Dear Editor,Dorsal pontine lesions may cause a variety of complex neuro-ophthalmic deficits,including horizontal gaze palsy(HGP),internuclear ophthalmoplegia,one-and-ahalf syndrome,abducens nerve palsy,skew deviation,...Dear Editor,Dorsal pontine lesions may cause a variety of complex neuro-ophthalmic deficits,including horizontal gaze palsy(HGP),internuclear ophthalmoplegia,one-and-ahalf syndrome,abducens nerve palsy,skew deviation,or any combination of these.Here we present a rare case of an adult patient who developed multiple complicated clinical manifestations after surgical removal of a pontine cavernous hemangioma(PCH).Our case highlights a single pontine lesion may involve complicated neural pathways and result in complicated symptoms and signs,in which abducens nerve palsy or skew deviation is easily missed when combined with HGP.展开更多
Dear Editor,Herpes zoster(HZ),which is characterized by a unilateral painful dermatomal rash,is caused by reactivation of the latent varicella-zoster virus(VZV)in the dorsal root ganglia following primary infection du...Dear Editor,Herpes zoster(HZ),which is characterized by a unilateral painful dermatomal rash,is caused by reactivation of the latent varicella-zoster virus(VZV)in the dorsal root ganglia following primary infection during childhood[1].HZ tends to occur more frequently in older adults,in whom cellmediated immunity often declines.The incidence of HZ among immunocompetent unvaccinated individuals aged>50y is 9.92/1000 person-years[2].HZ ophthalmicus(HZO)occurs when HZ involves the first division of the trigeminal nerve,i.e.,the ophthalmic nerve[3].展开更多
AIM:To measure abducens nerve palsy patients’visual angle using real time video-based gaze tracking system.METHODS:This research was a cross-sectional study.The subjects were taken by convenience sampling technique i...AIM:To measure abducens nerve palsy patients’visual angle using real time video-based gaze tracking system.METHODS:This research was a cross-sectional study.The subjects were taken by convenience sampling technique in the Neuro-ophthalmology department at Sardjito General Hospital Yogyakarta,Indonesia,and had met the inclusion and exclusion criteria.The visual angle measurements were performed using an eye tracker with a computer webcam(GENICULA system/Gaze Tracking Artificial Intelligence for Ocular Motor Palsy).The analytical method used was the Mann-Whitney test to compare the visual angle between the abducens nerve palsy group and the healthy eye group.The Wilcoxon test was used to see the significance of differences in visual angle improvement in abducens nerve palsy patients.RESULTS:A total of 39 subjects participated,with a mean age of 46.54±15.67y;17 were male and 22 were female.The visual angle was 20.88±3.76 in the abducens nerve palsy group(n=39 eyes)and 23.10±2.91 in the normal group(n=39 eyes,P=0.011).The visual angle improvement of abducens nerve palsy before and after cured was statistically significant(P=0.039).CONCLUSION:The real time video-based gaze tracking system is easy to use,efficient,and accurate.A slight decrease in visual angle measurement can be detected using this GENICULA system and therefore it is important for diagnosis slight deviation in abducens nerve palsy.展开更多
Rationale:Neuroleptospirosis is an uncommon manifestation of leptospirosis.Cranial nerve involvement is extremely rare.Patient concerns:A 17-year-old girl presented with fever,myalgia,and mild transaminitis.Her serolo...Rationale:Neuroleptospirosis is an uncommon manifestation of leptospirosis.Cranial nerve involvement is extremely rare.Patient concerns:A 17-year-old girl presented with fever,myalgia,and mild transaminitis.Her serology was positive for Leptospira in the second week of illness.During her hospital stay she developed bilateral 6th nerve palsy.Diagnosis:Rare manifestation of neuroleptospirosis presenting as bilateral abducens nerve palsy.Interventions:Antibiotics,cerebrospinal fluid analysis,retinal examination and careful monitoring.Outcomes:She recovered without any residual neurological deficit.Lessons:Patients suffering from acute febrile illness with cranial nerve palsy in tropical and subtropical regions may have central nervous system involvement due to pathogenic leptospires(i.e.,neuroleptospirosis).Early suspicion,careful monitoring,and timely intervention are required.展开更多
Dear Sir, I am Joo Yeon Kim, from the department of Ophthalmology of Kim’s Eye Hospital in Seoul, Korea. I write to present a case report of recurrent abducens nerve palsy with optic perineuritis Abducens nerve palsy...Dear Sir, I am Joo Yeon Kim, from the department of Ophthalmology of Kim’s Eye Hospital in Seoul, Korea. I write to present a case report of recurrent abducens nerve palsy with optic perineuritis Abducens nerve palsy is associated with trauma, viral infection or inoculation, central nervous system tumors, elevated intracranial pressure and idiopathic cause [1]. Optic perineuritis is an uncommon noninfectious inflammation of the optic nerve sheath and perineural fat. Optic perineuritis展开更多
