Case of the week 7 ( October 2011
) Multiple cranial nerve
affection
The mother of this girl complains that there is marked
impaired vision of her daughter since only 2 weeks ,
no history of head or ocular trauma , no past history of
systemic or ocular diseases , apart from impaired
vision the girl looks fine
Vision : 6/60
5/60
Fundus examination revealed bilateral papilledema
Ocular Motility revealed more .....
watch video
Of course
this is a case of multiple cranial nerve affection
mainly the sixth , the seventh and partial third nerve
of the left eye
In contrast with isolated
mononeuropathies, which are often benign and
vasculopathic in nature, involvement of more than one
ocular motor nerve rarely results from vasculopathic
lesions. It is very important to ascertain that multiple
nerves are involved, because establishment of this
enables localization of the lesion responsible.
Because the sixth nerve crosses along the petrous apex,
a syndrome that includes sixth nerve palsy, facial pain
and facial paralysis may occur. This is known as
Gradenigo's syndrome and may result from infectious
mastoiditis, tumor, trauma, aneurysm of the petrosal
segment of the internal carotid artery, or inferior
petrosal sinus thrombosis
For the most part,
these patients with Multiple
cranial nerve affection have lesions of the cavernous sinus, superior orbital
fissure, or orbital apex
This patient has a very
caracteristic sign of supranuclear oculomotor affection
, that is the cogwheel pursuits movements of the lt eye
( watch the movie again ) Neurological work up for
this patient showed intracranial tumor
الموقع المصري للحول
وامراض الجهاز الحركي للعين
The Egyptian Site of
Strabismus & Oculomotor Disorders
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