Cryptococcal meningitis is a rare complication of systemic lupus erythematosus (SLE). The nonspecific neurologic findings associated with this infection delays accurate diagnosis because initial neuropsychiatric manifestations of SLE are in instances indistinguishable from that of crytococcal meningitis. We report a case of cryptococcal meningitis presenting with unilateral sixth cranial nerve palsy in a male patient with SLE, which was successfully treated with antifungal agents.
Abducens Nerve Diseases/*etiology ; Adult ; Humans ; Lupus Erythematosus, Systemic/*complications ; Male ; Meningitis, Cryptococcal/*etiology

PURPOSE: To report a case of third, fourth, and six cranial nerve palsies with antiphospholipid syndrome (APS). METHODS: Medical records of a 16 year old female diagnosed with idiopathic intracranial hypertension (IIH) in primary APS were reviewed. RESULTS: A 16 year old female presented with headache and diplopia. Ocular examinations revealed marked bilateral disc edema. She was unable to depress, adduct, and abduct in left eye and had limited abduction in the right eye. Cerebrospinal fluid had a normal composition and a pressure of 400 mmH2O. Lupus anticoagulant and IgG anticardiolipin antibody were positive. There was no clinical evidence of other autoimmune disease. Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal. She was diagnosed with bilateral sixth, and left third and fourth cranial nerve palsies secondary to idiopathic intracranial hypertension in primary APS. CONCLUSIONS: To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.
Trochlear Nerve Diseases/diagnosis/*etiology ; Oculomotor Nerve Diseases/diagnosis/*etiology ; Humans ; Follow-Up Studies ; Female ; Diagnosis, Differential ; Antiphospholipid Syndrome/*complications/diagnosis ; Adolescent ; Abducens Nerve Diseases/diagnosis/*etiology

Lemierre's syndrome is characterized by anaerobic septicemia, internal jugular vein thrombosis, and septic emboli associated with infections of the head and neck. We describe an unusual and clinically confusing case of a young woman with an acute paresis of the abducens nerve and partial paresis of the right oculomotor nerve. After an extensive imaging diagnostic procedure, we also documented a peritonsillar abscess and various types of thromboses in intracranial and extracranial veins. Furthermore, we found brain and lung abscesses, which led us to establish the diagnosis of Lemierre's syndrome. Despite intensive anti-coagulation and antibiotic therapy, the patient developed a mycotic aneurysm in the right internal carotid artery directly adjacent to the previously thrombosed cavernous sinus. In summary, we were able to confirm that Lemierre's syndrome may occur in conjunction with uncharacteristic symptoms. Due to the sometimes confusing clinical symptoms as well as clinical and radiological specialties, we had to work on an interdisciplinary basis to minimize the delay prior to establishing the diagnosis and therapy.
Abducens Nerve Diseases/*diagnosis/etiology ; Acute Disease ; Diagnosis, Differential ; Female ; Humans ; Lemierre Syndrome/complications/*diagnosis ; Oculomotor Nerve Diseases/*diagnosis/etiology ; Paresis/*diagnosis/etiology ; Young Adult

Carotid cavernous dural arteriovenous fistula (DAVF) usually presents with conjunctival injection, proptosis, loss of visual acuity and ophthalmoplegia. There have been some carotid cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We experienced a patient presenting with bilateral abducens nerve palsy and no other ocular signs who was diagnosed as carotid cavernous DAVF after conventional angiography. According to this case, carotid cavernous DAVF should be considered in the differential diagnosis of isolated bilateral abducens nerve palsy, in which case conventional angiography may be helpful in diagnosis.
Abducens Nerve/physiopathology* ; Arteriovenous Fistula/complications* ; Carotid Artery Diseases/complications* ; Case Report ; Cavernous Sinus*/radiography ; Cranial Nerve Diseases/physiopathology ; Cranial Nerve Diseases/etiology ; Dura Mater/blood supply* ; Female ; Human ; Middle Age ; Paralysis/physiopathology ; Paralysis/etiology*

We present a very rare case of a 29-month-old boy with acute onset right abducens nerve palsy complicated by inferior petrosal sinus septic thrombosis due to mastoiditis without petrous apicitis. Four months after mastoidectomy, the patient fully recovered from an esotropia of 30 prism diopters and an abduction limitation (-4) in his right eye.
Abducens Nerve Diseases/diagnosis/*etiology ; Child, Preschool ; Diagnosis, Differential ; Humans ; Male ; Mastoiditis/*complications/diagnosis/surgery ; Otitis Media/*complications/diagnosis ; Sinus Thrombosis, Intracranial/*complications/diagnosis

