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Child's Nervous System : ChNS :... Apr 2022Malignant nerve sheath tumors are extremely rare pathologies. They tend to occur within peripheral nerves and have close association of neurofibromatosis disease. Here,...
Malignant nerve sheath tumors are extremely rare pathologies. They tend to occur within peripheral nerves and have close association of neurofibromatosis disease. Here, we present the second case of MNST of oculomotor nerve in literature. The patient was a 2-year-old girl with left sided oculomotor nerve palsy. After resection, the patient immediately had chemotherapy and radiotherapy. One year after surgery disease progressed with extensive intracranial seedings, and she passed away.
Topics: Brain Neoplasms; Child; Child, Preschool; Female; Humans; Nerve Sheath Neoplasms; Neurofibromatosis 1; Oculomotor Nerve
PubMed: 34370084
DOI: 10.1007/s00381-021-05283-9 -
Acta Neurochirurgica Oct 2023The anatomical basis of pituitary adenomas (PAs) with oculomotor cistern (OC) extension as a growth corridor is overlooked in the literature. In this paper, the authors...
BACKGROUND
The anatomical basis of pituitary adenomas (PAs) with oculomotor cistern (OC) extension as a growth corridor is overlooked in the literature. In this paper, the authors use the technique of epoxy sheet plastination to study the membranous structure of the OC and validate the results by retrospective analysis of patients with OC extension.
METHODS
Eighteen specimens were used to study the membranous anatomy surrounding the OC using the epoxy sheet plastination technique. Thirty-four patients with OC extension were retrospectively reviewed.
RESULTS
The OC consisted of two thin membranous layers. The inner layer was extended by the arachnoid layer from the posterior fossa, and the lateral layer consisted of the dura mater sinking from the roof of the cavernous sinus. The oculomotor nerve is more likely to displace with a superolateral trajectory due to the weakness of the posterior dura and the relatively large space in the medial and posterior trajectories, which is consistent with the intraoperative observations. Among the anatomical factors that affect the PA by OC extension, we found that the relative position of the internal carotid artery (ICA) and posterior clinoid process may lead to the narrowing of the OC. Of 34 cases, 28 patients achieved total resection. Among 24 preoperative patients with oculomotor nerve palsy, 16 cases were relieved to varying degrees postoperatively. There was no ICA injury or severe intracranial infection found in any of the patients.
CONCLUSIONS
Extension into the OC is influenced by two anatomical factors: a weak point in the dura in the posterior OC and a potential space beyond this region of the dura. Meticulous knowledge of the membranous anatomy in endoscopic endonasal surgery is required to safely and effectively resect PA with OC extension.
Topics: Humans; Pituitary Neoplasms; Retrospective Studies; Sella Turcica; Oculomotor Nerve; Oculomotor Nerve Diseases; Adenoma
PubMed: 37672094
DOI: 10.1007/s00701-023-05784-3 -
Neuroradiology Dec 2020Paroxysmal diplopia could be the expression of a multitude of clinical or anatomical conditions. Both ophthalmological and neurological pathologies could be responsible...
Paroxysmal diplopia could be the expression of a multitude of clinical or anatomical conditions. Both ophthalmological and neurological pathologies could be responsible of this symptom. Rarely, a neurovascular conflict involving the oculomotor nerve is the etiology. We present the case of a 75-year-old man who presented for a 20-year history of transient vertical diplopia. The radiological exams demonstrated the presence of a neurovascular conflict between the right oculomotor nerve and a fetal-type posterior communicating artery. This fetal posterior communicating artery had an aberrant downward course that compressed the third cranial nerve. Few cases of neurovascular conflict interesting the third cranial nerve were described in the literature whom the responsible artery was generally the superior cerebellar artery. No case of oculomotor nerve compression by the posterior communicating artery was published. Authors have reviewed the literature and discuss the embryology of the posterior communicating artery, pathophysiology, radiological findings, and therapeutic possibility.
Topics: Aged; Diagnosis, Differential; Diplopia; Humans; Magnetic Resonance Imaging; Male; Nerve Compression Syndromes; Oculomotor Nerve; Posterior Cerebral Artery
PubMed: 32632512
DOI: 10.1007/s00234-020-02489-7 -
Current Eye Research May 2019The intramuscular nerve distribution in the extraocular muscles may be crucial for understanding their physiological and pathological responses. This study aimed to...
