Subject(s)
Humans , Male , Aged , Pneumonia, Viral/complications , Coronavirus Infections/complications , Vasculitis, Central Nervous System/complications , Trochlear Nerve Diseases/etiology , Betacoronavirus , Pneumonia, Viral/cerebrospinal fluid , Pneumonia, Viral/diagnostic imaging , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Coronavirus Infections , Coronavirus Infections/cerebrospinal fluid , Coronavirus Infections/diagnostic imaging , Vasculitis, Central Nervous System/diagnostic imaging , Pandemics , Headache/etiologyABSTRACT
ABSTRACT Pseudotumor cerebri syndrome is puzzling because it results in elevated intracranial pressure with no identifiable underlying cause. Ocular motor nerve palsies, other than a unilateral or bilateral sixth cranial nerve palsy, are rarely seen in patients with this condition. We report here on a 25-year-old female patient with bilateral fourth cranial nerve palsy caused by pseudotumor cerebri syndrome, whose ocular and systemic signs and symptoms of nerve palsy were completely resolved after medical treatment. We infer that fourth nerve palsy could be associated with pseudotumor cerebri syndrome; therefore, clinicians should consider rare ocular motor nerve palsies, even bilaterally, in patients with pseudotumor cerebri syndrome.
RESUMO A sindrome do pseudotumor cerebral é uma síndrome enigmática caracterizada por aumento da pressão intracraniana sem causa definida. Na síndrome do pseudotumor cerebral, as paralisias de nervo oculomotor além da paralisia unilateral ou bilateral do sexto nervo craniano são raramente vistas. Nós reportamos o caso de uma paciente feminina de 25 anos com paralisia bilateral de quarto nervo craniano como resultado da síndrome do pseudotumor cerebral. Após tratamento médico para síndrome do pseudotumor cerebral, os sinais e sintomas oculares e sistêmicos da paralisia nervosa foram resolvidos. Em conclusão, a paralisia de quarto nervo craniano pode estar associada com síndrome de pseudotumor cerebral, portanto médicos devem considerar paralisias raras de nervo oculomotor, mesmo bilateralmente, em pacientes com síndrome do pseudotumor cerebral.
Subject(s)
Humans , Female , Adult , Pseudotumor Cerebri/complications , Trochlear Nerve Diseases/etiology , Syndrome , Pseudotumor Cerebri/physiopathology , Pseudotumor Cerebri/diagnostic imaging , Magnetic Resonance Imaging , Papilledema/etiology , Papilledema/diagnostic imaging , Trochlear Nerve Diseases/physiopathology , Trochlear Nerve Diseases/diagnostic imaging , Tomography, Optical CoherenceABSTRACT
ABSTRACT This report documents an unusual phenomenon. A 6-year-old girl with trochlear-oculomotor synkinesis presented with superior oblique and palpebral levator co-contraction. The literature was reviewed and the possibility of classifying this entity as a congenital cranial dysinnervation disorder was speculated.
RESUMO Este relato descreve um fenômeno incomum. Uma menina de 6 anos com sincinesia troclear-oculomotora apresentou co-contração do oblíquo superior e do levantador da pálpebra. A literatura foi revisada e especulou-se a possibilidade de classificar essa desordem como um distúrbio da congenital cranial dysinnervation disorder.
Subject(s)
Humans , Female , Child , Ocular Motility Disorders/congenital , Cranial Nerves/abnormalities , Trochlear Nerve Diseases/congenital , Synkinesis/congenital , Oculomotor Muscles/innervation , Ocular Motility Disorders/classification , Ocular Motility Disorders/pathology , Trochlear Nerve Diseases/classification , Trochlear Nerve Diseases/pathology , Rare Diseases , Synkinesis/classification , Synkinesis/pathology , Eyelids/abnormalitiesABSTRACT
The most cases with orbital metastases have been reported in patients with a prior established diagnosis of cancer and widespread systemic involvement. However, ocular symptoms can be developed as an initial presentation of cancer in patients without cancer history. We report a case of rapid progression from trochlear nerve palsy to orbital apex syndrome as an initial presentation of advanced gastric cancer.
