1/16. Cranial nerve palsy as a complication of operative traction.STUDY DESIGN: Case report. OBJECTIVE: This report documents one case of diplopia from abducens (sixth cranial) nerve palsy after spinal surgery using a Jackson table and cranial traction. SUMMARY OF BACKGROUND DATA: Cranial nerve deficits have frequently been described in the orthopedic literature after trauma, halo pelvic traction, and halo skeletal fixation. The theorized mechanism of injury to the abducens nerve involves stretch or traction force, which causes localized ischemia or a change in nerve position. An extensive literature search failed to show this type of injury using Gardner-Wells tongs in conjunction with the Jackson table. methods: This is a case report that included a chart review, examination of the patient, and a literature search. RESULTS: The patient had complete spontaneous resolution of abducens nerve dysfunction within 6 months. CONCLUSIONS: It is important for the surgeon to be aware of this potential complication and to inform patients who have diplopia that develops from abducens nerve palsy that most of these cranial nerve deficits spontaneously improve.- - - - - - - - - - ranking = 1keywords = injury (Clic here for more details about this article) |
2/16. Bilateral sixth nerve palsy after head trauma.Gaze deficits are not uncommon after head trauma and might be caused by injury to the central nervous system, the peripheral nerve, or the motor unit. Traumatic bilateral sixth cranial nerve palsies are a rare condition and are typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of a complete bilateral sixth nerve palsy in a 44-year-old male patient with trauma with no intracranial lesion, no associated skull or cervical spine fracture, and no altered level of consciousness. The emergency physician should be aware of the differential diagnosis, initial workup, and injuries associated with a traumatic gaze deficit.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
3/16. Ocular palsy following Le Fort 1 osteotomy: a case report.A 33-year-old female patient developed an ipsilateral sixth nerve palsy and partial third nerve palsy following a Le Fort 1 osteotomy. Complete resolution occurred at 10 weeks.The likely mechanism of injury secondary to pterygo-maxillary dysjunction is highlighted, with description of the relevant anatomy.Previous cases of ocular motility complications following Le Fort 1 osteotomy are discussed.We recommend that significant care be taken in osteotome placement in the pterygo-maxillary fissure, particularly in those prone to unpredicted fractures such as older patients, or where the anatomy is congenitally abnormal or altered by previous surgery.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
4/16. Bitemporal head crush injuries: clinical and radiological features of a distinctive type of head injury.OBJECT: Most craniocerebral injuries are caused by mechanisms of acceleration and/or deceleration. Traumatic injuries following progressive compression to the head are certainly unusual. The authors reviewed clinical and radiological features in a series of patients who had sustained a special type of cranial crush injury produced by the bilateral application of rather static forces to the temporal region. Their aim was to define the characteristic clinical features in this group of patients and to assess the mechanisms involved in the production of the cranial injuries and those of the associated cerebral and endocrine lesions found in this peculiar type of head injury. methods: Clinical records of 11 patients were analyzed with regard to the state of consciousness, cranial nerve involvement, findings on neuroimaging studies, endocrine symptoms, and outcome. Furthermore, an experimental model of bitemporal crush injury was developed by compressing a dried skull with a carpenter's vice. Seven of the 11 patients were 16 years old or younger. All patients presented with a characteristic clinical picture consisting of no loss of consciousness (six patients), epistaxis (nine patients), otorrhagia (11 patients), peripheral paralysis of the sixth and/or seventh cranial nerves (10 patients), hearing loss (five patients), skull base fractures (11 patients), pneumocephalus (11 patients), and diabetes insipidus (seven patients). Ten patients survived the injury and most recovered neurological function. CONCLUSIONS: Static forces applied to the head in a transverse axis produce fractures in the skull base that cross the midline structures without producing significant cerebral damage. Stretching of cranial nerves at the skull base explains the nearly universal finding of paralysis of these structures, whereas an increase in the vertical diameter of the skull accounts for the occurrence of diabetes insipidus in the presence of an intact function of the anterior pituitary lobe. The association of clinical, endocrine, and neuroimaging findings encountered in this peculiar type of head injury supports the idea that this subset of injured patients has a distinctive clinical condition, namely the syndrome of bitemporal crush injury to the head.- - - - - - - - - - ranking = 5keywords = injury (Clic here for more details about this article) |
5/16. Fourth and sixth cranial nerve injury after halo traction in children: a report of two cases.BACKGROUND: Spinal traction is the application of a longitudinal force to the spinal column as a means of stabilizing a damaged or abnormal spine. Although not well documented in the ophthalmic literature, complications include cranial nerve palsies, with the sixth nerve being most commonly affected. Fourth nerve palsies have not previously been reported to our knowledge. We present 2 cases of combined fourth and sixth palsies after cervical traction. methods: Retrospectively, we reviewed the ophthalmic findings in 2 children with diplopia after spinal traction. RESULTS: Case 1 suffered a traumatic rotatory atlantoaxial subluxation and underwent halo traction. Case 2 required traction to correct a scoliosis secondary to osteogenesis imperfecta. In both cases, sixth nerve palsies were apparent soon after traction. Careful orthoptic examination revealed additional fourth nerve involvement. After 3 months, both cases showed partial resolution of the cranial nerve injuries. CONCLUSIONS: Cranial nerve injury may occur with spinal traction. Fourth nerve palsy may be underreported because of masking by a coinciding sixth nerve palsy.- - - - - - - - - - ranking = 2.5keywords = injury (Clic here for more details about this article) |
