Proximal superior division oculomotor nerve palsy from metastatic subarachnoid infiltration

Journal of Neurology -     

外伤性动眼神经麻痹的临床特点分析

目的总结轻型颅脑损伤所致动眼神经麻痹后的临床特点。方法通过眼外肌运动、眼睑活动、瞳孔大小分析20例轻型颅脑损伤患者动眼神经麻痹的严重程度及功能恢复,随访时间平均为14.2月(3个月~2年)。结果 15名男性患者和5名女性患者纳入此次研究。最常见的外伤原因是交通事故65.4%(13例);眼内肌麻痹是最常见的临床症状;上睑下垂、眼外肌麻痹和眼内肌麻痹的恢复率分别是95%(19例),83.3%(17例)和50%(10例)。结论眼球活动受限是影响轻型颅脑损伤动眼神经麻痹患者生活质量的一个主要因素;蝶骨骨折可能是一个潜在的机制参与了外伤性动眼神经麻痹的发生。     

Ischaemic oculomotor nerve palsy

Summary Of 61 patients with isolated third nerve palsy, 23 (38%) had the characteristic clinical features of an ischaemic oculomotor nerve palsy. The essential sign of this usually painful disorder of acute onset was a marked discrepancy between complete or severe paresis of the extraocular muscles innervated by the third nerve, and sparing of the pupillary sphincter. All patients had completely recovered within 3 months. Fourteen had a history or on follow-up had other cranial mononeuropathies. Except for two patients, all were above the age of 60 years. Of the 23 cases, 11 had diabetes mellitus and 8 an abnormal glucose tolerance test, while in 4 the latter was normal. Almost all had hypertension and were overweight, and half were smokers. In 18 patients, four or five vascular risk factors were present.     

Traumatic oculomotor nerve palsy.

Traumatic isolated oculomotor nerve palsy is not common. Oculomotor nerve palsy without internal ophthalmoplegia (pupil sparing) is extremely rare. We report a case of this condition in a child. An 11-year-old boy was transferred to our hospital after a head injury in a traffic accident. Neuro-ophthalmic examination showed that the left eye had limited adduction, supraduction, and infraduction, incomplete convergence and left ptosis, but no internal ophthalmoplegia. Magnetic resonance imaging indicated mild bending of the ipsilateral oculomotor nerve at the posterior petroclinoid ligament. One month after injury, movement of the patient's eyes was normal on examination, but there was mild diplopia. The suggested mechanism of the oculomotor nerve palsy with pupil sparing in this case is stretching of the oculomotor nerve at the posterior petroclinoid ligament, maintaining an intact pupillomotor nerve.     

Isolated oculomotor nerve palsy in lymphoma

We report a patient with non-Hodgkin's lymphoma who developed a unilateral left oculomotor nerve palsy. Only eyelid lifting and vertical gaze were involved. Lateral gaze or sizes and light reactions of pupils were not involved. Magnetic resonance imaging revealed an enhancement of an upper part of left cavernous sinus and the posterior clinoid process. It was conceivable that lymphoma invaded the upper branch of oculomotor nerve. Such neurological symptoms in cases of oculomotor nerve palsy by lymphoma have not been reported previously. Because cranial neuropathy could occur as the first sign of lymphoma, lymphoma is an important differential diagnosis for the partial oculomotor palsy such as our present case.     

Isolated oculomotor nerve palsy in lymphoma

Abstract

We report a patient with non-Hodgkin’s lymphoma who developed a unilateral left oculomotor nerve palsy. Only eyelid lifting and vertical gaze were involved. Lateral gaze or sizes and light reactions of pupils were not involved. Magnetic resonance imaging revealed an enhancement of an upper part of left cavernous sinus and the posterior clinoid process. It was conceivable that lymphoma invaded the upper branch of oculomotor nerve. Such neurological symptoms in cases of oculomotor nerve palsy by lymphoma have not been reported previously. Because cranial neuropathy could occur as the first sign of lymphoma, lymphoma is an important differential diagnosis for the partial oculomotor palsy such as our present case. [Neurol Res 2000; 22: 347-348]     

Complete oculomotor palsy caused by persistent trigeminal artery

Primitive trigeminal artery (PTA) is the most frequent embryonic communication between the carotid and vertebro-basilar system. PTA is a pathophysiology phenomenon which has been implicated as a rare cause of cranial nerve dysfunction. We report the case of a 40-year-old woman who developed a complete oculomotor nerve palsy caused by a persistent ecstatic trigeminal artery. Brain MRI and MRA studies documented a neurovascular conflict between the oculomotor nerve and a PTA. To the best of our knowledge there is no report about complete third cranial nerve palsy NC due to a PTA. A role of this rare vascular condition is discussed.     

Inferior branch palsy of the oculomotor nerve

Three patients with inferior branch palsies of the oculomotor nerve are described. Two were under 10 years of age and the third was 30 years old at the onset. All 3 presented with painless diplopia. The onset was sudden in 2 patients and progressive in the third. The palsy cleared within a short time in the 2 patients with sudden onset, and a possible viral origin was considered. In the third patient, with progressive palsy, there was no change eight years later.     

