Pediatric Cranial Nerve Palsies

Abstract

The diagnostic evaluation and treatment of children with cranial nerve palsies is markedly different from that of adults. Genetic, traumatic, inflammatory, and compressive etiologies are common. Unlike adults, vascular etiologies are rare. Treatment entails addressing factors such as amblyopia and fusion. This manuscript will outline the etiologies, diagnostic work-up, and treatment of cranial nerve palsies in children.

Keywords

oculomotor nerve palsy - trochlear nerve palsy - abducens nerve palsy - pediatric cranial nerve palsy

• References

• 1 Brodsky MC. Ocular motor nerve palsies in children. In Pediatric Neuro-Ophthalmology. 2nd ed. New York; London: Springer; 2010: 253-308
• 2 Warwick R. Representation of the extraocular muscles in the oculomotor nuclei of the monkey. J Comp Neurol 1953; 98 (3) 449-503
• 3 Dehaene I. Isolated oculomotor nerve palsy. Acta Neurol Belg 1994; 94 (1) 5-7
• 4 Guy J, Savino PJ, Schatz NJ, Cobbs WH, Day AL. Superior division paresis of the oculomotor nerve. Ophthalmology 1985; 92 (6) 777-784
• 5 Guy J, Savino PJ, Schatz NJ, Cobbs WH, Day AL. Superior division paresis of the oculomotor nerve. Ophthalmology 1985; 92 (6) 777-784 Discussion
• 6 Haymaker W, Kuhlenbeck H. Disorders of the brainstem and its cranial nerves. In: Baker AB, Baker LH, , eds. Clinical Neurology, III. Philadelphia: JB Lippincott; 1988
• 7 Keith CG. Oculomotor nerve palsy in childhood. Aust N Z J Ophthalmol 1987; 15 (3) 181-184
• 8 Mudgil AV, Repka MX. Ophthalmologic outcome after third cranial nerve palsy or paresis in childhood. J AAPOS 1999; 3 (1) 2-8
• 9 Ng YS, Lyons CJ. Oculomotor nerve palsy in childhood. Can J Ophthalmol 2005; 40 (5) 645-653
• 10 Hamed LM. Associated neurologic and ophthalmologic findings in congenital oculomotor nerve palsy. Ophthalmology 1991; 98 (5) 708-714
• 11 Ing EB, Sullivan TJ, Clarke MP, Buncic JR. Oculomotor nerve palsies in children. J Pediatr Ophthalmol Strabismus 1992; 29 (6) 331-336
• 12 Chung M, Stout JT, Borchert MS. Clinical diversity of hereditary Duane's retraction syndrome. Ophthalmology 2000; 107 (3) 500-503
• 13 Norman AA, Farris BK, Siatkowski RM. Neuroma as a cause of oculomotor palsy in infancy and early childhood. J AAPOS 2001; 5 (1) 9-12
• 14 Patel CK, Taylor DSI, Russell-Eggitt IM, Kriss A, Demaerel P. Congenital third nerve palsy associated with mid-trimester amniocentesis. Br J Ophthalmol 1993; 77 (8) 530-533
• 15 Langmann A, Lindner S. Congenital third nerve palsy in septo-optic dysplasia. Br J Ophthalmol 2004; 88 (7) 969
• 16 White WL, Mumma JV, Tomasovic JJ. Congenital oculomotor nerve palsy, cerebellar hypoplasia, and facial capillary hemangioma. Am J Ophthalmol 1992; 113 (5) 497-500
• 17 Metry DW, Dowd CF, Barkovich AJ, Frieden IJ. The many faces of PHACE syndrome. J Pediatr 2001; 139 (1) 117-123
• 18 Metry DW, Haggstrom AN, Drolet BA , et al. A prospective study of PHACE syndrome in infantile hemangiomas: demographic features, clinical findings, and complications. Am J Med Genet A 2006; 140 (9) 975-986
