Isolated oculomotor nerve palsy (ONP) attributable to mild closed head trauma is a distinct rarity. Its diagnosis places high demands on the radiologist and the clinician. The authors describe this condition in a 36-year-old woman who slipped while walking and struck her face. Initial computed tomography did not reveal any causative cerebral and vascular lesions or orbital and cranial fractures. Enhancement and swelling of the cisternal segment of the oculomotor nerve was seen during the subacute phase on thin-sectioned contrast-enhanced magnetic resonance images. The current case received corticosteroid therapy, and then recovered fully in 13 months after injury. Possible mechanism of ONP from minor head injury is proposed and previous reports in the literature are reviewed.
Adult ; Craniocerebral Trauma* ; Diagnosis ; Female ; Head Injuries, Closed ; Head* ; Humans ; Magnetic Resonance Imaging ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Orbit ; Walking

The most common cause of isolated oculomotor nerve palsy is ischemia of the peripheral nerve caused by a disease, such as diabetes mellitus. Another common cause of isolated oculomotor nerve palsy is compression by an intracranial aneurysm, usually an posterior communicating artery aneurysm. However, it is extremely rare in the pituitary tumor. We report an unusual case of pituitary adenoma presenting with isolated oculomotor nerve palsy in the setting of pituitary apoplexy. We suggest that pituitary apoplexy should be included in the differential diagnosis of a patient with isolated oculomotor nerve palsy and early surgery should be considered for preservation of oculomotor nerve function.
Diabetes Mellitus ; Diagnosis, Differential ; Humans ; Intracranial Aneurysm ; Ischemia ; Oculomotor Nerve Diseases* ; Oculomotor Nerve* ; Peripheral Nerves ; Pituitary Apoplexy* ; Pituitary Neoplasms

PURPOSE: The purpose of our study was to evaluate the cause of acquired third, fourth, and sixth nerve palsy while also establishing recovery rates and important factors for recovery. METHODS: A retrospective chart review was performed for 92 patients who visited the ophthalmologic department of Konyang University Hospital with acquired third, fourth, and sixth nerve palsy from March 2015 to February 2016. Recovery rates and factors for recovery were evaluated in only 66 patients who received first ocular exam within 2 weeks of onset and who were followed up for at least 6 months. Complete recovery was defined as both complete recovery of the angle of deviation and the restoration of eye movement in all directions. For the degree of ocular motor restriction, −4 was defined as not crossing the midline and −2 was defined as 50% eye movement. The degree of ocular motor restriction was analyzed from −1/2 to 4. RESULTS: The fourth nerve was affected most frequently (n = 37, 40.2%), followed by the sixth cranial nerve (n = 33, 35.9%), the third cranial nerve (n = 18, 19.6%), and a combination of 2 or more cranial nerves (n = 4, 4.3%). Vasculopathy (n = 44, 47.8%) was the most common etiology, followed by trauma (n = 14, 15.2%), idiopathic (n = 13, 14.1%), inflammation(n = 10, 10.9%), neoplasm (n = 9, 9.8%), and aneurysm (n = 2, 2.2%). Complete recovery rate occurred for 66.7% (n = 44) of patients, and the overall recovery rate (i.e., at least partial recovery) was 86.3% (n = 57). Significant factors for complete recovery were the initial deviation angle and the limitation of extraocular movement (p < 0.001, p = 0.005, respectively, according to univariate analysis). CONCLUSIONS: In this study, paralytic strabismus due to vasculopathy was the most common etiology, and a lower degree of initial deviation resulted in an improved complete recovery rate. In addition, a high overall recovery rate was possible through quick diagnosis and early treatment of cranial nerve palsy.
Abducens Nerve ; Abducens Nerve Diseases ; Aneurysm ; Cranial Nerve Diseases ; Cranial Nerves ; Diagnosis ; Eye Movements ; Humans ; Oculomotor Nerve ; Retrospective Studies ; Strabismus*

Although isolated cranial nerve palsies are common in diabetic patients, multiple, simultaneous cranial neuropathies are rare. We describe the second case of a complete superior orbital fissure syndrome including the optic nerve in a middle-aged Papuan man with newly diagnosed diabetes mellitus. The differential diagnosis included septic cavernous sinus thrombosis and Tolosa Hunt syndrome, and management was initially directed at excluding these serious, treatable conditions.
Cavernous Sinus Thrombosis - diagnosis ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - diagnosis ; New Guinea ; Oculomotor Nerve Diseases - diagnosis ; Oculomotor Nerve Diseases - etiology ; Tolosa-Hunt Syndrome - diagnosis

