Isolated sixth nerve palsy secondary to spontaneous intracranial hypotension

Khemka, S.; Mearza, Ali

doi:10.1111/j.1468-1331.2006.01505.x

Cited by 21 publications

(17 citation statements)

References 7 publications

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“…Abducent nerve palsies have been described in trauma with or without fractures of the skull base, 4,[32][33][34] mass effect with brainstem shift, 38 ICA aneurysms, 3,31 intracranial hypotension, 9 lumbar puncture, 23,39 shunting for hydrocephalus, 10 sphenoid sinus pathology, 8 and suppurative middle ear infections. 16 While direct injury or compression is straightforward, the etiology of indirect injuries or stretch injuries in trauma or intracranial hypotension is more peculiar.…”

Section: Discussionmentioning

confidence: 99%

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

Kshettry

Lee

Ammirati

2013

FOC

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Interest in studying the anatomy of the abducent nerve arose from early clinical experience with abducent palsy seen in middle ear infection. Primo Dorello, an Italian anatomist working in Rome in the early 1900s, studied the anatomy of the petroclival region to formulate his own explanation of this pathological entity. His work led to his being credited with the discovery of the canal that bears his name, although this structure had been described 50 years previously by Wenzel Leopold Gruber. Renewed interest in the anatomy of this region arose due to advances in surgical approaches to tumors of the petroclival region and the need to explain the abducent palsies seen in trauma, intracranial hypotension, and aneurysms. The advent of the surgical microscope has allowed more detailed anatomical studies, and numerous articles have been published in the last 2 decades. The current article highlights the historical development of the study of the Dorello canal. A review of the anatomical studies of this structure is provided, followed by a brief overview of clinical considerations.

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Section: Discussionmentioning

confidence: 99%

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

Kshettry

Lee

Ammirati

2013

FOC

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“…15 Indeed, an impairment of the nerve function may result from hypoplastic Dorello's canal 3 or the dilation of venous structures surrounding this canal, which occurs in intracranial hypotension syndrome. 9 Finally, clival pathology, despite having minimal mass effect, may cause nerve dysfunction, 20 probably by compressing the nerve at the entrance of Dorello's canal. Our 2 cases confirm that a skull base tumor may have a similar effect independent of the lesion's size.…”

Section: Discussionmentioning

confidence: 99%

Recurrent and self-remitting sixth cranial nerve palsy: pathophysiological insight from skull base chondrosarcoma

Frassanito

Massimi

Rigante

et al. 2013

PED

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Palsy of the abducens nerve is a neurological sign that has a wide range of causes due to the nerve's extreme vulnerability. Need of immediate neuroimaging is a matter of debate in the literature, despite the risks of delaying the diagnosis of a skull base tumor. The authors present 2 cases of skull base tumors in which the patients presented with recurrent and self-remitting episodes of sixth cranial nerve palsy (SCNP). In both cases the clinical history exceeded 1 year. In a 17-year-old boy the diagnosis was made because of the onset of headache when the tumor reached a very large size. In a 12-year-old boy the tumor was incidentally diagnosed when it was still small. In both patients surgery was performed and the postoperative course was uneventful. Pathological diagnosis of the tumor was consistent with that of a chondrosarcoma in both cases. Recurrent self-remitting episodes of SCNP, resembling transitory ischemic attacks, may be the presenting sign of a skull base tumor due to the anatomical relationships of these lesions with the petroclival segment of the sixth cranial nerve. Physicians should promptly recommend neuroimaging studies if SCNP presents with this peculiar course.

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“…Typical neurological symptoms of CSF overdrainage include nausea, emesis, diplopia, orthostatic headaches, dizziness, difficulties in hearing, visual blurring [2, 10] and cranial nerve palsy [14,15]. Current publications report on reversible coma, intracranial vasospasms [17] or even stroke and death due to intracranial hypotension [11].…”

Section: Clinical Presentationmentioning

confidence: 99%

Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits

Sporns¹,

Schwindt²,

Cnyrim³

et al. 2016

Fortschr Röntgenstr

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Purpose: Intracranial hypotension has been reported as a complication of accidental drainage after surgical treatment in several cases. Application of negative pressure systems (wound drains, VAC?-therapy, chest tube drainage) had typically led to severe intracranial hypotension including intracranial hemorrhage and tonsillar herniation. In the last year the authors observed 2 cases of accidental spinal drainage of CSF in patients with neurological deficits, regressing after reduction of the device suction. Material and Methods: We conducted a systematic PubMed-based research of the literature to study the variety and frequency of the reported symptoms from 1st of January 1980 until 1st of October 2015. Results: Reviewing the literature 24 relevant citations including 27 reported cases of posttraumatic or postoperative loss of CSF leading to neurological symptoms were identified. All 15 reported cases in which a negative pressure suction device had been applied showed severe neurological and radiological symptoms such as coma or brain herniation and intracranial hemorrhage. In all cases patients recovered rapidly after removal of the suction device. Milder symptoms were observed in the patients without negative pressure suction, mainly only presenting with headaches or cranial nerve involvement. Additionally, we give an overview about current recommendations regarding cranial and spinal imaging to rule out dural laceration and cranial hypotension. Conclusion: Patients with dural laceration complicated by accidental drainage of CSF can present with life-threatening conditions. Increasing use of negative pressure suction devices makes the reported condition an important differential diagnosis. A precise radiological examination can help to rule out dural laceration and intracranial hypotension. Key Points: ??Undetected dural laceration complicated by negative pressure suction drains can induce life-threatening symptoms. ??Increasing use of negative pressure suction devices makes the reported condition an important differential diagnosis for radiologists Citation Format: ??Sporns PB, Schwindt W, Cnyrim CD et?al. Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits. Fortschr R?ntgenstr 2016; 188: 451???458

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Isolated sixth nerve palsy secondary to spontaneous intracranial hypotension

Cited by 21 publications

References 7 publications

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

The Dorello canal: historical development, controversies in microsurgical anatomy, and clinical implications

Recurrent and self-remitting sixth cranial nerve palsy: pathophysiological insight from skull base chondrosarcoma

Undetected Dural Leaks Complicated by Accidental Drainage of Cerebrospinal Fluid (CSF) can Lead to Severe Neurological Deficits

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