• 19 Burgerman RS, Wolf AL, Kelman SE, Elsner H, Mirvis S, Sestokas AK. Traumatic trochlear nerve palsy diagnosed by magnetic resonance imaging: case report and review of the literature. Neurosurgery 1989; 25 (6) 978-981
• 20 Wise J, Gomolin J, Goldberg LL. Bilateral superior oblique palsy: diagnosis and treatment. Can J Ophthalmol 1983; 18 (1) 28-32
• 21 Mandell GL, Bennett JE, Dolin R , eds. Principles and Practice of Infectious Diseases. 4th ed. New York: Churchill Livingstone; 1995: 84
• 22 Miller NR. Walsh and Hoyt's Clinical Neuro-Ophthalmology, IV. 4th ed. Baltimore: Williams and Wilkins; 1991: 2533-2538
• 23 Caksen H, Acar N, Odabaş D, Cakin C, Tuncer O, Ataş B. Isolated left oculomotor nerve palsy following measles. J Child Neurol 2002; 17 (10) 784-785
• 24 Kuki I, Kawawaki H, Okazaki S, Ikeda H, Tomiwa K. [Successful steroid pulse therapy for acute unilateral oculomotor nerve palsy associated with norovirus infection]. No To Hattatsu 2008; 40 (4) 324-327
• 25 Go T. Partial oculomotor nerve palsy associated with elevated anti-galactocerebroside and anti-GM1 antibodies. J Pediatr 2000; 137 (3) 425-426
• 26 Sanchez Dalmau BF. Young boy with progressive double vision. Surv Ophthalmol 1998; 43 (1) 47-52
• 27 Gabianelli EB, Klingele TG, Burde RM. Acute oculomotor nerve palsy in childhood. Is arteriography necessary?. J Clin Neuroophthalmol 1989; 9 (1) 33-36
• 28 Shelton JB, Ramakrishnaiah R, Glasier CM, Phillips PH. Cavernous sinus syndrome from an internal carotid artery aneurysm in an infant with tuberous sclerosis. J AAPOS 2011; 15 (4) 389-391
• 29 Headache Classification Committee of the International Headache Society. The International classification of headache disorders. Cephalagia 2004; 24: 1-151
• 30 Walsh JP, O'Doherty DS. A possible explanation of the mechanism of ophthalmoplegic migraine. Neurology 1960; 10: 1079-1084
• 31 Corbett JJ. Neuro-ophthalmic complications of migraine and cluster headaches. Neurol Clin 1983; 1 (4) 973-995
• 32 Friedman AP, Harter DH, Merritt HH. Ophthalmoplegic migraine. Arch Neurol 1962; 7: 320-327
• 33 Hupp SL, Kline LB, Corbett JJ. Visual disturbances of migraine. Surv Ophthalmol 1989; 33 (4) 221-236
• 34 Bachynski BN, Flynn JT. Direct trauma to the superior oblique tendon following penetrating injuries of the upper eyelid. Arch Ophthalmol 1985; 103 (10) 1510-1514
• 35 Carlow TJ. Oculomotor ophthalmoplegic migraine: is it really migraine?. J Neuroophthalmol 2002; 22 (3) 215-221
• 36 Lepore FE, Glaser JS. Misdirection revisited. A critical appraisal of acquired oculomotor nerve synkinesis. Arch Ophthalmol 1980; 98 (12) 2206-2209
• 37 Vijayan N. Ophthalmoplegic migraine: ischemic or compressive neuropathy?. Headache 1980; 20 (6) 300-304
• 38 Levin M, Ward TN. Ophthalmoplegic migraine. Curr Pain Headache Rep 2004; 8 (4) 306-309
• 39 O'Hara MA, Anderson RT, Brown D. Magnetic resonance imaging in ophthalmoplegic migraine of children. J AAPOS 2001; 5 (5) 307-310
• 40 Weber ED, Newman SA. Aberrant regeneration of the oculomotor nerve: implications for neurosurgeons. Neurosurg Focus 2007; 23 (5) E14
