Etiology and Outcomes of Acquired Pediatric Sixth Nerve Palsies

Chang, Melinda Y.; Borchert, Mark

doi:10.1097/wno.0000000000001390

Cited by 7 publications

(3 citation statements)

References 13 publications

(45 reference statements)

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“…Despite the commonly held belief that acquired esotropia is a benign condition, recent research has revealed the potential for serious neurological pathologies even in patients with normal neurological examination. 5,[24][25][26][27] In this study, 113 cases (63.8%) displayed normal neurological findings, while 26 cases (14.7%) were diagnosed with lifethreatening conditions such as tumors, inflammation, and vascular lesions. Additionally, degeneration and other pathologies were observed in 38 cases (21.5%).…”

Section: Discussionmentioning

confidence: 67%

Neuroimaging Findings in Acquired Esotropia Patients at Siriraj Hospital from 2009–2020

Surachatkumtonekul,

Khiewwan,

Hokierti

et al. 2023

Siriraj Med J

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Objective: To analyze the neuroimaging findings in patients with acquired esotropia at Siriraj Hospital from 2009 to 2020. Materials and Methods: A retrospective review of the medical records of all patients aged above 6 months old who presented with acquired esotropia was done. All the patients had an angle of deviation 10 prism diopters (PD), refraction < +3.0 diopters (D), and had neuroimaging performed. The patients with restrictive myopathy and extraocular neurological abnormalities were excluded from the study. Results: In total, 177 subjects aged between 8 months old to 81 years old (mean age 32.35 ± 24.40 years old) were included in the study. The patients’ demographic data, ocular findings, and neuroimaging findings were collected. The mean angle of deviation near and at distance were 26.88 ± 18.90 PD and 29.81 ± 17.25 PD, respectively. Of the 177 cases, 113 cases (63.8%) had no neuroimaging abnormalities, while 64 cases (36.2%) had abnormal neuroimaging findings. In those 64 cases with abnormal findings, there were 16 intracranial tumors, 6 inflammations, 4 vascular lesions, 7 degenerations, and 31 other lesions. Sixth nerve palsy was found to be significantly different between the positive and negative neuroimaging group from both the uni- and multivariate analysis. Conclusion: Although more than half of acquired esotropia patients had no abnormalities in neuroimaging, but 14.7% of those with abnormal neuroimaging findings had underlying serious conditions, which consisted of intracranial tumors, inflammation, and vascular lesions. Special attention should be concentrated to patients with sixth nerve palsy as it was the significant factor found to be associated with positive neuroimaging findings in acquired esotropia.

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Section: Discussionmentioning

confidence: 67%

Neuroimaging Findings in Acquired Esotropia Patients at Siriraj Hospital from 2009–2020

Surachatkumtonekul,

Khiewwan,

Hokierti

et al. 2023

Siriraj Med J

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“…Based on these results, the etiology of the abducens nerve palsy of the patient was considered due to infectious disease. In children, abducens nerve palsy is rarely caused after an upper respiratory tract infection known as "benign isolated abducens nerve palsy", and it has been suggested to be related to Mycoplasma or other viral infections [8,9]. In adults, we only found a case of a 52-year-old man who developed abducens nerve palsy due to a Mycoplasma infection, showing choreoathetoid movements and an acute psychosis, suggesting he had suffered from encephalitis and not exclusively abducens nerve palsy [10].…”

Section: Discussionmentioning

confidence: 99%

A Case of Mycoplasma Infection with an Atypical Presentation of Abducens Nerve Palsy, Erythema Multiforme and Polyarthritis without Respiratory Manifestations