PURPOSE
The intramuscular nerve distribution in the extraocular muscles may be crucial for understanding their physiological and pathological responses. This study aimed to determine the oculomotor nerve distribution in the medial rectus muscle (MR) using Sihler's staining.
METHOD
Thirty-seven MRs from 23 cadavers were investigated. The MR including the oculomotor nerve was finely dissected from its origin to its insertion point into the sclera. The total length of the muscle-belly, tendon length and maximum width of the muscle were measured. We evaluated the pattern of distribution and the length of the intramuscular nerve distribution by gross observation after performing Sihler's staining, which is a method for visualizing the distribution of nerve fibers without alteration of the nerve.
RESULTS
The total length of the muscle-belly, tendon length, and muscle width were 37.6 ± 4.6 mm, 4.4 ± 1.9 mm, and 10 ± 1.8 mm, respectively. The oculomotor nerve enters the MR at a mean of two-fifths along the muscle (24 ± 2.0 mm posterior to the insertion point) and then typically divides into a few branches (mean of 2.1). The intramuscular nerve distribution showed a Y-shaped ramification, forming the terminal nerve plexus, and its course typically finished at around 17 ± 1.5 mm posterior to the muscle insertion point by gross observation. The nerve plexus in the upper part generally coursed more distally than the lower part.
CONCLUSION
This new information regarding the nerve distribution pattern of MR will be helpful for understanding MR function and the diverse pathophysiology of strabismus.
Topics: Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Nerve Fibers; Oculomotor Muscles; Oculomotor Nerve; Staining and Labeling
PubMed: 30624996
DOI: 10.1080/02713683.2018.1562556 -
Oculomotor nerve palsy induced by internal carotid artery aneurysm: prognostic factors for recovery.Acta Neurochirurgica Jul 2015Aneurysms at the posterior face of the internal carotid artery can lead to oculomotor nerve palsy (ONP) with an uncertain prognosis of recovery post-treatment. The aim... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Aneurysms at the posterior face of the internal carotid artery can lead to oculomotor nerve palsy (ONP) with an uncertain prognosis of recovery post-treatment. The aim of this study was to define the prognostic factors for ONP recovery, with particular interest in treatment modality (surgery or endovascular techniques).
METHOD
A literature review was performed to select the most pertinent prognostic factors. A retrospective study was then performed to determine whether these factors had significantly modified the prognosis of ONP recovery in our series of patients.
RESULTS
In the literature, factors linked to poorer outcome were age, vascular risk factors, initial ONP severity and delay before treatment; better recovery was associated with surgical treatment. Between 2000 and 2013, 23 consecutive patients were treated in our department for ONP-inducing aneurysms: 14 by endovascular embolization and 9 by surgical clipping and aneurysm puncture. Mean follow-up was 48.8 months. After treatment, overall recovery occurred in 87% of cases, always within 6 months. Apart from treatment modality, no selected prognostic factor significantly modified the quality or timing of ONP recovery. In the endovascular group, four patients recovered completely, seven partially and three did not recover. In the surgical group, seven patients recovered completely and two partially. Surgery was significantly associated with a more complete and earlier ONP recovery (p < 0.05).
CONCLUSIONS
Surgery was associated with a more complete and earlier ONP recovery as compared to endovascular treatment, confirming the results of previous studies. However, conclusions must be confirmed by a prospective randomized study.
Topics: Adult; Aged; Carotid Artery, Internal; Embolization, Therapeutic; Endovascular Procedures; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Oculomotor Nerve Diseases; Prognosis; Recovery of Function
PubMed: 25956395
DOI: 10.1007/s00701-015-2440-6 -
Therapeutische Umschau. Revue... 2017
Review
Topics: Brain Injury, Chronic; Cerebrovascular Disorders; Combined Modality Therapy; Hemianopsia; Humans; Interdisciplinary Communication; Intersectoral Collaboration; Neurological Rehabilitation; Oculomotor Nerve Diseases; Perceptual Disorders; Vision Disorders; Visual Acuity; Visual Fields; Visual Perception
PubMed: 29583097
DOI: 10.1024/0040-5930/a000949 -
Scientific Reports Mar 2021Convergence insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when...
Convergence insufficiency (CI) is the most common binocular vision problem, associated with blurred/double vision, headaches, and sore eyes that are exacerbated when doing prolonged near work, such as reading. The Convergence Insufficiency Neuro-mechanism Adult Population Study (NCT03593031) investigates the mechanistic neural differences between 50 binocularly normal controls (BNC) and 50 symptomatic CI participants by examining the fast and slow fusional disparity vergence systems. The fast fusional system is preprogrammed and is assessed with convergence peak velocity. The slow fusional system optimizes vergence effort and is assessed by measuring the phoria adaptation magnitude and rate. For the fast fusional system, significant differences are observed between the BNC and CI groups for convergence peak velocity, final position amplitude, and functional imaging activity within the secondary visual cortex, right cuneus, and oculomotor vermis. For the slow fusional system, the phoria adaptation magnitude and rate, and the medial cuneus functional activity, are significantly different between the groups. Significant correlations are observed between vergence peak velocity and right cuneus functional activity (p = 0.002) and the rate of phoria adaptation and medial cuneus functional activity (p = 0.02). These results map the brain-behavior of vergence. Future therapeutic interventions may consider implementing procedures that increase cuneus activity for this debilitating disorder.
Topics: Adaptation, Physiological; Adolescent; Adult; Brain; Cerebellum; Disease Susceptibility; Female; Humans; Male; Ocular Motility Disorders; Oculomotor Nerve; Strabismus; Symptom Assessment; Young Adult
PubMed: 33753864
DOI: 10.1038/s41598-021-86171-9 -
Zhong Nan Da Xue Xue Bao. Yi Xue Ban =... Dec 2020Oculomotor nerve palsy is a kind of disease with many causes, showing eye movement disorders, abnormal eyelid position, and/or damage of the pupil. The etiology of...
OBJECTIVES
Oculomotor nerve palsy is a kind of disease with many causes, showing eye movement disorders, abnormal eyelid position, and/or damage of the pupil. The etiology of oculomotor nerve palsy in different departments is different. The study discussed the etiology, localization of the lesion, and prognosis for oculomotor nerve palsy firstly diagnosed in department of ophthalmology.
METHODS
Clinical data of 137 hospitalized patients with oculomotor nerve palsy at the Department of Ophthalmology, the First Medical Center of PLA General Hospital from 2009 to 2018 were retrospectively collected. The etiology and its distribution characteristics in different age groups, the location of the lesion, and the prognosis of patients were analyzed.
RESULTS
In 137 patients, the top 3 causes for oculomotor nerve palsy were head trauma (38.69%), cavernous sinus lesions (12.40%), and orbital inflammation (9.49%). Other causes included intracranial aneurysm, the intracranial space-occupying lesion, cerebral vessel diseases, infection, orbital tumors, diabetes, the operation of nasal cavity. Traumatic oculomotor nerve palsy was more common in young adults aged 20-49 years and in the patients with cerebral vascular disease in elderly people aged 60-69 years, while diabetic oculomotor nerve palsy is common in middle-aged and elderly people aged 50-69 years. The age distribution of other etiological types was relatively balanced. Seventy-five cases of orbital apex lesions were due to trauma, inflammation, infection, and tumor; 40 cases of cavernous sinus lesions were due to inflammation, tumor, and thrombosis; 6 cases of subarachnoid lesions were due to aneurysms, tumors, and trauma; 5 cases were oculomotor nucleus lesions were due to infarction; 11 cases could not be allocated because of unknown etiology. After treatment, the corrected visual acuity of oculomotor nerve palsy side was not significantly improved. The patients with oculomotor nerve palsy caused by intracranial aneurysm, cerebrovascular disease, and diabetes mellitus had the highest proportion of partial or complete recovery from ptosis and ocular dyskinesia.
