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Korean Journal of Ophthalmology : KJO Jun 2017Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in... (Review)
Review
Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in aberrant innervation of the ocular and facial musculature. Its diagnosis could be facilitated by the development of high resolution thin-section magnetic resonance imaging. The purpose of this review is to describe the method to visualize cranial nerves III, IV, and VI and to present the imaging findings of congenital cranial dysinnervation disorders including congenital oculomotor nerve palsy, congenital trochlear nerve palsy, Duane retraction syndrome, Möbius syndrome, congenital fibrosis of the extraocular muscles, synergistic divergence, and synergistic convergence.
Topics: Abducens Nerve; Cranial Nerve Diseases; Duane Retraction Syndrome; Humans; Magnetic Resonance Imaging; Oculomotor Nerve; Trochlear Nerve
PubMed: 28534340
DOI: 10.3341/kjo.2017.0024 -
Journal of AAPOS : the Official... Aug 2016Progressive strabismus initially considered idiopathic may be caused by isolated schwannomas of motor nerves to extraocular muscles, detectable only on careful imaging....
BACKGROUND
Progressive strabismus initially considered idiopathic may be caused by isolated schwannomas of motor nerves to extraocular muscles, detectable only on careful imaging. This study reviewed clinical experience of a referral practice in identifying schwannomas on magnetic resonance imaging (MRI).
METHODS
We reviewed 647 cases imaged for strabismus to identify presumed cranial nerve schwannomas, identified by gadodiamide-enhanced, high-resolution surface coil orbital MRI and thin-section cranial MRI. Clinical features and management were correlated with MRI.
RESULTS
Schwannomas were identified as fusiform intraneural enlargements in 8 cases: 1 affecting the trochlear nerve; 2, the abducens nerve; and 5 the oculomotor nerve. Involved muscles were atrophic. Both abducens schwannomas, 1 superior oblique, and 1 oculomotor schwannoma were subarachnoid; 3 were intraorbital, and bilateral oculomotor lesions of 1 case extended from cavernous sinus to orbit. Associated strabismus progressed for 3-17 years. Abducens schwannoma caused esotropia; trochlear schwannoma caused hypertropia and cyclotropia. Intracranial oculomotor schwannoma caused mydriasis and exotropia. Intraorbital schwannoma caused exotropia with or without hypertropia. Since lesion diameters were 3-9 mm, 6 had been previously missed on routine MRI.
CONCLUSIONS
Progressive, acquired strabismus may be caused by isolated cranial nerve schwannomas, representing about 1% of strabismus cases in this study, involving the oculomotor more than abducens nerve. Because most schwannomas are small and deep in the orbit, findings could be readily missed by routine imaging, leading to a possible diagnosis of idiopathic strabismus. Schwannomas should be suspected when extraocular muscles are atrophic, but the causative lesions themselves are identifiable only using targeted, high resolution MRI.
Topics: Humans; Magnetic Resonance Imaging; Neurilemmoma; Oculomotor Muscles; Oculomotor Nerve; Retrospective Studies; Strabismus; Trochlear Nerve
PubMed: 27424045
DOI: 10.1016/j.jaapos.2016.05.015 -
British Journal of Neurosurgery Oct 2023Gliomas involving the cranial nerves III-XIII are rare. Even rarer are glioblastomas multiforme (GBMs) with only 10 cases previously reported. Oculomotor nerve... (Review)
Review
Gliomas involving the cranial nerves III-XIII are rare. Even rarer are glioblastomas multiforme (GBMs) with only 10 cases previously reported. Oculomotor nerve involvement was described in only 2 patients. The mechanisms proposed so far include an origin from the nerve itself or an extension within the nerve of a midbrain tumor. We report the case of a 69-year-old man who presented with an isolated left oculomotor nerve palsy. He was found to have a left temporal GBM extended to the frontal lobe. Diagnostics and intraoperative and pathological findings clearly demonstrated a massive infiltration of the cisternal portion of the left oculomotor nerve. We suppose this could be the first case of direct oculomotor nerve invasion by exophytic spread of a supratentorial GBM or by subarachnoid seeding from a temporal tumor. Less probably, it could be the first case of an oculomotor nerve GBM with a temporal lobe invasion.