• 41 Balkan R, Hoyt CS. Associated neurologic abnormalities in congenital third nerve palsies. Am J Ophthalmol 1984; 97 (3) 315-319
• 42 Forster RK, Schatz NJ, Smith JL. A subtle eyelid sign in aberrant regeneration of the third nerve. Am J Ophthalmol 1969; 67 (5) 696-698
• 43 Anderson RL, Baumgartner SA. Strabismus in ptosis. Arch Ophthalmol 1980; 98 (6) 1062-1067
• 44 Anderson RL, Baumgartner SA. Amblyopia in ptosis. Arch Ophthalmol 1980; 98 (6) 1068-1069
• 45 Chan TK, Demer JL. Clinical features of congenital absence of the superior oblique muscle as demonstrated by orbital imaging. J AAPOS 1999; 3 (3) 143-150
• 46 Sato M. Magnetic resonance imaging and tendon anomaly associated with congenital superior oblique palsy. Am J Ophthalmol 1999; 127 (4) 379-387
• 47 Sato M, Yagasaki T, Kora T, Awaya S. Comparison of muscle volume between congenital and acquired superior oblique palsies by magnetic resonance imaging. Jpn J Ophthalmol 1998; 42 (6) 466-470
• 48 Donahue SP, Lavin PJ, Hamed LM. Tonic ocular tilt reaction simulating a superior oblique palsy: diagnostic confusion with the 3-step test. Arch Ophthalmol 1999; 117 (3) 347-352
• 49 Brazis PW. Palsies of the trochlear nerve: diagnosis and localization – recent concepts. Mayo Clin Proc 1993; 68 (5) 501-509
• 50 Tubbs RS, Oakes WJ. Relationships of the cisternal segment of the trochlear nerve. J Neurosurg 1998; 89 (6) 1015-1019
• 51 Demer J, Miller J. Magnetic resonance morphometry of the functional anatomy of the functional anatomy of the superior oblique muscle in normal and pathological states. Invest Ophthalmol Vis Sci 1993; (Suppl): 3941-3943
• 52 Helveston EM, Krach D, Plager DA, Ellis FD. A new classification of superior oblique palsy based on congenital variations in the tendon. Ophthalmology 1992; 99 (10) 1609-1615
• 53 Von Noorden GK. Binocular Vision and Ocular Motility. Theory and Management of Strabismus. 4th ed. St Louis, MO: CV Mosby; 1990: 184-186 , 347–349, 387
• 54 Kraft SP, Scott WE. Masked bilateral superior oblique palsy: clinical features and diagnosis. J Pediatr Ophthalmol Strabismus 1986; 23 (6) 264-272
• 55 Kushner BJ. The diagnosis and treatment of bilateral masked superior oblique palsy. Am J Ophthalmol 1988; 105 (2) 186-194
• 56 Tarczy-Hornoch K, Repka MX. Superior oblique palsy or paresis in pediatric patients. J AAPOS 2004; 8 (2) 133-140
• 57 Harris Jr DJ, Memmen JE, Katz NN, Parks MM. Familial congenital superior oblique palsy. Ophthalmology 1986; 93 (1) 88-90
• 58 Mottier ME, Mets MB. Vertical fusional vergences in patients with superior oblique palsies. Am Orthopt J 1990; 40: 88-93
• 59 Burger LJ, Kalvin NH, Smith JL. Acquired lesions of the fourth cranial nerve. Brain 1970; 93 (3) 567-574
• 60 Coppeto JM, Lessell S. Cryptogenic unilateral paralysis of the superior oblique muscle. Arch Ophthalmol 1978; 96 (2) 275-277
• 61 Glaser JS. Neuro-ophthalmologic examination: general considerations and special techniques. In: Tasman W, Jaeger EA, , eds. Duane's Clinical Ophthalmology, II. Philadelphia: JB Lippincott; 1988