PURPOSE: To report a case of third, fourth, and six cranial nerve palsies with antiphospholipid syndrome (APS). METHODS: Medical records of a 16 year old female diagnosed with idiopathic intracranial hypertension (IIH) in primary APS were reviewed. RESULTS: A 16 year old female presented with headache and diplopia. Ocular examinations revealed marked bilateral disc edema. She was unable to depress, adduct, and abduct in left eye and had limited abduction in the right eye. Cerebrospinal fluid had a normal composition and a pressure of 400 mmH2O. Lupus anticoagulant and IgG anticardiolipin antibody were positive. There was no clinical evidence of other autoimmune disease. Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal. She was diagnosed with bilateral sixth, and left third and fourth cranial nerve palsies secondary to idiopathic intracranial hypertension in primary APS. CONCLUSIONS: To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.
Trochlear Nerve Diseases/diagnosis/*etiology ; Oculomotor Nerve Diseases/diagnosis/*etiology ; Humans ; Follow-Up Studies ; Female ; Diagnosis, Differential ; Antiphospholipid Syndrome/*complications/diagnosis ; Adolescent ; Abducens Nerve Diseases/diagnosis/*etiology

Oculomotor cistern is normal anatomic structure that is like an arachnoid-lined cerebrospinal fluid-filled sleeve, containing oculomotor nerve. We report a case of arachnoid cyst in oculomotor cistern, manifesting as oculomotor nerve palsy. The oblique sagittal MRI, parallel to the oculomotor nerve, showed well-defined and enlarged subarachnoid spaces along the course of oculomotor nerve. Simple fenestration was done with immediate regression of symptom. When a disease develops in oculomotor cistern, precise evaluation with proper MRI sequence should be performed to rule out tumorous condition and prevent injury of the oculomotor nerve.
Adult ; Arachnoid Cysts/*diagnosis/surgery ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Neurosurgical Procedures ; Oculomotor Nerve/*pathology ; Oculomotor Nerve Diseases/*diagnosis/surgery

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.
Axons ; Cranial Nerves* ; Diagnosis ; Duane Retraction Syndrome ; Fibrosis ; Magnetic Resonance Imaging ; Methods ; Muscles ; Oculomotor Nerve Diseases ; Trochlear Nerve Diseases

Aged, 80 and over ; Humans ; Male ; Oculomotor Nerve Diseases ; diagnosis ; drug therapy ; Platelet Aggregation Inhibitors ; therapeutic use

Recently, it is reported that preganglionic oculomotor nerve palsies shows denervational supersensitive pupillary responses to dilute parasympathomimetic agents and this phenomenon is in inverse proportion to consciousness level. We measured pupillary diameters of 10 brain death patients(20 eyes) and 10 comatous patients (20 eyes). After we instilled 0.06% pilocarpine to patients that initial pupillary diameter is over 4.0mm(13 eyes in brain death group, 5 eyes in comatous group), we compared pupillary responses of two groups to evaluate whether this helps diagnosis of brain death. If pupillary diameter was changed over 25%(compared to initial diameter), we considered it positive. In comatous group, no one was positive. But in brain death group, 11 cases were positive(84.6%). It revealed significant difference statistically(P<0.05). Mean change of pupillary diameter to 0.06% pilocarpine was 0.46mm(9.35%) in comatous group, and 2.62mm(47.72%) in brain death group. With above results, we concluded that pupillary response to dilute parasympathomimetic agents is a useful indicator for diagnosis of brain death.
Brain Death* ; Brain* ; Consciousness ; Diagnosis ; Humans ; Oculomotor Nerve Diseases ; Parasympathomimetics ; Pilocarpine*

Lemierre's syndrome is characterized by anaerobic septicemia, internal jugular vein thrombosis, and septic emboli associated with infections of the head and neck. We describe an unusual and clinically confusing case of a young woman with an acute paresis of the abducens nerve and partial paresis of the right oculomotor nerve. After an extensive imaging diagnostic procedure, we also documented a peritonsillar abscess and various types of thromboses in intracranial and extracranial veins. Furthermore, we found brain and lung abscesses, which led us to establish the diagnosis of Lemierre's syndrome. Despite intensive anti-coagulation and antibiotic therapy, the patient developed a mycotic aneurysm in the right internal carotid artery directly adjacent to the previously thrombosed cavernous sinus. In summary, we were able to confirm that Lemierre's syndrome may occur in conjunction with uncharacteristic symptoms. Due to the sometimes confusing clinical symptoms as well as clinical and radiological specialties, we had to work on an interdisciplinary basis to minimize the delay prior to establishing the diagnosis and therapy.
Abducens Nerve Diseases/*diagnosis/etiology ; Acute Disease ; Diagnosis, Differential ; Female ; Humans ; Lemierre Syndrome/complications/*diagnosis ; Oculomotor Nerve Diseases/*diagnosis/etiology ; Paresis/*diagnosis/etiology ; Young Adult