Acquired onset of third, fourth, and sixth cranial nerve palsies in children and adolescents

Park, Kyung-Ah; Oh, Sei Yeul; Min, Ju-Hong; Kim, Byoung Joon; Kim, Yikyung

doi:10.1038/s41433-019-0353-y

Cited by 25 publications

(24 citation statements)

References 25 publications

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“…who noticed that 14.5% of their pediatric sixth nerve palsies were of congenital origin[ 3 ], and Park et al . who did not find any congenital case,[ 14 ] 21.7% of the cases in the present cohort were of congenital origin. Rare causes of pediatric sixth nerve palsies reported in the literature include ophthalmoplegic migraine,[ 24 ] Gradenigo syndrome,[ 25 26 ] iatrogenic causes including a lumbar puncture and myelography.…”

Section: Discussionmentioning

confidence: 52%

“…[ 1 ] Various other authors have found neoplasms to be the most common etiology. [ 14 22 23 ] Trauma was the most common cause for pediatric sixth nerve palsy in the present cohort. In contrast to Harley et al .…”

Section: Discussionmentioning

confidence: 82%

“…reported vascular and neoplastic etiologies to be the most common acquired causes, respectively. [ 3 14 ] Vascular causes of oculomotor palsy, mainly cerebral aneurysm, are rare in children and are reported to account for 7% of these nerve palsies in them. [ 4 6 ] Though 10% of pediatric oculomotor nerve palsies have been reported to be of neoplastic origin, we did not have any case of neoplasm in our study.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile

Priya

Guha

Mittal

et al. 2021

Indian Journal of Ophthalmology

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Purpose: The aim of this study was to describe epidemiological and clinical characteristics of pediatric ocular motor cranial nerve palsy. Methods: This was a retrospective record-based study, carried out at a tertiary eye care hospital in India, between January 2011 and January 2015 and included patients up to 16 years of age at the time of presentation, diagnosed with third, fourth, sixth nerve palsy or a combination of these with other cranial nerve palsy. Data analyzed included demographic details, etiologies, presence or absence of amblyopia, relevant investigations, and management. Results: A total of 90 cases were included in the study. Eighty patients (88.88%) presented with isolated nerve palsy. Forty-three patients (47.77%) had congenital nerve palsy. The most common nerve involved was third ( n = 35, 38.88%) followed by sixth ( n = 23, 25.55%) and fourth nerve ( n = 22, 24.44%). Most common cause of third and fourth cranial nerve palsy was congenital ( n = 18, 51.42% and n = 17, 77.30%, respectively), while it was trauma for the sixth nerve ( n = 7, 30.40%). Amblyopia was most frequently associated with third cranial nerve palsy ( n = 27, 77.14%). The radio-imaging yield was maximum ( n = 7, 70%) for combined cranial nerve palsy. Overall 44 (48.88%) patients were managed conservatively, while 46 (51.11%) patients needed squint with or without ptosis surgery. Conclusion: The most common ocular motor cranial nerve involved in the pediatric population was the third cranial nerve, and it was found to be the most amblyogenic in this age group. The neuroimaging yield was maximum for combined cranial nerve palsy. The most common conservatively managed nerve palsy in this study group was the fourth nerve palsy.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile

Priya

Guha

Mittal

et al. 2021

Indian Journal of Ophthalmology

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“…The abducens nerve is the most commonly affected cranial nerve in acute strabismus in children 27 . The most common etiology is tumor, reported in up to 45% of the children 28,29 …”

Section: Mri Of the Orbitsmentioning

confidence: 99%

Neuroimaging in Children with Ophthalmological Complaints: A Review

Rootman

Dotan

Konen

2021

Journal of Neuroimaging

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Pediatric patients are commonly referred to imaging following abnormal ophthalmological examinations. Common indications include papilledema, altered vision, strabismus, nystagmus, anisocoria, proptosis, coloboma, and leukocoria. Magnetic resonance imaging (MRI) of the brain and orbits (with or without contrast material administration) is typically the imaging modality of choice. However, a cranial CT scan is sometimes initially performed, particularly when MRI is not readily available. Familiarity with the various ophthalmological conditions may assist the radiologist in formulating differential diagnoses and proper MRI protocols afterward. Although MRI of the brain and orbits usually suffices, further refinements are sometimes warranted to enable suitable assessment and accurate diagnosis. For example, the assessment of children with sudden onset anisocoria associated with Horner syndrome will require imaging of the entire oculosympathetic pathway, including the brain, orbits, neck, and chest. Dedicated orbital scans should cover the area between the hard palate and approximately 1 cm above the orbits in the axial plane and extend from the lens to the midpons in the coronal plane. Fat‐suppressed T2‐weighted fast spin echo sequences should enable proper assessment of the globes, optic nerves, and perioptic subarachnoid spaces. Contrast material should be given judiciously, ideally according to clinical circumstances and precontrast scans. In this review, we discuss the major indications for imaging following abnormal ophthalmological examinations.

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“…Extraocular muscle weakness is not commonly reported in MS. Sixth nerve palsy is a rare presentation of adult MS. 14–16 Children reported with sixth nerve palsy is mostly due to neoplasms or trauma. 17 …”

Section: Introductionmentioning

confidence: 99%

Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child

Al-Yousuf¹,

Aljutaili²,

AlHuwais³

et al. 2021

IMCRJ

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We report a child with multiple sclerosis who presented with sixth nerve palsy. She is a twelve-year-old Bahraini female presented to the ophthalmology department complaining of double vision. She also had imbalance and paraesthesia. Extraocular muscle examination showed restriction of abduction in the right eye. There was no change in vision. MRI showed right eye optic neuritis (ON) and demyelination which was indicative of multiple sclerosis (MS). Ocular coherence tomography (OCT) showed thinning of nerve fibres of both eyes which was consistent with subclinical optic neuritis. Neurological examination showed brisk knee jerk on the left side and incoordination of movement on the same side. Disability Status Scale (EDSS) showed a score of 3.0. She was given Solu-medrol 500 mg intravenously (IV) in addition to omeprazole 40 mg IV and Vitamin D3 (cholecalciferol) 50,000 IU cap weekly for 8 weeks and Neurorubine forte tablets (vitamin B1, 6, 12) once a day for 2 months. She became asymptomatic in her follow-up visits. Children with MS can present as sixth cranial nerve palsy. Clinicians should have a high index of suspicion for early diagnosis and treatment. In addition to MRI, OCT is a useful diagnostic tool for optic neuritis and MS especially in children.

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Acquired onset of third, fourth, and sixth cranial nerve palsies in children and adolescents

Cited by 25 publications

References 25 publications

Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile

Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile

Neuroimaging in Children with Ophthalmological Complaints: A Review

Multiple Sclerosis Presenting with Sixth Nerve Palsy in a Child

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