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Seminars in Neurology Oct 2015An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing... (Review)
Review
An isolated ocular motor nerve palsy is defined as dysfunction of a single ocular motor nerve (oculomotor, trochlear, or abducens) with no associated or localizing neurologic signs or symptoms. When occurring in patients aged 50 or older, the most common cause is microvascular ischemia, but serious etiologies such as aneurysm, malignancy, and giant cell arteritis should always be considered. In this article, the authors review the clinical approach, anatomy, and differential diagnosis of each isolated ocular motor nerve palsy and discuss the clinical characteristics, pathophysiology, and treatment of microvascular ischemia.
Topics: Abducens Nerve Diseases; Humans; Oculomotor Nerve Diseases; Paralysis; Trochlear Nerve Diseases
PubMed: 26444399
DOI: 10.1055/s-0035-1563568 -
Seminars in Ultrasound, CT, and MR Oct 2022The oculomotor nerve is the third cranial nerve, exiting the brainstem in the medial border of the cerebral peduncle, from where it crosses straight to the superior...
The oculomotor nerve is the third cranial nerve, exiting the brainstem in the medial border of the cerebral peduncle, from where it crosses straight to the superior orbital fissure. It is a purely motor nerve responsible for the innervation of all the extraocular muscles, except the superior oblique and lateral rectus muscles. It also has parasympathetic pre-ganglionic fibers, responsible for the innervation of sphincter pupillae and ciliary muscles. Magnetic resonance imaging (MRI) is the best imaging exam to evaluate patients with clinical signs of third cranial nerve palsy. The oculomotor nerve can be affected by several diseases, such as congenital malformations, trauma, inflammatory or infectious diseases, vascular disorders, and neoplasms. This article aims to review the oculomotor nerve anatomy, discuss the best MRI techniques to evaluate each nerve segment, and demonstrate the imaging aspect of the diseases that most commonly affect it.
Topics: Humans; Magnetic Resonance Imaging; Oculomotor Muscles; Oculomotor Nerve; Oculomotor Nerve Diseases; Orbit
PubMed: 36116851
DOI: 10.1053/j.sult.2022.04.009 -
Survey of Ophthalmology 2022Oculomotor nerve schwannomas are rare benign cranial nerve tumors. There are only a limited number of reports on this pathology in the literature, and there are... (Review)
Review
Oculomotor nerve schwannomas are rare benign cranial nerve tumors. There are only a limited number of reports on this pathology in the literature, and there are currently no established management guidelines that aid providers in deciding on surgical versus nonsurgical management. We assess the published literature on the topic to identify indications for treatment as well as outcome measures (e.g., local control rates, survival rates, and complication rates) that have been reported as associated with the various treatment modalities. We attempt to develop an algorithm for evaluation and treatment of oculomotor nerve schwannomas in order to establish consensus on how these tumors should be treated.
Topics: Algorithms; Cranial Nerve Neoplasms; Humans; Neurilemmoma; Oculomotor Nerve; Oculomotor Nerve Diseases
PubMed: 34813853
DOI: 10.1016/j.survophthal.2021.11.008 -
Clinical Neurophysiology : Official... Jan 2017Fisher syndrome (FS), a variant of Guillain-Barré syndrome (GBS), is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. The lesion sites for... (Review)
Review
Fisher syndrome (FS), a variant of Guillain-Barré syndrome (GBS), is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia. The lesion sites for these unique clinical features include the oculomotor nerves and group 1a neurons in the dorsal root ganglion, and the presence of FS is determined by the expression of ganglioside GQ1b in the human nervous system. Neurophysiological findings suggest that ataxia and areflexia are due to an impaired proprioceptive afferent system. Typically, the soleus H-reflex is absent and a body-sway analysis using posturography shows a 1-Hz peak, which indicates proprioception dysfunction. Sensory nerve action potentials and somatosensory-evoked potentials are abnormal in approximately 30% of FS patients, indicating the occasional involvement of cutaneous (group 2) afferents. During the disease course, approximately 15% of FS patients suffer an overlap of axonal GBS with nerve conduction abnormalities that reflect axonal dysfunction. This review summarizes electrophysiological abnormalities and their clinical significance in FS.
Topics: Ataxia; Electrophysiological Phenomena; Evoked Potentials, Somatosensory; H-Reflex; Humans; Miller Fisher Syndrome; Neural Conduction; Oculomotor Nerve; Proprioception; Reflex, Abnormal
PubMed: 27923188
DOI: 10.1016/j.clinph.2016.11.009 -
Current Problems in Diagnostic Radiology 2022The purpose of this article is to understand the complex pathologic spectrum of oculomotor nerve palsy. We review the detailed anatomy and function of the oculomotor... (Review)
Review
The purpose of this article is to understand the complex pathologic spectrum of oculomotor nerve palsy. We review the detailed anatomy and function of the oculomotor nerve and demonstrate how the location of a lesion can drive the differential diagnosis. Lastly, we review atypical presentations of oculomotor nerve palsy to include oculomotor synkinesis and oculomotor nerve hyperactivity. Radiologists must be aware of the typical and atypical presentations of CN III palsy to accurately localize lesions as well as avoid premature exclusion of CN III pathology.
Topics: Diagnosis, Differential; Humans; Oculomotor Nerve; Oculomotor Nerve Diseases
PubMed: 33495031
DOI: 10.1067/j.cpradiol.2020.12.006 -
Clinical Neurology and Neurosurgery Feb 2023This study aims to describe the clinical characteristics of patients with isolated oculomotor nerve palsy from COVID-19 infection, and provide guidance on their...