• 62 Harley RD. Paralytic strabismus in children. Etiologic incidence and management of the third, fourth, and sixth nerve palsies. Ophthalmology 1980; 87 (1) 24-43
• 63 Khawam E, Scott AB, Jampolsky A. Acquired superior oblique palsy. Diagnosis and management. Arch Ophthalmol 1967; 77 (6) 761-768
• 64 Rougier J, Girod M, Bongrand M. Etiology of and recovery from trochlear nerve paralysis in neurology. Apropos of 40 cases. Bull Soc Ophtalmol Fr 1973; 73 (7–8): 739-744
• 65 Rucker CW. Paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol 1958; 46 (6) 787-794
• 66 Rucker CW. The causes of paralysis of the third, fourth and sixth cranial nerves. Am J Ophthalmol 1966; 61 (5 Pt 2): 1293-1298
• 67 Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases. Arch Ophthalmol 1981; 99 (1) 76-79
• 68 Younge BR, Sutula F. Analysis of trochlear nerve palsies. Diagnosis, etiology, and treatment. Mayo Clin Proc 1977; 52 (1) 11-18
• 69 Lavin PJ, Troost BT. Traumatic fourth nerve palsy. Clinicoanatomic correlations with computed tomographic scan. Arch Neurol 1984; 41 (6) 679-680
• 70 Lindenberg R. Significance of the tentorium in head injuries from blunt forces. Clin Neurosurg 1964; 12: 129-142
• 71 Guy JR, Friedman WF, Mickle JP. Bilateral trochlear nerve paresis in hydrocephalus. J Clin Neuroophthalmol 1989; 9 (2) 105-111
• 72 Baker RS, Buncic JR. Vertical ocular motility disturbance in pseudotumor cerebri. J Clin Neuroophthalmol 1985; 5 (1) 41-44
• 73 Speer C, Pearlman J, Phillips PH, Cooney M, Repka MX. Fourth cranial nerve palsy in pediatric patients with pseudotumor cerebri. Am J Ophthalmol 1999; 127 (2) 236-237
• 74 Brodsky MC, Boop AF. Primary trochlear nerve neoplasm in a child with neurofibromatosis 1. J Pediatr Ophthalmol Strabismus 1996; 33 (6) 328-329
• 75 Atilla H, Erkam N, Gündüz K, Günalp I. Superior oblique muscle palsy in a patient with orbital dermoid cyst. J AAPOS 2000; 4 (5) 311-312
• 76 Krohel GB, Mansour AM, Petersen WL, Evenchik B. Isolated trochlear nerve palsy secondary to a juvenile pilocytic astrocytoma. J Clin Neuroophthalmol 1982; 2 (2) 119-123
• 77 Barbe ME, Scott WE, Kutschke PJ. A simplified approach to the treatment of Duane's syndrome. Br J Ophthalmol 2004; 88 (1) 131-138
• 78 Ohtsuka K, Hashimoto M, Nakamura Y. Bilateral trochlear nerve palsy with arachnoid cyst of the quadrigeminal cistern. Am J Ophthalmol 1998; 125 (2) 268-270
• 79 Harada M, Ito Y. Surgical correction of cyclotropia. Jpn J Ophthalmol 1964; 8: 88-96
• 80 Knap P. Blow-out fractures. In: Symposium on strabismus. Trans New Orleans Acad Ophthalmol. St. Louis: CV Mosby. 285-291
• 81 Mitchell PR, Parks MM. Surgery of bilateral superior oblique palsy. Ophthalmology 1982; 89 (5) 484-488
• 82 Shauly Y, Weissman A, Meyer E. Ocular and systemic characteristics of Duane syndrome. J Pediatr Ophthalmol Strabismus 1993; 30 (3) 178-183
• 83 Alexandrakis G, Saunders RA. Duane retraction syndrome. Ophthalmol Clin North Am 2001; 14 (3) 407-417