A case of abducens nerve palsy was introduced in this paper.A female patient,37 years old,she complained double vision for 4 days.Acupuncture was applied and no other treatment was cooperated.Main acupoints included J...A case of abducens nerve palsy was introduced in this paper.A female patient,37 years old,she complained double vision for 4 days.Acupuncture was applied and no other treatment was cooperated.Main acupoints included Jīngmíng(睛明BL1),Chéngqì(承泣ST1),Tóngzǐliáo(瞳子髎GB1),Shuǐgōu(水沟GV26),belly side of lateral rectus muscle and Fēngchí(风池GB20).After consecutive treatment for 10 days,the orientation of the right eye was corrected and the patient narrated that double vision disappeared,the symptoms such as dizziness,distending pain of the eyeball disappeared.This therapy provided a new thought and approach to the treatment of abducens nerve palsy.展开更多
Diabetic abducens nerve palsy main symptoms include ocular motility disorders and diplopia.This disease is mainly caused by severe vascular degeneration.It is a serious impact on patient＇s quality of life and mental ...Diabetic abducens nerve palsy main symptoms include ocular motility disorders and diplopia.This disease is mainly caused by severe vascular degeneration.It is a serious impact on patient＇s quality of life and mental health.Currently,there is no effective means of intervention for eye movement disorders and diplopia,the patients could only expect for neural self-repair.[1] Our team invented intraorbital electroacupuncture （IEA） therapy to repair abducens nerve affected by diabetes.In the meantime,we applied it into clinical practice and achieved great success.展开更多
Purpose:This study aimed to propose a novel deep learning-based approach to assess the extent of abduction in patients with abducens nerve palsy before and after strabismus surgery.Methods:This study included 13 patie...Purpose:This study aimed to propose a novel deep learning-based approach to assess the extent of abduction in patients with abducens nerve palsy before and after strabismus surgery.Methods:This study included 13 patients who were diagnosed with abducens nerve palsy and underwent strabismus surgery in a tertiary hospital.Photographs of primary,dextroversion and levoversion position were collected before and after strabismus surgery.The eye location and eye segmentation network were trained via recurrent residual convolutional neural networks with attention gate connection based on U-Net(R2AU-Net).Facial images of abducens nerve palsy patients were used as the test set and parameters were measured automatically based on the masked images.Absolute abduction also was measured manually,and relative abduction was calculated.Agreements between manual and automatic measurements,as well as repeated automatic measurements were analyzed.Preoperative and postoperative results were compared.Results:The intraclass correlation coefficients(ICCs)between manual and automatic measurements of absolute abduction ranged from 0.985 to 0.992(P<0.001),and the bias ranged from-0.25 mm to-0.05 mm.The ICCs between two repeated automatic measurements ranged from 0.994 to 0.997(P<0.001),and the bias ranged from-0.11 mm to 0.05 mm.After strabismus surgery,absolute abduction of affected eye increased from 2.18±1.40 mm to 3.36±1.93 mm(P<0.05).The relative abduction was improved in 76.9%patients(10/13)after surgery(P<0.01).Conclusions:This image analysis technique demonstrated excellent accuracy and repeatability for automatic measurements of ocular abduction,which has promising application prospects in objectively assessing surgical outcomes in patients with abducens nerve palsy.展开更多
Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehen...Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Six experts were invited to grade and evaluate the scale. The study recruited 106 patients with a definite diagnosis of unilateral isolated ocular motor nerve palsy. Three physicians evaluated the patients using the scale. One of the three physicians evaluated the patients again after 24 hours. The content validity index（CVI） and factor analysis were used to analyze the scale＇s construct validity. The intraclass correlation coefficient and Cronbach＇s alpha were used to evaluate the inter-rater and test-retest reliability and the internal consistency. The CVI results（I-CVI = 1.0, S-CVI = 0.9, Pc = 0.016, K＊ = 1） indicated good content validity. Factor analysis extracted two common factors that accounted for 85.2% of the variance. Furthermore, the load value of each component was above 0.8, indicating good construct validity. The Ocular Motor Nerve Palsy Scale was found to be highly reliable, with an inter-rater reliability intraclass correlation coefficient of 0.965（P 0.01）, a test-retest reliability intraclass correlation coefficient of 0.976（P 0.01）, and Cronbach＇s alpha values of 0.63–0.70. In conclusion, the Ocular Motor Nerve Palsy Scale with good validity and reliability can be used to quantify the severity of ocular motor nerve palsy. This study was registered at Chinese Clinical Trial Registry（registration number： Chi CTR-OOC-17010702）.展开更多
