• Journal of the Korean Orthopaedic Association
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• v.55 no.6
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• pp.534-539
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• 2020

The management of severe scoliosis remains a challenge to spine surgeons. The rapid intraoperative correction of severe scoliosis may increase the risk of perioperative complications, such as neurological compromise and implant failure. To minimize these risks, various preoperative traction methods have been employed to achieve partial correction before performing definitive corrective surgery. On the other hand, some studies have shown that one of the complications associated with halo traction could lead to cranial nerve palsy, with the sixth nerve (abducens nerve) being most commonly affected. To reduce the complications, gradual increases in the traction weight and detailed neurological examinations are needed, particularly for patients who have previously undergone brain or cervical surgery. The authors report a case of sixth cranial nerve palsy by preoperative halo-pelvic traction in patients with severe scoliosis who underwent previous decompression surgery for a Chiari I malformation with a review of the relevant literature.

• The Korean Journal of Pain
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• v.19 no.1
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• pp.104-106
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• 2006

Tolosa-Hunt syndrome is a rare self-limiting disease that's characterized by painful ophthalmoplegia. It has a relapsing and remitting course, and the pain responds promptly to systemic corticosteroid therapy. Yet it is diagnosed by the exclusion of other major causes involving the superior orbital fissure or cavernous sinus, including trauma, neoplasm, aneurysm and inflammation. Further, the associated ophthalmoplegia may follow days to weeks after the onset of orbital or hemifacial pain. Hence, this condition is often misdiagnosed as atypical facial pain, and so improper management could result in unnecessary suffering of the patient. The following case describes a patient suffering with hemifacial pain associated with ipsilateral abducens nerve palsy, which was evident 2 weeks after the onset of pain, and this was misdiagnosed as trigeminal neuralgia and atypical facial pain.

• Journal of Korean Neurosurgical Society
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• v.57 no.3
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• pp.208-210
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• 2015

Tumors of the clivus and metastases to the clivus are very rare. Metastasis involving the clivus has previously been described in only two case reports. In skull metastasis, the breast and prostate are the most common primary foci, while metastasis from gastric carcinoma is extremely rare. A review of the English literature revealed only one published case of clivus metastases from gastric adenocarcinoma. There is no literature thoroughly explaining the differential diagnosis between chordoma and metastasis. Here we report a rare case of metastasis to the clivus from a gastric adenocarcinoma in a 42-year-old female patient with sudden blurry vision, presenting as bilateral cranial nerve VI palsy.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.10 no.2
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• pp.101-105
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• 2014

Moebius syndrome is a rare, congenital neurological disease involving facial paralysis and limitation of eye movements. It results from maldevelopment of the sixth and seventh cranial nerves. Dental features of this syndrome include micrognathia, microstomia, tongue deformity, cleft palate, hypoplasia of the teeth, and congenital missing teeth. A 7-year-old female with Moebius syndrome was referred from a local dental clinic for caries treatment. She presented with facial paralysis and microstomia. Oral findings included multiple caries with enamel hypoplasia, congenital missing teeth, and tongue deformity. Dental treatments including restorative and preventive procedures were performed. Oral findings and management aspects of Moebius syndrome for this case are discussed. Early evaluation and multidisciplinary care are needed for children with Moebius syndrome.

• The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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• v.33 no.4
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• pp.133-144
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• 2020

Objectives : The purpose of this study is to report the effect of Korean medicine treatment on limitation of eye movement in Miller-Fisher Syndrome. Methods : A patient was treated with herbal medicines, acupuncture(including electropuncture, phamacopuncture), Moxibustion and cupping therapy. To evaluate the result of this treatment, we used photographs of eye movement, Scott and Kraft score of both eye, length of eyeball movement and visual analogue scale(VAS) for subjective symptoms. Results : After treatment, the limitation of eye movement and diplopia were remarkably improved. Also, other symptoms such as dizziness, gait disturbance, facial nerve disorder were disappeared. Conclusions : This study suggests that Korean medicine treatments are effective for patient with limitation of eye movement in Miller-Fisher Syndrome.