Subject(s)
Humans , Diagnosis , Diplopia , Neoplasm Metastasis , Optic Nerve Diseases , Orbit , Stomach Neoplasms , Trochlear Nerve Diseases , Trochlear NerveABSTRACT
Cranial nerve palsies are relatively common after trauma, but trochlear nerve palsy is relatively uncommon. Although traumatic trochlear nerve palsy is easy to diagnose clinically because of extraocular movement disturbances, radiologic evaluations of this condition are difficult to perform because of the nerve's small size. Here, we report the case of a patient with delayed traumatic trochlear nerve palsy associated with a traumatic subarachnoid hemorrhage (SAH) and the related radiological findings, as obtained with high-resolution three-dimensional (3D) magnetic resonance imaging (MRI). A 63-year-old woman was brought to the emergency room after a minor head trauma. Neurologic examinations did not reveal any focal neurologic deficits. Brain computed tomography showed a traumatic SAH at the left ambient cistern. The patient complained of vertical diplopia at 3 days post-trauma. Ophthalmologic evaluations revealed trochlear nerve palsy on the left side. High-resolution 3D MRI, performed 20 days post-trauma, revealed continuity of the trochlear nerve and its abutted course by the posterior cerebral artery branch at the brain stem. Chemical irritation due to the SAH and the abutting nerve course were considered causative factors. The trochlear nerve palsy completely resolved during follow-up. This case shows the usefulness of high-resolution 3D MRI for evaluating trochlear nerve palsy.
Subject(s)
Female , Humans , Middle Aged , Brain , Brain Stem , Cranial Nerve Diseases , Craniocerebral Trauma , Diplopia , Emergency Service, Hospital , Follow-Up Studies , Imaging, Three-Dimensional , Magnetic Resonance Imaging , Neurologic Examination , Neurologic Manifestations , Posterior Cerebral Artery , Subarachnoid Hemorrhage, Traumatic , Trochlear Nerve Diseases , Trochlear NerveABSTRACT
PURPOSE: To report a case of trochlear nerve palsy caused by quadrigeminal cistern lipoma located in the dorsal midbrain. CASE SUMMARY: A 65-year-old male visited our clinic for intermittent vertical diplopia over 2-year period. Symptoms of diplopia had worsened over the past two weeks. He had no previous medical history except having had diabetes for 1 month. The best-corrected visual acuity was 20/25 in the right eye and 20/20 in the left eye. Pupillary examination was not remarkable. Extraocular examination showed 4 prism diopters (PD) left hypertropia at distant gaze and 4 PD exotropia at near gaze, with adduction elevation of the left eye. The Bielschowsky head tilt test revealed 6 PD left hypertropia on the left gaze and orthotropia on the right tilt. Fundus examination showed excyclotorsion of the right eye and incyclotorsion of the left eye. Brain magnetic resonance imaging revealed quadrigeminal cistern lipoma. Prism glasses were prescribed to alleviate diplopia, and we followed up the lesions without further treatment. CONCLUSIONS: Trochlear nerve palsy can be caused by quadrigeminal cistern lipoma; however, it is uncommon for this condition to be caused by a compressive lesion. Prompt neuroimaging can be helpful to rule out the causes of this condition in patients with atypical symptoms.
Subject(s)
Aged , Humans , Male , Brain , Diplopia , Exotropia , Eyeglasses , Glass , Head , Lipoma , Magnetic Resonance Imaging , Mesencephalon , Neuroimaging , Strabismus , Trochlear Nerve Diseases , Trochlear Nerve , Visual AcuityABSTRACT
Superior oblique myokymia (SOM) is a rare disorder characterized by unilateral paroxysmal oscillopsia or diplopia. Recent studies revealed that SOM can be associated with neuro-vascular cross compression (NVCC) of the trunk of the trochlear nerve. Although it frequently occurs without any underlying systemic disease or concurrent neurologic sign, we need to consider this NVCC especially in cases with persistent disturbing symptoms. Hereby, we present two cases of SOM whose neuroimaging studies suggest NVCCs and, discuss recent update of the pathomechanism of SOM.
Subject(s)
Diplopia , Nerve Compression Syndromes , Neuroimaging , Neurologic Manifestations , Trochlear Nerve , Trochlear Nerve DiseasesABSTRACT
Paranasal sinus mucoceles are an uncommon cause of isolated palsies of cranial nerves III, IV, and VI. The trochlear nerve has been reported to be less frequently affected than the abducens and oculomotor nerves. Isolated sphenoid sinus diseases may cause serious complications by involving adjacent vital structures such as the optic nerve, cavernous sinus, internal carotid artery, and cranial nerves III–VI. We report a case of a 76-year-old woman who presented to our emergency department with a chief complaint of acute double vision and headache. Her diplopia was diagnosed as left trochlear nerve palsy. Brain CT and MRI revealed expanding cystic lesions in both sphenoid sinuses with bony erosion of the left sinus wall. The patient underwent an endoscopic intranasal sphenoidotomy and recovered completely from diplopia at postoperative 2 months. The relationship between the trochlear nerve palsy and its anatomy is also discussed.
