Sixth Nerve Palsy in Children Etiology, Long-Term Course, and a Diagnostic Algorithm.

BACKGROUND: Acute onset strabismus is worrisome for parents and physicians. This condition is sometimes attributed to sixth cranial nerve palsy, which may be secondary to various etiologies. Debate still exists about the appropriate diagnostic approach. OBJECTIVE: The objective of this study was to describe the common etiologies of sixth nerve palsy in our pediatric population and to suggest a clear, implementable diagnostic algorithm. METHODS: The authors conducted an electronic medical review of files of patients admitted to the pediatric department at Emek Medical Center between January 2014 and April 2020. They reviewed the medical records from the study period of patients with the following diagnoses according to the International Classification of Diseases 9: sixth nerve palsy, acute infective polyneuritis, Guillain-Barré syndrome, benign intracranial hypertension, malignant neoplasm of the brain, strabismus, myasthenia gravis, and multiple sclerosis. The authors extracted information regarding clinical presentation, previous history, and diagnostic work-up, including serological testing, cerebrospinal fluid testing, and neuroimaging. Final diagnosis and clinical follow-up were assessed. RESULTS: Seventeen patients with sixth nerve palsy were identified. The most common etiologies were increased intracranial hypertension and anti-GQ1B syndrome (3 patients each). CONCLUSIONS: This is a retrospective study of patients diagnosed in one medical center. The suggested algorithm was not validated on a prospective study. The etiologies of sixth nerve palsy in children are variable. The authors suggest performing neuroimaging in all patients and considering serum and cerebrospinal fluid testing in selected patients. Initial neuroimaging combined with laboratory testing is useful and provides rational tools for proper diagnosis.

Diplopia from abducens nerve paresis as a presenting symptom of COVID-19: a case report and review of literature.

Neurological manifestations of novel coronavirus disease 3019 (COVID-19) remain unclear. We report the case of a 44-year-old febrile man who presented with double vision and headache 2 d after initial symptoms of fatigue, generalized muscle weakness, and loss of appetite. He was subsequently diagnosed with COVID-19 and transient abducens nerve paresis. He did not present with any respiratory symptoms or additional specific neurological findings. We recommend that with the rising number of cases across the world, physicians develop a greater index of suspicion for COVID-19 in patients with cranial neuropathies, even in those with mild disease without typical respiratory symptoms.

Assessing abnormal head posture: a new paradigm.

PURPOSE OF REVIEW: We aim to give a systematic approach on how to assess the cause of a patient's abnormal head posture (AHP). RECENT FINDINGS: Over the decades, many important clinical observers and teachers have described diagnostic techniques for patients with AHP. Recently, Wong has added a new set of office-based diagnostic criteria that expand and solidify the office assessment of AHP. SUMMARY: We describe old and new, well known and poorly known office techniques for the assessment of AHP.

Preoperative topical moxifloxacin 0.5% and povidone-iodine 5.0% versus povidone-iodine 5.0% alone to reduce bacterial colonization in the conjunctival sac.

PURPOSE: To assess the effectiveness of adding topical moxifloxacin 0.5% to topical povidone-iodine 5.0% for preoperative reduction of bacterial recovery from the conjunctiva. SETTING: Emek Medical Center, Afula, Israel. METHODS: The study population comprised adult patients scheduled for elective intraocular surgery. Two hours before surgery, patients were randomly assigned to topical therapy with moxifloxacin 0.5% drops (study group) or normal saline drops (control group). Povidone-iodine 5% solution was also instilled in the conjunctival sac in both groups for 3 minutes immediately before surgery. Conjunctival cultures were obtained before prophylactic therapy and just before surgery. The major outcome measures were the rate of bacterial colonization and bacterial type in conjunctival cultures obtained after instillation of povidone-iodine and immediately before surgery. RESULTS: Overall, 464 patients completed the study; there were 237 patients in the study group and 227 patients in the control group. Positive conjunctival cultures were obtained before prophylactic therapy in 91 patients (38%) in the study group and 94 patients (41%) in the control group and just before surgery in 10 patients (4%) and 6 patients (3%), respectively; neither difference was statistically significant. Coagulase-negative Staphylococcus was the most prevalent bacteria and was found equally in both groups. CONCLUSIONS: Treatment with povidone-iodine 5.0% alone was effective in preoperative reduction of conjunctival bacterial colonization. Adding topical moxifloxacin 0.5% to povidone-iodine 5.0% had no significant effect on further reduction in the bacterial colonization rate.