An unusual presentation of scrub typhus with lateral rectus palsy in a child

Scrub typhus, an acute febrile infectious disease prevalent in the “Tsutsugamushi triangle”, is a mite-born rickettsial zoonosis, caused by Orientia tsutsugamushi. Although the clinical presentation is protean, it rarely causes abducens nerve palsy. We report a 13-year-old previously healthy Indian boy who presented with a recent onset right abducens nerve palsy, headache and fever but without the classic dermatological manifestation (“eschar”) of the disease. After exclusion of common infectious and other causes, he was finally diagnosed with scrub typhus associated with an abducens nerve palsy, which responded to doxycycline therapy.

Vertical rectus transposition procedures for lateral rectus palsy: A systematic review

Multiple transposition procedures have been described for management of lateral rectus palsy. However, relative effect and indications of each procedure are unclear. This systematic review was planned to evaluate functional and anatomical outcomes of vertical rectus transposition (VRT) surgery in patients with lateral rectus palsy. We searched databases in English language, namely, MEDLINE, PubMed Central, EMBASE, Google Scholar, Scopus, and Index Copernicus without any date restrictions in electronic searches, using the search words 'vertical rectus transposition for lateral rectus palsy,” “vertical rectus transposition for abducens palsy,” “superior rectus transposition,” “inferior rectus transposition,” and “Hummelsheim procedure.” References of the selected publications were also searched to find any relevant studies. We searched for studies that provided data on single VRT and double VRT surgeries for lateral rectus palsies. Three authors independently assessed the related studies gathered from electronic and manual searches. We found 27 studies which were relevant to the review question. As there were no randomized control trials (RCTs) available related to our study question, nonrandomized studies were used to arrive at summarization of outcomes of different transposition procedures. There is a need for prospective RCTs to investigate the different types of transposition procedures for lateral rectus palsy.

Transient diplopia: A loco regional complication of inferior alveolar nerve block

A 34-year-old female patient required surgical removal of lower left third molar under local anesthesia. Two percent lignocaine with 1:80000 adrenaline was used for administrating inferior alveolar nerve block at dental clinic. Twenty five minutes after the surgical removal, patient developed diplopia on the left eye. This transient diplopia could be due to retro flow of local anesthetic agent through the inferior alveolar artery and indirectly to the ophthalmic artery paralyzing the lateral rectus muscle. Patient recovered after 60 minutes. This article discusses the possible etiologies of diplopia, the mechanism behind this ophthalmic complication, and the review of various reported literature.

Adenoid cystic carcinoma of the hard palate presenting as ipsilateral sixth nerve palsy

Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm composed of basaloid epithelial and myoepithelial cells. The palate is the most commonly involved intraoral site for ACC. Here, we document the case of an advanced ACC arising from the hard palate that presented with right-sided sixth nerve palsy in a 75-year-old male with no other systemic illnesses. ACC of the head and neck involving the cavernous sinus and presenting as isolated sixth nerve palsy is exceedingly rare. In the absence of vasculopathic or ischemic risk factors, regardless of the age of the patient; neuroimaging should be performed in cases of isolated nontraumatic sixth nerve palsy.

Bilateral lateral rectus palsies in high altitude illness.

A 50-year-old man with high altitude illness had bilateral lateral rectus palsies when he went to the Himalaya at 5,000 meters. He had no other neurological signs, except headache. He received acetazolamide, prednisone, and spent time in a hyperbaric chamber; but unfortunately he showed no improvement. Two months later, his diplopia completely resolved itself without any treatment, after his descent to a lower altitude.

The Effect of Jensen Procedure with Medial Rectus Recession in Lateral Rectus Palsy

Jensen procedures with medial rectus recession were performed on 13 eyes of 10 patients with lateral rectus palsy caused by trauma. The cases were reviewed retrospectively to assess efficacy of the procedure and long-term stability. After the average 10.2 months of follow-up period, the 7 patients on whom unilateral Jensen procedures and medial rectus muscle recession were performed improved an average of 45.0 delta, and the 3 patients who underwent bilateral Jensen procedures and medial rectus muscle recession improved an average of 82.3 delta. Preoperatively, 12 eyses demonstrated abduction of -4, and 1 eye demonstrated abduction of -1. Postoperatively, abductions of eyes are as follows: 3 eyes -4, 5 eyes -3, 3 eyes -2, and 2 eyes -1. 10 eyes (76.9%) showed improved abduction of lateral rectus muscle, but 3 eyes(23.1%) were not changed. 4 patients(40.0%) acquired a functional area of diplopia free vision, but 6 patients(60.0%) did not, 1 patient developed diplopia postoperatively. No significant cases of vertical deviation were created. One showed anterior segment ischemia, but recovered without complications. Based on these results, the Jensen procedure combined with medial rectus recession is effective in correcting palsies of the lateral rectus muscle that is not recovered.