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Published on: October 7, 2021
Infectious ocular motor neuropathies
Jeffrey Gluckstein1, Sashank Prasad2
1Massachusetts General Hospital, Department of Neurology.
Purpose Of Review:
Describe the range of infectious causes of ocular motor neuropathies, from common presentations to unusual manifestations of diseases less frequently seen in the developed world. Provide information on recent developments in diagnostic testing for pathogens that may cause ocular motor neuropathies.
Recent Findings:
Antigen detection in serum or CSF has improved the diagnosis of cryptococcal disease. Cartridge PCR testing for tuberculosis has increased diagnostic accuracy, though tuberculous meningitis remains difficult to diagnose. Rapid, multiplex PCR and unbiased sequencing allow for diagnosis of a wider range of organisms.
Summary:
Infectious ocular motor neuropathies can occur anywhere along the length of cranial nerves III, IV, and VI. Characteristic clinical findings and imaging can be used to localize infections. Infectious causes may have characteristic clinical, laboratory, or imaging findings, but must still be carefully separated from inflammatory or neoplastic conditions.
Insights
Infectious causes of ocular motor neuropathies affecting cranial nerves III, IV, and VI are diverse. Advanced diagnostic tools like PCR and sequencing improve pathogen identification, aiding in differentiating infections from other conditions.
Area of Science:
- Neuro-infectious diseases
- Ophthalmology
- Neurology
Background:
- Ocular motor neuropathies involve cranial nerves III, IV, and VI.
- Infectious etiologies present a broad spectrum, from common to rare pathogens.
- Accurate diagnosis is crucial for effective management.
Purpose of the Study:
- To outline the spectrum of infectious causes of ocular motor neuropathies.
- To discuss diagnostic advancements for relevant pathogens.
- To differentiate infectious causes from inflammatory or neoplastic conditions.
Main Methods:
- Review of infectious etiologies affecting cranial nerves III, IV, and VI.
- Discussion of current diagnostic techniques, including antigen detection and PCR.
- Analysis of clinical, laboratory, and imaging findings for localization and differentiation.
Main Results:
- Improved diagnosis of cryptococcal disease via serum or cerebrospinal fluid (CSF) antigen detection.
- Enhanced accuracy in tuberculosis diagnosis with cartridge PCR, though tuberculous meningitis remains challenging.
- Rapid multiplex PCR and unbiased sequencing enable broader organism identification.
Conclusions:
- Infectious ocular motor neuropathies can affect any part of cranial nerves III, IV, and VI.
- Clinical and imaging findings aid in localizing infections.
- Distinguishing infectious causes from inflammatory or neoplastic conditions requires careful evaluation of clinical, laboratory, and imaging data.
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