Isolated trochlear palsy due to midbrain stroke

Trochlear palsy from intra-axial lesions usually accompanies other neurological deficits, and isolated trochlear palsy due to midbrain stroke is extremely rare. We report two patients with isolated trochlear nerve palsy due to circumscribed dorsal midbrain strokes, one from infarction and the other from hemorrhage, which are located in the region of the trochlear nucleus or adjacent fascicle. Focal brain stem stroke should be considered as a rare cause of trochlear palsy even though there are no associated neurological deficits.     

Isolated reversible hypoglossal nerve palsy as the initial manifestation of pre-eclampsia

Isolated hypoglossal nerve lesions often reflect sinister neoplastic or vascular pathology. Rarely, reversible lesions occur, perhaps via mechanisms similar to Bell's palsy. We report a patient with reversible isolated hypoglossal nerve palsy as the first and predominant early manifestation of pre-eclampsia and speculate on the pathogenesis behind this abnormality.     

An unusual case of isolated trochlear nerve palsy

Trochlear nerve palsy is rarely encountered in children and only 5% are truly isolated. Multiple sclerosis (MS) is also extremely uncommon in children. This report describes an otherwise healthy 10-year-old boy who presented with a 5-day history of vertical diplopia with associated dizziness, decreased appetite, and unsteadiness. He had no recent history of infection and no previous history of neurological symptoms. Ophthalmologic assessment revealed full ocular ductions and right hyperdeviation in primary gaze during alternate cover test. This hyperdeviation increased during left gaze, and right head tilt consistent with paresis of the right oblique muscle. Brain MRI revealed multiple well-defined hyperintense T2 lesions in the periventricular and subcortical white matter, and brainstem, suggestive of MS. His symptoms resolved after 2 weeks with no treatment. To conclude, isolated trochlear nerve palsy can be the initial clinical manifestation of childhood MS. Long term follow up is needed to confirm the diagnosis of MS.     

Combined trochlear nerve palsy and internuclear ophthalmoplegia.

We report a case of left superior oblique palsy combined with a right internuclear ophthalmoplegia. A right mesencephalic lesion involving the trochlear nerve nucleus (or its fibers prior to decussation) and the medial longitudinal fascicle was hypothesized. Magnetic resonance imaging showed a lesion at the suspected level.     

Isolated brain-stem third nerve palsy

Midbrain hemorrhage from a presumed vascular anomaly caused a severe third nerve palsy without other ocular motor or neurologic signs or symptoms.     

Isolated painful third nerve palsy

A 50-year-old woman presented with an acute painful complete third nerve palsy involving the pupil. Noninvasive imaging ruled out an aneurysmal compression of the third nerve, and brain magnetic resonance imaging demonstrated an intrinsic lesion of the third nerve. Work-up remained negative. All symptoms and signs resolved with steroids. In this case review, we briefly discuss the management of isolated third nerve palsies.     

Isolated nontraumatic abducens nerve palsy

INTRODUCTION: Abducens nerve palsy (ANP) is the most common isolated palsy. The injury of the abducens nerve can occur anywhere along its long course, so differential diagnosis of ANP occasionally demands thorough investigation to find the proper cause. PATIENTS: Ten patients with isolated ANP are presented. The causes included nasopharyngeal carcinoma, diabetes, cholesteatoma of the inner ear, carotid-cavernous fistula, subarachnoid bleeding, hydrocephalus, toxic ANP, multiple sclerosis, clinically isolated syndrome suggestive of multiple sclerosis, and Tolosa-Hunt syndrome. DISCUSSION: Based on the cases presented and review of the literature, we argue that every patient with isolated nontraumatic ANP requires brain MRI as an initial diagnostic tool. If this finding remains inconclusive, additional tests including angiography and CSF examination should be performed.     

Isolated oculomotor nerve palsy as the presenting clinical manifestation of a meningeal carcinomatosis: a case report

Abstract We present a previously unreported case of isolated oculomotor nerve palsy as the inaugural clinical sign of meningeal carcinomatosis (MC). Gadolinium-enhanced magnetic resonance images (MRI) were unremarkable. Cerebrospinal fluid (CSF) analysis showed malignant cells consistent with a pulmonary adenocarcinoma; the chest CT revealed a small pulmonary mass in the upper right lobe. This case highlights the importance of considering MC in all patients who develop sudden oculomotor palsy; lumbar punctures should always be performed on patients with normal MRI when other possible causes of oculomotor palsy have been ruled out.     

Isolated unilateral hypoglossal nerve palsy: nine cases

We report nine patients with hypoglossal nerve palsy as the sole neurological manifestation, without simultaneous involvement of other cranial nerves or long-tract signs. In four patients, no cause was found and the outcome was excellent. The next common cause proved to be metastatic disease at the base of the skull in three patients. Two exceptional causes were Chiari malformation in one case and dural arteriovenous fistula of the transverse sinus in another. Although the aetiological importance and ominous prognosis of neoplasia has been emphasized by others, our study suggests that an isolated hypoglossal nerve palsy may be benign and idiopathic. Received: 21 July 1997 Received in revised form: 1 October 1997 Accepted: 8 October 1997     

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]     

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.