Subject(s)
Aged , Female , Humans , Brain , Carotid Artery, Internal , Cavernous Sinus , Cranial Nerves , Diplopia , Emergency Service, Hospital , Headache , Magnetic Resonance Imaging , Mucocele , Oculomotor Nerve , Optic Nerve , Paralysis , Sphenoid Sinus , Trochlear Nerve Diseases , Trochlear NerveABSTRACT
Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in aberrant innervation of the ocular and facial musculature. Its diagnosis could be facilitated by the development of high resolution thin-section magnetic resonance imaging. The purpose of this review is to describe the method to visualize cranial nerves III, IV, and VI and to present the imaging findings of congenital cranial dysinnervation disorders including congenital oculomotor nerve palsy, congenital trochlear nerve palsy, Duane retraction syndrome, Möbius syndrome, congenital fibrosis of the extraocular muscles, synergistic divergence, and synergistic convergence.
Subject(s)
Axons , Cranial Nerves , Diagnosis , Duane Retraction Syndrome , Fibrosis , Magnetic Resonance Imaging , Methods , Muscles , Oculomotor Nerve Diseases , Trochlear Nerve DiseasesABSTRACT
PURPOSE: Superior oblique myokymia is intermittent spontaneous contractions of the superior oblique muscle presenting as rapid and small-amplitude intorsions and depressions of the eye. The authors report a case of superior oblique myokymia that was objectively and quantitatively diagnosed with slit lamp examination and video-oculography and completely resolved with medical treatment. CASE SUMMARY: A 44-year-old woman presented with a seven-year history of intermittent oscillopsia which continued for few seconds. She had no history of head trauma or systemic ocular disease, and the anterior segment and fundus examination were unremarkable. Right eye intorsion lasting for a few seconds as detected by slit lamp examination. Eye movements were recorded using video-oculography, which showed a torsional nystagmus of 5 to 10 degrees with 2 to 5 vertical components in the right eye. Based on these findings, the patient was diagnosed with superior oblique myokymia. The patient was prescribed topical timolol ophthalmic solution, one drop twice per day, but the symptoms persisted. Timolol ophthalmic solution was stopped and replaced with carbamazepine, 200 mg twice a day, which resolved her symptoms. CONCLUSIONS: Slit lamp examination and video-oculography can be used as objective and quantitative diagnostic tools in order to confirmed a diagnosis and lead to proper treatment.
Subject(s)
Adult , Female , Humans , Carbamazepine , Craniocerebral Trauma , Depression , Diagnosis , Eye Movements , Slit Lamp , Timolol , Trochlear Nerve DiseasesABSTRACT
La microangiopatía cerebral retiniana con calcificaciones y quistes es una enfermedad poco frecuente, caracterizada por alteraciones cerebrales, retinianas y óseas, así como por predisposición al sangrado gastrointestinal. Existen pocos reportes de casos de esta condición, especialmente en adultos, en quienes la incidencia es baja. Los hallazgos por medio de neuroimágenes son característicos, con calcificaciones bilaterales y múltiples formaciones quísticas. El propósito de este artículo fue hacer una revisión bibliográfica e ilustrar dos casos cuyo diagnóstico fue posible con la ayuda de neuroimágenes.
Cerebroretinal microangiopathy with calcifications and cysts is a rare condition characterized by brain, retinal and bone anomalies, as well as a predisposition to gastrointestinal bleeding. There are few reported cases of this condition in adults, among whom the incidence is low. Neuroimaging findings are characteristic, with bilateral calcifications, leukoencephalopathy and intracranial cysts. The purpose of this article was to do a literature survey and illustrate two cases diagnosed with the aid of neuroimaging.
