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Fulltext Enterovirus 71 can directly infect the brainstem via cranial nerves and infection can be ameliorated by passive immunization

Tan SH, Ong KC, Wong KT

J. Neuropathol. Exp. Neurol., 2014 Nov;73(11):999-1008.
PMID: 25289894 DOI: 10.1097/NEN.0000000000000122

Enterovirus 71 (EV71)-associated hand, foot, and mouth disease may be complicated by encephalomyelitis. We investigated EV71 brainstem infection and whether this infection could be ameliorated by passive immunization in a mouse model. Enterovirus 71 was injected into unilateral jaw/facial muscles of 2-week-old mice, and hyperimmune sera were given before or after infection. Harvested tissues were studied by light microscopy, immunohistochemistry, in situ hybridization, and viral titration. In unimmunized mice, viral antigen and RNA were detected within 24 hours after infection only in ipsilateral cranial nerves, motor trigeminal nucleus, reticular formation, and facial nucleus; viral titers were significantly higher in the brainstem than in the spinal cord samples. Mice given preinfection hyperimmune serum showed a marked reduction of ipsilateral viral antigen/RNA and viral titers in the brainstem in a dose-dependent manner. With optimum hyperimmune serum given after infection, brainstem infection was significantly reduced in a time-dependent manner. A delay in disease onset and a reduction of disease severity and mortality were also observed. Thus, EV71 can directly infect the brainstem, including the medulla, via cranial nerves, most likely by retrograde axonal transport. This may explain the sudden cardiorespiratory collapse in human patients with fatal encephalomyelitis. Moreover, our results suggest that passive immunization may still benefit EV71-infected patients who have neurologic complications.

Matched MeSH terms: Cranial Nerves/metabolism; Cranial Nerves/virology*
Oncologic outcome in surgical management of jugular paraganglioma and factors influencing outcomes

Lope Ahmad RA, Sivalingam S, Konishi M, De Donato G, Sanna M

Head Neck, 2013 Apr;35(4):527-34.
PMID: 22544660 DOI: 10.1002/hed.22987

The purpose of this study was to identify the factors that may influence the management outcome in patients with jugular paragangliomas.

Matched MeSH terms: Cranial Nerves/pathology*; Cranial Nerves/surgery
Fulltext Co-existing of sinonasal inverted papilloma and angiofibroma: case report and review of the literature

Shahrjerdi B, Angoyaroko A, Abdullah B

Acta Inform Med, 2012 Dec;20(4):261-3.
PMID: 23378696 DOI: 10.5455/aim.2012.20.261-263

Sinonasal tumors may grow to considerable size before presentation and in view of their relation to the base of skull, orbit, cranial nerves and vital vessels; a precise diagnostic and therapeutic planning is needed to achieve the optimal results. We report a case who presented with unilateral nasal blockage, rhinorrhea and episodes of epistaxis which diagnosed as sinonasal inverted papilloma and angiofibroma.

Matched MeSH terms: Cranial Nerves
Metastatic Adenocarcinoma of Temporal Bone with Collet-Sicard Syndrome

Subha ST, Nordin AJ

Iran J Otorhinolaryngol, 2018 Nov;30(101):361-364.
PMID: 30560103

Introduction: Metastatic tumors of the temporal bone are extremely rare. Collet-Sicard syndrome is an uncommon condition characterized by unilateral palsy of the lower four cranial nerves. The clinical features of temporal bone metastasis are nonspecific and mimic infections such as chronic otitis media and mastoiditis.
Case Report: This report describes a rare case of metastatic adenocarcinoma of the temporal bone causing Collet-Sicard syndrome, presenting with hearing loss, headache and ipsilateral cranial nerve palsies. The patient was a 68-year old woman initially diagnosed with extensive mastoiditis and later confirmed as having metastatic adenocarcinoma of the temporal bone, based on histopathologic findings.
Conclusion: Clinical presentation of metastatic carcinoma of the temporal bone can be overshadowed by infective or inflammatory conditions. This case report is to emphasize the point that a high index of clinical suspicion is necessary for the early diagnosis of this aggressive disease which carries relatively poor prognosis. This report highlights that it is crucial to suspect malignant neoplasm in patients with hearing loss, headache and cranial nerve palsies.