We report a case of multiple myeloma that presented as a fluctuating sixth cranial nerve palsy in the absence of widespread signs of systemic disease. A 63-year-old woman presented with horizontal diplopia of two weeks duration that subjectively changed over time. Ocular examination showed a fluctuating sixth nerve palsy. A computed tomography (CT) scan of the brain showed multiple, enhancing, soft tissue, mass-like lesions involving the left cavernous sinus and the apex of both petrous bones. Based on bone marrow biopsy and hematologic findings, she was diagnosed with multiple myeloma. Multiple myeloma may be included in the differential diagnosis of a fluctuating sixth nerve palsy, and although ophthalmic signs are rare and generally occur late in the course of multiple myeloma, they can still be its first signs.
Abducens Nerve Diseases/diagnosis/*etiology ; Brain/pathology/radiography ; Diagnosis, Differential ; Diplopia/etiology ; Esotropia/etiology/physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Multiple Myeloma/*complications/diagnosis ; Tomography, X-Ray Computed

A 51-year-old woman with breast cancer presented with progressive diplopia. Neuro-ophthalmologic examination revealed right gaze palsy and peripheral facial nerve palsy. Brain magnetic resonance imaging (MRI) was normal. However, two months later a repeat brain MRI revealed an enhancing round nodular mass at the right facial colliculus of the lower pons, at the location of the abducens nucleus. Localized metastasis to the abducens nucleus can cause gaze palsy in a patient with breast cancer.
*Abducens Nerve Diseases ; Breast Neoplasms/*pathology ; Cranial Nerve Neoplasms/*complications/*secondary ; Facial Paralysis/complications ; Female ; Fixation, Ocular ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Ocular Motility Disorders/*etiology/physiopathology ; Pons/pathology

A 68-year-old male patient presented with a week of sudden diplopia. He had been diagnosed with nasopharyngeal cancer 8 months prior and had undergone chemotherapy with radiotherapy. Eight-prism diopter right esotropia in the primary position and a remarkable limitation in abduction in his right eye were observed. Other pupillary disorders and lid drooping were not found. After three weeks, the marginal reflex distance 1 was 3 mm in the right eye and 5 mm in the left eye. The pupil diameter was 2.5 mm in the right eye, and 3 mm in the left eye under room illumination. Under darkened conditions, the pupil diameter was 3.5 mm in the right eye, and 5 mm in the left eye. After topical application of 0.5% apraclonidine, improvement in the right ptosis and reversal pupillary dilatation were observed. On brain magnetic resonance imaging, enhanced lesions on the right cavernous sinus, both sphenoidal sinuses, and skull base suggested the invasion of nasopharyngeal cancer. Lesions on the cavernous sinus need to be considered in cases of abducens nerve palsy and ipsilateral Horner's syndrome.
Abducens Nerve Diseases/*etiology ; Aged ; Carcinoma, Squamous Cell/complications/pathology/therapy ; Cavernous Sinus/pathology ; Combined Modality Therapy ; Horner Syndrome/*etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Nasopharyngeal Neoplasms/complications/pathology/therapy

Abducens Nerve Diseases ; etiology ; Brain ; diagnostic imaging ; Cognitive Dysfunction ; etiology ; Epilepsies, Partial ; etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multiple Sclerosis, Chronic Progressive ; cerebrospinal fluid ; complications ; diagnostic imaging ; Muscle Weakness ; etiology ; Oligoclonal Bands ; cerebrospinal fluid ; Paresis ; etiology ; Paresthesia ; etiology ; Seizures ; etiology

A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.
Abducens Nerve Diseases/diagnosis/*etiology ; Antibodies, Viral/*analysis ; Diagnosis, Differential ; Electromyography ; Female ; Follow-Up Studies ; Herpes Zoster/*complications/diagnosis/virology ; Herpesvirus 3, Human/*immunology ; Horner Syndrome/diagnosis/*etiology ; Humans ; Magnetic Resonance Imaging ; Meningitis/*complications/diagnosis/virology ; Middle Aged ; Tomography, X-Ray Computed