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Dr Heng Li Wei
2 Apr 2009
TTSH GRAND ROUNDS
History
36yo / Bangladeshi / Male
No past medical history
Presented in 2008 with
- L upper eye pain x 4 days, a/w L parietal
headache
- Diplopia x 3 days
I I I 0 0
R L
I I I 0 0 0 -3
0 0
I I I
Orbital apex
Petrous apex Brainstem
Cavernous sinus
Subarachnoid space
TTSH GRAND ROUNDS
Raymonds syndrome Nuclear VI syndrome
- VI + contralateral hemiparesis - VI, VII + horiz gaze palsy
Millard Gubler syndrome
- VI, VII + contralateral hemiparesis
Fovilles syndrome
- V, VI, VII, VIII + horiz gaze palsy + Horners synd.
TTSH GRAND ROUNDS
Localization of VIn. palsy
Subarachnoid space
TTSH GRAND ROUNDS
@ Subarachnoid space
Raised ICP
Downward displacement of brainstem
Stretching of VIn. which is tethered at its
exit from pons and in Dorello canal
False-localising VIn. palsy.
Petrous apex
Clinical features:
- No age or gender predilection.
- Usually unilateral.
- Retro-orbital pain several days (up to 2 weeks) prior to
ophthalmoplegia.
- If left untreated, may resolve spontaneously at ~8 wks.
- Relapses are often.
- Involvement of CN III most frequently (85%), VI (70%), V (30%),
IV (29%). Horners syndrome in 20% of pts.
Treatment:
- Systemic steriods with rapid resolution of pain
w/n 72 hrs, ophthalmoplegia over 2-8 wks.
- No evidence tt steriods alter the prognosis.