CONCLUSIONS
Oculomotor nerve palsy is a common cause of ophthalmoplegia and diplopia. Head trauma, cavernous sinus lesions, and orbital inflammation are the most common causes for oculomotor nerve palsy first diagnosed in ophthalmology department. Traumatic oculomotor nerve palsy is common in adolescents. Oculomotor nerve palsy caused by diabetes and cerebrovascular disease are common in the middle-aged and elderly people. Most of the lesions locate in the orbital apex and cavernous sinus. The prognosis of corrected visual acuity is poor. The prognosis of ptosis and ocular dyskinesia caused by intracranial aneurysm, cerebrovascular disease, and diabetes is good. Figuring out the cause timely and accurately is the basis and key to treat oculomotor nerve palsy.
Topics: Adolescent; Adult; Aged; Cavernous Sinus; Humans; Middle Aged; Oculomotor Nerve Diseases; Ophthalmoplegia; Prognosis; Retrospective Studies; Young Adult
PubMed: 33472998
DOI: 10.11817/j.issn.1672-7347.2020.190539 -
Arquivos de Neuro-psiquiatria Jan 2019Changes in postural balance and visual complaints are frequent consequences of stroke. We aimed to investigate the symptoms and the vestibular and oculomotor functions... (Observational Study)
Observational Study
OBJECTIVE
Changes in postural balance and visual complaints are frequent consequences of stroke. We aimed to investigate the symptoms and the vestibular and oculomotor functions of patients with dizziness post ischemic and hemorrhagic stroke and compare the results among them.
METHODS
Fifty patients with dizziness after stroke were evaluated through a clinical anamnesis and computerized vector electronystagmography: calibration of ocular movements, spontaneous nystagmus, semi-spontaneous nystagmus, pendular tracking, optokinetic nystagmus, rotary chair testing, and the caloric test.
RESULTS
All patients complained of dizziness, especially imbalance. Ischemic stroke in the carotid territory was the prevalent type. Visual complaints were reported by 56% of the sample and were related to abnormalities in oculomotor and caloric tests.
CONCLUSION
The occurrence of visual symptoms was related to some abnormalities in the vector electronystagmography tests, being more frequent in cases of stroke in the vertebrobasilar system, and with oscillopsia and reduced visual acuity as symptoms.
Topics: Adult; Aged; Aged, 80 and over; Caloric Tests; Cross-Sectional Studies; Dizziness; Electronystagmography; Female; Humans; Male; Middle Aged; Nystagmus, Pathologic; Oculomotor Nerve; Statistics, Nonparametric; Stroke; Vestibular Function Tests; Vestibule, Labyrinth; Vision Disorders; Visual Acuity
PubMed: 30758439
DOI: 10.1590/0004-282X20180154 -
Journal of Clinical Neurology (Seoul,... Oct 2020Contrast enhancement of the oculomotor nerve in MRI was recently noticed in patients with clinical ischemic isolated oculomotor nerve palsy (iIONP). The opinions about...
BACKGROUND AND PURPOSE
Contrast enhancement of the oculomotor nerve in MRI was recently noticed in patients with clinical ischemic isolated oculomotor nerve palsy (iIONP). The opinions about whether this is a sign of inflammation and whether or not to administer steroids vary between doctors. The study aimed to determine the associations between this enhancement and vascular-disease risk factors (VRFs) and inflammatory factors in iIONP patients.
METHODS
The study recruited patients who had experienced iIONP during the previous 2 years. They were divided into groups A and B based on whether or not they exhibited an enhanced oculomotor nerve in MRI of the cavernous sinus using thin-section, fat-suppressed, and contrast-enhanced sequences. VRFs, inflammatory factors, and improvement scores were compared between the two groups.
RESULTS
Most (71.1%) of the 45 included iIONP patients had enhanced oculomotor nerves in MRI. VRFs, periorbital pain, elevated C-reactive protein and erythrocyte sedimentation rate, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not significantly associated with the enhancement. Four of the five patients in group A exhibited an elevated cerebrospinal fluid (CSF) IgG synthesis rate. The improvement score of eight patients who received 80 mg of methylprednisolone in addition to the routine therapy was not significantly different from the scores of the other patients (=0.485).
CONCLUSIONS
More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level.
PubMed: 33029972
DOI: 10.3988/jcn.2020.16.4.653