{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T09:38:10Z","timestamp":1763545090029},"reference-count":9,"publisher":"California Digital Library (CDL)","issue":"4","license":[{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Cranial nerve (CN) VI palsy is a common complaint seen in the emergency department (ED) and has a wide range of causes. Bilateral CN VI palsies are uncommon and appear to be associated with more severe complications. \nCase Report: A 29-year-old male presented to the ED from an ophthalmology office for diplopia, headache, and strabismus. He was found to have bilateral CN VI palsies and new-onset seizure in the ED. A lumbar puncture revealed cryptococcal meningitis. Additional tests revealed a new diagnosis of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and syphilis. \nConclusion: Cryptococcal meningitis remains a life-threatening complication of HIV\/AIDS. Coinfections with HIV, particularly syphilis, further complicate a patient\u2019s prognosis as both can lead to devastating neurological sequelae. In cryptococcal meningitis, elevated intracranial pressure is a complication that can manifest as seizures, altered mental status, and cranial nerve palsies.<\/jats:p>","DOI":"10.5811\/cpcem.2021.8.53347","type":"journal-article","created":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T00:00:04Z","timestamp":1637366404000},"page":"515-518","source":"Crossref","is-referenced-by-count":4,"title":["Bilateral Cranial Nerve VI Palsies in Cryptococcal Meningitis, HIV, and Syphilis: A Case Report"],"prefix":"10.5811","volume":"5","author":[{"given":"Germaine","family":"Rival","sequence":"first","affiliation":[{"name":"Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onyi","family":"Okorji","sequence":"additional","affiliation":[{"name":"Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachael","family":"Kern","sequence":"additional","affiliation":[{"name":"Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Preya","family":"Patel","sequence":"additional","affiliation":[{"name":"Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Fradeneck","sequence":"additional","affiliation":[{"name":"Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darragh","family":"Cullen","sequence":"additional","affiliation":[{"name":"Jefferson Health Northeast, Department of Emergency Medicine, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2021,11,1]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Elder C, Hainline C, Galetta SL, et al. Isolated abducens nerve palsy: update on evaluation and diagnosis. Curr Neurol Neurosci Rep. 2016;16(8):69-76.","DOI":"10.1007\/s11910-016-0671-4"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Abassi M, Boulware D, Rhein J. Cryptococcal meningitis: diagnosis and management. Curr Trop Med Rep. 2015;2(2):90-9.","DOI":"10.1007\/s40475-015-0046-y"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Temfack E, Boyer-Chammard T, Lawrence D, et al. New insights into cryptococcus spp. Biology and cryptococcal meningitis. Curr Neurol Neurosci Rep. 2019;19(10):81-91.","DOI":"10.1007\/s11910-019-0993-0"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:291-322.","DOI":"10.1086\/649858"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Kidd S, Torrone E, Su J, et al. Reported primary and secondary syphilis cases in the United States: implications for HIV infection. Sex Transm Dis. 2018;45(9):S42-S47.","DOI":"10.1097\/olq.0000000000000810"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Merins V and Hahn K. Syphilis and neurosyphilis: HIV-coinfection and value of diagnostic parameters in cerebrospinal fluid. Eur J Med Res. 2015;20:81-8.","DOI":"10.1186\/s40001-015-0175-8"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Joo T, Lee Y, Kim T. Herpes zoster involving the abducens and vagus nerves without typical skin rash: a case report and literature review. Medicine. 2019; 98(19):e15619-e15622.","DOI":"10.1097\/md.0000000000015619"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Lundin M, Sandel S, Suciu C, Spicehandler D. Lyme disease with erythema migrans presenting concurrently with optic nerve perineuritis and abducens nerve palsy. BMJ Case Rep. 2020;13:e231889-e231891.","DOI":"10.1136\/bcr-2019-231889"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Jordan K, Marino J, Damast M. Bilateral oculomotor paralysis due to neurosyphilis. Ann Neurol. 1978;3(1):90-3.","DOI":"10.1002\/ana.410030114"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2021,11,20]],"date-time":"2021-11-20T00:00:08Z","timestamp":1637366408000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/9nr7735g"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,1]]},"references-count":9,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,11,10]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2021.8.53347","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2021,11,1]]}}}