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An Approach to Oculomotor Anomalies in a Child
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
The presentation of an isolated abducens nerve palsy can vary depending on the severity of the paralysis. Patients may present with a small esotropia and face turn, or a large esotropia that precludes fusion in any direction of gaze. Due to the anatomical course of the sixth nerve, several associated symptoms must be sought in order to localize the lesion. In the sixth nerve nucleus, neurons that are destined to climb within the medial longitudinal fasciculus to innervate the contralateral medial rectus muscle for ipsilateral gaze reside. For this reason, a nuclear abducens palsy is typically associated with a gaze palsy in the ipsilateral direction. In addition, nuclear abducens palsies are also almost always associated with facial nerve palsies due to the proximity of the facial nerve nucleus and genu. As the sixth nerve traverses the petrous apex, it can be affected by intracranial pressure changes as well as by skull base tumors. In the cavernous sinus, the oculosympathetic fibers are adjacent to the abducens nerve, and therefore, a co-existent Horner syndrome must be sought.
Complications of Skull Base Surgery
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Abdul Karim Nassimizadeh, Chris Coulson
The cranial nerves III, IV and VI are at risk during operations of the petrous apex adjacent to the cavernous sinus and the anterior skull base. The trochlear nerve exits the posterior brainstem and has a relatively long intracranial course, but is well protected in the tentorium and is infrequently injured. Abducens nerve palsy has been reported after lumbar drain placement – it is not known whether this is through an ischaemic or traction injury. Abducens nerve palsy management tends to be symptomatic, with recovery tending to be slow and progressive. In paediatric patients occlusive patch therapy for eyes will help avoid amblyopia, until residual palsy improves. Monitoring of extraocular movements is important in recovery.
Synopsis of the Nervous System
Published in Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner, The Integrated Nervous System, 2017
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner
The nuclei of CN V (trigeminal), VI (abducens), VII (facial) and VIII (vestibulo-cochlear) are all found within the pons. The trigeminal nerve supplies sensation to the skin of the face and is motor to the chewing muscles (mastication). The abducens nerve is responsible for lateral eye movement. The facial nerve supplies the muscles of facial expression (around the eyes and the lips); parasympathetic fibers supply some of the salivary glands and the lacrimal gland. The special senses of hearing and body motion are carried in the VIIIth nerve.
Persistent Trigeminal Artery Causing an Abducens Nerve Palsy: A Case Report
Published in Neuro-Ophthalmology, 2023
Aimee Lloyd, Sunila Jain, Diana Duke, Somenath Chatterjee, Bahauddin Ibrahim
She was assessed and diagnosed with a right abducens nerve palsy. A non-contrast computed tomography scan of her head was carried out, which identified no abnormalities. MRI was not requested at the time of presentation, as the compatibility of the clip used for the sphenopalatine artery ligation was not known. Her symptoms were managed with a ‘Fresnel’ prism. She was been given exercises to try to help her control the esophoria, which did not help, so they were discontinued. Due to the coronavirus pandemic, she then experienced delays to her follow-up appointments. At her next appointment, almost 2 years later, there had been some improvement in the abducens nerve palsy. She now had no diplopia in primary position. She was subsequently referred to the neuro-ophthalmology clinic at Lancashire Teaching Hospital NHS Trust (LTHTR) for further evaluation.
Trigeminal schwannoma: a single-center experience with 43 cases and review of literature
Published in British Journal of Neurosurgery, 2021
Mingchu Li, Xu Wang, Ge Chen, Jiantao Liang, Hongchuan Guo, Gang Song, Yuhai Bao
Among the 43 patients, the tumor was totally removed in 39 patients (90.7%) and near-totally removed in three patients (7.0%). In one patient (2.3%), the tumor was only partially removed, because the ICA was injured, and the patient died after the operation. The abducens nerve was damaged in two patients (4.7%), and the nerve function achieved a significant improvement during the follow up. One patient developed mild facial paralysis and two patients developed intracranial infection after the operation. However, all of them achieved complete recovery before discharge. All four patients with trigeminal neuralgia achieved total recovery. However, the facial numbness got relief in only four patients, and this still continued in 24 patients (85.7%). In two patients, facial numbness even aggravated after the operation. For the nine patients with preoperative trigeminal motor impairment, the symptom did not achieve relief in any patient. Patients with oculomotor nerve paralysis, abducent paralysis and hearing decrease also achieved significant improvement during the follow-up. At a median of 45.3 ± 25.5 months (6–84 months) of follow up, the tumor recurred in only one patient, and this patient received a second operation via FTSA. The surgical results and follow-up results are shown in Table 4.
Combined neurosurgical and orbital intervention for spheno-orbital meningiomas - the Manchester experience
Published in Orbit, 2020
J. Young, F. Mdanat, A. Dharmasena, P. Cannon, B. Leatherbarrow, C. Hammerbeck-Ward, S. Rutherford, S. Ataullah
Post-operative cranial nerve palsies were found in 10 patients. This included abducens nerve (CN VI) palsy in six patients. Only one of those patients had a persisting CN VI deficit at last follow-up. Two patients had an oculomotor nerve (CN III) palsy, which persisted in one patient but was noted to have improved at last follow-up. Two patients had injuries involving three cranial nerves. One of them had an oculomotor nerve (CNIII) injury, hypoaesthesia of the ophthalmic branch of the trigeminal nerve (V1), and an abducens nerve (CN VI) palsy. The other had an oculomotor nerve (CN III) injury, as well as trochlear nerve (CN IV) and abducens nerve (VI) palsies. Both of these patients had persisting cranial nerve deficit at last follow-up. These cranial nerve palsies were most likely due to intraoperative manipulation, particularly in those patients with a tumour encroaching on or involving the superior orbital fissure and cavernous sinus.