Delayed-onset bilateral abducens paresis after head trauma.

Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

Transient diplopia in dental outpatient clinic: An uncommon iatrogenic event.

A healthy 32-year-old female patient required an extraction of the right maxillary third molar. Lidocaine containing 1:80,000 epinephrine for right posterior superior alveolar nerve block was administered in the mucobuccal fold above the third molar to be extracted at our hospital. After few minutes of posterior superior alveolar block anesthesia, patient felt double vision. The condition was subsequently diagnosed as transient diplopia due to temporary paralysis of lateral rectus muscle due to involvement of the VI cranial nerve. The patient recovered in 30 minutes and the treatment was performed successfully. This article discusses the possible scientific explanation for this phenomenon.

Traumatismo craniencefálico associado à lesão bilateral tardia de nervo abducente sem alteração neurorradiológica / Late bilateral traumatic abducens nerve palsy without neuroradiologic abnormality

Os autores apresentam um caso de paralisia bilateral do nervo abducente de aparecimento tardio após traumatismo craniencefálico grave, sem evidências de anormalidades neurorradiológicas em exames de tomografia computadorizada e ressonância nuclear magnética. É realizada uma revisão da literatura enfatizando sua etiologia, manejo e prognóstico referentes a este tipo de lesão

A Case of Inflammatory Pseudotumor of the Temporal Bone with Extraocular Muscle Palsy / 대한이비인후과학회지

Inflammatory pseudotumors are benign tumors rarely that occurs in the head and neck. We present the case of a 39-year-old man presenting extraocular muscle palsy with inflammatory pseudotumor affecting the temporal bone including mastoid, middle ear and petrosal apex. At computed tomography and magnetic resonance imaging (MRI) scan, the lesion appeared as an enhancing mass of soft tissue occupying the majority of the mastoid bone and petrosal apex causing diplopia. The patient was treated with conservative surgical excision (a open cavity mastoidectomy and tympanoplasty) and postoperative steroid therapy. Microscopic examination showed predominantly mature plasma cells. The patient remains free of disease 8 months after treatment. We believe this is the first case report of inflammatory pseudotumor affecting the middle ear and mastoid involving the petrous apex.

Parálisis del VI nervio en el ojo fijador y angiopatía retinal traumática (síndrome de Purtscher) en el ojo contralateral. (Revisión de la literatura y manejo a propósito de un caso) / Sixth nerve palsy of the fixation eye and traumatic retinal angiopathy (Purtscher syndrome) in the contralateral eye. (Review of the literature and management of a case)

Se presenta un paciente con angiopatía retiniana traumática (síndrome de Purtscher) en ojo izquierdo asociado a parálisis de VI y VII nervios derechos, hemiparesia derecha y aneurisma de la arteria cerebral media izquierda, secundarios a accidente automovilístico. Durante su tratamiento se logró la rehabilitación completa del ojo derecho paralizado, y se estableció atrofia óptica del izquierdo. Se demuestra la utilidad de la toxina botulínica en el tratamiento del estrabismo paralítico como mejor indicación en pacientes con estado de salud comprometido para impedir la evolución hacia un estrabismo permanente. Se realiza una revisión de la literatura del síndrome de Purtscher.

Botulinum toxin treatment of the sixth nerve palsy: an experience of 5-year duration in Thailand.

Forty-five patients (48 eyes) with sixth nerve palsy were treated with botulinum toxin injection to antagonist medial rectus muscle at Siriraj Hospital from October 1995 to September 2000. The common causes of palsy were ischemia, trauma and inflammation. Thirty-eight patients (group I) had an interval to treatment of less than 24 weeks (average, 8.7 weeks) and seven patients (group II), longer than 24 weeks. The mean pre-injection esodeviation and extent of abduction in group I were 28.1 prism diopters (PD) and 28.4 per cent, and in group II were 38 PD and 8.1 per cent respectively. After a mean follow-up of 12.2 months, twenty-seven (71.1%) patients in group I recovered completely after the first injection and three (7.9%), after the second injection with a mean interval to recovery of 8.1 weeks. One (14.3%) of 7 patients of group II obtained complete recovery without fusion. Twenty-six (83.9%) of 31 patients with complete resolution achieved binocular function. We conclude that botulinum toxin treatment is a safe and effective alternative to traditional surgery of acute onset sixth nerve palsy.

Estudo eletro-oculográfico cinético nas paralisias tronculares do nervo abducente / Kinetic electrooculographic study of the truncal paralysis of the abducent nerve

Objetivo: Estudo eletro-oculográfico cinético nas paralisias tronculares do nervo abducente. Local: Laboratório de eletrofisiologia da UFF (Universidade Federal Fluminense). Método: Estudo prospectivo de uma série de 30 pacientes com paralisia troncular do nervo abducente. Foram usados os módulos de Gay et al. (1974)na medida das velocidades dos movimentos oculares, quando eram registrados eletro-oculograficamente, com corrente contínua (DC). As velocidades dos movimentos oculares dos pacientes portadores de lesões do nervo abducente foram comparadas com padrões normais existentes no laboratório de eletro-fisiologia da U.F.F. Resultados: Os resultados obtidos confirmaram a utilidade dos referidos módulos na medida das velocidades dos movimentos oculares. Conclusões: Há correlação entre os movimentos lentos e rápidos, diminuição das velocidades nas lesões do nervo abducente e diminuição da amplitude do movimento ocular nestas lesões.

Parálisis del motor ocular externo en Pediatría / Abducens paralysis in childhood

La parálisis del sexto par craneal es la más común de las parálisis adquiridas que comprometen los nervios oculomotores.Las causas en niños difieren de las de los adultos,Las principales son las de origen traumático,tumorales,infecciosas,hipertensión endocraneana,siendo una causa menos frecuente la forma benigna.Ante la presencia de una parálisis del sexto par,debe sospecharse patología intracraneal.Si ésta es descartada,dentro de los diagnósticos diferenciales y,sobre todo,con examen físico normal,se deberá tener en cuenta la forma benigna.Se presenta una paciente de 10 años de edad que cursó una forma benigna de parálisis del sexto par recuperando los movimientos oculares normales luego de 5 meses.Se efectúo una revisión bibliográfica sobre parálisis del sexto par craneano en pediatría