Inferior oblique myectomy for postoperative limitation of elevation in abduction.

Antielevation syndrome is commonly described following anteriorization of the inferior oblique muscle. A similar phenomenon may occur following inferior oblique muscle recession, creating a distinct strabismus pattern in the setting of cranial trochlear nerve palsy. We report 3 adult patients, 69-72 years of age, who presented at the Stanford Byers Eye Institute with a similar strabismus pattern-limited elevation in abduction following previous inferior oblique muscle recession for congenital/long-standing trochlear nerve palsy.

Case Report and Literature Review: Isolated Trochlear Nerve Palsy due to Herpes Zoster Infection.

Introduction: Trochlear nerve palsy (TNP) is a common cause of vertical diplopia resulting from superior oblique muscle weakness. While herpes zoster is a well-documented cause of cranial neuropathies, reports of TNP associated with herpes zoster infection remain limited.

Case Presentation: We report a case of a 65-year-old patient with typical herpes zoster ophthalmicus on the left side of his face with subsequent corneal endotheliitis and isolated TNP.

[Significance of accurately interpreting the Bielschowsky tilt test in the differential diagnosis of superior oblique muscle paralysis].

Superior oblique muscle paralysis is a common type of vertical rotatory strabismus with various subtypes. Regardless of the subtype, the Bielschowsky tilt test plays a crucial role in the diagnosis of superior oblique muscle paralysis and is often considered a significant criterion for diagnosis and differential diagnosis. However, the sensitivity and specificity of the Bielschowsky tilt test for diagnosing superior oblique muscle paralysis are not 100% due to the mechanism involved.

Teaching Video NeuroImage: Monocular Rotational Nystagmus Caused by Superior Oblique Myokymia.

A 61-year-old man presented with 2 days of "flickering" vision. The symptom resolved with closure of the left eye. Examination demonstrated involuntary high-frequency, low-amplitude intorting movements of the left eye, consistent with superior oblique myokymia (Video 1).

Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes of Medial Incisural Space: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part III: Arachnoid Membranes, Cranial Nerves, and Surgical Implications.

BACKGROUND Anatomical dissections play an irreplaceable role in the training of new generations of effective neurosurgeons, especially when addressing skull base lesions is required.The Authors describe an inter-laboratory dissection study aimed at improving the knowledge of a complex region of the skull base. The anterior and middle incisural spaces are of remarkable anatomical and surgical interest due to complex relationships between bony, dural, arachnoidal, and neurovascular structures.

Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes of Anterior and Middle Incisural Spaces: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part II: Free Edge of the Tentorium, Petroclinoid Folds, and Incisural Spaces.

BACKGROUND Anatomical dissections play an irreplaceable role in the training of new generations of effective neurosurgeons, especially when addressing skull base lesions is required.The Authors describe an inter-laboratory dissection study aimed at improving the knowledge of a complex region of the skull base. The anterior and middle incisural spaces are of remarkable anatomical and surgical interest due to complex relationships between bony, dural, arachnoidal, and neurovascular structures.

Petroclival Clinoidal Folds and Relationships with Arachnoidal Membranes and Neural Structures of Anterior and Middle Incisural Spaces: Old Neuroanatomical Terms for a New Neurosurgical Speech in Cadaver Labs with Limited Resources Era. Part I: Osteology and Structural Anatomy of Dura Mater.

Purpose The role of cadaver labs in preparing new generations of effective neurosurgeons is of paramount importance. The Authors describe a personal cadaver lab experience aimed at improving the knowledge of a difficult region of the central skull base. The anterior and middle incisural spaces are regions of remarkable anatomical, and surgical interest due to complex relationships between bony, dural, arachnoidal, and neurovascular structures.

Comparison of head tilt test between sagging eye syndrome and acquired unilateral trochlear nerve palsy.

Purpose: To investigate the distinction between sagging eye syndrome (SES group) and acquired unilateral trochlear nerve palsy (Trochlear group) in the Bielschowsky head tilt test (BHTT).

Methods: Fifteen patients in the SES group (mean age 74.6 ± 5.

Botulinum Toxin Injection for the Treatment of Third, Fourth, and Sixth Nerve Palsy: A Meta-Analysis.

The efficacy of botulinum toxin injection for the treatment of third, fourth, and sixth nerve palsy was evaluated. PubMed, Scopus, EMBASE, Web of Science, and Google Scholar databases were searched. Data about the duration of palsy (acute vs chronic), cause of the palsy, type of toxin used, mean dose, and other background characteristics were collected.

The Frequency and Manifestations of Ocular Causes of Abnormal Head Posture.

Purpose: To determine the frequency and manifestations of different ocular causes of abnormal head posture (AHP).

Method: This prospective, consecutive case series study was performed on 149 patients with ocular AHP at Farabi hospital, Iran, from February 2020 to June 2021. All patients underwent routine ophthalmic examinations.

Isolated neurosarcoidosis with a primary lesion in the cauda equina.

A man in his late 50s without notable medical background was admitted with subacute onset of bilateral lower extremity weakness. Blood and physiological examinations revealed no significant abnormalities. Cerebrospinal fluid (CSF) examination revealed elevated cell count and protein levels and an immunoglobulin G index of 2.

Postoperative outcomes for unilateral congenital trochlear nerve palsy: A retrospective cohort study.

Purpose: Congenital trochlear nerve palsy is the most common cause of vertical strabismus. The goal of this study was to investigate surgical outcomes after superior oblique tendon plication with or without inferior oblique recession in children and adults with unilateral congenital trochlear nerve palsy.