• Archives of Plastic Surgery
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• v.34 no.3
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• pp.325-329
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• 2007

Purpose: Mobius syndrome is a rare congenital disorder characterized by facial diplegia and bilateral abducens palsy, which occasionally combines with other cranial nerve dysfunction. The inability to show happiness, sadness or anger by facial expression frequently results in social dysfunction. The classic concept of cross facial nerve grafting and free muscle transplantation, which is standard in unilateral developmental facial palsy, cannot be used in these patients without special consideration. Our experience in the treatment of three patients with this syndrome using transfer of muscles innervated by trigeminal nerve showed rewarding results. Methods: We used bilateral temporalis muscle elevated from the bony temporal fossa. Muscles and their attached fascia were folded down over the anterior surface of the zygomatic arch. The divided strips from the attached fascia were passed subcutaneously and anchored to the medial canthus and the nasolabial crease for smiling and competence of mouth and eyelids. For the recent 13 years the authors applied this method in 3 Mobius syndrome cases- 45 year-old man and 13 year-old boy, 8 year-old girl. Results: One month after the surgery the patients had good support and already showed voluntary movement at the corner of their mouth. They showed full closure of both eyelids. There was no scleral showing during eyelid closure. Also full closure of the mouth was achieved. After six months, the reconstructed movements of face were maintained. Conclusion: Temporalis muscle transfer for Mobius syndrome is an excellent method for bilateral reconstruction at one stage, is easy to perform, and has a wide range of reconstruction and reproducibility.

• Journal of Dental Anesthesia and Pain Medicine
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• v.18 no.4
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• pp.255-259
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• 2018

Sudden headache onset may rarely be caused by spontaneous intracranial hypotension (SIH). Other associated symptoms in patients with SIH are nausea, vomiting, vertigo, hearing alteration, and visual disturbance. This case report describes a 43-year-old female diagnosed with SIH who developed diplopia after resolution of an abrupt-onset headache, which was managed with conservative treatments, including bed rest and hydration. She was also diagnosed with secondary right sixth cranial nerve palsy. Although conservative management relieved her headache, the diplopia was not fully relieved. Application of an autologous epidural blood patch successfully relieved her diplopia, even after 14 days from the onset of visual impairment.

• Investigative Magnetic Resonance Imaging
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• v.23 no.2
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• pp.167-171
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• 2019

$M\ddot{o}bius$ syndrome is a rare congenital condition, characterized by abducens and facial nerve palsy, resulting in limitation of lateral gaze movement and facial diplegia. However, to our knowledge, there have been few studies on evaluation of cranial nerves, on MR imaging in $M\ddot{o}bius$ syndrome. Herein, we describe a rare case of $M\ddot{o}bius$ syndrome representing limitation of lateral gaze, and weakness of facial expression, since the neonatal period. In this case, high-resolution MR imaging played a key role in diagnosing $M\ddot{o}bius$ syndrome, by direct visualization of corresponding cranial nerves abnormalities.

• The Journal of Pediatrics of Korean Medicine
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• v.34 no.1
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• pp.61-70
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• 2020

Objectives The purpose of this study is to report the effectiveness of Korean medicine on treating paralytic strabismus in childhood. Methods We treated a 4-years-old patient who was diagnosed with paralytic strabismus with herbal medicine, laser acupuncture, T-acupuncture and moxibustion. Results After 5 months of the Korean medicine treatment, the child's strabismus, diplopia, and limitation of abduction were improved. There was no recurrence of the symptoms for 1 year and 4 months. Conclusions Korean medicine treatment can be effective in improving symptoms of paralytic strabismus. However, further studies are needed to demonstrate the treatment benefits to abducens nerve palsy.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.28-32
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• 2010

Purpose: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. Methods: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients (0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of $Medpor^{(R)}$. Clinical symptoms and signs were a little different from each other. Results: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP (visual evoked potential), visual field test, electromyogram. With ophthalmologic test and followup CT, we can rule out the orbital apex syndrome. We gave $Salon^{(R)}$ (methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with $Methylon^{(R)}$ (methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. Conclusion: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.