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Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache

This case report discusses a cranial nerve III palsy in a 47‐year‐old, type II diabetic man that originally presented with a cluster headache that was treated with 100% oxygen by nasal cannula, 975 mg Tylenol, and 100 mg of Imitrex without any symptom relief. He then received a sphenopalatine fossa...

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Autores principales: Davis, Philip M., Riddle, Mark L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593431/
https://www.ncbi.nlm.nih.gov/pubmed/33145543
http://dx.doi.org/10.1002/emp2.12074
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author Davis, Philip M.
Riddle, Mark L.
author_facet Davis, Philip M.
Riddle, Mark L.
author_sort Davis, Philip M.
collection PubMed
description This case report discusses a cranial nerve III palsy in a 47‐year‐old, type II diabetic man that originally presented with a cluster headache that was treated with 100% oxygen by nasal cannula, 975 mg Tylenol, and 100 mg of Imitrex without any symptom relief. He then received a sphenopalatine fossa block using 1 ampule of 4% cocaine. Three days after medicinal, intranasal cocaine for treatment of a cluster headache, the patient presented with a cranial nerve III palsy with spontaneous resolution in 4 months without any intervention. Previously, intranasal cocaine had been standard treatment for cluster headaches; however, recently lidocaine has come into favor for the sphenopalatine block. Intranasal cocaine has been associated with cerebrovascular accidents, even in young adults. The time from cocaine use to cerebrovascular accident can range from hours to years. This known side effect of intranasal cocaine in young, otherwise healthy individuals should be considered when this medication is being used to treat headache, especially in higher risk patients. Therefore, when considering a sphenopalatine nerve block for treatment of headaches, both cluster and migraine, lidocaine should be the preferential treatment over intra‐nasal cocaine.
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spelling pubmed-75934312020-11-02 Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache Davis, Philip M. Riddle, Mark L. J Am Coll Emerg Physicians Open Neurology This case report discusses a cranial nerve III palsy in a 47‐year‐old, type II diabetic man that originally presented with a cluster headache that was treated with 100% oxygen by nasal cannula, 975 mg Tylenol, and 100 mg of Imitrex without any symptom relief. He then received a sphenopalatine fossa block using 1 ampule of 4% cocaine. Three days after medicinal, intranasal cocaine for treatment of a cluster headache, the patient presented with a cranial nerve III palsy with spontaneous resolution in 4 months without any intervention. Previously, intranasal cocaine had been standard treatment for cluster headaches; however, recently lidocaine has come into favor for the sphenopalatine block. Intranasal cocaine has been associated with cerebrovascular accidents, even in young adults. The time from cocaine use to cerebrovascular accident can range from hours to years. This known side effect of intranasal cocaine in young, otherwise healthy individuals should be considered when this medication is being used to treat headache, especially in higher risk patients. Therefore, when considering a sphenopalatine nerve block for treatment of headaches, both cluster and migraine, lidocaine should be the preferential treatment over intra‐nasal cocaine. John Wiley and Sons Inc. 2020-05-23 /pmc/articles/PMC7593431/ /pubmed/33145543 http://dx.doi.org/10.1002/emp2.12074 Text en © 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Neurology
Davis, Philip M.
Riddle, Mark L.
Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache
title Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache
title_full Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache
title_fullStr Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache
title_full_unstemmed Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache
title_short Pupil‐sparing cranial nerve III palsy after intranasal cocaine treatment for cluster headache
title_sort pupil‐sparing cranial nerve iii palsy after intranasal cocaine treatment for cluster headache
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7593431/
https://www.ncbi.nlm.nih.gov/pubmed/33145543
http://dx.doi.org/10.1002/emp2.12074
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