Vascular endothelial growth factor(VEGF)was discovered by its angiogenic activity.However,during evolution,it appeared earlier as a neurotrophic factor required for the development of the nervous system in invertebrat...Vascular endothelial growth factor(VEGF)was discovered by its angiogenic activity.However,during evolution,it appeared earlier as a neurotrophic factor required for the development of the nervous system in invertebrates lacking a circulatory system.We aimed at reviewing recent evidence indicating that VEGF has neuroprotective effects in neurons exposed to a variety of insults.Of particular interest is the link established between VEGF and motoneurons,especially after the design of the VEGFδ/δmutant mice.These mice are characterized by low levels of VEGF and develop muscle weakness and motoneuron degeneration resembling amyotrophic lateral sclerosis.The administration of VEGF through several routes to animal models of amyotrophic lateral sclerosis delays motor impairment and motoneuron degeneration and increases life expectancy.There are new recent advances in the role of VEGF in the physiology of motoneurons.Our experimental aims use the extraocular(abducens)motoneurons lesioned by axotomy as a model for studying VEGF actions.Axotomized abducens motoneurons exhibit severe alterations in their discharge activity and a loss of synaptic boutons.The exogenous administration of VEGF to axotomized abducens motoneurons,either from the transected nerve or intraventricularly,fully restores the synaptic and discharge properties of abducens motoneurons,despite being axotomized.In addition,when an anti-VEGF neutralizing antibody is delivered from the muscle to intact,uninjured abducens motoneurons,these cells display alterations in their discharge pattern and a loss of synaptic boutons that resemble the state of axotomy.All these data indicate that VEGF is an essential neurotrophic factor for motoneurons.展开更多
AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with poste...AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.展开更多
BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less ...BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less common metastatic site.CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus,Meckel’s cave,and the petrous bone involving multiple cranial nerves in an 82-year-old woman.At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(MRI)revealed multiple HCC nodules in both right and left lobes.Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC.Molecular targeted therapy with Lenvatinib(8 mg/d for 94 d,per os)and Ramucirumab(340 mg/d and 320 mg/d,two times by intravenous injection)were administered for 4 mo,resulting in progression of the disease.Three months after the start of molecular target therapy,the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye,indicating disturbances in the right trigeminal and abducens nerves.Brain MRI disclosed a mass involving the cavernous sinus,Meckel’s cave and the petrous bone.Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus,Meckel’s cave,and the petrous bone was made based on neurological findings and imaging studies including MRI,but not on histological examinations.Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.展开更多
Godtfredsen syndrome or clival syndrome is a rare syndrome of abducens and hypoglossal nerve palsies (cranial nerve 6th and 12th respectively) that localizes to a clival mass. There are few reported cases of this clin...Godtfredsen syndrome or clival syndrome is a rare syndrome of abducens and hypoglossal nerve palsies (cranial nerve 6th and 12th respectively) that localizes to a clival mass. There are few reported cases of this clinical presentation. The aim of this case report is to describe this rare manifestation observed in a woman with clival metastases arising from a thymoma. A previously well 34-year-old native lady presented to a district hospital in Sabah, Malaysia, with history of blurring of vision and headache for 1 month. Cranial nerve examination reveals right abducens nerve palsy (right 6th CN) and right hypoglossal nerve palsy (right 12th CN). Initial imaging with CT brain reveals a subtle extra-axial hyperdense mass adjacent to the clivus and a