6/16. Posttraumatic abducens to oculomotor nerve misdirection.INTRODUCTION: Paradoxical patterns of extraocular muscle, eyelid, or pupillary movements can occur following injury between divisions of the oculomotor nerve, trigeminal and abducens nerves, and trigeminal and oculomotor nerves. We report three cases of unusual ocular motility and eyelid movements that are a result of aberrant connections between the abducens and oculomotor nerves. methods: Three patients with unusual eye movement abnormalities after trauma were studied. A complete ophthalmic examination plus neuroradiologic evaluation were performed. RESULTS: Each patient manifested an aberrant connection between the 6th and 3rd cranial nerves resulting in third nerve function during sixth nerve stimulation. Two patients demonstrated complete third nerve palsies except for adduction on attempted abduction. The third showed improved bilateral ptosis on abduction. CONCLUSIONS: The neuroanatomical abnormalities involve intraorbital structures in one patient and central nervous system pathways in the others. Explanations such as retrograde regeneration, ephaptic transmission, or denervation supersensitivity do not appear to explain these unusual eye movements. The most likely mechanism involves some form of peripheral neuronal misdirection. These rare sixth to third nerve misdirection cases add support to the "neuronal misdirection hypothesis" of aberrant eye movements after trauma.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
7/16. Bilateral traumatic facial paralysis associated with unilateral abducens palsy: a case report.Bilateral traumatic facial paralysis is a very rare clinical condition. Abducens palsy, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 24-year-old male, who developed immediate bilateral facial and right abducens paralyses following a motor vehicle accident, is presented. The patient was referred for neurotologic evaluation 22 days after the injury. Electroneurography (ENoG) demonstrated 100 per cent degeneration at the first examination and, correspondingly, electromyography showed no regeneration potentials. Using high-resolution computed tomography (HRCT), a longitudinal fracture on the right and a mixed-type fracture on the left were identified. The patient had good cochlear reserve on both sides. The decision for surgery was based not on ENoG, because of the delayed referral of the patient, but on the HRCT, which showed clear fracture lines on both sides. The middle cranial fossa approach for decompression of the right facial nerve was performed on the 55th day following the trauma, and a combined procedure using the middle cranial fossa and transmastoid approaches was applied for decompression of the left facial nerve on the 75th day following the trauma. On the right, there was dense fibrosis surrounding the geniculate ganglion and the proximal tympanic segment whereas, on the left, bone fragments impinging on the geniculate ganglion, dense fibrosis surrounding the geniculate ganglion, and a less extensive fibrotic tissue surrounding the pyramidal segment were encountered. There were no complications or hearing deterioration. At the one-year follow up, the patient had House-Brackmann (HB) grade 1 recovery on the right, and HB grade 2 recovery on the left side, and the abducens palsy regressed spontaneously. The middle cranial fossa approach and its combinations can be performed safely in bilateral temporal bone fractures as labyrinthine sparing procedures if done on separate occasions.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
8/16. Traumatic bilateral abducent nerve palsies.A patient sustained a severe cranio-facial injury which included a transverse fracture of the middle cranial fossa through the sella turcica producing otorrhoea, rhinorrhoea, a bilateral abducents palsy and a large aero-coele. All gradually remitted spontaneously. The management of this patient and the patterns of cranial base fractures and their associated clinical features, particularly of the middle cranial fossa, are discussed.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
9/16. Transient first-degree AV block and sixth nerve palsy in a patient with closed head injury.We present the case of an 8-year-old girl who suffered a closed head injury with the development of bilateral sixth-nerve palsies, and who was noted upon arrival to the emergency department to be in first-degree AV block. The sixth-nerve palsies and the first-degree AV block resolved simultaneously within 24 hours of injury. We discuss dysrhythmias and ECG changes previously reported with central nervous system diseases and their proposed etiology.- - - - - - - - - - ranking = 3keywords = injury (Clic here for more details about this article) |
10/16. Trigemino-abducens synkinesis: an unusual case of aberrant regeneration.An unusual case of major head trauma is described involving injury to the right third, fifth, sixth and seventh cranial nerves in a basal skull fracture in a young woman. Two years later there persisted a total voluntary abducens nerve palsy, right facial hemianaesthesia and right temporalis and masseter palsy. However, involuntary abduction of the involved eye occurred on eating or chewing. electromyography of the lateral rectus muscle documented aberrant reinnervation to support the clinical findings. Extraocular muscle surgery improved the compensatory head posture and minimized the chewing-induced abduction. The mechanisms for acquired synkinesis and the anatomy of the involved nerves are reviewed. It is postulated that regenerating motor fibres of the trigeminal nerve were misdirected along proprioceptive channels to the lateral rectus in the case reported here.- - - - - - - - - - ranking = 0.5keywords = injury (Clic here for more details about this article) |
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