Nerve Palsies

ABSTRACTIsolated cranial nerve (CN) palsies are frequently encountered by strabismologists. Management decisions for patients with isolated ocular motor nerve palsies must take into account multiple factors, including patient age, historical features, the specific CN affected, examination findings, and coexistent medical diagnoses. In general, isolated ocular motor nerve palsies in children are assessed and managed differently than adults. Furthermore, older adults with vascular risk factors may be managed differently than younger adults and children. The need for urgent neuroimaging in older adults with microvascular risk factors is under debate and requires the physician to weigh the risks and benefits of close observation with immediate testing. The presence of multiple cranial neuropathies should also raise the level of concern and indicate the need for a more urgent work-up. The following manuscript aims to provide information on common etiologies of isolated ocular motor nerve palsies and to suggest algorithms for the management of these CN palsies in children and adult.

Bell's palsy in an adolescent girl - not always a neurologist's territory: A case report and review of literature

Infections, inflammatory, and autoimmune conditions are the well-recognized etiologies of acute facial nerve paralysis in children. Bell's palsy is idiopathic peripheral facial nerve palsy. Cranial neuropathies do occur in children due to the central nervous system involvement by malignancies but uncommon in pediatric acute lymphoblastic leukemias and even rarer in acute myeloid leukemias (AMLs). We report a case of a 13-year-old girl who presented with acute facial nerve palsy, was being treated as Bell's palsy elsewhere and was later diagnosed to have AML.

Management of facial nerve paralysis in children

Management of facial nerve paralysis in children

Pediatric Cranial Nerve Palsies

The diagnostic evaluation and treatment of children with cranial nerve palsies is markedly different from that of adults. Genetic, traumatic, inflammatory, and compressive etiologies are common. Unlike adults, vascular etiologies are rare. Treatment entails addressing factors such as amblyopia and fusion. This manuscript will outline the etiologies, diagnostic work-up, and treatment of cranial nerve palsies in children.

Acute isolated partial oculomotor nerve palsy due to Lyme neuroborreliosis in a 5 year old girl

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.

Clinical Characteristics and Prognosis of Facial Nerve Palsy in Children

Clinical Characteristics and Prognosis of Facial Nerve Palsy in Children

Pediatric Ramsay Hunt syndrome: A rare clinical entity

Ramsay Hunt syndrome is a rare cause of facial nerve paralysis in children, caused due to reactivation of latent Varicella–Zoster virus within the geniculate ganglion. In addition to the facial nerve, Ramsay Hunt syndrome may also affect the vestibulocochlear nerve leading to inner ear dysfunction and in severe case may also involve other cranial nerves. We report a case of Ramsay Hunt syndrome in a 15-year-old child.

Surgical management of third nerve palsy

Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell's phenomenon, superior oblique (SO) overaction, and lateral rectus (LR) contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%), trauma (20%), inflammation (13%), aneurysm (7%), and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension), aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles.

Combined VIth and VIIth nerve palsy: Consider idiopathic intracranial hypertension!

Idiopathic intracranial hypertension (IIH) is a rare condition in children. VIth nerve palsy is the most common cranial nerve deficit related to that condition. Other cranial nerve dysfunctions have also been described but remain rare in paediatric daily practice. We here report the case of a 13-year-old girl who presented with VIth and contralateral VIIth nerve palsy due to IIH. Although rarely encountered, paediatricians should be familiar with the possible association of VIth and contralateral VIIth nerve palsy in children suffering from IIH. Moreover, other cranial nerve deficits may also be affected.

PP05.17 – 2757: Acute acquired nontraumatic VIth cranial nerve palsies in children: about 22 cases

Introduction Acute isolated acquired nontraumatic VIth nerve palsy is not uncommon in children. Few studies have been conducted in this population. Objective Describe clinical and laboratory characteristics of children with acute VIth nerve palsy, instituted treatments and evolution. Methods Retrospective data collect in all children presenting with acute nontraumatic VIth nerve palsy between January 2002 and December 2012 in the pediatric neurology department of the University Hospital of Montpellier. Results Twenty-two children were included. The mean age was 5 years and 2 months. The sex ratio was 1.75 boy to a girl. Involvement of the left VIth nerve was predominant (73.7%). All patients underwent ophthalmologic examination with fundoscopy and brain MRI. Eighty-two percent had lumbar punction (LP) with cerebrospinal fluid analysis. Visual evoked potential were performed in 77% of cases. Etiology was not found in 50% of cases. Decompensated hypermetropia was the most common etiology (27%) followed by neuroinflammatory (13.6%) and tumoral diseases (9%). Among laboratory exams, VEP had best sensibility (83%) in case of symptomatic VIth nerve palsy, versus 25% and 33% for brain MRI and LP respectively. All these tests had 100% specificity. Conclusion Tumoral etiology is the haunting of physicians and inflammatory disease is their fear in case of acute isolated nontraumatic VIth nerve palsy in children. To our knowledge, this is the first study focusing on VEP data among these patients. These results seem promising, but the diagnosis approach needs to be better defined with larger prospective pediatric cohorts.

Paralysie faciale idiopathique de l’enfant

Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis.

Facial nerve paralysis in children.

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology.