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World Neurosurgery Apr 2016Oculomotor nerve palsy can result as a manifestation of diabetic mellitus or aneurysmal compression. Vascular loop compression is a very rare etiology of oculomotor... (Review)
Review
BACKGROUND
Oculomotor nerve palsy can result as a manifestation of diabetic mellitus or aneurysmal compression. Vascular loop compression is a very rare etiology of oculomotor nerve palsy. Here, we present a case report of microvascular decompression for oculomotor nerve palsy.
CASE DESCRIPTION
We present a 16-year-old male patient, otherwise healthy, who presented with right oculomotor nerve palsy for a period of 1 year. Aneurysmal compression and intracranial lesion were ruled out by cerebral angiogram and magnetic resonance imaging. The presence of vessel loop compression on the nerve was suspected on the basis of features on magnetic resonance imaging. The patient underwent microvascular decompression via a right subtemporal approach. We intraoperatively confirmed vessel loop compression at the exit zone of the nerve from midbrain. Subsequently, the patient's oculomotor palsy has improved gradually over a period of 6 months.
CONCLUSIONS
Vascular compression of the oculomotor nerve is a very rare finding in neurosurgical practice. A diagnosis of vascular compression is made by excluding other pathologies and using high-resolution images that visualize the nerve and the offending vessel loop. Microvascular decompression can be an effective treatment method for this condition.
Topics: Adolescent; Decompression, Surgical; Humans; Male; Microsurgery; Microvessels; Nerve Compression Syndromes; Oculomotor Nerve Diseases; Treatment Outcome; Vascular Surgical Procedures
PubMed: 26850973
DOI: 10.1016/j.wneu.2015.12.083 -
La Revue de Medecine Interne Dec 2017Diplopia is defined as "double vision" when looking at a single object. Monocular diplopia is related to an ocular disorder and must be differentiated from binocular... (Review)
Review
Diplopia is defined as "double vision" when looking at a single object. Monocular diplopia is related to an ocular disorder and must be differentiated from binocular diplopia which is secondary to ocular misalignment. The examination of the patient with binocular diplopia is often challenging for non-specialists. However, a careful and systematic clinical examination followed by targeted ancillary testing allows the clinician to localize the lesion along the oculomotor pathways. The lesion may involve the brainstem, the ocular motor nerves III, IV or VI, the neuromuscular junction, the extraocular ocular muscles, or the orbit. Causes of binocular diplopia are numerous and often include disorders typically managed by internal medicine such as inflammatory, infectious, neoplastic, endocrine, and metabolic disorders. In addition to treating the underlying disease, it is important not to leave diplopia uncorrected. Temporary occlusion of one eye by applying tape on one lens or patching one eye relieves the diplopia until more specific treatments are offered should the diplopia not fully resolve.
Topics: Abducens Nerve; Diabetic Retinopathy; Diagnosis, Differential; Diplopia; Humans; Internal Medicine; Neoplasms; Oculomotor Nerve; Oculomotor Nerve Diseases; Orbital Diseases; Paraneoplastic Syndromes, Ocular; Trochlear Nerve
PubMed: 28325621
DOI: 10.1016/j.revmed.2017.01.016 -
Scientific Reports Sep 2020Despite recent advances on the mechanisms and purposes of fine oculomotor behavior, a rigorous assessment of the precision and accuracy of the smallest saccades is still...
Despite recent advances on the mechanisms and purposes of fine oculomotor behavior, a rigorous assessment of the precision and accuracy of the smallest saccades is still lacking. Yet knowledge of how effectively these movements shift gaze is necessary for understanding their functions and is helpful in further elucidating their motor underpinnings. Using a combination of high-resolution eye-tracking and gaze-contingent control, here we examined the accuracy and precision of saccades aimed toward targets ranging from [Formula: see text] to [Formula: see text] eccentricity. We show that even small saccades of just 14-[Formula: see text] are very effective in centering the stimulus on the retina. Furthermore, we show that for a target at any given eccentricity, the probability of eliciting a saccade depends on its efficacy in reducing the foveal offset. The pattern of results reported here is consistent with current knowledge on the motor mechanisms of microsaccade production.
Topics: Adult; Eye Movements; Female; Fixation, Ocular; Fovea Centralis; Humans; Male; Oculomotor Nerve; Orientation; Saccades; Young Adult
PubMed: 32999363
DOI: 10.1038/s41598-020-72432-6 -
Journal of Neuro-ophthalmology : the... Jun 2021An isolated oculomotor nerve (CN III) palsy is a diagnostic concern because of the potential for serious morbidity or life-threatening causes. We present 5 unusual...
BACKGROUND
An isolated oculomotor nerve (CN III) palsy is a diagnostic concern because of the potential for serious morbidity or life-threatening causes. We present 5 unusual causes of oculomotor nerve palsy that escaped initial diagnosis in order to raise awareness of their associated features that will facilitate correct diagnosis.
METHODS
This study consisted of a retrospective analysis of clinical features and imaging of 5 patients who were referred for neuro-ophthalmologic evaluation with presumed diagnosis of oculomotor nerve palsy of unknown reasons.
RESULTS
A complete CN III palsy and an inferior division CN III palsy were diagnosed with a schwannoma in the cavernous sinus and orbital apex portion, respectively; a middle-aged woman with aberrant regeneration was found to have a small meningioma; an adult man with ptosis was diagnosed with cyclic oculomotor paresis with spasms; and a patient after radiation was diagnosed with neuromyotonia.
CONCLUSIONS
Localizing the lesion of oculomotor nerve palsy and careful examination of the imaging is crucial. Aberrant regeneration, cyclic pupil changes, and past medical history of amblyopia, strabismus, or radiation are also very helpful for diagnosis.
Topics: Adult; Cranial Nerve Diseases; Cranial Nerve Neoplasms; Eye Movements; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurilemmoma; Oculomotor Nerve; Oculomotor Nerve Diseases; Retrospective Studies; Young Adult
PubMed: 32833860
DOI: 10.1097/WNO.0000000000001032 -
The American Journal of Case Reports May 2024BACKGROUND Symptoms caused by developmental venous anomalies (DVAs) are usually mild and unspecific. Despite the benign nature of DVAs, they can occasionally be... (Review)
Review
BACKGROUND Symptoms caused by developmental venous anomalies (DVAs) are usually mild and unspecific. Despite the benign nature of DVAs, they can occasionally be symptomatic. CASE REPORT A 67-year-old woman presented with sudden diplopia and left eyelid ptosis for 10 days. A neurologic examination revealed left complete oculomotor nerve palsy. Other neurologic deficits, including eye pain or pulsatile tinnitus, were not detected. Furthermore, the visual acuity was normal. Additionally, no retinal hemorrhage, venous dilatation, or fundus tortuosity were observed. No ischemia lesions or neoplasms were observed in MRI, and no widening or enhancement of the cavernous sinus was detected in post-contrast T1-weighted images, but magnetic resonance tomography cerebral angiography (MRTA) detected an offending vessel compressing the left oculomotor nerve in the fossa interpeduncular. We hypothesized that oculomotor nerve palsy (ONP) was caused by an abnormal arterial structure. However, digital subtraction angiography (DSA) revealed no aneurysm or abnormal arterial structure in the arterial phase, while a tortuous and dilated collecting vein was detected in the venous phase, connecting the left temporal lobe to the left cavernous sinus. This indicated a typical caput medusae appearance, suggesting the mechanism of oculomotor palsy caused by compressive impairment of the DVA. The patient refused microvascular decompression surgery, and ONP persisted after 30 days. Management was conservative, with spontaneous resolution at 60 days and no recurrence during the 2-year follow-up. CONCLUSIONS ONP is rarely caused by DVAs, which are easily ignored due to their benign nature. Cerebral vein examinations are advised for patients exhibiting clinical symptoms of unknown etiology.
Topics: Humans; Female; Aged; Oculomotor Nerve Diseases; Cerebral Veins; Cerebral Angiography; Angiography, Digital Subtraction; Magnetic Resonance Angiography
PubMed: 38762752
DOI: 10.12659/AJCR.943363 -
Operative Neurosurgery (Hagerstown, Md.) Jun 2018Schwannomas of the parasellar region may arise from the trigeminal, oculomotor, trochlear, and abducens nerves.
BACKGROUND
Schwannomas of the parasellar region may arise from the trigeminal, oculomotor, trochlear, and abducens nerves.
OBJECTIVE
To define the tumor origin, location, and dural relationship (extradural vs extra-intradural vs cisternal) on preoperative magnetic resonance imaging (MRI), in order to plan the best surgical approach (purely extradural vs extra-intradural).
METHODS
Twenty-four patients with parasellar schwannomas who underwent surgery were retrospectively analyzed. Twenty arose from the trigeminal nerve (7 intracavernous and 13 within the Meckel's cave), 3 from the oculomotor nerve, and 1 from the abducens nerve. The preoperative identification of the tumor location (extradural vs extra-intradural vs cisternal) and the nerve of origin was defined on MR sequences. All patients were operated on through a pterional approach (extradural or extra-intradural route).
RESULTS
The tumor location was correctly defined on MRI in 22 out of 24 cases (92%) and the nerve of origin in 22 (92%). An extradural approach without intradural exploration was performed in all 5 intracavernous trigeminal schwannomas, in 11 out of 13 of the Meckel's cave, and in 2 schwannomas of the oculomotor nerve. Two schwannomas of the Meckel's cave with transgression of the medial dural wall, 1 of the oculomotor nerve, and the abducens nerve schwannoma required an extra-intradural approach. Complete tumor resection was obtained in 19 out of 24 cases (80%).
CONCLUSION
The pterional extradural approach is sufficient for Dolenc type I and II trigeminal schwannomas, excepting for those transgressing the inner dural layer. Schwannomas of the oculomotor and abducens nerves with cisternal location require an extradural-intradural approach.
Topics: Abducens Nerve Diseases; Adolescent; Adult; Aged; Cranial Nerve Neoplasms; Craniotomy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurilemmoma; Neuroimaging; Oculomotor Nerve Diseases; Radiosurgery; Retrospective Studies; Trigeminal Nerve Diseases; Trochlear Nerve Diseases; Young Adult
PubMed: 28961901
DOI: 10.1093/ons/opx174 -
Frontiers in Surgery 2022To present a surgical treatment regimen of transnasal endoscopic decompression through the optic strut for traumatic oculomotor nerve palsy based on the anatomical study...
OBJECTIVE
To present a surgical treatment regimen of transnasal endoscopic decompression through the optic strut for traumatic oculomotor nerve palsy based on the anatomical study of the superior orbital fissure and the oculomotor nerve fissure segment.
METHODS
The bone structure of the oculomotor nerve fissure segment and the important bone anatomical landmarks of the lateral wall of the sphenoidal sinus were identified on a dried skull and a cadaveric head, respectively, using a nasal endoscope, and a surgical plan was determined. Decompression was conducted on the orbital apex, the superior orbital fissure, the optic canal and the optic strut of the two patients in sequence, after which the degree and range of decompression were identified by three-dimensional (3D) computed tomography (CT).
RESULTS
The oculomotor nerve had a close correlation with the lateral surface of the optic strut. The transnasal endoscope was employed to identify the lateral optic-carotid recess (LOCR), as well as the positions of the optic nerve, internal carotid artery (ICA), and superior orbital fissure, collectively called the "optic strut triangle". The surgical plans for decompression of the orbital apex, superior orbital fissure, optic canal, and optic strut and the necessity of optic strut drilling were determined, and the surgical procedures for safe drilling of the optic strut were elaborated. After surgery, the two patients had significantly improved symptoms, without complications. In addition, their postoperative CT showed that the medial margin of the superior orbital fissure was fully decompressed.
CONCLUSION
The optic strut triangle is a crucial anatomical landmark in the decompression of the oculomotor nerve, and optic strut drilling is necessary for such decompression. For patients with traumatic oculomotor nerve palsy and fractures of the medial wall of the superior orbital fissure on CT, the oculomotor nerve fissure segment can be decompressed in an effective, complete and safe manner as per the surgical plan of decompressing the orbital apex, superior orbital fissure, optic canal and optic strut in turn under a transnasal endoscope, conducive to the recovery of neurological function of patients.
PubMed: 36684233
DOI: 10.3389/fsurg.2022.1051354 -
Journal of Neuro-ophthalmology : the... Jun 2022
Topics: Diagnosis, Differential; Humans; Oculomotor Nerve; Optic Nerve; Polychondritis, Relapsing; Tomography, X-Ray Computed
PubMed: 34348364
DOI: 10.1097/WNO.0000000000001321 -
Journal of Clinical Medicine Jun 2020To investigate the morphometric characteristics of the oculomotor nerve and its association with horizontal rectus muscle volume in patients with Duane's retraction...
OBJECTIVE
To investigate the morphometric characteristics of the oculomotor nerve and its association with horizontal rectus muscle volume in patients with Duane's retraction syndrome (DRS) according to the presence of the abducens nerve.
METHODS
Fifty patients diagnosed with unilateral DRS were divided into two groups according to high-resolution magnetic resonance imaging (MRI) findings; DRS without an abducens nerve on the affected side (absent group, = 41), and DRS with symmetric abducens nerves on both sides (present group, = 9). Oculomotor nerve diameter was measured on high-resolution MRI in the middle of the cisternal space. The medial rectus muscle (MR) and lateral rectus muscle (LR) volumes were measured on T2-weighted coronal MRI of the orbit. Associations of oculomotor nerve diameter and horizontal rectus muscle volumes were performed according to the presence and absence of the abducens nerve.
RESULTS
Oculomotor nerve diameter on the affected side was thicker than that of the non-affected side in the absent group ( < 0.001), but not in the present group ( = 0.623). In the absent group, there was a positive correlation between oculomotor nerve diameter and MR volume ( = 0.779, < 0.001), as well as the LR volume ( = 668, = 0.023) of the affected eye.
CONCLUSIONS
In DRS patients with an absent abducens nerve, the oculomotor nerve diameter was thicker in the affected eye compared to the non-affected eye. Oculomotor nerve diameter was associated with MR and LR volumes in the absent group. This study provides structural correlates of aberrant innervation of the oculomotor nerve in DRS patients.
PubMed: 32599889
DOI: 10.3390/jcm9061983 -
Deutsches Arzteblatt International Apr 2018
Topics: Aneurysm; Blepharoptosis; Carotid Artery, Internal; Female; Humans; Middle Aged; Oculomotor Nerve Diseases; Pain
PubMed: 29789114
DOI: 10.3238/arztebl.2018.0298b