Cases reported "Esotropia"

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1/4. eye problem following foot surgery--abducens palsy as a complication of spinal anesthesia.

    BACKGROUND: paralysis of abducens nerve is a very rare complication of lumbar puncture, which is a common procedure most often used for diagnostic and anesthetic purposes. CASE REPORT: A 38-year-old man underwent surgery for a left hallux valgus while he was under spinal anesthesia. On the first postoperative day, the patient experienced a severe headache that did not respond to standard nonsteroidal anti-inflammatory medication and hydration. During the second postoperative day, nausea and vomiting occurred. On the fourth postoperative day, nausea ceased completely but the patient complained of diplopia. Examination revealed bilateral strabismus with bilateral abducens nerve palsy. His diplopia resolved completely after 9 weeks and strabismus after 6 months. CONCLUSION: Abducens palsy following spinal anesthesia is a rare and reversible complication. Spinal anesthesia is still a feasible procedure for both the orthopaedic surgeon and the patient. Other types of anesthesia or performing spinal anesthesia with smaller diameter or atraumatic spinal needles may help decrease the incidence of abducens palsy. Informing the patient about the reversibility of the complication is essential during the follow-up because the palsy may last for as long as 6 months. Special attention must be paid to patient positioning following the operation. Recumbency and lying flat should be accomplished as soon as possible to prevent cerebrospinal fluid leakage and resultant intracranial hypotension. This becomes much more important if the patient has postdural puncture headache.
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2/4. 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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3/4. The time course of a sixth nerve paresis following epidural anesthesia.

    An isolated sixth nerve palsy is seldom seen following epidural anesthesia. An unintentional puncture through the dura may cause a leak of cerebrospinal fluid resulting in a shift of the cerebral content. This may cause a stretching of the sixth cranial nerve giving an abduction palsy. The palsy is benign and resolves completely within two months. The time course of a case will be described.
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4/4. 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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