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Physiotherapy in Postinfection Injury to Cranial Nerves III, IV, and VI

A Case Study

Rongies, Witold, PhD; Bojakowski, Jacek, MD, PhD; Koktysz, Lidia, MSc; Dolecki, Włodzimierz, MSc; Lewińska, Agnieszka Olga, MSc; Krzeski, Antoni, MD

American Journal of Physical Medicine & Rehabilitation: June 2019 - Volume 98 - Issue 6 - p e57–e59
doi: 10.1097/PHM.0000000000001060
Case Report

The patient with bacterial infection sequelae in the form of damage to cranial nerves III, IV, and VI was followed up. He had exhibited clinical and radiographic signs of paranasal sinusitis. Before his physiotherapy, the patient received standard treatment with natural and synthetic antibiotics and steroids. After acute signs of infection resolved without any functional improvement, the patient was referred to a rehabilitation unit to undergo neuromuscular re-education of the paralyzed extraocular muscles. Periorbital hydrocortisone iontophoresis and visuomotor exercises with intense ideomotor stimulation led to complete and rapid resolution of extraocular muscle paralysis and diplopia. Physiotherapy can be an effective treatment of choice after failed pharmacological treatment in patients with damage to cranial nerves III and VI. It has many theoretical advantages, including noninvasiveness and avoidance of first-pass metabolism of drugs administered systemically.

From the Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland (WR); Department of Neurology, Medical University of Warsaw, Warsaw, Poland (JB); Department of Rehabilitation, Public Central Teaching Clinical Hospital, Warsaw, Poland (LK); Department of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland (WD); 2nd Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland (AOL); and Department of Otorhinolaryngology, Medical University of Warsaw, Warsaw, Poland (AK).

All correspondence should be addressed to: Agnieszka Olga Lewińska, MSc, 2nd Department of Clinical Radiology, Medical University of Warsaw, ul. Stefana Banacha 1a, 02-097 Warsaw, Poland.

All patients consented to the use of their images.

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Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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