routine chest x-ray reveals a mediastinal mass. Further imaging of thorax showed right anterior mediastinal mass, which then proceeded with Video-Assisted Thoracoscopic Surgery (VATS) guided biopsy. The biopsy result was consistent with the finding of thymoma, type B2. She was then diagnosed with aggressive form of thymoma, which unfortunately has metastasized to the bone, lung, liver and brain. Despite prognosis at the time of diagnosis is guarded, she still opted to undergo chemotherapy. Despite the completion of 6 cycles of chemotherapy, her disease progressed, and she eventually succumbed to the illness. In short, the presence of combined 6th and 12th palsy should alert clinician to the possibility of clival mass or metastases and hence could earlier workup with appropriate imaging can lead to earlier diagnosis and better treatment outcome.展开更多
Introduction: Schwannomas of the 6th nerve are extremely rare.Only 22 cases of intracranial schwannomas of the 6th cranial nerve pathologically confirmed have been reported.Case Presentation: Here, we report a case of...Introduction: Schwannomas of the 6th nerve are extremely rare.Only 22 cases of intracranial schwannomas of the 6th cranial nerve pathologically confirmed have been reported.Case Presentation: Here, we report a case of a 14-year-old girl who presented with isolated progressive 6th nerve palsy.A cisternal type of schwannomawas found from neuro-imaging.Subtotal removal of the tumor was performed by a routine left subtemporal craniotomy with an petrosectomy.The attachment to the 6th nerve was found.After surgery, the patient's 6th nerve palsy remained.Histological images revealed a cellular schwannoma.Then the classification, clinical presentation, diagnosis, operation, stereotactic radiosurgery are reviewed.Conclusions: The location and the attachment to the 6th nerve is the key for diagnosis.Most cases are treated surgically.It looks like it is not easy to completely remove for CA type because of invasion of the cavernous sinus or firm adherence to the nerves.The 6th nerve function seldom completely recovered postoperatively.The direction of further research is to improve the diagnosis and therapy to have better nerve recovery.展开更多
文摘Dear Editor,Dorsal pontine lesions may cause a variety of complex neuro-ophthalmic deficits,including horizontal gaze palsy(HGP),internuclear ophthalmoplegia,one-and-ahalf syndrome,abducens nerve palsy,skew deviation,or any combination of these.Here we present a rare case of an adult patient who developed multiple complicated clinical manifestations after surgical removal of a pontine cavernous hemangioma(PCH).Our case highlights a single pontine lesion may involve complicated neural pathways and result in complicated symptoms and signs,in which abducens nerve palsy or skew deviation is easily missed when combined with HGP.
文摘Dear Editor,Herpes zoster(HZ),which is characterized by a unilateral painful dermatomal rash,is caused by reactivation of the latent varicella-zoster virus(VZV)in the dorsal root ganglia following primary infection during childhood[1].HZ tends to occur more frequently in older adults,in whom cellmediated immunity often declines.The incidence of HZ among immunocompetent unvaccinated individuals aged>50y is 9.92/1000 person-years[2].HZ ophthalmicus(HZO)occurs when HZ involves the first division of the trigeminal nerve,i.e.,the ophthalmic nerve[3].
文摘AIM:To measure abducens nerve palsy patients’visual angle using real time video-based gaze tracking system.METHODS:This research was a cross-sectional study.The subjects were taken by convenience sampling technique in the Neuro-ophthalmology department at Sardjito General Hospital Yogyakarta,Indonesia,and had met the inclusion and exclusion criteria.The visual angle measurements were performed using an eye tracker with a computer webcam(GENICULA system/Gaze Tracking Artificial Intelligence for Ocular Motor Palsy).The analytical method used was the Mann-Whitney test to compare the visual angle between the abducens nerve palsy group and the healthy eye group.The Wilcoxon test was used to see the significance of differences in visual angle improvement in abducens nerve palsy patients.RESULTS:A total of 39 subjects participated,with a mean age of 46.54±15.67y;17 were male and 22 were female.The visual angle was 20.88±3.76 in the abducens nerve palsy group(n=39 eyes)and 23.10±2.91 in the normal group(n=39 eyes,P=0.011).The visual angle improvement of abducens nerve palsy before and after cured was statistically significant(P=0.039).CONCLUSION:The real time video-based gaze tracking system is easy to use,efficient,and accurate.A slight decrease in visual angle measurement can be detected using this GENICULA system and therefore it is important for diagnosis slight deviation in abducens nerve palsy.