Subject(s)
Adolescent , Adult , Female , Humans , Ataxia/pathology , Brain Neoplasms/pathology , Brain/pathology , Calcinosis/pathology , Central Nervous System Cysts/pathology , Cerebral Small Vessel Diseases/pathology , Leukoencephalopathies/pathology , Magnetic Resonance Imaging , Muscle Spasticity/pathology , Neuroimaging/methods , Retinal Diseases/pathology , Seizures/pathology , Ataxia/diagnosis , Brain Neoplasms/diagnosis , Calcinosis/diagnosis , Central Nervous System Cysts/diagnosis , Cerebral Small Vessel Diseases/diagnosis , Diagnosis, Differential , Hair Color , Hypopigmentation/etiology , Intellectual Disability/etiology , Leukoencephalopathies/diagnosis , Muscle Spasticity/diagnosis , Quadriplegia/etiology , Retinal Diseases/diagnosis , Seizures/diagnosis , Trochlear Nerve Diseases/etiologyABSTRACT
PURPOSE: To report a case of bilateral trochlear nerve palsy following cisternography. CASE SUMMARY: A 43-year-old male with intermittent watery rhinorrhea persisting for 3 months visited the neurosurgery department of our institute. His past medical history included removal of a pituitary adenoma 22 years prior to presentation. Cerebrospinal fluid leakage was suspected and cisternography was performed. The patient was referred to our ophthalmology department for diplopia 3 days after the cisternography. An alternate prism cover test showed 5 prism diopter (PD) right hypertrophia in the primary position, and underaction of bilateral superior oblique muscles and overaction of the left inferior oblique muscle. A positive Bielschowsky test with the head tilted to either side was observed and excyclotorsion was 9degrees on the double Maddox rod test. The patient was diagnosed with bilateral trochlear nerve palsy. After 2 years of follow-up, diplopia persisted and recession of the bilateral inferior oblique muscles was performed. After the surgery, diplopia disappeared, the fundus photography showed no excyclotorsion, and the double Maddox rod test indicated 3degrees of excyclotorsion. CONCLUSIONS: Cisternography should be carefully performed due to the possibility of bilateral trochlear nerve palsy, an extremely rare but possible occurrence following the procedure.
Subject(s)
Adult , Humans , Male , Cerebrospinal Fluid , Diplopia , Follow-Up Studies , Head , Muscles , Neurosurgery , Ophthalmology , Photography , Pituitary Neoplasms , Spinal Puncture , Trochlear Nerve Diseases , Trochlear NerveABSTRACT
PURPOSE: To investigate the clinical features and risk factors of ischemic third, fourth, sixth cranial nerve palsy. METHODS: Retrospectively, we reviewed the medical records of 46 eyes of 46 patients who were diagnosed with ischemic third, fourth, sixth nerve palsy alone such as age of onset, risk factors, recovery rate and recovery time. RESULTS: The mean age of onset was 64.9 years. Of the 46 patients, 15 patients (32.6%) in third cranial nerve palsy group, 15 patients (32.6%) in fourth cranial nerve palsy group, 16 patients (34.8%) in sixth cranial nerve palsy group. The risk factor of hypertension in 30 patients (65.2%) was the most common than other risk factors such as diabetes, hyperlipidemia, elevated blood hematocrit, ischemic heart disease, left ventricular hypertrophy, smoking. The mean number of risk factors was 2.3 +/- 0.5 in third cranial nerve palsy group, 1.6 +/- 1.1 in sixth cranial nerve palsy group, 1.4 +/- 1.1 in fourth cranial nerve palsy group. Of the 46 patients, 42 patients (91.3%) were recovered. There was no significant difference in recovery rate by cranial nerve palsy. Recovery time of intracranial abnormalities group (10.5 +/- 2.9 weeks) in brain imaging study was late as compared with that of no intracranial abnormalities group (7.5 +/- 5.1 weeks). CONCLUSIONS: The overall recovery rate of isolated ischemic third, fourth, sixth cranial nerve was high. But if there are intracranial abnormalities in imaging study, it took a long time to recover. Also ischemic third cranial nerve palsy had multiple risk factors characteristically.
