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Karl C Golnik - One of the best experts on this subject based on the ideXlab platform.

Madhura A Tamhankar - One of the best experts on this subject based on the ideXlab platform.

  • management of acute Cranial Nerve 3 4 and 6 palsies role of neuroimaging
    Current Opinion in Ophthalmology, 2015
    Co-Authors: Madhura A Tamhankar, Nicholas J Volpe
    Abstract:

    Purpose of reviewThis article will discuss the management of isolated, acute Cranial Nerve 3,4 and 6 palsies with special focus on the role of neuroimaging in older adults based on recently published data.Recent findingsAcute Cranial Nerve palsies affecting the third, fourth or sixth Cranial Nerves

  • isolated third fourth and sixth Cranial Nerve palsies from presumed microvascular versus other causes a prospective study
    Ophthalmology, 2013
    Co-Authors: Madhura A Tamhankar, Valerie Biousse, Guishuang Ying, Sashank Prasad, Prem S Subramanian, Michael S Lee, Eric Eggenberger, Heather E Moss, Stacy L Pineles, Jeffrey L Bennett
    Abstract:

    Purpose To estimate the proportion of patients presenting with isolated third, fourth, or sixth Cranial Nerve palsy of presumed microvascular origin versus other causes. Design Prospective, multicenter, observational case series. Participants A total of 109 patients aged 50 years or older with acute isolated ocular motor Nerve palsy. Testing Magnetic resonance imaging (MRI) of the brain. Main Outcome Measures Causes of acute isolated ocular motor Nerve palsy (presumed microvascular or other) as determined with early MRI and clinical assessment. Results Among 109 patients enrolled in the study, 22 had Cranial Nerve III palsy, 25 had Cranial Nerve IV palsy, and 62 had Cranial Nerve VI palsy. A cause other than presumed microvascular ischemia was identified in 18 patients (16.5%; 95% confidence interval, 10.7–24.6). The presence of 1 or more vasculopathic risk factors (diabetes, hypertension, hypercholesterolemia, coronary artery disease, myocardial infarction, stroke, and smoking) was significantly associated with a presumed microvascular cause ( P  = 0.003, Fisher exact test). Vasculopathic risk factors were also present in 61% of patients (11/18) with other causes. In the group of patients who had vasculopathic risk factors only, with no other significant medical condition, 10% of patients (8/80) were found to have other causes, including midbrain infarction, neoplasms, inflammation, pituitary apoplexy, and giant cell arteritis (GCA). By excluding patients with third Cranial Nerve palsies and those with GCA, the incidence of other causes for isolated fourth and sixth Cranial Nerve palsies was 4.7% (3/64). Conclusions In our series of patients with acute isolated ocular motor Nerve palsies, a substantial proportion of patients had other causes, including neoplasm, GCA, and brain stem infarction. Brain MRI and laboratory workup have a role in the initial evaluation of older patients with isolated acute ocular motor Nerve palsies regardless of whether vascular risk factors are present. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Jaime R. Lopez - One of the best experts on this subject based on the ideXlab platform.

  • 31 intraoperative monitoring of motor Cranial Nerves and Cranial Nerve nuclei
    Clinical Neurophysiology, 2016
    Co-Authors: Jaime R. Lopez
    Abstract:

    Intraoperative neurophysiologic monitoring of Cranial Nerve function is primarily performed in those Cranial Nerves whose function has a motor component. The rationale, as well as the stimulation and recording techniques employed, is similar to that used in assessing the functional integrity of motor peripheral Nerves. The primary difference is in the placement of the recording electrodes and the neural structures that are at risk for injury. In addition, Cranial Nerve dysfunction is not solely confined to a Cranial Nerve but can also involve the nucleus of the specific Nerve. Thus, a special application of Cranial Nerve monitoring is the functional assessment and monitoring of Cranial Nerve nuclei. The goal of this presentation is to review the neurophysiologic techniques, consisting primarily of EMG, used to monitor motor Cranial Nerves and Cranial Nerve nuclei, and highlight this with case examples.

  • intraoperative electrical stimulation for identification of Cranial Nerve nuclei
    Muscle & Nerve, 1999
    Co-Authors: Steven D Chang, Jaime R. Lopez, Gary K Steinberg
    Abstract:

    The purpose of this study was to evaluate the feasibility and usefulness of Cranial Nerve nuclei monitoring during resection of brainstem cavernous malformations. Eleven patients with brainstem cavernous malformations underwent resection of their malformations utilizing Cranial Nerve nuclei monitoring. Cranial Nerves V and VII were monitored by placing electrodes in muscle groups innervated by these Nerves and recording manipulation-induced neurotonic discharges and triggered electromyographic (EMG) activity, after electrical stimulation of the corresponding brainstem nuclei. Seven of 11 procedures (64%) with Cranial Nerve nuclei monitoring were noted to have Cranial Nerve nuclei activity corresponding to manipulation of the nuclei. The cavernous malformation was completely resected in 5 of 7 cases with Cranial Nerve nuclei activity and in all 4 cases without activity. In the remaining 2 cases, the cavernous malformation was not resected due to the proximity of the monitored Cranial Nerve nuclei to the cavernous malformation and to increasing neurotonic activity as the cavernous malformation was approached. None of the 11 patients had new permanent postoperative deficits corresponding to the Cranial Nerve nuclei monitored; 1 patient had a transient partial facial palsy lasting 2 days. Preliminary results indicate that Cranial Nerve nuclei monitoring proves useful in preserving neurologic function and reducing surgical morbidity during resection of brainstem cavernous malformations, particularly indicating when lesion resection places these nuclei at risk. © 1999 John Wiley & Sons, Inc. Muscle Nerve 22: 1538–1543, 1999

Manpreet S Chhabra - One of the best experts on this subject based on the ideXlab platform.

Nicholas J Volpe - One of the best experts on this subject based on the ideXlab platform.