文摘Rationale:Neuroleptospirosis is an uncommon manifestation of leptospirosis.Cranial nerve involvement is extremely rare.Patient concerns:A 17-year-old girl presented with fever,myalgia,and mild transaminitis.Her serology was positive for Leptospira in the second week of illness.During her hospital stay she developed bilateral 6th nerve palsy.Diagnosis:Rare manifestation of neuroleptospirosis presenting as bilateral abducens nerve palsy.Interventions:Antibiotics,cerebrospinal fluid analysis,retinal examination and careful monitoring.Outcomes:She recovered without any residual neurological deficit.Lessons:Patients suffering from acute febrile illness with cranial nerve palsy in tropical and subtropical regions may have central nervous system involvement due to pathogenic leptospires(i.e.,neuroleptospirosis).Early suspicion,careful monitoring,and timely intervention are required.
文摘Dear Sir, I am Joo Yeon Kim, from the department of Ophthalmology of Kim’s Eye Hospital in Seoul, Korea. I write to present a case report of recurrent abducens nerve palsy with optic perineuritis Abducens nerve palsy is associated with trauma, viral infection or inoculation, central nervous system tumors, elevated intracranial pressure and idiopathic cause [1]. Optic perineuritis is an uncommon noninfectious inflammation of the optic nerve sheath and perineural fat. Optic perineuritis
基金Major Science and Technology Projects of Yunnan Science and Technology Plan:No.2018ZF009Yunnan Ophthalmic Disease Clinical Medical Center:No.2019ZF013。
文摘A case of abducens nerve palsy was introduced in this paper.A female patient,37 years old,she complained double vision for 4 days.Acupuncture was applied and no other treatment was cooperated.Main acupoints included Jīngmíng(睛明BL1),Chéngqì(承泣ST1),Tóngzǐliáo(瞳子髎GB1),Shuǐgōu(水沟GV26),belly side of lateral rectus muscle and Fēngchí(风池GB20).After consecutive treatment for 10 days,the orientation of the right eye was corrected and the patient narrated that double vision disappeared,the symptoms such as dizziness,distending pain of the eyeball disappeared.This therapy provided a new thought and approach to the treatment of abducens nerve palsy.
基金This work was supported by a grant from the National Natural Science Foundation of China （No. 81674052）.
文摘Diabetic abducens nerve palsy main symptoms include ocular motility disorders and diplopia.This disease is mainly caused by severe vascular degeneration.It is a serious impact on patient＇s quality of life and mental health.Currently,there is no effective means of intervention for eye movement disorders and diplopia,the patients could only expect for neural self-repair.[1] Our team invented intraorbital electroacupuncture （IEA） therapy to repair abducens nerve affected by diabetes.In the meantime,we applied it into clinical practice and achieved great success.
基金supported by General Planning Project of Education Science Planning of Zhejiang Province(2024SCG251)Key Program of the National Natural Science Foundation of China(82330032)+1 种基金National Natural Science Foundation Regional Innovation and Development Joint Fund(U20A20386)Key Research and Development Program of Zhejiang Province(2024C03204).