Matched MeSH terms: Cranial Nerves
Basilar invagination: A mimicker of bulbar-onset amyotrophic lateral sclerosis

Tan JSH, Lee S, Hiew FL

eNeurologicalSci, 2021 Mar;22:100321.
PMID: 33553704 DOI: 10.1016/j.ensci.2021.100321

Amyotrophic lateral sclerosis (ALS) is characterized by progressive onset motor deficits with heterogenous presentations ranging from dysarthria to foot drop. Approximately 20% of the patients present with focal bulbar symptoms, in which some may remain restricted to bulbar region (isolated bulbar palsy), and the remaining eventually spreads to involve other body regions (classical ALS). Without accompanying upper and lower motor neurons signs elsewhere, differential diagnoses for isolated bulbar symptoms are extensive, include ALS variants as well as potentially treatable mimics. Therefore, it is important to take heed on every possible aetiology that may disrupt the hypoglossal nucleus, nerve, or lingual muscle itself. Herein, we illustrated a rare presentation of Group A basilar invagination, which mimicked bulbar-onset ALS.

Matched MeSH terms: Cranial Nerves
Fulltext Isolated unilateral vocal fold palsy following skull base fracture: a case report

Marina M.B., Hazleigh N.M., Thean, Y.K., Sani A.

International Medical Journal Malaysia, 2018;17(3):95-98.
MyJurnal

Isolated lower cranial nerve (CN) palsy affecting the CN X resulting from a skull base fracture is very rare. The clinical manifestation and natural history is related closely to the complex anatomy of this region and mechanism of injury. Here, we report a case of a 54 year-old man who presented with a delayed onset of dysphonia and dysphagia with aspiration following a closed head injury sustained from a motor vehicle accident. Injection laryngoplasty was implemented to alleviate symptoms of his CN X palsy, which eventually almost completely resolved. High index of suspicion should be maintained when investigating possible skull base fractures, especially with a suggestive clinical presentation of lower CN palsies affecting one or all the lower CNs. Delayed onset of these CN palsies are likely to have more favourable outcomes.

Matched MeSH terms: Cranial Nerves
Fulltext An audit of dysphagia patients attending speech therapy clinic at a tertiary hospital in Malaysia

Amelia Inbam Neelagandan, Esther Tuin, Tay, Chia Yi, Rajesh Kumar Muniandy

Borneo Journal of Medical Sciences, 2021;15(1):21-29.
MyJurnal

Swallowing involves 55 muscles, five cranial nerves and two cervical nerve roots. When the coordination of this reflex is disturbed, dysphagia occurs. Dysphagia refers either to the difficulty someone may have with the initial phases of a swallow or to the sensation that the foods or the liquids are being obstructed in their passage from the mouth to the stomach. The objective of the study was to identify the diagnosis of patients attending Speech Therapy clinic, in Queen Elizabeth Hospital, Kota Kinabalu, Sabah, and to identify the demography of dysphagic patients. From the 406 patients that came during the study period, 139 patients (34.2%) were diagnosed with dysphagia, followed by developmental language disorders (33.3%). Of the 139 patients diagnosed with dysphagia, most of them are within the 41 to 60 (43.2%) and above 60 (42.2%) age groups. The majority were males (66.2%). A total of 81 (58.3%) patients with dysphagia had a history of cerebrovascular accident. Dysphagia is a common disorder among patients attending Speech Therapy Clinics at Queen Elizabeth Hospital, Kota Kinabalu. Training of Speech Therapists and early dysphagia intervention leads to a better outcome.

