Isolated oculomotor nerve palsy revealing infectious mononucleosis

Malclès, Ariane; Ronsin, Solène; Agard, Émilie; Abouaf, Lucie; Tilikete, Caroline; Vighetto, Alain; Biotti, Damien

doi:10.1111/aos.12636

Cited by 5 publications

(5 citation statements)

References 4 publications

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“…e Higher magnification of ( b ) showing a pattern of contrast enhancement resembling a “shooting star” ( f ), with the focal hyperintense edematous change at the oculomotor nerve exit zone corresponding to the meteor and adjacent leptomeningeal enhancement corresponding to the visible streak of light of a shooting star. g , h Higher magnifications of MR images from previous case reports by Malclés et al [ 9 ] and Erben et al [ 10 ] showing a similar radiologic pattern with focal hyperintense edematous changes and leptomeningeal enhancement lining the adjacent part of the mesencephalon.…”

Section: Figsupporting

confidence: 52%

Oculomotor Nerve Palsy as a Presenting Symptom of Epstein-Barr Virus-Associated Infectious Mononucleosis: Case Report and Review of the Literature

et al. 2021

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Primary Epstein-Barr virus (EBV) infection is the main cause of infectious mononucleosis (IM), which typically presents with a triad of fever, lymphadenopathy, and tonsillar pharyngitis in young adults. In contrast, neurological manifestations of IM are rare. We report on a 23-year-old man with subacute oculomotor nerve palsy followed by symptoms of IM 6 days later. Primary EBV infection was confirmed by PCR detection of EBV DNA in blood as well as by subsequent serology. High-resolution magnetic resonance imaging revealed an edematous change at the root exit zone and gadolinium enhancement of the right oculomotor nerve as well as pial enhancement adjacent to the right ventral mesencephalon. A review of the literature identified 5 further patients with isolated oculomotor nerve palsy as the presenting symptom of unfolding primary EBV infection. MRIs performed in 3 of those 5 patients revealed a pattern of contrast enhancement similar to that of the present case. This case report and literature review highlight that, although rare, IM should be considered in the differential diagnosis of oculomotor nerve palsy in young adults.

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Section: Figsupporting

confidence: 52%

Oculomotor Nerve Palsy as a Presenting Symptom of Epstein-Barr Virus-Associated Infectious Mononucleosis: Case Report and Review of the Literature

et al. 2021

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“…Therefore, the patient presented a partial acute extrinsic paralysis of the left third cranial nerve, spontaneously resolving in 7 days following a severe form of SARS-CoV-2. To our knowledge, third cranial nerve palsy has already been described with some viruses, suggesting some hypotheses [1][2][3][4]. SARS-CoV-2 is a neurotrophic virus that can induce encephalitis.…”

Section: Dear Sirsmentioning

confidence: 99%

Isolated post SARS-CoV-2 diplopia

et al. 2020

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“…Some of the ocular complications reported include conjunctivitis, dacryoadenitis, episcleritis, keratitis, iritis, and optic neuritis in herpetic viral infections 27,28 . Ophthalmoplegia and cranial nerve palsies, abnormal ocular movements, nystagmus, anisocoria, ptosis, jerky movements, and oscillopsia have also documented an association with encephalitis [29][30][31][32] . However, there is a scarcity of studies that describe ophthalmological findings in a pediatric population with non-traumatic coma.The few ophthalmologic findings in this study did not significantly influence the management of our patients.…”

Section: Resultsmentioning

confidence: 99%

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

et al. 2020

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The ophthalmological examination is a vital aspect of the central nervous system examination in comatose children. Several authors have documented different findings with disparities in their recommendations about making ophthalmological examination a routine in the management of the unconscious child. This study sought to evaluate the relevance of routine ophthalmological examination in the management of unconscious children admitted into the paediatric emergency room of Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria. This was a prospective longitudinal study conducted from April 2018 to March 2019. Unconscious patients whose caregivers gave consent were recruited into the study. Traumatic causes of coma were excluded. Demographic features of the patients were obtained. The ophthalmologic examination and diagnoses were made by an ophthalmologist, while the emergency room pediatrician made clinical assessment and diagnoses. Sixteen unconscious children had ophthalmologic examinations done. The Glasgow coma scale scores ranged from 3 to 11, with a mean of 6.6±2.2. Thirteen (81.3%) of the children were classified as severe unconsciousness while the rest were moderate. The degree of unconsciousness was significantly associated with the outcome (χ2 =16.0, P = 0.03). A total of six (37.5%) ophthalmologic diagnoses were made, which included cerebral malaria, degenerative myopia, orbital cellulitis, and exposure keratopathy. The presence of an abnormal ophthalmologic finding was not significantly associated with outcome (χ2 =0.36, P = 0.55). Routine ophthalmologic examination may not be justified as a management protocol in unconscious children but may be considered in selected cases.

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Isolated oculomotor nerve palsy revealing infectious mononucleosis

Cited by 5 publications

References 4 publications

Oculomotor Nerve Palsy as a Presenting Symptom of Epstein-Barr Virus-Associated Infectious Mononucleosis: Case Report and Review of the Literature

Oculomotor Nerve Palsy as a Presenting Symptom of Epstein-Barr Virus-Associated Infectious Mononucleosis: Case Report and Review of the Literature

Isolated post SARS-CoV-2 diplopia

Ophthalmological Findings in Paediatric Non-Traumatic Coma in Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria

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