Isolated abducens nerve palsy secondary to Lemierre syndrome

Bababeygy, Simon R.; Almarzouki, Hashem; Buffenn, Angela N.

doi:10.1016/j.jaapos.2011.06.010

Cited by 14 publications

(4 citation statements)

References 9 publications

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“…Twenty-four percent of the cases were presented with a complaint in the pharyngeal area (tonsillitis, pharyngitis, common sore throat), whereas a few came with an initial complaint of a swelling of the neck, 37 , 61 , 64 – 66 , 73 , 82 due to either the thrombus itself or an abscess located in the neck region. Only eleven cases were described with initial difficulties in the dental region, 6 , 16 , 18 , 42 , 46 the otogenic region, 18 , 19 , 68 , 77 or the central nervous system. 29 , 45 Atypical presentations included seizures 90 and blindness.…”

Section: Diagnosismentioning

confidence: 99%

Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

159

160

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This is a systematic review of cases with Lemierre’s syndrome (LS) in the past 5 years. LS is characterized by sepsis often evolving after a sore throat or tonsillitis and then complicated by various septic emboli and thrombosis of the internal jugular vein. Symptoms include sepsis, pain, and/or swelling in the throat or neck, as well as respiratory symptoms. Laboratory findings show elevated infectious parameters and radiological findings show thrombosis of the internal jugular vein and emboli in the lungs or other organs. The syndrome is often associated with an infection with Fusobacterium necrophorum. We found a total of 137 cases of LS, of which 47 were infected with F. necrophorum and others with Staphylococcus and Streptococcus. Complications of this rare but severe disease included osteomyelitis, meningitis, and acute respiratory distress syndrome. Mortality was extremely high in the pre-antibiotic era but has diminished with the advent of antibiotics. This review showed a mortality rate of only 2% of which none of the cases involved fusobacteria. Duration of treatment varied; a 4–6-week course of carbapenem or piperacillin/tazobactam in combination with metronidazole was optimum. Other treatment options included anticoagulants in 46% of cases, which is unwarrantedly high, as to date, no evidence of the positive effects of anticoagulants in LS exists. Only two cases had ligation of the internal jugular vein performed. This review confirms the rare, but severe aspects of LS. Mortality from LS in this day and age appears to be low, however the syndrome is difficult to recognize, and still requires the full attention of the clinician.

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Section: Diagnosismentioning

confidence: 99%

Lemierre’s syndrome: current perspectives on diagnosis and management

Johannesen

Bødtger

2016

IDR

159

160

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“…Of 712 patients with Lemierre syndrome included in the overall cohort, we found 27 (3.8%) who presented with or were described having ophthalmic complications or related symptoms (Benhayoun et al 2003;Figueras Nadal et al 2003;Ahad et al 2004;Arat et al 2004;Bentham et al 2004;Peng et al 2005;Olson & Mandava 2006;Westhout 2007;Kadhiravan et al 2008;Shivashankar et al 2008;van Dijk et al 2008;Jones & Arnold 2009;Aouad et al 2010;Bababeygy et al 2011;Kahn 2011;Miller et al 2012;Rehman 2012;Akiyama et al 2013;Gutzeit et al 2013;Stauffer 2013;Creemers-Schild 2014;Golan et al 2014;Garibova 2015;Holm et al 2015;Nishida et al 2015;Ballester et al 2016;Hama et al 2016). Nine (33%) patients were women and the median age was 20 (Q1-Q3 15-33) years.…”

Section: Resultsmentioning

confidence: 97%

Ophthalmic complications of Lemierre syndrome

Kreuzpointner

Valerio

Corsi

et al. 2021

Acta Ophthalmologica

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Purpose: Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. Methods: We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). Results: Nine(33%)patientswerewomen;themedianagewas20(Q1-Q3:15-33)years. Fusobacteriumspp.wasinvolvedin56%ofcases.Themostprevalentinitialmanifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nervepalsy(28%)andproptosis(28%).Venousinvolvement,notablycerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. Conclusion: Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists.

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“…This is presented in Table 3. Of these cases, four patients made complete recoveries [4,21,24,35], while three patients had a remaining abducens nerve palsy upon discharge [12,25,26]. Two cases had unclear or unstated outcomes [18,23].…”

Section: Diagnosismentioning

confidence: 97%

A Systematic Review of Lemierre’s Syndrome With a Focus on Ophthalmologic Complications

Dasari¹,

Jha²

2020

Cureus

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Lemierre's syndrome (LS), once known as "the forgotten disease," is a rare and potentially lifethreatening condition that has had a gain in incidence over the last 30 years due to a variety of factors that could include changes in antibody prescription patterns, particularly in regard to the treatment of pharyngitis/tonsillitis. Due to its low incidence and broad spectrum of symptoms, LS does not have an obvious clinical diagnosis and can confuse the clinician managing the patient. Furthermore, it is equally difficult to treat patients suffering from LS as it requires a multidisciplinary approach from multiple subspecialties. Thus, communication between hospitalists, radiologists, otolaryngologists, neurologists, and ophthalmologists is critical towards quickly diagnosing the disease condition so that prompt antibiotics, anticoagulation, and surgical intervention can occur. Atypical presentations can also exist, making the diagnosis and management exponentially more challenging. Ophthalmologic symptoms are a particularly rare and atypical presentation of LS. These rare symptoms in LS can be terrifying for patients and providers alike; yet, there does not seem to be any modern medical literature that summarizes ophthalmologic complications for LS patients. To our knowledge, this is the first systematic review of LS with a focus on ophthalmologic complications that has been done. The main objective of this review paper is to provide an up-to-date literature review of LS epidemiology, pathophysiology, diagnosis, and treatment while also performing a novel systematic review of reported cases of LS with ophthalmological complications. We hope to bring more awareness towards LS and its atypical presentations so that physicians will be better able to rapidly diagnose and treat their patients in order to minimize long-term morbidity and mortality.

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Isolated abducens nerve palsy secondary to Lemierre syndrome

Cited by 14 publications

References 9 publications

Lemierre’s syndrome: current perspectives on diagnosis and management

Lemierre’s syndrome: current perspectives on diagnosis and management

Ophthalmic complications of Lemierre syndrome

A Systematic Review of Lemierre’s Syndrome With a Focus on Ophthalmologic Complications

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Isolated abducens nerve palsy secondary to Lemierre syndrome

Cited by 14 publications

References 9 publications

Lemierre&rsquo;s syndrome: current perspectives on diagnosis and management

Lemierre&rsquo;s syndrome: current perspectives on diagnosis and management

Ophthalmic complications of Lemierre syndrome

A Systematic Review of Lemierre’s Syndrome With a Focus on Ophthalmologic Complications

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Product

Resources

About

Lemierre’s syndrome: current perspectives on diagnosis and management

Lemierre’s syndrome: current perspectives on diagnosis and management