- Pathogenesis of cranial neuropathies in Moebius syndrome: Electrodiagnostic orofacial studies. [Journal Article]
- MNMuscle Nerve 2018 Feb 09
- CONCLUSIONS: Our results support the hypothesis of an early developmental defect localized in motor cranial nerves with spared V to VII internuclear pathways. This article is protected by copyright. All rights reserved.
- Primitive Squamous Cell Carcinoma of Pterygopalatine Fossa. [Journal Article]
- JCJ Craniofac Surg 2018 Feb 07
- Primitive tumors of pterygopalatine fossa (PPF) are often benign tumors or extension of a malignant sinonasal tract. Primitive tumors may rarely occur in PPF.The authors present a 71-year-old woman w...
Primitive tumors of pterygopalatine fossa (PPF) are often benign tumors or extension of a malignant sinonasal tract. Primitive tumors may rarely occur in PPF.The authors present a 71-year-old woman with a 6-month history of left cranial nerve palsy. Magnetic resonance imaging and positron emission tomography-computed tomography showed an enhancing isolated lesion at the PPF. A transmaxillary biopsy was performed, leading to diagnosis of primitive squamous cell carcinoma. The patient underwent radiotherapy treatment.Primitive tumors of PPF are rare and diagnosis may be difficult. Endoscopic access for diagnosis can be performed. Squamous cell carcinoma occurring in PPF is associated with poor prognosis.
- Extended middle fossa approach to lateralized pontine cavernomas in children. [Journal Article]
- JNJ Neurosurg Pediatr 2018 Feb 02; :1-5
- CONCLUSIONS: The extended middle fossa approach can be used for resection of lateral pontine hemorrhagic cavernomas with minimal morbidity in the pediatric population.
- Botulinum toxin as an initial therapy for management of sixth nerve palsies caused by nasopharyngeal carcinomas. [Journal Article]
- EEye (Lond) 2018 Jan 26
- PurposeThe purpose of this study is to evaluate the efficacy and safety of botulinum toxin injection as a primary treatment for strabismus in a cohort of patients with nasopharyngeal carcinoma (NPC)-...
PurposeThe purpose of this study is to evaluate the efficacy and safety of botulinum toxin injection as a primary treatment for strabismus in a cohort of patients with nasopharyngeal carcinoma (NPC)-related chronic sixth nerve palsy.Patients and methodsWe retrospectively reviewed all cases of NPC-related sixth nerve palsy receiving botulinum toxin injection in the Hong Kong Eye Hospital between January 2009 and January 2016. Only cases with diplopia for at least 6 months; and failed a trial of Fresnel prism therapy were recruited. We excluded cases with prior strabismus surgery and multiple cranial nerve palsies. Patients were offered botulinum toxin injection as primary treatment for their strabismus and were given further injections or offered surgery if diplopia persisted. Success with botulinum toxin was defined as a final distant orthophoria of <15 PD in primary gaze, no diplopia in primary position, and no head turn, as measured 6 months after the last injection, without requiring a second treatment.ResultsA total of 25 patients were included in the study. All patients received concurrent chemo-radiotherapy for NPC. There was a statistically significant reduction in the mean deviation at distant after the last injection compared to that at presentation (P<0.001, Wilcoxin signed rank test). Overall, 7 patients (28%) achieved clinical success and 15 patients (64%) remained diplopia-free by repeated botulinum toxin injections alone. Nine patients went on to receive definitive surgery and all achieved good ocular alignment after surgery. Transient ptosis or vertical deviation was seen in 7 patients, which resolved within 3 months and no serious complications arose from the treatment in our series.ConclusionsBotulinum toxin injection is a relatively less-invasive alternative to surgery that can be done under a topical anesthesia setting, which improves patient's quality of life via reduction in diplopia. It is a recommendable initial option in patients with chronic nerve palsies who may have higher risks associated with strabismus surgery.Eye advance online publication, 26 January 2018; doi:10.1038/eye.2017.276.
- A case study of Ramsay Hunt Syndrome in conjunction with cranial polyneuritis. [Case Reports]
- MMedicine (Baltimore) 2017; 96(47):e8833
- CONCLUSIONS: Considering that targeted antiviral therapy can be used to increase the effectiveness of treatment, early diagnosis, and timely use of medication is critical.
- Isolated intracranial Rosai-Dorfman disease mimicking petroclival meningioma in a child: Case report and review of the literature. [Case Reports]
- MMedicine (Baltimore) 2017; 96(47):e8754
- CONCLUSIONS: Preoperative diagnosis of petroclival RDD is full of challenges. Although surgical resection of lesions is an effective treatment option, total resection is not highly recommended because the surgery-related defect must be minimal. Patient with residual lesion can be put on steroid therapy and/or radiotherapy, especially for IgG4 positive subset of RDD.
