New Onset Facial Nerve Palsy : A Part of Post COVID Mucormycosis Disease Spectrum — A Descriptive Observational Study

Introduction : COVID Associated Mucor (CAM) is a well known entity with defined symptomatology. Cranial Nerve Palsy involving II, III, IV, V, VI th Nerve is common. Facial Nerve involvement is an out of tract presentation. The study was aimed to find the incidence of Facial Nerve involvement in CAM and document their route of involvement. Material and Method : Descriptive observational study was done in an Apex Centre for CAM in West Bengal between April, 2021 to January, 2022. CAM having Rhino-orbital-cerebral Mucormycosis (ROCM) and new onset Facial Palsy were considered. Participants were included following stipulated inclusion and exclusion criteria. Collected data was analysed. Observations : Total 11 patients of new onset Facial Palsy in COVID-19-Associated ROCM were included. 81.8% had coexisting other Cranial Nerve involvement. Facial Palsy was one of the primary presentations in the patients of ROCM. Discussion : CAM is angioinvasive and can cause concomitant hypoxic neural damage due to involvement of the vasa nervorum. Skull base involvement can be hypothesized to be the predominant route of Facial Nerve involvement. Facial palsy can be an important initial presentation of CAM. Conclusion : Facial Nerve Palsy may be a part of the spectrum of disease presentation in CAM.

Neuro-ophthalmic Analyses of Head Trauma Patients

PURPOSE: To investigate the types and clinical features of neurological diseases after head trauma. METHODS: From March 2010 to December 2018, a total of 177 patients were enrolled in this study. We retrospectively reviewed the clinical features of neurological ophthalmic diagnoses and frequencies, the types of head injuries, and the prognoses. RESULTS: Cranial nerve palsy was the most common (n = 63, 35.6%), followed by traumatic optic neuropathy (n = 45, 25.4%), followed by optic disc deficiency, ipsilateral visual field defect, Nystagmus, skewing, ocular muscle paralysis between nuclei, and Terson syndrome. Neuro-ophthalmic deficits occurred in relatively strong traumas accompanied by intracranial hemorrhage or skull fracture. However, convergence insufficiency and decompensated phoria occurred in relatively weak trauma such as concussion. The prognoses of the diseases were poor (p < 0.05) for traumatic optic neuropathies and visual field defects. The prognoses of neurological diseases were poor if accompanied by intracranial hemorrhages or skull fractures (p < 0.05). CONCLUSIONS: After head trauma, various neuro-ophthalmic diseases can occur. The prognosis may differ depending on the type of the disease, and the strength of the trauma may affect the prognosis.

Secondary involvement of the skull base in malignant B-cell lymphoma / 대한내과학회지

We report a case of B-cell lymphoma with multiple asymmetrical cranial nerve palsies as the initial presentation. A 70-year-old woman complained of chin numbness, diplopia, dysarthria, and headache that had developed insidiously over the previous 2 months. The neurological examination showed multiple cranial nerve dysfunction, including right V and left VI nerve palsies. Her cerebrospinal fluid was normal, while her bone marrow biopsy revealed CD20-positive B-cell lymphoma. Five days after starting R-CHOP (rituximab-cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy, her cranial nerve palsies and pain had improved markedly. Twenty days after starting R-CHOP chemotherapy, however, she was rehospitalized due to general worsening paralysis. In the hospital, the general paralysis progressed rapidly and she lapsed into delirium. No additional treatment was given based on the directives of her guardian and herself, and she was allowed to leave the hospital for hospice care.

The Sixth Cranial Nerve Paralysis Caused by Nasopharyngeal Cancers

PURPOSE: To investigate cases of the nasopharyngeal cancer with the sixth cranial nerve paralysis and review the current literatures on the nasopharyngeal cancer and the sixth nerve paralysis. METHODS: We analysed retrospectively clinical characteristics of 41 patients diagnosed with the nasopharyngeal cancer from January 1994 to December 2000. RESULTS: In 41 patients with the nasopharyngeal cancer, 6 patients (14.6%) had the sixth cranial nerve involvement. 4 patients of them visited ophthalmologic department after diagnosed with nasophryngeal cancer with symptom of neck mass or tinnitus. 2 patients visited ophthalmologic department and then were diagnosed with nasopharyngeal cancer with magnetic resonance imaging and biopsy. CONCLUSIONS: The sixth cranial nerve paralysis may be caused by trauma, intracranial disorder (tumor, meningitis, demyelination), vascular disorder, diabetes, hypertension, and viral illnesses. We emphasize the suspicion for the possibility of the nasopharyngeal cancer in patients with unexplained sixth cranial nerve paralysis causing diplopia and limitation of extraocular muscle.

Facial Palsy as a Presenting Symptom of Wegener's Granulomatosis / 대한류마티스학회지

Wegener's granulomatosis is a serious multi-systemic disease pathologically characterized by necrotizing vasculitis and granuloma. Although nervous system is one of major target organs in Wegener's granulomatosis, the involvement of facial nerve was rarely reported as an initial symptom. We experienced a female patient with Wegener's granulomatosis presenting otitis media, sinusitis and right facial palsy. Nasal mucosal biopsy revealed necrotizing vasculitis with granuloma formation, which was consistent with Wegener's granulomatosis. During steroid and cyclophosphamide therapy, she developed paralysis of abducens nerve. Methyprednisolone pulse therapy was administrated with symptomatic improvement. We describe a case of Wegener's granulomatosis presenting facial nerve palsy.