1/18. Fourth cranial nerve palsy in pediatric patients with pseudotumor cerebri.PURPOSE: To describe three children with acute fourth cranial nerve palsy secondary to pseudotumor cerebri. methods: We reviewed the medical records of children younger than 18 years who were diagnosed with pseudotumor cerebri between 1977 and 1997. pseudotumor cerebri was defined by normal neuro-imaging, elevated intracranial pressure measured by lumbar puncture, and normal cerebrospinal fluid composition. RESULTS: Three children with pseudotumor cerebri presented with vertical diplopia and clinical signs of fourth cranial nerve palsy including a hypertropia of the affected eye, which increased with adduction and ipsilateral head tilt. The fourth cranial nerve palsy resolved after reduction of the intracranial pressure in all three children. CONCLUSIONS: Fourth cranial nerve palsy may occur in children with pseudotumor cerebri and may be a nonspecific sign of elevated intracranial pressure.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/18. Transient oculomotor cranial nerves palsy in spontaneous intracranial hypotension.Transient sixth cranial nerves palsy may occur in rare cases after lumbar puncture, spinal anesthesia and myelography as well as in more rare cases of spontaneous intracranial hypotension. We report three cases of spontaneous intracranial hypotension with sixth cranial nerves palsy. One of these patients presented also third cranial nerve palsy, never reported in spontaneous intracranial hypotension.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/18. Cranial nerve palsy and intracranial subdural hematoma following implantation of intrathecal drug delivery device.BACKGROUND AND OBJECTIVES: Complications related to cerebrospinal fluid (CSF) leak and low CSF pressure can occur following placement of an intrathecal drug delivery device. methods: A 58-year-old man with chronic, intractable lower back pain underwent implantation of an intrathecal drug delivery device. On the fourth postoperative day, he developed a postural headache and diplopia with findings compatible with left sixth cranial nerve palsy. The headache subsequently became constant and nonpostural. Cranial magnetic resonance imaging was obtained that showed the presence of a posterior subdural intracranial hematoma. Conservative treatment for postdural puncture headache did not improve the symptomatology. Therefore, an epidural blood patch was performed that produced rapid improvement and eventual resolution of symptoms. CONCLUSIONS: Intrathecal catheter implantation can result in CSF loss that might not resolve promptly with conservative therapy. In this case, epidural blood patch proved to be a safe and effective form of treatment.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/18. Neuropathic complications of mandibular implant surgery: review and case presentations.Injuries to trigeminal nerves during endosseous implant placement in the posterior mandible appear to occur acutely in approximately 5-15 of cases, with permanent neurosensory disorder resulting in approximately 8%. Nerve lateralization holds even higher risks from epineurial damage or ischaemic stretching. Neuropathy from implant compression and drill punctures can result in neuroma formation of all types, and in some cases precipitate centralized pain syndrome. Two patterns of clinical neuropathy are seen to result; hypoaesthesias with impaired sensory function, often seen with phantom pain, and hyperaesthesias with minimal sensory impairment but presence of much-evoked pain phenomena. The clinician must differentiate, through careful patient questioning and stimulus-response testing, those patients who are undergoing satisfactory spontaneous nerve recovery from those who are developing dysfunctional or dysaesthetic syndromes. Acute nerve injuries are treated with fixture and nerve decompression and combined with supportive anti-inflammatory, narcotic and anti-convulsant therapy. Surgical exploration, neuroma resection and microsurgical repair, with or without nerve grafting, are indicated when unsatisfactory spontaneous sensory return has been demonstrated, and in the presence of function impairment and intractable pain.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
5/18. A case of AIDS associated cryptococcal meningitis with multiple cranial nerve neuropathies.Cryptococcal meningitis is a common opportunistic infection among patients with AIDS. Cranial nerve neuropathies are well-known complications that occur due to increased intracranial pressure and inflammation of cranial nerves in such patients but have not been previously reported to involve more than four cranial nerves simultaneously. Our patient had involvement of five cranial nerves resulting in the complete loss of vision and hearing as well palsies of the third, sixth and seventh cranial nerves. He was treated with multiple antifungal medications. Repeated high volume lumbar punctures and Ommaya reservoir were used to lower intracranial pressure. At the time of discharge the patient had complete recovery of the functions of third, sixth and seventh cranial nerves bilaterally and partial recovery of hearing and vision.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
6/18. Benign intracranial hypertension--its unusual manifestations.Among our patients with benign intracranial hypertension, we encountered 3 who presented with unusual clinical features. Presentations were pseudotumor without papilledema, unilateral papilledema, and IIIrd and Vth cranial nerve involvement. Lumbo-peritoneal shunt completely resolved the symptoms and signs in 2 of the patients; in the third, symptoms and signs cleared following lumbar puncture.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
7/18. Surgical treatment of a rare congenital anomaly of the vertebral artery: case report and review of the literature.A case of an abnormal loop of the vertebral artery compressing both the cervicomedullary junction and the accessory nerve is reported. The embryological development of the vertebrobasilar system may explain this anatomical anomaly. The possibility of an abnormal location of the vertebral artery may complicate the lateral C1-C2 puncture for myelography. Only five similar cases have been reported previously, but none of them presented any clinical symptomatology, and surgical treatment was never required. The present patient was cured by microvascular decompression. The pathogenetic and surgical implications are discussed in light of the literature.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
8/18. Sixth nerve palsy after lumbar anesthesia.A middle aged man was referred from orthopedics with the complaint of diplopia, which developed 3 weeks after a lumbar puncture for spinal anesthesia. The practitioner should be aware of this rare effect among other common and not so common causes of 6th nerve paresis/paralysis.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/18. Fourth cranial nerve palsy following spinal anesthesia. A case report.Fourth nerve palsy has been rarely seen following lumbar puncture, myelogram, or spinal anesthesia. We report a case of 4th nerve and 6th nerve palsies following spinal anesthesia. The 4th nerve palsy was best detected by using a Maddox rod. If all 6th nerve palsies occurring after spinal anesthesia were examined with a Maddox rod, more cyclovertical palsies might be discovered.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/18. Bilateral sixth-nerve palsy. A rare complication of water-soluble contrast myelography.The appearance of bilateral sixth-nerve palsy is usually a harbinger of serious intracranial disease or a nonspecific sign of increased intracranial pressure from any cause. Although unilateral sixth-nerve palsy is a well-recognized complication of lumbar puncture, the appearance of bilateral sixth-nerve palsy following water-soluble myelography is not generally recognized. We describe our experience with three patients and emphasize the benign and self-limiting character of these bilateral sixth-nerve palsies.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
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