后交通动脉瘤所致动眼神经麻痹患者血管内栓塞治疗

目的探讨后交通动脉瘤所致的动眼神经麻痹患者血管内栓塞治疗的疗效。方法回顾性分析21例由后交通动脉瘤(PComAA)致动眼神经麻痹患者,均行后交通动脉血管内栓塞术,评估年龄、是否存在蛛网膜下腔出血、动脉瘤大小、术前动眼神经麻痹的严重程度和症状出现后至手术时间。结果治疗后动眼神经麻痹症状改善17例(80.9%),其中完全康复14例(66.7%),部分恢复3例(14.3%),4例无恢复(19.0%)。结论血管内栓塞术对治疗后交通动脉瘤所致的动眼神经麻痹患者有较好疗效。     

Posttraumatic pneumocephalus-induced bilateral oculomotor nerve palsy

Bilateral third nerve palsy often points to the involvement of its nucleus. Third nerve palsy as a result of posttraumatic nuclear involvement is an extremely rare condition. A 23-year-old man presented with a depressed skull fracture after acute head trauma and had Glasgow Coma Scale Score of 9. The diameters of the pupils were 6.5 and 7.5 mm and they were not reactive to light stimulation. There was bilateral ptosis. Computed tomography (CT) relieved bilateral perimesensephalic pneumocephalus. We suggested that bilateral oculomotor nerve paresis might develop in association with posttraumatic bilateral perimesensephalic pneumocephalus, which affected the nucleus of the third nerve.     

Posttraumatic pneumocephalus-induced bilateral oculomotor nerve palsy

Bilateral third nerve palsy often points to the involvement of its nucleus. Third nerve palsy as a result of posttraumatic nuclear involvement is an extremely rare condition. A 23-year-old man presented with a depressed skull fracture after acute head trauma and had Glasgow Coma Scale Score of 9. The diameters of the pupils were 6.5 and 7.5 mm and they were not reactive to light stimulation. There was bilateral ptosis. Computed tomography (CT) relieved bilateral perimesensephalic pneumocephalus. We suggested that bilateral oculomotor nerve paresis might develop in association with posttraumatic bilateral perimesensephalic pneumocephalus, which affected the nucleus of the third nerve.     

Diabetic inferior division palsy of the oculomotor nerve

In this case report we present a diabetic patient with isolated, pupil-sparing, incomplete inferior division third cranial nerve palsy. Laboratory tests for the evaluation of thyroid function, infection, myasthenia gravis and autoimmune diseases were normal. Cranial computed tomography, magnetic resonance imaging and magnetic resonance angiography also showed normal findings. Accordingly, diabetes related vasculopathic third nerve palsy was suggested. The ocular signs of oculomotor palsy completely disappeared 2 months later. Although this clinical entity is rarely reported, differential diagnosis with pupil-sparing third nerve palsy of other etiologies such as compression by an aneurysm or tumor still need to be investigated.     

后交通动脉瘤所致动眼神经麻痹患者完全恢复的影响因素

目的 分析伴有动眼神经麻痹的中青年后交通动脉瘤患者神经功能完全恢复的影响因素。方法 选取了华中科技大学附属同济医学院附属同济医院2014年1月—2020年1月收治的伴有动眼神经麻痹的后交通动脉瘤患者,年龄18~60岁,根据动眼神经麻痹的恢复情况,将患者分为完全恢复组（63例）和非完全恢复组（26例）。比较两组的临床资料,并分析相关影响因素。结果 动眼神经麻痹类型（OR： 0.144,95% CI：0.030~0.688,P=0.015）、治疗方式（OR： 7.622,95% CI：1.823~31.870,P =0.005）和治疗前动眼神经麻痹持续时间（OR： 0.848,95% CI：0.783~0.919,P =0.000）是神经功能完全恢复的影响因素。结论 在中青年患者中,开颅夹闭比介入栓塞更有利于动眼神经麻痹的完全恢复。术前动眼神经麻痹的类型也与神经功能的完全恢复相关,而完全恢复的最佳预测因素是治疗前症状的持续时间。 [国际神经病学神经外科学杂志, 2022, 49(5): 13-17]     

Isolated oculomotor palsy caused by aneurysm of the basilar artery bifurcation

Summary A 65-year-old woman had diplopia and ptosis of her left eye. A CT scan and vertebrobasilar angiography showed an aneurysm on the basilar artery bifurcation.     

Isolated left oculomotor nerve palsy following measles

A 10-month-old boy was admitted with ptosis on the left eyelid, which rapidly occurred following a disease with rash about 20 days before admission to our hospital. By history, none of the vaccinations had been performed. On physical examination, his vital signs were stable, and he had marasmus. Isolated left oculomotor nerve palsy was diagnosed. Cranial magnetic resonance imaging was normal. Serum IgM antibody to measles virus was positive. Oculomotor nerve palsy markedly improved on the 15th day of follow-up, and complete improvement was noted on the second month of follow-up. To our knowledge, this is the first case of oculomotor nerve palsy following measles.