文摘Purpose:This study aimed to propose a novel deep learning-based approach to assess the extent of abduction in patients with abducens nerve palsy before and after strabismus surgery.Methods:This study included 13 patients who were diagnosed with abducens nerve palsy and underwent strabismus surgery in a tertiary hospital.Photographs of primary,dextroversion and levoversion position were collected before and after strabismus surgery.The eye location and eye segmentation network were trained via recurrent residual convolutional neural networks with attention gate connection based on U-Net(R2AU-Net).Facial images of abducens nerve palsy patients were used as the test set and parameters were measured automatically based on the masked images.Absolute abduction also was measured manually,and relative abduction was calculated.Agreements between manual and automatic measurements,as well as repeated automatic measurements were analyzed.Preoperative and postoperative results were compared.Results:The intraclass correlation coefficients(ICCs)between manual and automatic measurements of absolute abduction ranged from 0.985 to 0.992(P<0.001),and the bias ranged from-0.25 mm to-0.05 mm.The ICCs between two repeated automatic measurements ranged from 0.994 to 0.997(P<0.001),and the bias ranged from-0.11 mm to 0.05 mm.After strabismus surgery,absolute abduction of affected eye increased from 2.18±1.40 mm to 3.36±1.93 mm(P<0.05).The relative abduction was improved in 76.9%patients(10/13)after surgery(P<0.01).Conclusions:This image analysis technique demonstrated excellent accuracy and repeatability for automatic measurements of ocular abduction,which has promising application prospects in objectively assessing surgical outcomes in patients with abducens nerve palsy.
基金supported by the National Natural Science Foundation of China,No.81674052
文摘Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Six experts were invited to grade and evaluate the scale. The study recruited 106 patients with a definite diagnosis of unilateral isolated ocular motor nerve palsy. Three physicians evaluated the patients using the scale. One of the three physicians evaluated the patients again after 24 hours. The content validity index（CVI） and factor analysis were used to analyze the scale＇s construct validity. The intraclass correlation coefficient and Cronbach＇s alpha were used to evaluate the inter-rater and test-retest reliability and the internal consistency. The CVI results（I-CVI = 1.0, S-CVI = 0.9, Pc = 0.016, K＊ = 1） indicated good content validity. Factor analysis extracted two common factors that accounted for 85.2% of the variance. Furthermore, the load value of each component was above 0.8, indicating good construct validity. The Ocular Motor Nerve Palsy Scale was found to be highly reliable, with an inter-rater reliability intraclass correlation coefficient of 0.965（P 0.01）, a test-retest reliability intraclass correlation coefficient of 0.976（P 0.01）, and Cronbach＇s alpha values of 0.63–0.70. In conclusion, the Ocular Motor Nerve Palsy Scale with good validity and reliability can be used to quantify the severity of ocular motor nerve palsy. This study was registered at Chinese Clinical Trial Registry（registration number： Chi CTR-OOC-17010702）.
基金supported by the I+D+i project P20_00529 Consejería de Transformación Económica Industria y Conocimiento,Junta de Andalucía-FEDERsupported by project PGC2018-094654-B-100 and PID2021-124300NB-I00 funded by MCIN/AEI/FEDER“A way of making Europe”+1 种基金P.M.C.was a scholar of Ministerio de Educación y Ciencia(BES-2016-077912)in Spain and is now a“Margarita Salas”postdoctoral fellowRGH is a postdoctoral fellow from PAIDI-2019,“Talento Doctores”Junta de Andalucía in Spain,and is now a“Ramón y Cajal”fellow in Spain。
文摘Vascular endothelial growth factor(VEGF)was discovered by its angiogenic activity.However,during evolution,it appeared earlier as a neurotrophic factor required for the development of the nervous system in invertebrates lacking a circulatory system.We aimed at reviewing recent evidence indicating that VEGF has neuroprotective effects in neurons exposed to a variety of insults.Of particular interest is the link established between VEGF and motoneurons,especially after the design of the VEGFδ/δmutant mice.These mice are characterized by low levels of VEGF and develop muscle weakness and motoneuron degeneration resembling amyotrophic lateral sclerosis.The administration of VEGF through several routes to animal models of amyotrophic lateral sclerosis delays motor impairment and motoneuron degeneration and increases life expectancy.There are new recent advances in the role of VEGF in the physiology of motoneurons.Our experimental aims use the extraocular(abducens)motoneurons lesioned by axotomy as a model for studying VEGF actions.Axotomized abducens motoneurons exhibit severe alterations in their discharge activity and a loss of synaptic boutons.The exogenous administration of VEGF to axotomized abducens motoneurons,either from the transected nerve or intraventricularly,fully restores the synaptic and discharge properties of abducens motoneurons,despite being axotomized.In addition,when an anti-VEGF neutralizing antibody is delivered from the muscle to intact,uninjured abducens motoneurons,these cells display alterations in their discharge pattern and a loss of synaptic boutons that resemble the state of axotomy.All these data indicate that VEGF is an essential neurotrophic factor for motoneurons.
