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

OBJECTIVETo anatomically reconstruct the oculomotor nerve, trochlear nerve, and abducent nerve by skull base surgery.

METHODSSeventeen cranial nerves (three oculomotor nerves, eight trochlear nerves and six abducent nerves) were injured and anatomically reconstructed in thirteen skull base operations during a period from 1994 to 2000. Repair techniques included end-to-end neurosuture or fibrin glue adhesion, graft neurosuture or fibrin glue adhesion. The relationships between repair techniques and functional recovery and the related factors were analyzed.

RESULTSFunctional recovery began from 3 to 8 months after surgery. During a follow-up period of 4 months to 6 years, complete recovery of function was observed in 6 trochlear nerves (75%) and 4 abducent nerves (67%), while partial functional recovery was observed in the other cranial nerves including 2 trochlear nerves, 2 abducent nerves, and 3 oculomotor nerves.

CONCLUSIONSComplete or partial functional recovery could be expected after anatomical neurotization of an injured oculomotor, trochlear or abducent nerve. Our study demonstrated that, in terms of functional recovery, trochlear and abducent nerves are more responsive than oculomotor nerves, and that end-to-end reconstruction is more efficient than graft reconstruction. These results encourage us to perform reconstruction for a separated cranial nerve as often as possible during skull base surgery.

Abducens Nerve ; surgery ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Nerve Regeneration ; Nerve Transfer ; methods ; Oculomotor Nerve ; surgery ; Oculomotor Nerve Injuries ; Skull Base Neoplasms ; surgery ; Trochlear Nerve ; surgery ; Trochlear Nerve Injuries

Of all the potentially lethal complications of the head injury, extradural hemorrhage is the most readily diagnosed and remediable, yet the mortality rate remains distressingly high. The authors report on 58 consecutive patients with extradural hematoma. The mortality was 31%. The classical clinical course with a lucidal interval was seen in three patients only. The classical neurological signs of an extradural hematoma, contralateral hemiparesis, and ipsilateral third nerve palsy were seen in 9 patients(15.5%). The main factors associated with increased mortality were concomitant brain injury, rapid development of the hematoma and unconsciousness at the time of operation. In almost half of the fatal cases, there was a delay in the diagnosis and operation. Consequently better results are possible with better organization of the supervision and treatment of brain injured patients.
Brain ; Brain Injuries ; Craniocerebral Trauma ; Diagnosis ; Hematoma* ; Hemorrhage ; Humans ; Mortality* ; Oculomotor Nerve Diseases ; Organization and Administration ; Paresis ; Unconsciousness

OBJECTIVETo observe the difference in the clinical efficacy on oculomotor impairment between electroacupuncture and acupuncture and explore the best therapeutic method in the treatment of this disease.

METHODSSixty cases of oculomotor impairment were randomized into an electroacupuncture group and an acupuncture group, 30 cases in each one. In the electroacupuncture group, the points were selected on extraocular muscles, the internal needling technique in the eye was used in combination of electroacupuncture therapy. In the acupuncture group, the points and needling technique were same as the electroacupuncture group, but without electric stimulation applied. The treatment was given 5 times a week, 15 treatments made one session. After 3 sessions of treatment, the clinical efficacy, palpebral fissure size, pupil size, oculomotor range and the recovery in diplopia were compared before and after treatment in the two groups.

RESULTSIn the electroacupuncture group, the palpebral fissure size was (9.79+/-2.65)mm and the eyeball shifting distance was (18.12+/-1. 30)mm, which were hig-her than (8.23+/-2.74)mm and (16.71+/-1. 44)mm respectively in the acupuncture group. In the electroacupuncture group, the pupil diameter was (0. 44 +/-0. 42)mm, which was less than (0. 72 +/- 0. 53)mm in the acupuncture group, indicating the significant difference (all P<0. 05). The cured rate was 63. 33% (19/30) and the total effective rate was 93.33% (28/30) in the electroacupuncture group, which was better than 36.67% (11/30) and 83. 333 (25/30) in the acupuncture group separately, indicating the significant difference (all P<0. 05).

CONCLUSIONElectroacupuncture presents the obvious advantages in the treatment of oculomotor impairment, characterized as quick and high effect, short duration of treatment and remarkable improvements in clinical symptoms, there are important significance for the improvement of survival quality of patients.

Acupuncture Points ; Adolescent ; Adult ; Aged ; Electroacupuncture ; Female ; Humans ; Male ; Middle Aged ; Oculomotor Nerve Diseases ; physiopathology ; therapy ; Ophthalmic Nerve ; injuries ; physiopathology ; Treatment Outcome ; Young Adult

PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.
Adult ; Angiography ; Blindness ; Brain ; Cicatrix ; Exophthalmos ; Female ; Frontal Lobe ; Hemangioma, Cavernous ; Humans ; Infarction* ; Ischemia ; Oculomotor Nerve ; Ophthalmoplegia ; Optic Nerve Injuries ; Orbit* ; Papilledema ; Paralysis ; Prunus ; Radiotherapy ; Scalp*

PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.
Adult ; Angiography ; Blindness ; Brain ; Cicatrix ; Exophthalmos ; Female ; Frontal Lobe ; Hemangioma, Cavernous ; Humans ; Infarction* ; Ischemia ; Oculomotor Nerve ; Ophthalmoplegia ; Optic Nerve Injuries ; Orbit* ; Papilledema ; Paralysis ; Prunus ; Radiotherapy ; Scalp*

PURPOSE: To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors. METHODS: We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months. RESULTS: Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request. CONCLUSIONS: Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.
Adult* ; Brain Neoplasms ; Diplopia ; Fistula ; General Surgery ; Humans ; Myasthenia Gravis ; Oculomotor Nerve ; Paralysis ; Retrospective Studies ; Strabismus* ; Trochlear Nerve Diseases ; Wounds and Injuries

PURPOSE: In accordance with the increasing number of accidents caused by various reasons and recently developed fine diagnostic skills, the incidence of orbital blow-out fracture cases is increasing. As it causes complications, such as diplopia and enophthalmos, surgical reduction is commonly required. This article reports a retrospective series of 5 blow-out fracture cases that had unusual nerve injuries after reduction operations. We represents the clinical experiences about treatment process and follow-up. METHODS: From January 2000 to August 2009, we treated total 705 blow-out fracture patients. Among them, there were 5 patients(0.71%) who suffered from postoperative neurologic complications. In all patients, the surgery was performed with open reduction with insertion of Medpor(R). Clinical symptoms and signs were a little different from each other. RESULTS: In case 1, the diagnosis was oculomotor nerve palsy. The diagnosis of the case 2 was superior orbital fissure syndrome, case 3 was abducens nerve palsy, and case 4 was idiopathic supraorbital nerve injury. The last case 5 was diagnosed as optic neuropathy. Most of the causes were extended fracture, especially accompanied with medial and inferomedial orbital blow-out fracture. Extensive dissection and eyeball swelling, and over-retraction by assistants were also one of the causes. Immediately, we performed reexploration procedure to remove hematomas, decompress and check the incarceration. After that, we checked VEP(visual evoked potential), visual field test, electromyogram. With ophthalmologic test and follow-up CT, we can rule out the orbital apex syndrome. We gave Salon(R)(methylprednisolone, Hanlim pharmaceuticals) 500 mg twice a day for 3 days and let them bed rest. After that, we were tapering the high dose steroid with Methylon(R)(methylprednisolon 4 mg, Kunwha pharmaceuticals) 20 mg three times a day. Usually, it takes 1.2 months to recover from the nerve injury. CONCLUSION: According to the extent of nerve injury after the surgery of orbital blow-out fracture, the clinical symptoms were different. The most important point is to decide quickly whether the optic nerve injury occurred or not. Therefore, it is necess is to diagnose the nerve injury immediately, perform reexploration for decompression and use corticosteroid adequately. In other words, the early diagnosis and treatment is most important.
Abducens Nerve Diseases ; Bed Rest ; Decompression ; Diplopia ; Early Diagnosis ; Enophthalmos ; Follow-Up Studies ; Hematoma ; Humans ; Incidence ; Linear Energy Transfer ; Oculomotor Nerve Diseases ; Optic Nerve Diseases ; Optic Nerve Injuries ; Orbit ; Orbital Fractures ; Retrospective Studies ; Visual Field Tests

OBJECTIVE: To elucidate the problems that must be dealt with in the prognosis of patients with severe head injury and to find out the prognosis factors related to severe head injury. METHODS: A clinical analysis was carried out retrospectively with 292cases of severe head- injured patients (Glasgow coma scale score 3-8) admitted to the our department for 10 years from January 1987 to December 1996. RESULTS: Patients who were classified as having severe brain injury belonged to 13.1% of all craniocerebral trauma cases among which sixty-three cases had diffuse brain injury. The causes of head injuries were motor vehicle accident, falls from heights, bicycle and other causes in order of frequency. Pediatric patients showed better outcome(51.4%), compared with only 28.1% of all adult cases(p<0.0001). The patients with high initial GCS score(6-8, 47.9%) had significantly better outcome than the patients with low initial GCS socre(3-5, 16.9%) (p<0.0001). Fifty point three percents of patients with good motor response had good outcome, whereas only 15.8 percent in patients with poor motor response. The cases with diffuse head injury without basal cistern compression had significantly higher percentage of good outcome(74.0%) than those with basal cistern compression(16.9%, p<0.0001). The cases with normal pupillary reaction had significantly higher percentage of good outcome(50.3%) than those with bilateral oculomotor nerve palsy(18.4%, p<0.0001). The patients with skull fracture had good outcome(48.1%), compare to 20.3% of patients without skull fracture(p<0.0017). CONCLUSION: The good prognostic factors in this study were young age, initial high Glasgow coma scale, good motor response, diffuse brain injury type I, II, bilaterally intact light reflex, with skull fracture. Individual prognostic factor is significant to indicate the patient's outcome and may be utilized for assessing the relative efficacy of the alternative treatment and prognosis.
Adult ; Brain Injuries ; Coma ; Craniocerebral Trauma* ; Fibrinogen ; Glasgow Coma Scale ; Head* ; Humans ; Motor Vehicles ; Oculomotor Nerve ; Prognosis ; Reflex ; Retrospective Studies ; Skull ; Skull Fractures