Topics: Male; Humans; Aged; Oculomotor Nerve; Glioblastoma; Oculomotor Nerve Diseases; Glioma; Brain Stem Neoplasms
PubMed: 33095069
DOI: 10.1080/02688697.2020.1837732 -
European Journal of Neurology Jun 2024The etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of... (Review)
Review
BACKGROUND AND PURPOSE
The etiological distribution of oculomotor nerve palsy has varied amongst the studies. This study aimed to define the clinical features and underlying etiologies of isolated oculomotor nerve palsy by recruiting patients from all departments in a referral-based university hospital.
METHODS
The medical records of 672 patients who had a confirmed diagnosis of isolated oculomotor nerve palsy at all departments of Seoul National University Bundang Hospital, Seongnam, South Korea, from 2003 to 2020 were reviewed. A proportion of the etiology of isolated oculomotor nerve palsy was also compared with that of patients pooled from the previous studies that were searched on PubMed in May 2022.
RESULTS
The most common etiology was microvascular (n = 168, 26.5%), followed by vascular anomalies (n = 110, 17.4%), neoplastic (n = 86, 13.6%), inflammatory (n = 79, 12.5%), idiopathic (n = 60, 9.5%) and traumatic (n = 53, 8.4%). Neurologists were mainly involved in the management of microvascular and inflammatory oculomotor nerve palsies whilst ophthalmologists mainly participated in the care of idiopathic, neoplastic and traumatic palsies. Neurosurgeons mostly took care of oculomotor nerve palsy due to vascular anomalies.
CONCLUSIONS
The proportion of etiologies of isolated oculomotor nerve palsy may differ according to the specialties involved in the management. The results of previous studies on the etiological distribution of isolated oculomotor nerve palsy should be interpreted with this consideration.
Topics: Humans; Oculomotor Nerve Diseases; Middle Aged; Adult; Male; Female; Aged; Adolescent; Young Adult; Child; Aged, 80 and over; Child, Preschool; Republic of Korea
PubMed: 38411317
DOI: 10.1111/ene.16261 -
Anatomical Record (Hoboken, N.J. : 2007) Mar 2019The oculomotor (OM) complex is a combination of somatic and parasympatethic neurons. The correct development and wiring of this cranial pair is essential to perform...
The oculomotor (OM) complex is a combination of somatic and parasympatethic neurons. The correct development and wiring of this cranial pair is essential to perform basic functions: eyeball and eyelid movements, pupillary constriction, and lens accommodation. The improper formation or function of this nucleus leads pathologies such as strabismus. We describe the OM organization and function in different vertebrate brains, including chick, mouse, and human. The morphological localization is detailed, as well as the spatial relation with the trochlear nucleus in order to adjust some misleading anatomical topographic descriptions. We detailed the signaling processes needed for the specification of the OM neurons. The transcriptional programs driven the specification and differentiation of these neurons are partially determined. We summarized recent genetic studies that have led to the identification of guidance mechanisms involved in the migration, axon pathfinding, and targeting of the OM neurons. Finally, we overviewed the pathology associated to genetic malformations in the OM development and related clinical alterations. Anat Rec, 302:446-451, 2019. © 2018 Wiley Periodicals, Inc.
Topics: Animals; Cell Differentiation; Cell Movement; Chickens; Cranial Nerves; Eye Movements; Humans; Mice; Motor Neurons; Neural Pathways; Oculomotor Nerve
PubMed: 29663710
DOI: 10.1002/ar.23827 -
Surgical and Radiologic Anatomy : SRA Oct 2022The oculomotor nerve (OMN) innervates the pupil, ciliary body, upper eyelid, and extraocular muscles through two divisions: a superior division that innervates the... (Review)
Review
BACKGROUND
The oculomotor nerve (OMN) innervates the pupil, ciliary body, upper eyelid, and extraocular muscles through two divisions: a superior division that innervates the levator palpebrae superioris (LPS) and superior rectus (SR), and an inferior division that supplies the medial rectus (MR), inferior rectus (IR), inferior oblique (IO), and parasympathetic fibers to the pupil and ciliary body. We present a case of complete splitting of the cisternal segment of bilateral OMNs that was discovered incidentally on magnetic resonance imaging (MRI) in a patient who had no ocular complaints.