文摘AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.
文摘BACKGROUND Metastasis occurs as a late event in the natural history of hepatocellular carcinoma(HCC),and most patients die of liver failure attributed to the tumor supplanting the liver.Conversely,the brain is a less common metastatic site.CASE SUMMARY We describe a rare case of hepatitis C virus-related multiple HCC metastasizing to the cavernous sinus,Meckel’s cave,and the petrous bone involving multiple cranial nerves in an 82-year-old woman.At admission imaging studies including Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging(MRI)revealed multiple HCC nodules in both right and left lobes.Ultrasound guided biopsy of the left lobe revealed moderately differentiated HCC.Molecular targeted therapy with Lenvatinib(8 mg/d for 94 d,per os)and Ramucirumab(340 mg/d and 320 mg/d,two times by intravenous injection)were administered for 4 mo,resulting in progression of the disease.Three months after the start of molecular target therapy,the patient presented with symptoms of hyperalgesia of the right face and limited abduction of the right eye,indicating disturbances in the right trigeminal and abducens nerves.Brain MRI disclosed a mass involving the cavernous sinus,Meckel’s cave and the petrous bone.Contrast-enhanced MRI with gadolinium-chelated contrast medium revealed a well-defined mass with abnormal enhancement around the right cavernous sinus and the right Meckel’s cave.CONCLUSION The diagnosis of metastatic HCC to the cavernous sinus,Meckel’s cave,and the petrous bone was made based on neurological findings and imaging studies including MRI,but not on histological examinations.Further studies may provide insights into various methods for diagnosing HCC metastasizing to the craniospinal area.
文摘Godtfredsen syndrome or clival syndrome is a rare syndrome of abducens and hypoglossal nerve palsies (cranial nerve 6th and 12th respectively) that localizes to a clival mass. There are few reported cases of this clinical presentation. The aim of this case report is to describe this rare manifestation observed in a woman with clival metastases arising from a thymoma. A previously well 34-year-old native lady presented to a district hospital in Sabah, Malaysia, with history of blurring of vision and headache for 1 month. Cranial nerve examination reveals right abducens nerve palsy (right 6th CN) and right hypoglossal nerve palsy (right 12th CN). Initial imaging with CT brain reveals a subtle extra-axial hyperdense mass adjacent to the clivus and a routine chest x-ray reveals a mediastinal mass. Further imaging of thorax showed right anterior mediastinal mass, which then proceeded with Video-Assisted Thoracoscopic Surgery (VATS) guided biopsy. The biopsy result was consistent with the finding of thymoma, type B2. She was then diagnosed with aggressive form of thymoma, which unfortunately has metastasized to the bone, lung, liver and brain. Despite prognosis at the time of diagnosis is guarded, she still opted to undergo chemotherapy. Despite the completion of 6 cycles of chemotherapy, her disease progressed, and she eventually succumbed to the illness. In short, the presence of combined 6th and 12th palsy should alert clinician to the possibility of clival mass or metastases and hence could earlier workup with appropriate imaging can lead to earlier diagnosis and better treatment outcome.
文摘Introduction: Schwannomas of the 6th nerve are extremely rare.Only 22 cases of intracranial schwannomas of the 6th cranial nerve pathologically confirmed have been reported.Case Presentation: Here, we report a case of a 14-year-old girl who presented with isolated progressive 6th nerve palsy.A cisternal type of schwannomawas found from neuro-imaging.Subtotal removal of the tumor was performed by a routine left subtemporal craniotomy with an petrosectomy.The attachment to the 6th nerve was found.After surgery, the patient's 6th nerve palsy remained.Histological images revealed a cellular schwannoma.Then the classification, clinical presentation, diagnosis, operation, stereotactic radiosurgery are reviewed.Conclusions: The location and the attachment to the 6th nerve is the key for diagnosis.Most cases are treated surgically.It looks like it is not easy to completely remove for CA type because of invasion of the cavernous sinus or firm adherence to the nerves.The 6th nerve function seldom completely recovered postoperatively.The direction of further research is to improve the diagnosis and therapy to have better nerve recovery.