Subject(s)
Humans , Abducens Nerve , Abducens Nerve Diseases , Age of Onset , Cranial Nerve Diseases , Hematocrit , Hyperlipidemias , Hypertension , Hypertrophy, Left Ventricular , Medical Records , Myocardial Ischemia , Neuroimaging , Oculomotor Nerve , Paralysis , Prognosis , Retrospective Studies , Risk Factors , Smoke , Smoking , Trochlear Nerve DiseasesABSTRACT
PURPOSE: To investigate the clinical features and risk factors of ischemic third, fourth, sixth cranial nerve palsy. METHODS: Retrospectively, we reviewed the medical records of 46 eyes of 46 patients who were diagnosed with ischemic third, fourth, sixth nerve palsy alone such as age of onset, risk factors, recovery rate and recovery time. RESULTS: The mean age of onset was 64.9 years. Of the 46 patients, 15 patients (32.6%) in third cranial nerve palsy group, 15 patients (32.6%) in fourth cranial nerve palsy group, 16 patients (34.8%) in sixth cranial nerve palsy group. The risk factor of hypertension in 30 patients (65.2%) was the most common than other risk factors such as diabetes, hyperlipidemia, elevated blood hematocrit, ischemic heart disease, left ventricular hypertrophy, smoking. The mean number of risk factors was 2.3 +/- 0.5 in third cranial nerve palsy group, 1.6 +/- 1.1 in sixth cranial nerve palsy group, 1.4 +/- 1.1 in fourth cranial nerve palsy group. Of the 46 patients, 42 patients (91.3%) were recovered. There was no significant difference in recovery rate by cranial nerve palsy. Recovery time of intracranial abnormalities group (10.5 +/- 2.9 weeks) in brain imaging study was late as compared with that of no intracranial abnormalities group (7.5 +/- 5.1 weeks). CONCLUSIONS: The overall recovery rate of isolated ischemic third, fourth, sixth cranial nerve was high. But if there are intracranial abnormalities in imaging study, it took a long time to recover. Also ischemic third cranial nerve palsy had multiple risk factors characteristically.
Subject(s)
Humans , Abducens Nerve , Abducens Nerve Diseases , Age of Onset , Cranial Nerve Diseases , Hematocrit , Hyperlipidemias , Hypertension , Hypertrophy, Left Ventricular , Medical Records , Myocardial Ischemia , Neuroimaging , Oculomotor Nerve , Paralysis , Prognosis , Retrospective Studies , Risk Factors , Smoke , Smoking , Trochlear Nerve DiseasesABSTRACT
PURPOSE: To evaluate the natural course of superior oblique palsy (SOP) with objective criteria, and to show the contemporary etiology and recovery rates among several factors. The clinical features of SOP were compared to previous studies. METHODS: A retrospective chart review of 80 patients diagnosed with SOP between January 1, 2006 and December 31, 2011 was performed. RESULTS: Clinical SOP features showed variation when compared to previous studies. Out of 80 patients, 71 were identified with unilateral isolated and 9 bilateral cases of SOP. Twenty cases were congenital and 60 cases were acquired SOPs. Acquired SOPs were affected most commonly by trauma (31%) and vascular disease (30%). Twenty-four out of 49 patients, who were followed up over 2 months after the first visit recovered, especially vascular origin cases, which was statistically significant (75%, p = 0.000). Patients with initial vertical deviation smaller than 5 Prism diopters (PD) experienced a more successful recovery than patients with an initial deviation larger than 5 PD. CONCLUSIONS: SOP has different recovery rates depending on the etiology. Accurate ocular examination and understanding of SOP etiology are necessary for successful treatment.
Subject(s)
Humans , Natural History , Paralysis , Retrospective Studies , Trochlear Nerve Diseases , Vascular DiseasesABSTRACT
Epiduroscopic laser discectomy and neural decompression (ELND) is known as an effective treatment for intractable lumbar pain and radiating pain which develop after lumbar surgery, as well as for herniation of the intervertebral disk and spinal stenosis. However, various complications occur due to the invasiveness of this procedure and epidural adhesion, and rarely, cranial nerve damage can occur due to increased intracranial pressure. Here, the authors report case in which double vision occurred after epiduroscopic laser discectomy and neural decompression in a patient with failed back surgery syndrome (FBSS).
Subject(s)
Humans , Cranial Nerves , Decompression , Diplopia , Diskectomy , Failed Back Surgery Syndrome , Intervertebral Disc , Intracranial Pressure , Spinal Stenosis , Trochlear Nerve , Trochlear Nerve DiseasesABSTRACT
PURPOSE: To evaluate the correlation between hypertropia and excyclotorsion in acquired superior oblique palsy (SOP). METHODS: Thirty-one patients with acquired unilateral SOP were recruited for this study. The torsional angle of each patient was assessed via one objective method (fundus photography) and two subjective methods (double Maddox rod test and major amblyoscope). The patient population was divided into two groups (concordance group, n = 19 and discordance group, n = 12) according to the correspondence between the hypertropic eye (paralytic eye) and the more extorted eye (non-fixating eye), which was evaluated by fundus photography. RESULTS: The mean value of objective torsion was 5.09degrees +/- 3.84degrees. The subjective excyclotorsion degrees were 5.18degrees +/- 4.11degrees and 3.65degrees +/- 1.93degrees as measured by double Maddox rod test and major amblyoscope, respectively. Hypertropia and the excyclotorsional angle did not differ significantly between the groups (p = 0.257). Although no correlation was found in the discordance group, the concordance group showed a significant and positive correlation between hypertropia and excyclotorsion (p = 0.011). CONCLUSIONS: Torsional deviation was not related to hypertropia. However, in the concordance patients in whom the hypertropic eye showed excyclotorsion, a significant positive correlation was found between hypertropia and excyclotorsion.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Diagnostic Techniques, Ophthalmological , Eye Movements , Follow-Up Studies , Oculomotor Muscles/physiopathology , Ophthalmologic Surgical Procedures/methods , Ophthalmoplegia/etiology , Retrospective Studies , Strabismus/etiology , Treatment Outcome , Trochlear Nerve Diseases/complicationsABSTRACT
PURPOSE: To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors. METHODS: We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months. RESULTS: Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request. CONCLUSIONS: Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.