Matched MeSH terms: Cranial Nerves
Incidence, Clinico-Radiological Features and Outcome of Skull Base versus Non-Skull Base Meningiomas Treated in Kuala Lumpur General Hospital: A Five-Year Experience

Kong CC, Kandasamy R, Haspani S, Idris Z, Abdullah JM

Malays J Med Sci, 2018 May;25(3):88-102.
PMID: 30899190 MyJurnal DOI: 10.21315/mjms2018.25.3.9

Background: Meningiomas are the most common intracranial tumours; they account for 13%-26% of all the primary intracranial tumours. Skull base meningiomas make up 25% of all meningiomas and are one of the most difficult intracranial tumours to be managed surgically. This is due to the fact that it is difficult to approach the lesions which are also close to vital structures such as cranial nerves and major blood vessels. Despite the abundance of these cases in Malaysia, local data on meningiomas is scarce.
Methods: This is a retrospective study consisting of 199 patients with meningiomas who have been operated at the Kuala Lumpur General Hospital from January 2010-December 2014. They were categorised into skull base and non-skull base groups. Demography, tumour characteristics, and patient outcomes were analysed. Kaplan-Meier survival curves as well as Cox hazard univariable and multivariable regressions for the possible predictors of survival were analysed.
Results: 97.5% of the patients (n = 194) had WHO grade I meningioma and only five patients had WHO grade II meningioma. There was a female predominance (n = 134; 67.3%), with a male-to-female ratio of 1:2. Some 27.1 % patients had skull base meningiomas. Patients with skull base meningiomas had poorer outcomes and discharge conditions (n = 23; 42.6% P < 0.01), in addition to higher risk of incomplete resections (n = 34; 63% P < 0.01). Multivariate cox hazard regressions showed that the skull base meningioma group had four times the risk of death of the non-skull base group.
Conclusions: Symptomatic meningiomas can be curative if the tumour is completely removed. Our study has revealed that skull base meningiomas which were operated locally had higher rates of incomplete resection and poorer surgical outcomes as compared to the non-skull base group. Patients with skull base meningiomas had four times the risk of death vis-à-vis non-skull base ones. More local studies are needed to look into skull base meningiomas for the improvement of its surgical outcomes.

Matched MeSH terms: Cranial Nerves
Fulltext Scedosporium apiospermum: A Rare Cause of Aggressive Orbital Apex Syndrome

Loh UL, Tai PY, Hussein A, A Qamarruddin F

Cureus, 2018 Dec 17;10(12):e3743.
PMID: 30800553 DOI: 10.7759/cureus.3743

Orbital apex syndrome (OAS) is a localized orbital cellulitis at the orbital apex that can cause vision loss from optic neuropathy and ophthalmoplegia involving multiple cranial nerves. Herein, we report a rare and rapidly progressive case of OAS secondary to fungal pansinusitis caused by Scedosporiumapiospermum in an immunocompromised patient following the extraction of abscessed teeth. A 48-year-old man with diabetes mellitus who had failed to adhere to his treatment presented with complaints of a right-sided headache and toothache for two weeks, with nausea and vomiting for two days prior to presentation. The patient was treated for septic shock secondary to the dental abscesses. Non-contrast brain computed tomography (CT) showed no significant intracranial abnormalities other than pansinusitis. Four days later, dental extraction was performed. The patient reported progressive painless blurring of the vision in his right eye following the dental extractions and was referred to the ophthalmology department. Subsequent examinations revealed decreased optic nerve function and ophthalmoplegia in his right eye and dental caries in the upper molars, with a mucopurulent discharge from the right sphenoid region. The clinical diagnosis was OAS. Pus near the orbital apex was drained surgically. Methicillin-resistant Staphylococcus aureus was isolated from the pus and a nasal swab. Tissue culture from the septal wall yielded S.apiospermum. The patient's condition deteriorated, despite intensive antibiotic and antifungal treatment and repeated surgical debridement. The disease progressed rapidly to his left eye. Sixty-seven days after the inital presentation, his visual acuity (VA) of both eyes was classified as no perception of light (NPL). The patient discharged himself from the hospital (at own risk discharge) and subsequently failed to attend a scheduled appointment in the ophthalmology clinic. If immunocompromised patients present with OAS, fungal infections should be ruled out. Prompt and aggressive treatment using a multidisciplinary approach is mandatory in cases of potentially life-threatening and vision-threatening fungal infections.

Matched MeSH terms: Cranial Nerves