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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 -
European Radiology Jul 2021• The intriguing "Check Mark Sign" suggests 3rd cranial nerve involvement in GCA.
• The intriguing "Check Mark Sign" suggests 3rd cranial nerve involvement in GCA.
Topics: Giant Cell Arteritis; Humans; Oculomotor Nerve
PubMed: 33713170
DOI: 10.1007/s00330-021-07739-7 -
Strabismus Mar 2023Effective outcome of inferior oblique (IO) corrective surgeries demands a detailed knowledge of morphometry and variations of IO. Our aim was to study and...
Effective outcome of inferior oblique (IO) corrective surgeries demands a detailed knowledge of morphometry and variations of IO. Our aim was to study and morphometrically define the surgical anatomy of the IO muscle and its variations. Also to provide easily identifiable surgical coordinates to locate, the IO origin and the oculomotor nerve entry point into the IO. Dissection was performed on 16 cadaveric orbits. IO anatomy, variations, morphometry and relevant surgical distances were measured using digital caliper. IO with multiple bellies was found in five specimens. The IO mean length was 33.1 ± 3.3 mm, width at origin was 3.1 ± 0.6 mm, and width at insertion was 8.8 ± 1.5 mm. For easy localization of origin, its distance from the palpable landmarks, Zygomatico-maxillary suture and fronto-maxillary suture was measured. The mean distance between IO and the optic nerve was 10 mm. Distance of the nerve to inferior oblique entry point to the origin and insertion of the inferior oblique was measured. The nerve to IO was 28 mm long. The mean distance of the nerve entry point to IO origin was 15.5 ± 2.3 mm and distance to IO insertion was 15.2 ± 2.8 mm. A muscular bridge between the Inferior rectus (IR) & IO was found in one case, affecting ~¼ of the IO length; the distal end of the bridge was 5 mm from the IO insertion. Origin of the IO can be localized on the orbital surface of maxilla, 1-2 cm from the point where zygomatico-maxillary suture cuts the inferior orbital margin and 1-2 cm from the fronto-maxillary suture. In 19% of the orbits, the IO length was less than 30 mm, which may cause traction injury in muscle transposition procedures. The width at insertion is useful as most corrective surgeries are performed at the insertion site. The nerve to IO consistently entered at the center of medial border. The nerve entry point is important surgically as myectomy is performed between it and the insertion point. The safe distance available from the optic nerve was 7 mm. Detailed morphometry of IO may aid surgeons in better surgical planning and execution.
Topics: Humans; Oculomotor Muscles; Orbit; Oculomotor Nerve; Dioctyl Sulfosuccinic Acid; Strabismus
PubMed: 36755440
DOI: 10.1080/09273972.2023.2168706 -
Journal of Oncology Pharmacy Practice :... Apr 2022Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, is the standard treatment of recurrent glioblastoma multiforme. In addition...
INTRODUCTION
Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, is the standard treatment of recurrent glioblastoma multiforme. In addition to common systemic side effects of bevacizumab, there are rare cases of cranial nerve palsy.
CASE REPORT
We report a case of transient oculomotor nerve palsy after systemic administration of bevacizumab. Twenty-four hours after the systemic infusion of bevacizumab, transient oculomotor nerve palsy developed in a 49-year-old male patient. In the cranial MRI, there was no malignancy-related progression.
MANAGEMENT AND OUTCOME
Bevacizumab treatment was discontinued. Methylprednisolone was started considering that bevacizumab increased the inflammatory response. Oculomotor nerve palsy resolved in 14 days.
DISCUSSION
There are many side effects of bevacizumab whose mechanisms of action have not been fully explained. Cranial nerve involvement is rarely reported. Our case is the first reported case of bevacizumab-induced oculomotor nerve palsy.
Topics: Bevacizumab; Glioblastoma; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Oculomotor Nerve Diseases; Vascular Endothelial Growth Factor A
PubMed: 34878367
DOI: 10.1177/10781552211066888 -
Neuroradiology Apr 2023To describe the neuroanatomical correlates of unilateral congenital isolated oculomotor palsy by means of high-resolution MRI.
PURPOSE
To describe the neuroanatomical correlates of unilateral congenital isolated oculomotor palsy by means of high-resolution MRI.
METHODS
Children with a clinical diagnosis of congenital isolated oculomotr palsy and with a high-resolution MRI acquisition targeted on the orbits and cranial nerves were selected and included in the study. An experienced pediatric neuroradiologist evaluated all the exams, assessing the integrity and morphology of extraocular muscles, oculomotor, trochlear and abducens nerves as well as optic nerves and globes. Clinical data and ophthalmologic evaluations were also collected.