- Cranial neuropathy and severe pain due to early disseminatedBorrelia burgdorferiinfection. [Journal Article]
- BCBMJ Case Rep 2018 Jan 23; 2018
- A 61-year-old man presented to the emergency department in the summer with a right seventh cranial nerve lower motor neuron palsy and worsening paraesthesias for 6 weeks. He had debilitating pain at ...
A 61-year-old man presented to the emergency department in the summer with a right seventh cranial nerve lower motor neuron palsy and worsening paraesthesias for 6 weeks. He had debilitating pain at the scalp and spine. Prior work up was unrevealing. The patient resided in the upper Midwest region of the USA and worked outdoors, optimising the landscape for white tailed deer. Repeat cerebrospinal fluid testing revealed a lymphocytic pleocytosis and positive IgM Lyme serology. Brain MRI demonstrated enhancement of multiple cranial nerves bilaterally. He was diagnosed with early Lyme neuroborreliosis and treated with 28 days of intravenous ceftriaxone. While the painful meningoradiculitis, also known as Bannwarth syndrome, is more commonly seen in Europe, facial palsy is more frequently encountered in the USA. Clinical manifestations of neuroborreliosis are important to recognise as the classic presentation varies by geography and on occasion repeat serological testing may be necessary.
- Collet-Sicard Syndrome With Hypoglossal Nerve Schwannoma: A Case Report. [Journal Article]
- ARAnn Rehabil Med 2017; 41(6):1100-1104
- Collet-Sicard syndrome is a rare syndrome that involves paralysis of 9th to 12th cranial nerves. We report an uncommon case of schwannoma of the hypoglossal nerve in a 39-year-old woman presented wit...
Collet-Sicard syndrome is a rare syndrome that involves paralysis of 9th to 12th cranial nerves. We report an uncommon case of schwannoma of the hypoglossal nerve in a 39-year-old woman presented with slurred speech, hoarse voice, and swallowing difficulty. Physical examination revealed decreased gag reflex on the right side, decreased laryngeal elevation, tongue deviation to the right side, and weakness of right trapezius muscle. MRI revealed a mass lesion in the right parapharyngeal space below the jugular foramen. The tumor was surgically removed. It was confirmed as hypoglossal nerve schwannoma via pathologic examination. Videofluoroscopic swallowing study revealed aspiration of liquid food and severe bolus retention in the vallecula and piriform sinus. Laryngoscopy revealed right vocal cord palsy. Electrodiagnostic study revealed paralysis of the right 11th cranial nerve. In summary, we report an uncommon case of schwannoma of the hypoglossal nerve with 9th to 12th cranial nerve palsy presenting as Collet-Sicard syndrome.
- Case Report: Neurobrucellosis with Plastered Spinal Arachnoiditis: A Magnetic Resonance Imaging-Based Report. [Journal Article]
- AJAm J Trop Med Hyg 2018 Jan 15
- Diffuse spinal arachnoiditis in neurobrucellosis is a rare manifestation. We report a boy aged 17, presenting with hearing impairment and recurrent vomiting for 18 months, weight loss for 12 months, ...
Diffuse spinal arachnoiditis in neurobrucellosis is a rare manifestation. We report a boy aged 17, presenting with hearing impairment and recurrent vomiting for 18 months, weight loss for 12 months, dysphagia, dysarthria, hypophonia for 6 months, and gait unsteadiness for 5 months. He had bilateral 5th (motor) to 12th cranial nerve palsy, wasting and weakness of limbs, fasciculations, absent tendon reflexes, and positive Babinski's sign. Cerebrospinal fluid (CSF) showed raised protein and pleocytosis. Magnetic resonance imaging (MRI) showed extensive enhancing exudates in cisterns and post-contrast enhancement of bilateral 5th, 6th, 7th, and 8th nerves. Spine showed clumping with contrast enhancement of the cauda equina roots and encasement of the cord with exudates. Serum and CSF were positive for anti-Brucellaantibodies. He showed significant improvement with antibiotics. At 4 months follow-up, MRI demonstrated near complete resolution of cranial and spinal arachnoiditis. It is important to recognize such rare atypical presentations of neurobrucellosis.
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- Head and neck paragangliomas: A two-decade institutional experience and algorithm for management. [Journal Article]
- LILaryngoscope Investig Otolaryngol 2017; 2(6):380-389
- CONCLUSIONS: An algorithmic approach to clinical management of these tumors, derived from our longitudinal institutional experience and current empiric evidence, may assist otolaryngologists, radiation oncologists, and geneticists in the care of these complex neoplasms.