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(a) Clinical image of patient no. 8 showing alternating esotropia and bilateral LR palsy, (b) T2W axial MRI imaging showing bilateral enlarged optic nerve sheath with empty sella turcica, (c) fundus image at presentation showing papilledema, and (d) clinical images (e) fundus picture on follow-up showing complete recovery e
Source publication
Purpose:
This study was done to evaluate the clinical profile in pediatric patients (0-16 years) presenting with acute onset esotropia due to sixth nerve palsy and its management options in a tertiary care set up of Southern India.
Methods:
A total of 12 patients presenting to our OPD with acute onset esotropia due to sixth nerve palsies were in...
Context in source publication
Context 1
... but intermittent 8 PD esodeviation was present postsurgery. Stereopsis was regained in two cases and was absent in case 4. Patients 8, 9, and 10 had episodes of headache prior to presentation. Papilledema was present in both eyes of all three. Neuroimaging showed empty sella suggestive of pseudotumour cerebri and optic nerve sheath edema [ Fig. 2]. Only one case (no. 10) underwent surgical correction. All three had good binocular vision and motor alignment on ...
Citations
... 4 In children injury is the commonest cause for 4th nerve palsy. 5 However, acquired ocular motor nerve palsies may often be the primary ominous sign of a more sinister pathology like neoplasia (space occupying lesion), meningitis, encephalitis, intracranial aneurysm, poison intoxication, and myasthenia gravis. 6 Management of such acquired motor palsies often require extensive systemic investi-gations and neuroimaging especially in children. ...
Objective: To provide an account on the demographics, etiology, co-morbidities, presentation findings and frequency of patients with cranial nerve palsies presenting to our Neuro-Ophthalmology clinic. Study Design: Cross-sectional study. Place and Duration of Study: Department of Neuro-Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, Pakistan from Dec 2017 to Jun 2022. Methodology: A total of 82 patients were included in the study. The data was compiled on a single proforma by a single investigator which included Co-morbidities, presentation findings (ptosis, headache, diplopia, extra-ocular movements, Anisocoria, Visual Acuity for both eyes, Media and Fundus examination findings). Contrast Enhanced MRI (CEMRI) results were also tabulated where performed. Potential causes such as diabetes mellitus, hypertension, space occupying lesions, aneurysms and injury were also documented for each patient. Results: A total of 22 patients had 3rd nerve palsy, 9(40.91%) out of them had partial 3rd nerve palsy while 6(27.31%) had ischemic 3rd nerve palsy. Out of 45 cases of 4th and 6th nerve palsy, 13(28.90%) patients had ischemic fourth nerve palsy and 13(28.90%) patients had ischemic 6th nerve palsy, followed by post-traumatic fourth nerve palsy. Conclusion: We have provided an account of the possible etiologies and presentation findings in patients presenting with ocular motility disorders in our setting. Diabetes Mellitus was the most common microvascular cause for ischemic cranial nerve palsies. More sinister pathologies like myasthenia gravis, often presenting as mimickers of isolated cranial nerve palsies were quite common in our study.
... ICSNP is an uncommon finding that is barely mentioned in the literature. The understanding that the more common acquired six nerve palsy can result from an intracranial neoplasm; increased intracranial pressure (ICP) or trauma is alarming and frequently promotes cautious and extensive work-up to exclude such dangerous etiologies [7][8][9][10][11][12]. ...
... Although still debatable, it has been shown in some cases that the fetus's ICP increases during labor [18][19][20][21]. This transient increase can damage the abducens nerve, which later spontaneously recovers, similarly to acquired cases due to increased ICP in the pediatric population [7][8][9][10]22]. ...
Purpose
The purpose of this study is to describe a case series of infants with isolated congenital sixth nerve palsy (ICSNP) and suggest a management algorithm based on our experience and a review of the literature.
Methods
A retrospective cohort design was used. The clinical database of a single tertiary medical center was reviewed to identify all patients diagnosed with ICSNP from January 2020 to November 2022. Data were collected as follows: demographic parameters, age at initial presentation, presenting symptoms and signs, findings on ophthalmic and neurologic examinations, findings on follow-up, and outcome.
Results
Six patients were included. All were born at term. The average gestational weight was 3675.7 ± 262.7 g. Three mothers had gestational diabetes. Five deliveries necessitated labor induction either by oxytocin (n = 4) or by membrane stripping followed by oxytocin (n = 1). One had also gone a forceps assisted delivery.
Symptoms were noticed in all newborns by their parents within the first week of life. Ophthalmological and neurological examinations were otherwise unremarkable apart of one patient with a head turn to the side of the involved eye. Four patients underwent brain imaging that were unremarkable. All abduction deficits resolved by 1 to 3 months of age. Follow up examinations were unremarkable (mean follow up 14.3 ± 5.0 months, range 4–23).
Conclusions
This case series, together with previous reports, support ICSNP’s benign nature. We suggest an initial basic work-up that solely includes ophthalmological and neurological examinations which will be elaborated in case of any additional pathologic findings or if ICSNP does not fully resolve by 3 months.
