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Year : 2015  |  Volume : 63  |  Issue : 10  |  Page : 806

Varicella vasculopathy and chronic suppurative otitis media: Differential diagnosis for isolated sixth nerve palsy

Department of Neuro-Ophthalmology, Clinic and Glaucoma Service, AG Eye Hospital, Puthur, Tiruchirappalli, Tamil Nadu, India

Date of Web Publication10-Dec-2015

Correspondence Address:
Dr. N Venugopal
No. 19, Mathuram Apartments, Officer's Colony, Puthur, Tiruchirappalli - 620 017, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0301-4738.171531

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How to cite this article:
Venugopal N. Varicella vasculopathy and chronic suppurative otitis media: Differential diagnosis for isolated sixth nerve palsy. Indian J Ophthalmol 2015;63:806

How to cite this URL:
Venugopal N. Varicella vasculopathy and chronic suppurative otitis media: Differential diagnosis for isolated sixth nerve palsy. Indian J Ophthalmol [serial online] 2015 [cited 2020 Jul 10];63:806. Available from: http://www.ijo.in/text.asp?2015/63/10/806/171531

Dear Sir,

Nair et al. [1] In Sankara Nethralaya Abducens Nerve Palsy study: Report 1, have highlighted the importance of ruling out neurological signs prior to diagnosing isolated sixth nerve palsy. We appreciate the authors' effort and research work. We would like to highlight a few points regarding sixth nerve palsy associated with ear and pharynx infection. Three of their patients had upper respiratory tract infection. Middle ear infection may cause isolated sixth nerve palsy without petrositis and raised intracranial tension. [2] Incidence of chronic suppurative otitis media (CSOM) disease is higher in developing countries especially among low socioeconomic society because of malnutrition, overcrowding, poor hygiene, inadequate health care, and recurrent upper respiratory tract infection. [3] The brainstem [4] contains vital nodes of all functional systems in the central nervous system, including the visual, auditory, gustatory, vestibular, somatic, and visceral senses, and the somatomotor as well as the autonomic nervous system. We observed an elderly, diabetic, male patient who had maxillary sinusitis, mastoiditis, and brain stem Virchow-Robin space presenting clinically as sixth nerve palsy of short duration. We advised (and explained) emergency otolaryngologist consultation since Gradenigo's syndrome is a life threatening but treatable condition. To conclude, the timing of the neuroimaging study, if sixth nerve palsy develops in a patient undergoing treatment for upper respiratory tract infection and/or CSOM is open for discussion. Varicella vasculopathy should be ruled out in idiopathic isolated sixth nerve palsy. [5]

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  References Top

Nair AG, Ambika S, Noronha VO, Gandhi RA. The diagnostic yield of neuroimaging in sixth nerve palsy - Sankara Nethralaya Abducens Palsy Study (SNAPS): Report 1. Indian J Ophthalmol 2014;62:1008-12.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Mathew L, Singh S, Rejee R, Varghese AM. Gradenigo′s syndrome: Findings on computed tomography and magnetic resonance imaging. J Postgrad Med 2002;48:314-6.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
Prakash R, Juyal D, Negi V, Pal S, Adekhandi S, Sharma M, et al. Microbiology of chronic suppurative otitis media in a tertiary care setup of Uttarakhand state, India. N Am J Med Sci 2013;5:282-7.  Back to cited text no. 3
Beissner F, Baudrexel S. Investigating the human brainstem with structural and functional MRI. Front Hum Neurosci 2014;8:116.  Back to cited text no. 4
Pisapia R, Rianda A, Mariano A, Testa A, Galgani S, Vincenzi L, et al. Varicella zoster virus infection presenting as isolated diplopia: A case report. BMC Infect Dis 2013;13:138.  Back to cited text no. 5


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