CASE REPORT
A 69-year-old patient was found to have bilateral splitting of the cisternal segments of OMNs during an MRI for trigeminal neuralgia workup. Both nerves sprang from the midbrain as distinct roots. They were symmetric on the right and minimally asymmetric on the left. On both sides, the medial root was slightly inferiorly situated. The patient had no visual problems and continued to function normally. A review of the literature for similar cases identified no such variants; however, it did identify eight examples of OMN fenestrations produced by aneurysms (AN), six of which had no OMN palsy symptoms.
CONCLUSION
An anatomic variant of split bilateral OMN cisternal segments is described. The superior and inferior divisions may have different brainstem origins. Although this variant is an anatomic curiosity, it may have clinical significance and explain the various presentation of compressive OMN palsies.
Topics: Humans; Aged; Oculomotor Nerve; Incidental Findings; Oculomotor Nerve Diseases; Oculomotor Muscles; Magnetic Resonance Imaging
PubMed: 36178524
DOI: 10.1007/s00276-022-03024-4 -
European Neurology 2021Imaging data were scarce on diabetic oculomotor nerve palsy (ONP). Our study explored the MRI features and their clinical implications for diabetic ONP.
INTRODUCTION
Imaging data were scarce on diabetic oculomotor nerve palsy (ONP). Our study explored the MRI features and their clinical implications for diabetic ONP.
METHODS
Fifty-nine patients with a clinical diagnosis of diabetic ONP were recruited from our department between January 2015 and December 2019. Orbital MRI was retrospectively analyzed, and follow-up scans were obtained for 5 patients. Based on the ocular motor nerve palsy scale, the difference in the scores on the first and last hospital days was defined as the improvement score and was used to assess the treatment effects in all.
RESULTS
Thirty-eight (64.41%) patients presented thickening and enhancement of the cavernous segment and inferior division of the intraorbital segment of the ipsilateral oculomotor nerve, with the cisternal segment spared in all. After complete resolution of symptoms, follow-up MRI in 5 patients revealed that the enhancement was less obvious compared with the previous images. 6 patients in the enhancement group and 4 patients in the nonenhancement group were treated with 80 mg of methylprednisolone. Significant differences were not detected in the median improvement scores between patients with and those without corticosteroid use (p = 0.240).
CONCLUSION
Thickening and enhancement of the unilateral oculomotor nerve were common imaging findings in diabetic ONP, and they persisted after complete resolution of symptoms in some patients. The cavernous segment and the inferior division of the intraorbital segment were simultaneously involved, and the cisternal segment was often spared. Refraining from corticosteroids was recommended even with nerve enhancement.
Topics: Cavernous Sinus; Diabetes Mellitus; Humans; Magnetic Resonance Imaging; Oculomotor Nerve; Oculomotor Nerve Diseases; Orbit; Retrospective Studies
PubMed: 33975309
DOI: 10.1159/000514100 -
QJM : Monthly Journal of the... Jun 2022
Topics: Humans; Intracranial Aneurysm; Oculomotor Nerve Diseases; Subarachnoid Hemorrhage
PubMed: 35394546
DOI: 10.1093/qjmed/hcac097 -
Japanese Journal of Ophthalmology Jul 2019To present cases with idiopathic third and sixth cranial nerve neuritis. (Observational Study)
Observational Study
PURPOSE
To present cases with idiopathic third and sixth cranial nerve neuritis.
