The diagnostic yield of neuroimaging in sixth nerve palsy - Sankara Nethralaya Abducens Palsy Study (SNAPS): Report 1

Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm composed of basaloid epithelial and myoepithelial cells. The palate is the most commonly involved intraoral site for ACC. Here, we document the case of an advanced ACC arising from the hard palate that presented with right-sided sixth nerve palsy in a 75-year-old male with no other systemic illnesses. ACC of the head and neck involving the cavernous sinus and presenting as isolated sixth nerve palsy is exceedingly rare. In the absence of vasculopathic or ischemic risk factors, regardless of the age of the patient; neuroimaging should be performed in cases of isolated nontraumatic sixth nerve palsy.

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“…In patients over 50 years of age, isolated sixth nerve palsy in the absence of vasculopathic risk factors requires neuroimaging. [ 10 ]…”

Section: Discussionmentioning

confidence: 99%

Adenoid cystic carcinoma of the hard palate presenting as ipsilateral sixth nerve palsy

Nair

Gopinathan

Singh

et al. 2018

Indian J Ophthalmol

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“…8 Following trauma, 7% developed sixth nerve palsy. 9 It was more frequent below the age of 40 years. Most commonly, it was due to automobile accidents.…”

Section: Aetiologymentioning

confidence: 98%

“…9 Only in 30% of patients who complained of diplopia were advised to use occlusion to avoid diplopia. 9 Many patients surprisingly learned to ignore diplopia by adapting compensatory head posture. Almost, all patients received neurovitamins as a supportive therapy along with specific therapy.…”

Section: Treatmentmentioning

confidence: 99%

A Comprehensive Analysis of Isolated Infranuclear Abducens Nerve Palsy in a Tertiary Eye Care Centre

Dhamodaran¹,

Santhi²

2017

jebmh

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BACKGROUND A comprehensive analysis of the aetiology and clinical profile of isolated infranuclear abducens nerve palsy in a tertiary eye care centre. MATERIALS AND METHODS A hospital-based retrospective case series analysis of 90 isolated infranuclear neurogenic abducens nerve palsies. Documentation included age, gender, presenting complaints, history of diabetes mellitus, hypertension, mode of onset, progression of the disease, treatment given and recovery rate was evaluated. Detailed ophthalmic evaluation of both eyes including anterior segment examination, extraocular movements, diplopia charting and Hess charting. Thorough central nervous system examination and systemic examination was done. Inclusion Criteria-All isolated infranuclear neurogenic lesions of abducens nerve palsy. Exclusion Criteria-Conditions like supranuclear lesions, myasthenia, orbital inflammation and myopathies, false localising sign of abducens nerve palsy were excluded by appropriate testing and investigations.

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“…3,7 The most cited series describes 101 patients with IIH where 14 patients had sixth nerve palsy (11 unilateral and 3 bilateral), 8 whereas another study cites 2 out of 104 neurologically isolated cases. 9 Several pathophysiologic mechanisms have been suggested; the most accepted being stretching of the nerve due to its long intracranial course. 1 Another hypothesis involves compression of the nerve against the petrous ligament or ridge of the petrous temporal bone.…”

Section: Sixth Nerve Palsymentioning

confidence: 99%

Chameleons, red herrings, and false localizing signs in neurocritical care

Sursal

Bowers

et al. 2020

British Journal of Neurosurgery

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False localizing signs (FLS) and other misleading neurological signs have long been an intractable aspect of neurocritical care. Because they suggest an incorrect location or etiology of the pathological lesion, they have often led to misdiagnosis and mismanagement of the patient. Here, we reviewed the existing literature to provide an updated, comprehensive descriptive review of these difficult to diagnose signs in neurocritical care. For each sign presented, we discuss the non-false localizing presentation of symptoms, the common FLS or misleading presentation, etiology/pathogenesis of the sign, and diagnosis, as well as any other clinically relevant considerations. Within cranial neuropathies, we cover cranial nerves III, IV, V, VI, VII, VIII, as well as multiple cranial nerve involvement of IX, X, and XII. FLS ophthalmologic symptoms indicate diagnostically challenging neurological deficits, and here we discuss downbeat nystagmus, pingpong-gaze, one-and-a-half syndrome, and wall-eyed bilateral nuclear ophthalmoplegia (WEBINO). Cranial herniation syndromes are integral to any discussion of FLS and here we cover Kernohan's notch phenomenon, pseudo-Dandy Walker malformation, and uncal herniation. FLS in the spinal cord have also been relatively well documented, but in addition to compressive lesions, we also discuss newer findings in radiculopathy and disc herniation. Finally, pulmonary syndromes may sometimes be overlooked in discussions of neurological signs but are critically important to recognize and manage in neurocritical care, and here we discuss Cheyne-Stokes respiration, cluster breathing, central neurogenic hyperventilation, ataxic breathing, Ondine's curse, and hypercapnia. Though some of these signs may be rare, the framework for diagnosing and treating them must continue to evolve with our growing understanding of their etiology and varied presentations.

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The diagnostic yield of neuroimaging in sixth nerve palsy - Sankara Nethralaya Abducens Palsy Study (SNAPS): Report 1

Cited by 29 publications

References 17 publications

Adenoid cystic carcinoma of the hard palate presenting as ipsilateral sixth nerve palsy

Adenoid cystic carcinoma of the hard palate presenting as ipsilateral sixth nerve palsy

A Comprehensive Analysis of Isolated Infranuclear Abducens Nerve Palsy in a Tertiary Eye Care Centre

Chameleons, red herrings, and false localizing signs in neurocritical care

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