Recurrent abducens nerve palsy with optic perineuritis

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

Effects of Intraorbital Electroacupuncture on Diabetic Abducens Nerve Palsy

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.

Case of abducens nerve palsy

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.

Case Report of Combined Sixth and Twelfth Cranial Nerve Palsy: A Rare Case of Clival Syndrome Arising from Thymoma

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.

Outcomes of half-width vertical rectus transposition augmented with posterior fixation sutures for sixth cranial nerve palsy

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.