RESULTS
Six children (age range: 1-16 years; males: 3) were selected. All patients showed, on the affected side (left:right = 5:1), anomalies of the III nerve and extraocular muscles innervated by the pathological nerve. One patient had complete nerve agenesis, two patients showed a diffuse thinning of the nerve, from the brainstem to the orbit and 3 patients showed a distal thinning of the oculomotor nerve, starting at the level of the cavernous sinus. In all cases atrophy of corresponding muscles was noticed, but the involvement of the affected muscles varied with the nervous pattern of injury.
CONCLUSIONS
High-resolution MRI represents a valuable tool for the diagnosis of III nerve anomalies in unilateral congenital IOP, showing different patterns of nerve involvement and muscular atrophy.
Topics: Male; Humans; Child; Infant; Child, Preschool; Adolescent; Oculomotor Nerve Diseases; Oculomotor Nerve; Cranial Nerves; Ophthalmoplegia; Magnetic Resonance Imaging
PubMed: 36580093
DOI: 10.1007/s00234-022-03106-5 -
Cephalalgia : An International Journal... Aug 2015In recurrent painful ophthalmoplegic neuropathy (RPON) that was previously termed as ophthalmoplegic migraine, enhancement of the ocular motor cranial nerves could be... (Review)
Review
BACKGROUND
In recurrent painful ophthalmoplegic neuropathy (RPON) that was previously termed as ophthalmoplegic migraine, enhancement of the ocular motor cranial nerves could be seen in the cisternal segment during the acute phase. However, various tumors involving the oculomotor nerve may mimic RPON.
METHODS
We report two patients with MRI findings of oculomotor nerve schwannoma who initially presented with RPON, and found through the literature review five more patients with oculomotor nerve tumors that masqueraded as RPON.
RESULTS
All patients showed an involvement of the oculomotor nerve. The radiological or pathological diagnosis included schwannoma in five, venous angioma in one, and neuromuscular harmatoma in another one. MRIs with gadolinium documented an enhancing nodule involving the cisternal portion of the oculomotor nerve in six of them, which was also observed on follow-up MRIs without an interval change.
CONCLUSIONS
It should be recognized that an incomplete recovery may occur during future attacks in patients with otherwise uncomplicated RPON. Follow-up MRIs are required to detect tumors involving the ocular motor cranial nerves, especially in patients with suspected RPON when the recovery is incomplete.
Topics: Adult; Cranial Nerve Neoplasms; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Oculomotor Nerve Diseases; Ophthalmoplegic Migraine
PubMed: 25366549
DOI: 10.1177/0333102414558886 -
Investigative Ophthalmology & Visual... Apr 2017To spatially and temporally define ocular motor nerve development in the presence and absence of extraocular muscles (EOMs).
PURPOSE
To spatially and temporally define ocular motor nerve development in the presence and absence of extraocular muscles (EOMs).
METHODS
Myf5cre mice, which in the homozygous state lack EOMs, were crossed to an IslMN:GFP reporter line to fluorescently label motor neuron cell bodies and axons. Embryonic day (E) 11.5 to E15.5 wild-type and Myf5cre/cre:IslMN:GFP whole mount embryos and dissected orbits were imaged by confocal microscopy to visualize the developing oculomotor, trochlear, and abducens nerves in the presence and absence of EOMs. E11.5 and E18.5 brainstems were serially sectioned and stained for Islet1 to determine the fate of ocular motor neurons.
RESULTS
At E11.5, all three ocular motor nerves in mutant embryos approached the orbit with a trajectory similar to that of wild-type. Subsequently, while wild-type nerves send terminal branches that contact target EOMs in a stereotypical pattern, the Myf5cre/cre ocular motor nerves failed to form terminal branches, regressed, and by E18.5 two-thirds of their corresponding motor neurons died. Comparisons between mutant and wild-type embryos revealed novel aspects of trochlear and oculomotor nerve development.
CONCLUSIONS
We delineated mouse ocular motor nerve spatial and temporal development in unprecedented detail. Moreover, we found that EOMs are not necessary for initial outgrowth and guidance of ocular motor axons from the brainstem to the orbit but are required for their terminal branching and survival. These data suggest that intermediate targets in the mesenchyme provide cues necessary for appropriate targeting of ocular motor axons to the orbit, while EOM cues are responsible for terminal branching and motor neuron survival.
Topics: Animals; Axons; Eye Movements; Mice; Microscopy, Confocal; Models, Animal; Motor Neurons; Oculomotor Muscles; Oculomotor Nerve
PubMed: 28437527
DOI: 10.1167/iovs.16-21268 -
Human Brain Mapping Dec 2021The aim of this study is to investigate the trajectory of medial longitudinal fasciculus (MLF) and explore its anatomical relationship with the oculomotor nerve using...