Methods: Data and outcomes were collected in patients with a diagnosis of unilateral congenital superior oblique palsy during a retrospective single-center study conducted at the University Hospital of Tours.

Trapping and side-to-end superior cerebellar artery to superior cerebellar artery bypass for treatment of fusiform superior cerebellar artery aneurysm.

We describe the technical nuances of in-situ bypass for treatment of a fusiform superior cerebellar artery (SCA) aneurysm via surgical trapping and a side-to-end in-situ bypass between duplicated SCAs. Our patient is a 40-year-old male who presented with an incidental aneurysm of the proximal right superior cerebellar artery (SCA). Formal angiography was performed that demonstrated a fusiform morphology of the aneurysm, as well as a duplicated SCA on that side.

Are isolated ocular motor nerve palsies in the elderly truly 'low risk' for abnormal neuro-imaging outcomes?

Background: Neurologically isolated ocular motor nerve palsies often present a management dilemma. Neuroimaging is more likely to be offered to patients <50 years without coexisting ischaemic risk factors as their risk of sinister underlying causes is thought to be higher. However, populations are rapidly ageing and advanced neuroimaging is now more widely available.

Surgical management of superior oblique palsy with coexisting exotropia.

Purpose: To analyze the surgical results of patients treated for superior oblique palsy with coexisting exotropia.

Methods: The medical records of patients with superior oblique palsy and exotropia who underwent inferior oblique weakening and simultaneous lateral rectus recession by a single surgeon from 1996 to 2022 were reviewed retrospectively. Demographics, pre- and postoperative vertical and horizontal deviation, and presence of diplopia were recorded.

Recovery of Third, Fourth, and Sixth Cranial Nerve Palsies in Pituitary Adenoma and Meningioma Patients.

Background: This retrospective, observational cohort study aimed to determine recovery rate and recovery time of ocular motor nerve palsies (OMP) of third (CN III), fourth (CN IV), or sixth cranial nerves (CN VI)-and associated prognostic factors-in meningioma and pituitary adenoma (PA) patients.

Methods: A total of 25 meningioma (28 eyes) and 33 PA patients (36 eyes), treated at the Leiden University Medical Center in the Netherlands from January 1, 1978 to January 31, 2021, were included. OMPs were evaluated according to a newly created recovery scale using on-clinical and orthoptic examinations, which were performed every 3-4 months until palsy recovery, or at 18 months follow-up.

Cranial Nerve Palsies in the Setting of Arachnoid Cysts: A Case Series and Literature Review.

Background: Arachnoid cysts (ACs) are benign lesions typically believed to not cause neurologic defects in the adult population and are most often found incidentally on imaging. We describe 2 patients with ACs potentially leading to isolated cranial nerve (CN) dysfunction.

Methods: We describe 2 patients, 1 with a fourth nerve palsy and the other with a sixth nerve palsy found to have ACs on MRI brain imaging in locations that potentially caused a compressive CN palsy.

[Posterior inferior cerebellar artery infarction with episodic postural diplopia as the initial symptom: A case report].

Accurate and timely diagnosis of posterior circulation ischemic stroke is a challenge for emergency neurology clinicians, even MRI scan which is believed to be sensitive to acute ischemic lesions may be negative. It is particularly important to obtain the typical or characteristic symptoms and signs of the patients through comprehensive physical examination. We report a case of posterior inferior cerebellar artery (PICA) territory infarction with "episodic postural diplopia" as the initial symptom, hoping that clinicians notice the vertical diplopia caused by the disfunction of otolith gravity conduction pathway, which is characterized by the degree of diplopia being affected by postural changes.

The Superior Cerebellar Artery: Variability and Clinical Significance.

The superior cerebellar artery (SCA) arises from the distal part of the basilar artery and passes by the oculomotor, trochlear, and trigeminal nerves. SCA is known to play a crucial role in the development of trigeminal neuralgia. However, due to its anatomical variability, it may also trigger other neurovascular compression (NVC), including hemifacial spasm, oculomotor nerve palsy, and ocular neuromyotonia.

COVID-19 and sudden-onset ocular neurogenic palsy in prior healthy patients: a systematic review.

Background: The aim of this systematic review is to identify cases of neurogenic ocular palsy in the presence of COVID-19 and to document patient characteristics, type of palsy and possible aetiologies.

Methods: A systematic search of PubMed, Medline and CINAHL databases was conducted on the 6th of January 2023 to identify cases of neurogenic ocular palsy in patients with current or previous COVID-19 infection. Data were pooled to summarise the neurogenic palsy, patient clinical characteristics and proposed palsy mechanisms.

Usefulness of posterior transpetrosal approach for the large solid cerebellopontine angle hemangioblastoma fed from multiple blood supplies: A technical case report.

Background: Extra-axial cerebellopontine angle (CPA) hemangioblastomas are rare clinical entity and surgical treatment is challenging due to the anatomical difficulties and multi-directional blood supplies. On the other hand, the risk of endovascular treatment for this disease has also been reported. Herein, we successfully applied a posterior transpetrosal approach to remove a large solid CPA hemangioblastoma without preoperative feeder embolization.

Microsurgical Resection of a Giant Trochlear Nerve Schwannoma: 2-Dimensional Operative Video.

We present the case of a 17-year-old male, who complained of a 1-year onset of pulsatile headache, dysphagia, speech changes, and emotional lability. Neuroimaging revealed a large left-sided contrast-enhancing tumor located at the infratentorial space consistent with a large trochlear nerve schwannoma. The tumor was compressing the brainstem, obstructing the outflow of the third and lateral ventricles causing hydrocephalus, and disturbing the cortico-bulbar pathways bilaterally leading to the diagnosis of pseudobulbar palsy.