Cases reported "Diplopia"

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1/11. 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.
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2/11. Spontaneous intracranial hypotension.

    PURPOSE: To describe a patient with classic presentation of spontaneous intracranial hypotension and subsequent improvement with targeted epidural blood patch. methods: Report of one case and review of the literature. RESULTS: Examination of cerebrospinal fluid after lumbar puncture disclosed a reduced opening pressure, an increased level of protein, and lymphocytic pleocytosis. magnetic resonance imaging of the brain with gadolinium showed diffuse enhancement of the pachymeninges, no evidence of leptomeningeal enhancement, and chronic subdural fluid collection. Radionuclide cisternography demonstrated reduced activity over the cerebral convexities, early accumulation of radiotracer in the urinary bladder, and direct evidence of leakage at the cervicothoracic junction (C7-T1). Clinical, laboratory, and radiologic features were consistent with the diagnosis of spontaneous intracranial hypotension. Therapy with a targeted epidural blood patch resulted in the rapid resolution of symptoms. CONCLUSIONS: In this report, we describe a classic case of spontaneous intracranial hypotension in a 63-year-old man with an initial presentation of postural headaches, blurred vision, pain in the left eye, diplopia on left gaze, and neck soreness.
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3/11. 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.
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4/11. meningeal carcinomatosis manifested as bilateral progressive sensorineural hearing loss.

    OBJECTIVE: meningeal carcinomatosis is defined as the diffuse infiltration of the leptomeninges and subarachnoid space by malignant cells metastasizing from systemic cancer. The authors describe a rare case of meningeal carcinomatosis initially appearing as bilateral progressive sensorineural hearing loss. PATIENT: A 57-year-old man with lung cancer was referred to the authors' clinic because of progressive hearing loss, tinnitus, dizziness, and blurred vision for 1 month. RESULTS: magnetic resonance imaging revealed abnormal leptomeningeal enhancement. meningeal carcinomatosis was diagnosed by the detection of malignant cells in the cerebrospinal fluid after lumbar puncture. The patient died 1 year after diagnosis. CONCLUSIONS: meningeal carcinomatosis must be considered in the differential diagnosis in cancer patients with bilateral progressive sensorineural hearing loss. gadolinium-enhanced magnetic resonance imaging is a useful complementary diagnostic tool before lumbar puncture.
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5/11. Combined fourth and sixth cranial nerve palsy after lumbar puncture: a rare complication. A case report.

    Palsies of cranial nerves are well-known complications after lumbar puncture. Sixth nerve palsies are the most common. They normally occur 4 to 14 days after the lumbar puncture and spontaneously recover in a few weeks or months. The occurrence of a fourth nerve palsy following lumbar puncture however is extremely rare. We report on a patient who developed a combined contralateral fourth and sixth nerve palsy after lumbar puncture (syndrome of intracranial hypotension), requiring surgical correction for secondary diplopia.
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6/11. diplopia in a patient with carcinomatous meningitis: a case report and review of the literature.

    In a patient with a history of malignancy, an isolated neurologic sign or symptom may indicate metastasis to the central nervous system. To exclude this possibility, a lumbar puncture should still be performed after a nondiagnostic cranial computed tomography (CT) scan even in the absence of signs of infection. A case is presented of a 59 year-old man recently diagnosed with non-Hodgkin's lymphoma that presented to the Emergency Department (ED) with the sole complaint of diplopia. Examination was unremarkable except for a left abducens nerve palsy. Cranial CT scan was normal but initial cerebrospinal fluid results were suggestive of carcinomatous meningitis, and cytology results later confirmed this diagnosis. A review of diplopia and carcinomatous meningitis is presented, along with a suggested conservative diagnostic algorithm for cancer patients presenting with neurologic signs or symptoms.
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7/11. pseudotumor cerebri induced by minocycline therapy for acne vulgaris.

    BACKGROUND: We report a case of a young girl who developed pseudotumor cerebri while taking minocycline for acne vulgaris. CASE: A 16-year-old girl without a history of menstrual irregularity, weighing 60 kg (body mass index: 26.0%) presented with a history of 1 week of headache and sudden onset of a horizontal diplopia. observation: Examination revealed bilateral papilledema and an abduction deficit in her right eye. Her cerebrospinal fluid had an opening pressure of 400 mm H(2)O and a normal composition. Following normal findings on computed tomography and magnetic resonance imaging, a diagnosis of pseudotumor cerebri was made. She reported receiving minocycline to treat acne vulgaris during the previous 3 weeks. The headache resolved with withdrawal of minocycline. The diplopia and papilledema resolved after two lumbar punctures, although the visual field defects persisted. The minocycline concentrations in the serum and cerebrospinal fluid taken after cessation of the drug were below the detectable level. CONCLUSION: The role of minocycline should be considered and routine ophthalmologic examination during minocycline treatment should be performed when pseudotumor cerebri occurs in patients treated for acne vulgaris.
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8/11. Bilateral sixth cranial nerve palsy after unintentional dural puncture.

    PURPOSE: Bilateral sixth nerve palsy is a known though uncommon complication following dural puncture. The recommended treatment consists of hydration and alternate monocular occlusion. The value and the timing of an epidural blood patch (EBP) for sixth nerve palsy remains controversial as some authors have demonstrated benefits in performing an EBP early in course of the nerve palsy whereas others have not found any advantage when an EBP was performed later. CLINICAL FEATURES: A 40-yr-old woman developed bilateral sixth nerve palsy ten days after an unintentional dural puncture. An EBP was done within 24 hr after the onset of the symptoms and immediate improvement of the diplopia was noted by the patient and confirmed by an ophthalmologist. Complete resolution of the diplopia occurred 36 days after the dural puncture. CONCLUSION: blood patching within 24 hr of the onset of diplopia may be a reasonable treatment for ocular nerve palsy as it relieved the postdural puncture headache and produced partial improvement of the diplopia.
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9/11. 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.
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10/11. pseudotumor cerebri associated with cyclosporine use.

    PURPOSE: An 11-year-old boy had a one-month history of horizontal diplopia. Three years earlier, he had undergone allogeneic bone marrow transplantation complicated by graft versus host disease. methods: The patient had esotropia and bilateral optic disk edema. A magnetic resonance imaging scan disclosed no intracranial lesion. The opening pressure of the lumbar puncture was 500 mm of water. pseudotumor cerebri secondary to cyclosporine was diagnosed. RESULTS: The patient improved with resolution of his esotropia and diplopia within five days of discontinuing his cyclosporine. The optic disk edema resolved within three months. CONCLUSION: cyclosporine must be added to the list of medications with a known association with pseudotumor cerebri.
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