The aim of this study is to investigate the trajectory of medial longitudinal fasciculus (MLF) and explore its anatomical relationship with the oculomotor nerve using tractography technique. The MLF and oculomotor nerve were reconstructed at the same time with preset three region of interests (ROIs): one set at the area of rostral midbrain, one placed on the MLF area at the upper pons, and one placed at the cisternal part of the oculomotor nerve. This mapping protocol was tested in an HCP-1065 template, 35 health subjects from Massachusetts General Hospital (MGH), 20 healthy adults and 6 brainstem cavernous malformation (BCM) patients with generalized q-sampling imaging (GQI)-based tractography. Finally, the 200 μm brainstem template from Center for In Vivo Microscopy, Duke University (Duke CIVM), was used to validate the trajectory of reconstructed MLF. The MLF and oculomotor nerve were reconstructed in the HCP-1065 template, 35 MGH health subjects, 20 healthy adults and 6 BCM patients. The MLF was in conjunction with the ipsilateral mesencephalic part of the oculomotor nerve. The displacement of MLF was identified in all BCM patients. Decreased QA, RDI and FA were found in the MLF of lesion side, indicating axonal loss and/or edema of displaced MLF. The reconstructed MLF in Duke CIVM brainstem 200 μm template corresponded well with histological anatomy. The MLF and oculomotor nerve were visualized accurately with our protocol using GQI-based fiber tracking. This GQI-based tractography is an important tool in the reconstruction and evaluation of MLF.
Topics: Adult; Brain Stem; Diffusion Tensor Imaging; Female; Hemangioma, Cavernous, Central Nervous System; Humans; Male; Middle Aged; Neural Pathways; Oculomotor Nerve; White Matter; Young Adult
PubMed: 34597450
DOI: 10.1002/hbm.25670 -
The Neurologist Nov 2020Pituitary apoplexy (PA)-induced oculomotor palsy, although rare, can be caused by compression on the lateral wall of the cavernous sinus. This study aimed to visualize...
OBJECTIVES
Pituitary apoplexy (PA)-induced oculomotor palsy, although rare, can be caused by compression on the lateral wall of the cavernous sinus. This study aimed to visualize PA-induced oculomotor nerve damage using diffusion tensor imaging (DTI) tractography.
MATERIALS AND METHODS
We enrolled 5 patients with PA-induced isolated oculomotor palsy (patient group) and 10 healthy participants (control group); all underwent DTI tractography preoperatively. Fractional anisotropy (FA) and mean diffusion (MD) values of the cisternal portion of the bilateral oculomotor nerve were measured. DTI tractography was repeated after the recovery of oculomotor palsy.
RESULTS
While no statistical difference was observed in FA and MD values of the bilateral oculomotor nerve in the control group (P>0.05), the oculomotor nerve on the affected side was disrupted in the patient group, with a statistical difference in FA and MD values of the bilateral oculomotor nerve (P<0.01). After the recovery of oculomotor palsy, the FA value of the oculomotor nerve on the affected side increased, whereas the MD value decreased (P<0.01). Meanwhile, no significant difference was observed in FA and MD values of the bilateral oculomotor nerve (P>0.05). DTI tractography of the oculomotor nerve on the affected side revealed restoration of integrity. Furthermore, the symptoms of oculomotor palsy improved in all patients 7 days postoperatively.
CONCLUSION
DTI tractography could be a helpful adjunct to the standard clinical and paraclinical ophthalmoplegia examinations in patients with PA; thus, this study establishes the feasibility of DTI tractography in this specific clinical setting.
Topics: Adult; Aged; Diffusion Tensor Imaging; Female; Humans; Male; Middle Aged; Ophthalmoplegia; Pituitary Apoplexy; Retrospective Studies
PubMed: 33181723
DOI: 10.1097/NRL.0000000000000290 -
Surgical Neurology International 2023Isolated oculomotor nerve palsy is a relatively uncommon symptom of pituitary adenoma that usually occurs in association with pituitary apoplexy or cavernous sinus (CS)...
BACKGROUND
Isolated oculomotor nerve palsy is a relatively uncommon symptom of pituitary adenoma that usually occurs in association with pituitary apoplexy or cavernous sinus (CS) invasion.
CASE DESCRIPTION
We report two cases of relatively small pituitary adenomas with neither apoplexy nor CS invasion presenting as isolated oculomotor nerve palsy. Both patients presented with gradually worsening diplopia, without headache or visual field defects. Magnetic resonance imaging (MRI) showed a pituitary tumor with no evidence of intratumoral hemorrhage. Computed tomography revealed a lateroposterior extension of the tumor with the erosion of the posterior clinoid process. Constructive interference in steady-state MRI revealed compression of the oculomotor nerve by the tumor at the oculomotor triangle. The patients underwent endoscopic transsphenoidal surgery, and the intraoperative findings showed that the tumors did not invade the CS. The tumors were completely resected, and the oculomotor palsies resolved fully.
CONCLUSION
These cases illustrate the need to consider isolated oculomotor nerve palsy as an initial manifestation of a relatively small pituitary adenoma with neither apoplexy nor CS invasion. Based on the characteristic radiological findings, early surgical treatment is recommended to preserve oculomotor function.
PubMed: 37810282
DOI: 10.25259/SNI_421_2023