Diabetes plus third nerve palsy not always diabetic third nerve palsy

Venkatesan, Prasanna; Gnanashanmugam, G; Parimalam, N; Pranesh, M B

doi:10.4103/0022-3859.147055

Cited by 3 publications

(3 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Here, we report 2 patients who developed CCFs in close temporal relationship to a microvascular ischemic 4th NP (4 NP). Though it is possible that a posteriorly draining CCF mimicked a microvascular ischemic NP [7], this is unlikely since both patients had spontaneous improvement and were asymptomatic between the microvascular ischemic NP and the CCF. The signs and symptoms of an indirect CCF can be dynamic with the pattern of drainage [8,9], which may switch from posterior to anterior if the former pathway becomes thrombosed [3,10].…”

Section: Discussionmentioning

confidence: 99%

The Development of Indirect Carotid Cavernous Fistulas after Microvascular Ischemic 4th Nerve Palsies

Pickel

Micieli²

2022

Case Rep Ophthalmol

View full text Add to dashboard Cite

An indirect carotid cavernous fistula (CCF) is an abnormal connection between the cavernous sinus and internal or external carotid artery. Indirect CCFs often occur spontaneously, particularly in the setting of vascular risk factors such as hypertension, diabetes, and atherosclerosis. Microvascular ischemic nerve palsies (NPs) share these vascular risk factors. However, to date, no temporal relationship between microvascular ischemic NP and indirect CCF occurring sequentially has been reported. We describe the cases of 64- and 73-year-old women who developed indirect CCFs within 1–2 weeks after spontaneous resolution of a microvascular ischemic 4th NP. Both patients had complete resolution and an asymptomatic period between the 4th NP and CCF. This case highlights the shared pathophysiology and risk factors between microvascular ischemic NPs and CCFs, and emphasizes that CCFs should be kept in the differential diagnosis for red eye or recurrent diplopia in patients with previous microvascular ischemic NP.

show abstract

Section: Discussionmentioning

confidence: 99%

The Development of Indirect Carotid Cavernous Fistulas after Microvascular Ischemic 4th Nerve Palsies

Pickel

Micieli²

2022

Case Rep Ophthalmol

View full text Add to dashboard Cite

show abstract

“…Microvascular ischemia is regarded as the most common cause [2], and it is closely related to diabetes [3]. In addition, differences have been reported in the incidence rates of other causes of cranial nerve palsy in diabetic patients [4, 5]. Hence, diabetic ONP should be distinguished from other etiologies of isolated ONP.…”

Section: Introductionmentioning

confidence: 99%

Diabetic Oculomotor Nerve Palsy Displaying Enhancement of the Oculomotor Nerve in the Orbit and Cavernous Sinus on MRI

Zhao¹,

Li²,

Chang³

et al. 2021

Eur Neurol

View full text Add to dashboard Cite

Introduction: Imaging data were scarce on diabetic oculomotor nerve palsy (ONP). Our study explored the MRI features and their clinical implications for diabetic ONP. Methods: Fifty-nine patients with a clinical diagnosis of diabetic ONP were recruited from our department between January 2015 and December 2019. Orbital MRI was retrospectively analyzed, and follow-up scans were obtained for 5 patients. Based on the ocular motor nerve palsy scale, the difference in the scores on the first and last hospital days was defined as the improvement score and was used to assess the treatment effects in all. Results: Thirty-eight (64.41%) patients presented thickening and enhancement of the cavernous segment and inferior division of the intraorbital segment of the ipsilateral oculomotor nerve, with the cisternal segment spared in all. After complete resolution of symptoms, follow-up MRI in 5 patients revealed that the enhancement was less obvious compared with the previous images. 6 patients in the enhancement group and 4 patients in the nonenhancement group were treated with 80 mg of methylprednisolone. Significant differences were not detected in the median improvement scores between patients with and those without corticosteroid use (p = 0.240). Conclusion: Thickening and enhancement of the unilateral oculomotor nerve were common imaging findings in diabetic ONP, and they persisted after complete resolution of symptoms in some patients. The cavernous segment and the inferior division of the intraorbital segment were simultaneously involved, and the cisternal segment was often spared. Refraining from corticosteroids was recommended even with nerve enhancement.

show abstract

“…Microvascular ischemia is regarded as the most common cause (2), and the incidence of cranial nerve palsies among affected patients is 10-fold higher in those with diabetes than in the nondiabetic population (3). In addition, differences in the incidence rates of other causes of cranial nerve palsies have been reported in diabetic patients (4,5). Thus, the occurrence of isolated ONP in diabetics should be prudently distinguished from occurrences with other etiologies.…”

Section: Introductionmentioning

confidence: 99%

Unilateral Oculomotor Nerve Enhancement in Diabetic Oculomotor Nerve Palsy: A Retrospective Study

Zhao¹,

Li²,

Chang³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background No previous studies have explored the imaging features of oculomotor nerve palsy (ONP) in diabetic patients. In our clinical practice, isolated ONP with diabetes is partly treated with glucocorticosteroids because nerve enhancement is habitually interpreted as inflammation. Our study thus aims to summarize the imaging findings of isolated ONP with diabetes.Methods Our study included 59 patients with a clinical diagnosis of diabetic ONP. Patients were recruited from our department between January 2015 and December 2019. Orbital MRI was retrospectively analyzed for each patient, and follow-up imaging was obtained for 3 patients.Results Thickening and enhancement of the ipsilateral oculomotor nerve were detected in 38 (64.41%) patients, indicating simultaneous involvement of the cavernous segment and inferior division of the intraorbital segment. After clinically complete recovery, repeated MRI in 3 patients revealed a slightly reduced degree of enhancement of the oculomotor nerve. No differences were detected in the sex ratio (p=0.976), median onset age (p=0.563), median duration of diabetes (p=0.697), plasma glycosylated hemoglobin (HbAlc) level (p=0.278) or interval from disease onset to MRI between patients with and without enhancement of the oculomotor nerve. Conclusions Thickening and enhancement of the unilateral oculomotor nerve can be detected in patients with diabetic ONP and indicates the main involvement of the cavernous segment and the inferior division of the intraorbital segment, which may be helpful for differentiating this condition from other etiologies in isolated ONP.

show abstract

Diabetes plus third nerve palsy not always diabetic third nerve palsy

Cited by 3 publications

References 5 publications

The Development of Indirect Carotid Cavernous Fistulas after Microvascular Ischemic 4th Nerve Palsies

The Development of Indirect Carotid Cavernous Fistulas after Microvascular Ischemic 4th Nerve Palsies

Diabetic Oculomotor Nerve Palsy Displaying Enhancement of the Oculomotor Nerve in the Orbit and Cavernous Sinus on MRI

Unilateral Oculomotor Nerve Enhancement in Diabetic Oculomotor Nerve Palsy: A Retrospective Study

Contact Info

Product

Resources

About