AIM
This study aims to describe the clinical characteristics of patients with isolated oculomotor nerve palsy from COVID-19 infection, and provide guidance on their treatment and management.
METHODS
We performed a systematic review and retrospective analysis on the clinical features and outcomes of patients with isolated oculomotor nerve palsy from COVID-19 reported in literature over the past three years.
RESULTS
We analyzed a total of 11 cases; 9 identified in literature from January 2020 to September 2022, together with our two patients. Their median age was 46 years (range 2-65), and three were children. More than half (6/11, 55 %) were without medical history. Oculomotor nerve palsies tended to occur early (longest interval of 16 days), but they can also occur concurrently (2/11, 18 %) or before the appearance of COVID-19 symptoms (1/11, 9 %). COVID-19 symptoms tended to be mild (8/11, 73 %). Oculomotor nerve palsies, however, displayed neither a clear gender predilection, nor consistent clinical features in terms of the severity of extraocular weakness and the involvement of pupillary light responses. Nearly two-thirds (7/11, 64 %) received no pharmacological treatment. Regardless, recovery was complete in nearly all (9/10, 90 %), with most occurring within a month (8/9, 89 %) CONCLUSION: Isolated oculomotor nerve palsies are early but uncommon complications of COVID-19. They affect patients with mild infections, and can be the first symptom. Prognosis is excellent, with recovery being often complete and early. Early discharge and outpatient clinical review, with or without short courses of oral steroids, are reasonable treatment measures.
Topics: Child; Humans; Child, Preschool; Adolescent; Young Adult; Adult; Middle Aged; Aged; Retrospective Studies; COVID-19; Oculomotor Nerve Diseases; Prognosis; Oculomotor Nerve
PubMed: 36696848
DOI: 10.1016/j.clineuro.2023.107601 -
Journal Francais D'ophtalmologie Dec 2022
Topics: Humans; Oculomotor Nerve; Edema
PubMed: 36030107
DOI: 10.1016/j.jfo.2022.04.022 -
Clinical Anatomy (New York, N.Y.) Jan 2017The oculomotor nerve supplies the extraocular muscles. It also supplies the ciliary and sphincter pupillae muscles through the ciliary ganglion. The nerve fibers leave... (Review)
Review
The oculomotor nerve supplies the extraocular muscles. It also supplies the ciliary and sphincter pupillae muscles through the ciliary ganglion. The nerve fibers leave the midbrain through the most medial part of the cerebral peduncle and enter the interpeduncular cistern. After the oculomotor nerve emerges from the interpeduncular fossa, it enters the cavernous sinus slightly lateral and anterior to the dorsum sellae. It enters the orbit through the superior orbital fissure, after exiting the cavernous sinus, to innervate the extraocular muscles. Therefore, knowledge of the detailed anatomy and pathway of the oculomotor nerve is critical for the management of lesions located in the middle cranial fossa and the clival, cavernous, and orbital regions. This review describes the microsurgical anatomy of the oculomotor nerve and presents pictures illustrating this nerve and its surrounding connective and neurovascular structures. Clin. Anat. 30:21-31, 2017. © 2016 Wiley Periodicals, Inc.
Topics: Humans; Microsurgery; Oculomotor Nerve
PubMed: 27859787
DOI: 10.1002/ca.22811 -
Primary Care Sep 2015Defining the type of strabismus creates a framework for work-up and management. Comitant esotropia is most commonly a childhood condition treated with glasses and... (Review)
Review
Defining the type of strabismus creates a framework for work-up and management. Comitant esotropia is most commonly a childhood condition treated with glasses and surgery. Comitant exotropia is often a childhood condition that may require surgical correction. Microvascular disease is the most common cause of ocular cranial nerve palsies in adult patients.
Topics: Abducens Nerve; Cranial Nerves; Esotropia; Exotropia; Humans; Oculomotor Nerve; Primary Health Care; Referral and Consultation; Strabismus; Trochlear Nerve
PubMed: 26319345
DOI: 10.1016/j.pop.2015.05.006 -
Surgical Neurology International 2019Oculomotor nerve schwannoma (ONS) is an extremely rare intracranial benign tumor. Till date, there is no standard treatment of oculomotor schwannoma. Here, we present an... (Review)
Review
BACKGROUND
Oculomotor nerve schwannoma (ONS) is an extremely rare intracranial benign tumor. Till date, there is no standard treatment of oculomotor schwannoma. Here, we present an illustrative case report of ONS, perform a systematic review of literature on surgically and radiosurgically treated cases and morbidity related to both treatment modalities.
METHODS
We performed a systematic review of literature for cases with ONS treated with surgery or radiosurgery using PubMed/Ovid Medline.
RESULTS
Till date, there are 60 reported cases of ONS (45 treated surgically and seven radiosurgically) with the dominance of female gender (53%) and mean age of 35.2 years (Range 1-66). In 8% of the cases, there was no involvement of cranial nerve (CN) III and 92% of the cases CN III alone or together with CN II, IV, V, and VI. In 67% of the cases a complete resection and 33% a partial resection performed. In 73% of the cases, postoperative third nerve palsy was documented, 22% improved after surgery and in around 5% of cases, the outcome was not described. In the radiosurgically treated cases of nonvestibular schwannoma including ONS, the progression-free interval of approximately 2 years was above 90%.
CONCLUSION
Due to the high rate of postoperative complete oculomotor nerve palsy, a subtotal resection avoiding the nerve injury seems to be a feasible option. Radiosurgery is another option to treat small size schwannoma. A combined treatment with microsurgery followed by radiosurgery may allow effective treatment for large size oculomotor schwannoma.
PubMed: 31528378
DOI: 10.25259/SNI-75-2019