Subject(s)
Adult , Humans , Brain Neoplasms , Diplopia , Fistula , General Surgery , Myasthenia Gravis , Oculomotor Nerve , Paralysis , Retrospective Studies , Strabismus , Trochlear Nerve Diseases , Wounds and InjuriesABSTRACT
PURPOSE: Residual head tilt has been reported in patients with superior oblique muscle palsy (SOP) after surgery to weaken the inferior oblique (IO) muscle. The treatments for these patients have not received appropriate attention. In this study, we evaluated the superior rectus (SR) muscle recession as a surgical treatment. METHODS: The medical records of 12 patients with SOP were retrospectively reviewed. Each of these patients had unilateral SR muscle recession for residual head tilt after IO muscle weakening due to SOP. The residual torticollis was classified into three groups on the basis of severity: mild, moderate, or severe. Both IO muscle overaction and vertical deviation, features of SOP, were evaluated in all patients. The severity of the preoperative and postoperative torticollis and vertical deviation were compared using a paired t-test and Fisher's exact test. RESULTS: The torticollis improved in nine of 12 (75%) patients after SR muscle recession. The difference between the preoperative and postoperative severity of torticollis was statistically significant (p = 0.0008). After surgery, the mean vertical deviation was significantly reduced from 12.4 prism diopters to 1.3 prism diopters (p = 0.0003). CONCLUSIONS: Unilateral SR muscle recession is an effective method to correct residual head tilt after IO muscle weakening in patients with SOP. This surgical procedure is believed to decrease head tilt by reducing the vertical deviation and thereby the compensatory head tilt.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Male , Diplopia/surgery , Head Movements , Oculomotor Muscles/surgery , Retrospective Studies , Strabismus/surgery , Torticollis/surgery , Treatment Outcome , Trochlear Nerve Diseases/surgeryABSTRACT
PURPOSE: To suggest a surgical normogram for lateral rectus recession in exotropia associated with unilateral or bilateral superior oblique muscle palsy (SOP). METHODS: We retrospectively reviewed the charts of 71 patients with exotropia who were successfully corrected over one year. Each patient had undergone unilateral or bilateral rectus recession associated with uni- or bilateral inferior oblique (IO) 14 mm recession, using a modified surgical normogram for lateral rectus (LR) recession, which resulted in 1 to 2 mm of reduction of LR recession. We divided all patients into 2 groups, the 34 patients who had undergone LR recession with unilateral IO (UIO) recession group and the remaining 37 patients who had undergone LR recession with bilateral IO (BIO) recession group. Lateral incomitancy was defined when the exoangle was reduced by more than 20% compared to the primary gaze angle. The surgical effects (prism diopters [PD]/mm) of LR recession were compared between the two groups using the previous surgical normogram as a reference (Parks' normogram). RESULTS: The mean preoperative exodeviation was 20.4 PD in the UIO group and 26.4 PD in the BIO group. The recession amount of the lateral rectus muscle ranged from 4 to 8.5 mm in the UIO group and 5 to 9 mm in the BIO group. Lateral incomitancy was noted as 36.4% and 70.3% in both groups, respectively (p = 0.02). The effect of LR recession was 3.23 +/- 0.84 PD/mm in the UIO group and 2.98 +/- 0.62 PD/mm in the BIO group and there was no statistically significant difference between two the groups (p = 0.15). CONCLUSIONS: Reduction of the LR recession by about 1 to 2 mm was successful and safe to prevent overcorrection when using on IO weakening procedure, irrespective of the laterality of SOP.