CLIVAL METASTASES CAUSING DIPLOPIA - AN UNUSUAL PRESENTATION OF BRONCHOGENIC CARCINOMA

Lung Cancer is the most common cancer worldwide with most cases being detected at Stage IV. Among these, metastases to the clivus are rare with only very few cases reported in literature. The long course of the abducent nerve in relation to the clivus, makes it susceptible for metastases and subsequent lateral rectus palsy. We present the case of a heavy smoker, 64 years old man who presented with headache and diplopia, on evaluation diagnosed as bronchogenic carcinoma with clival metastases on magnetic resonance imaging(MRI).

Anatomical study of the central origins of the abducent nerve (nerviabducentis)

The question of the course of the central roots of the abducting nerves, as well as of the connections of these nerves with the cerebral cortex, seems to be far from being developed at the present time.

Guillain-Barr é syndrome in COVID-19: A scoping review

IntroductionThe novel corona virus (COVID19) can result in several neurological complications. Guillain-Barré Syndrome (GBS) is one of them and has been reported from different parts of the world in this pandemic. It is an acute post infectious polyneuropathy. The review aims to summarize the demographic features, clinical presentation, diagnostics workup, and management strategies of COVID-19 associated GBS reported in literature.Material and methodWe searched Medline, PubMed Central, SCOPUS and Google Scholar using pre-defined keywords, with no time limits and in English language only. We aimed to include all kind of manuscripts. Last search was done on 18th May 2020.Demographics, clinical features, diagnostic workup, management, and outcomes were documented in the data sheet.ResultsWe identified 24 cases of COVID-19 associated GBS. Most of the cases were reported from Italy followed by USA. Majority were males (18 /24) The age ranged from 23 -84 years. The clinical presentation was typical sensory-motor GBS in most. Nine patients had facial palsy of which five had bilateral involvement. Two patients had bilateral abducent nerve palsy while two presented as paraparetic GBS variant with autonomic dysfunction. Electrodiagnostics was performed in 17 patients only and 12 had typical features of acute inflammatory demyelinating polyneuropathy.. Intravenous immunoglobulins were the preferred mode of treatment in most of the patient. There was one death, and most were discharged to rehabilitation or home.ConclusionGBS is a frequent neurological complication associated with COVID-19. There is no clear causative relationship between GBS, and COVID-19 at present and more data are needed to establish the casualty. However, most cases have a post-infectious onset with male preponderance. Most of the cases have a typical presentation but some may present in an atypical way. Prognosis is generally good.

Recurrence risk factors in detachable balloon embolization of traumatic direct carotid cavernous fistulas in 188 patients

PurposeTo investigate the effects of detachable balloons in embolizing traumatic carotid cavernous fistulas (TCCFs) and the risk factors for recurrence after balloon embolization.Materials and methods188 patients with TCCFs were enrolled, and clinical, treatment, and follow-up data were analyzed for possible risk factors for recurrence after embolization.ResultsAmong 188 patients, 182 (96.8%) had successful balloon embolization; 6 patients failed. One balloon was used in 94 cases and multiple (two or more) balloons were used in 62 patients. 26 patients had occlusion of the parent artery whereas the remainder had parent artery preservation. Periprocedural complications occurred in 3 patients (1.6%) including cerebral embolism in 1 and abducent nerve paralysis in the other 2. Immediately following embolization, headache appeared in 92 patients and was relieved after 3–5 days with medications. A total of 165 patients (87.8%) had follow-up (6 months to 16 years, mean 5 years). 23 (13.9%) patients with internal carotid artery preservation had recurrence 1–33 days (mean 11 days) after the first embolization and were retreated to complete occlusion. Factors affecting recurrence were multiple balloons and residual fistula (p<0.05). Logistic regression confirmed the independent factors affecting recurrence were multiple balloons (≥2 balloons, OR 7.80, 95% CI 2.28 to 26.73; p=0.001) and residual fistula immediately following embolization (OR 10.46, 95% CI 2.99 to 36.5; p=0.000).ConclusionThe recurrence rate is high in the first month after embolization with detachable balloons, and multiple balloons and residual fistula are two independent factors affecting recurrence following balloon embolization.