• 84 Porter JD, Baker RS, Ragusa RJ, Brueckner JK. Extraocular muscles: basic and clinical aspects of structure and function. Surv Ophthalmol 1995; 39 (6) 451-484
• 85 Mekari-Sabbagh ON, DaCunha RP. Crossed eyes in a six-year-old girl. Surv Ophthalmol 2001; 45 (4) 331-334
• 86 Lee MS, Galetta SL, Volpe NJ, Liu GT. Sixth nerve palsies in children. Pediatr Neurol 1999; 20 (1) 49-52
• 87 Robertson DM, Hines JD, Rucker CW. Acquired sixth-nerve paresis in children. Arch Ophthalmol 1970; 83 (5) 574-579
• 88 Gómez-Gosálvez F, Sala AG, Rubio A , et al. [Acquired oculomotor paralysis in the adolescent]. Rev Neurol 2001; 32 (3) 241-244
• 89 Cohen SM, Keltner JL. Thrombosis of the lateral transverse sinus with papilledema. Arch Ophthalmol 1993; 111 (2) 274-275
• 90 Benson PF. Transient unilateral external rectus muscle palsy in newborn infants. BMJ 1962; 1 (5284): 1054-1055
• 91 de Grauw AJC, Rotteveel JJ, Cruysberg JR. Transient sixth cranial nerve paralysis in the newborn infant. Neuropediatrics 1983; 14 (3) 164-165
• 92 Reisner SH, Perlman M, Ben-Tovim N, Dubrawski C. Transient lateral rectus muscle paresis in the newborn infant. J Pediatr 1971; 78 (3) 461-465
• 93 Archer SM, Sondhi N, Helveston EM. Strabismus in infancy. Ophthalmology 1989; 96 (1) 133-137
• 94 Sato K, Yoshikawa H. Bilateral abducens nerve paresis associated with anti-GQ1b IgG antibody. Am J Ophthalmol 2001; 131 (6) 816-818
• 95 Afifi AK, Bell WE, Bale JF, Thompson HS. Recurrent lateral rectus palsy in childhood. Pediatr Neurol 1990; 6 (5) 315-318
• 96 Martonyi EJ. Pediatric sixth nerve palsy: case reviews and management guidelines. Am Orthopt J 1990; 40: 24-31
• 97 Manzouri B, Sainani A, Plant G, Lee J, Sloper J. The aetiology and management of long-lasting sixth nerve palsy in ophthalmoplegic migraine. Cephalalgia 2007; 27 (3) 275-278
• 98 Crough Jr ER, Urist MJ. Lateral rectus muscle paralysis associated with closed-head trauma. Am J Ophthalmol 1975; 79 (6) 990-996
• 99 Dripps RD, Vandam LD. Hazards of lumbar puncture. J Am Med Assoc 1951; 147 (12) 1118-1121
• 100 Perlman EM, Barry D. Bilateral sixth-nerve palsy after water-soluble contrast myelography. Arch Ophthalmol 1984; 102 (7) 968
• 101 Gradinego G. A special syndrome of endocranialotitic complications (Paralysis of the motor oculi externus of otitic origin). Ann Otol Rhinol Laryngol 1904; 13: 637-637
• 102 Price T, Fayad G. Abducens nerve palsy as the sole presenting symptom of petrous apicitis. J Laryngol Otol 2002; 116 (9) 726-729
• 103 Thorsen G. Neurological complications after spinal anesthesia. Acta Chir Scand 1947; 95 (Suppl 121): 1-272
• 104 Marianowski R, Rocton S, Ait-Amer JL, Morisseau-Durand MP, Manach Y. Conservative management of Gradenigo syndrome in a child. Int J Pediatr Otorhinolaryngol 2001; 57 (1) 79-83
• 105 Aroichane M, Repka MX. Outcome of sixth nerve palsy or paresis in young children. J Pediatr Ophthalmol Strabismus 1995; 32 (3) 152-156
• 106 Scott AB, Kraft SP. Botulinum toxin injection in the management of lateral rectus paresis. Ophthalmology 1985; 92 (5) 676-683