STUDY DESIGN
Retrospective observational study METHODS: The results of high resolution pre- and post- cranial nerve magnetic resonance images (MRI) with three-dimensional sequences for visualizing cranial nerves in patients with third, fourth, and sixth cranial nerve palsies who were treated at the Neuro-ophthalmology Department of Samsung Medical Center were reviewed. Patients with cranial nerve enhancement confirmed by experienced radiologists were identified. The medical records of these patients were reviewed, and their demographics, clinical presentations, laboratory results, and clinical outcomes were analyzed.
RESULTS
Of 265 patients with third, fourth, and sixth cranial nerve palsy, 60 were identified by high resolution MRI as having enhancement of the corresponding cranial nerve. Among these, 17 patients with infiltrative, granulomatous, or tumorous lesions were excluded. In addition, 28 patients with identifiable causes of cranial nerve palsy, such as Miller-fisher syndrome, virus infection, or radiation-induced neuropathy, as well as patients with vasculopathic risk factors, were also excluded. Ultimately, a total of 15 patients with idiopathic third and sixth cranial nerve neuritis were included in this study. The mean age of these patients was 43 ± 15 years. Eight patients had sixth cranial nerve palsy, six third cranial nerve palsy (two partial and four complete), and one patient with complete third and sixth cranial nerve palsy. Nine patients received steroid treatment. Eleven patients recovered fully within a period ranging from a few days to one year. Two patients were much improved up to 1 month after initial presentation, but were then ultimately lost to follow-up. Another patient was lost to follow-up after the initial work-up. The other patient lost to follow-up had partially recovered during the first 6 months.
CONCLUSIONS
We present patients with idiopathic third and sixth cranial nerve neuritis. They tended to respond well to steroid treatment and to have good prognoses. In order to better understand the long-term prognosis of cranial nerve neuritis and possible association with other neurologic disorders, a larger scale and longer-term study is needed.
Topics: Abducens Nerve; Abducens Nerve Diseases; Adult; Aged; Eye Movements; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuritis; Oculomotor Nerve; Oculomotor Nerve Diseases; Retrospective Studies; Young Adult
PubMed: 31006061
DOI: 10.1007/s10384-019-00666-7 -
Scientific Reports Feb 2021Abnormal iron accumulation around the substantia nigra (SN) is a diagnostic indicator of Parkinsonism. This study aimed to identify iron-related microarchitectural... (Observational Study)
Observational Study
Abnormal iron accumulation around the substantia nigra (SN) is a diagnostic indicator of Parkinsonism. This study aimed to identify iron-related microarchitectural changes around the SN of brains with progressive supranuclear palsy (PSP) via postmortem validations and in vivo magnetic resonance imaging (MRI). 7 T high-resolution MRI was applied to two postmortem brain tissues, from one normal brain and one PSP brain. Histopathological examinations were performed to demonstrate the molecular origin of the high-resolution postmortem MRI findings, by using ferric iron staining, myelin staining, and two-dimensional laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) imaging. In vivo iron-related MRI was performed on five healthy controls, five patients with Parkinson's disease (PD), and five patients with PSP. In the postmortem examination, excessive iron deposition along the myelinated fiber at the anterior SN and third cranial nerve (oculomotor nerve) fascicles of the PSP brain was verified by LA-ICP-MS. This region corresponded to those with high R values and positive susceptibility from quantitative susceptibility mapping (QSM), but was less sensitive in Perls' Prussian blue staining. In in vivo susceptibility-weighted imaging, hypointense pixels were observed in the region between the SN and red nucleus (RN) in patients with PSP, but not in healthy controls and patients with PD. R and QSM values of such region were significantly higher in patients with PSP compared to those in healthy controls and patients with PD as well (vs. healthy control: p = 0.008; vs. PD: p = 0.008). Thus, excessive iron accumulation along the myelinated fibers at the anterior SN and oculomotor nerve fascicles may be a pathological characteristic and crucial MR biomarker in a brain with PSP.
Topics: Aged; Aged, 80 and over; Female; Healthy Volunteers; Humans; Iron; Magnetic Resonance Imaging; Male; Middle Aged; Oculomotor Nerve; Substantia Nigra; Supranuclear Palsy, Progressive
PubMed: 33536537
DOI: 10.1038/s41598-021-82469-w