Presenting features suggestive for later recurrence of idiopathic sixth nerve paresis in children

Yousuf, Salman J.; Khan, Arif O.

doi:10.1016/j.jaapos.2007.02.013

Cited by 24 publications

(21 citation statements)

References 30 publications

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“…They found the mean age in the recurrent cohort to be younger than in the “non-recurrent” cohort. Also, they note a trend toward “non-recurrence” in boys, more pronounced in boys with right-sided palsy, and recurrence in girls, more pronounced in girls with left-sided palsy 5. Our review corroborates their finding that all patients who had a benign sixth nerve palsy temporally related to vaccination had at least one recurrence.…”

Section: Discussionsupporting

confidence: 86%

“…Yousuf and Khan also found that “all children who presented at 14 months of age or younger developed recurrence” 5. Our review, however, found seven such patients with reasonable follow-up, who did not develop recurrence.…”

Section: Discussionmentioning

confidence: 57%

“…Recently, Yousuf and Khan reviewed the clinical features in cases of benign sixth nerve palsies through a meta-analysis of prior reviews and reports 5. They found the mean age in the recurrent cohort to be younger than in the “non-recurrent” cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Our review, however, found seven such patients with reasonable follow-up, who did not develop recurrence. Perhaps this is a consequence of the authors’ suggested selection bias from previously reported cases5 and our benefit of reviewing all the cases presented to one specialist. Still, our study is nonetheless problematic having been conducted at a referral institution as therefore both uncommon presentations of benign cases and the overall number of neoplasm and neurosurgical patients may be over-represented.…”

Section: Discussionmentioning

confidence: 99%

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Benign recurrent sixth (abducens) nerve palsies in children

Mahoney

Liu

2009

Archives of Disease in Childhood

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Sixth nerve palsy can occur as a result of elevated intracranial pressure, neoplasm or trauma. Reports from tertiary centres indicate that between 5% and 16% of referred cases have no ascribed aetiology and are classified as benign. Rarely, these benign palsies can recur. A retrospective chart review of a cohort of 253 paediatric patients with sixth nerve palsies was analysed and uncovered 30 cases of benign sixth nerve palsy, nine of which recurred. Our data and review of other studies on the subject imply that a new onset sixth nerve palsy presenting in children can be benign in approximately 13% of cases, so a thorough history and physical examination to evaluate for any other neurological symptoms or signs followed by MRI of the brain with and without contrast is recommended.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Benign recurrent sixth (abducens) nerve palsies in children

Mahoney

Liu

2009

Archives of Disease in Childhood

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“…Such cases are also isolated, sporadic, and predominantly left sided, and they occur more frequently in girls. [10][11][12][13][14] Although considered benign, many cases nonetheless leave a residual sixth nerve paresis, indicating a degree of permanent axonal and substrate damage. 15…”

Section: Neuroanatomy Of Duane Syndromementioning

confidence: 99%

Thromboembolism and Congenital Malformations

Parsa

Robert²

2013

JAMA Ophthalmol

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To propose a pathophysiologic mechanism to unify a variety of disparate sporadic congenital malformations. Methods: Inductive and deductive analyses to correlate malformation laterality with asymmetries in thoracic anatomy, critical analysis of malformations with female predominance, and concepts of hydrodynamic pressure gradients in vascular growth were applied to the ensuing development of guiding tissue scaffolds for cellular proliferation, differentiation, and apoptosis. Results: Duane syndrome may develop following a focal vascular insult to the sixth nerve trunk with axonal degeneration, allowing for substitutive innervation from third nerve axons to the lateral rectus muscle. Causative fibrin clots may originate from the venous system and paradoxically migrate through physiological right-toleft shunts, or they may arise directly from the heart. Hence, the unilateral, left-sided, and female predominance of Duane syndrome results from the asymmetry in the thoracic anatomy and from thrombosis risk factors. Embolic occlusions may also alter local hemody-namic pressure gradients, leading to the compensatory enlargement and persistence of the fetal vasculature and may dysregulate tissue growth. Within the eye, this results in forms of Peters anomaly, unilateral congenital cataracts, and the morning glory disc anomaly, all in the vascular territory of the carotid arteries that also share a propensity for left-sided involvement in girls. Most aberrant misinnervation phenomena (eg, jaw-winking syndrome, crocodile tear syndrome, Brown syndrome, and congenital fibrosis syndrome) and, by extrapolation, the hypoplasia or dysgenesis of noncephalic anatomical structures (including limbs) may be similarly explained. Such malformations will occur more frequently under thrombogenic conditions, such as those induced by thalidomide. Conclusions: Fibrin emboli and focal hypoperfusion may explain the development of many sporadic congenital malformations.

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Ocular Motor Nerve Palsies in Children

Sullivan

Clarke

et al. 2009

Pediatric Neuro-Ophthalmology

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Presenting features suggestive for later recurrence of idiopathic sixth nerve paresis in children

Cited by 24 publications

References 30 publications

Benign recurrent sixth (abducens) nerve palsies in children

Benign recurrent sixth (abducens) nerve palsies in children

Thromboembolism and Congenital Malformations

Ocular Motor Nerve Palsies in Children

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