Yoshimoto,

Matsubara,

Kobayashi

et al. 2023

Medicina

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Mycoplasma pneumoniae is a self-propagating microorganism that commonly causes respiratory tract infections. It can also cause a variety of extrapulmonary symptoms with or independently of respiratory symptoms, such as skin lesions, arthralgia, myalgia, hemolysis, cardiac lesions, gastrointestinal symptoms, and central nervous system lesions, which are rare manifestations reported in approximately 0.1% of cases. In this study, we present a unique case of Mycoplasma-related abducens nerve palsy, polyarthritis, and erythema multiforme without respiratory disease. The patient was a 69-year-old woman who presented to our hospital with a skin rash, fever, arthralgia, and diplopia without respiratory symptoms. Brain magnetic resonance imaging showed optic neuritis on the right side, suggesting the diplopia was caused by right abducens nerve palsy. However, the etiologies of abducens nerve palsy were not revealed by the physical examination, blood biochemistry tests, or bacteriological examinations, including the cerebrospinal fluid examination obtained at admission. Mycoplasma infection was suspected from erythema multiforme revealed by a skin biopsy and polyarthralgia, and it was finally diagnosed according to elevated Mycoplasma particle agglutination (PA) antibodies in paired serum. Though minocycline did not improve her diplopia, the daily administration of 30 mg of prednisolone gradually improved her symptoms, and the Mycoplasma PA antibody titer, which was regularly measured in the clinical course, also decreased, suggesting a relationship between Mycoplasma infection and abducens nerve palsy. This is the first case of isolated abducens nerve palsy, which was reported as the only central neurological symptom in an adult patient with Mycoplasma infection. The mechanism or pathogenesis of CNS manifestations caused by Mycoplasma pneumoniae remains to be elucidated, and further investigation is needed. Hence, Mycoplasma infection is a common disease. Clinicians should be aware of the diverse manifestations, including abducens nerve palsy, of Mycoplasma infection and should consider Mycoplasma infection even in the absence of typical respiratory symptoms.

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“…1 Lesions might be isolated 2,3 or with additional cranial nerve involvement. 4 Generally, frequent causes of children's abducens nerve palsy are often associated with postviral or postvaccination, idiopathic, trauma, elevated intracranial pressure, neoplasm, or viral infections; [5][6][7] while in adults are microvascular diseases, vasculopathies, tumors, and inflammatory conditions. 8,9 Ten years cohort study showed the etiologies of old population were presumed to be vascular (56.6%), idiopathic (27.2%), neoplastic (5.6%), and traumatic (4.9%).…”

Section: Introductionmentioning

confidence: 99%

Abducens Nerve Palsy Due to Coronavirus Disease (COVID-19)

Goenawan,

Mahayana

2023

J. Kdokt Meditek

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The main causes of N.VI paralysis in adults are microvascular disease, vasculopathy, tumors, and inflammatory conditions. However, recent studies suggest that neurotropic viruses may be the etiology of N.VI paralysis. COVID-19 also has neurotropic and neuroinvasive capabilities that make the eye susceptible to bilateral optic neuritis, papilledema, and cranial nerve paralysis, the most common of which is abducens nerve palsy. The aim of this literature review is to review studies that describe the occurrence of abducens nerve palsy in COVID-19 patients. The literature search began in the period April-May 2022 from the Google Scholar database (https://scholar.google.com/). This mini review used the AMSTAR (Assessment of Multiple Systemic Review 2, including randomized and nonrandomized studies) checklist and reviewers independently agreed on the selection of eligible studies and reached consensus regarding which studies to include with inclusion criteria. This mini review found that 75% of cases were strongly associated with viral infection and 25% of cases were strongly associated with COVID-19 vaccination. Only 50% of cases report improvement in abducens nerve palsy. This has the implication that with the increasing prevalence of COVID-19 worldwide, ophthalmologists should be aware that abducens nerve palsy may be part of COVID-19.

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Etiology and Outcomes of Acquired Pediatric Sixth Nerve Palsies

Cited by 7 publications

References 13 publications

Neuroimaging Findings in Acquired Esotropia Patients at Siriraj Hospital from 2009–2020

Neuroimaging Findings in Acquired Esotropia Patients at Siriraj Hospital from 2009–2020

A Case of Mycoplasma Infection with an Atypical Presentation of Abducens Nerve Palsy, Erythema Multiforme and Polyarthritis without Respiratory Manifestations

Abducens Nerve Palsy Due to Coronavirus Disease (COVID-19)

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