Child, Preschool ; Humans ; Male ; Ophthalmoplegia ; etiology ; Recurrence

The authors present the clinical findings of a 30-year-old female and a 29-year-old male who both had isolated unilateral lateral rectus muscle palsy in neuro-Behcet's disease. The clinical feature related to isolated abduscens nerve palsy was identified by CT, systemic assessment and extraocular examination. These patients' constellation of findings appear to be unique: it does not follow any previously reported pattern of ocular manifestations of neuro-Behcet's disease.
Abducens Nerve/physiopathology ; Adult ; Behcet's Syndrome/complications* ; Case Report ; Eye Movements/physiology ; Female ; Human ; Male ; Ophthalmoplegia/physiopathology ; Ophthalmoplegia/etiology* ; Paralysis/physiopathology ; Paralysis/etiology*

To the best of our knowledge, isolated bilateral oculomotor nuclear palsy has not yet been reported in the literature, while bilateral oculomotor nuclear palsy with more widespread rostral brainstem infarction has often been reported. We present a patient having top of the basilar syndrome with midbrain infarction selectively involving the bilateral oculomotor nucleus. A 61-year-old woman with two episodes of vertebrobasilar infarction presented with sudden onset of bilateral ptosis. Examination revealed pronounced bilateral ptosis. In the primary position, fixation of either eye produced an approximately 50 prism diopter exotropia. Adduction of the right eye was restricted to the midline. There was moderately decreased adduction of the left eye, severe limitation of depression, and moderately decreased elevation of both eyes. Abduction of both eyes was normal. The pupils were equal, round, and reactive to light. Bilateral ptosis is suggestive of oculomotor nuclear palsy. On the basis of clinical findings alone, we could not establish whether the precise location of the lesion was all the subdivisions of the oculomotor nucleus except the Edinger-Westphal nucleus or the central caudal nucleus and bilateral fascicles. However, because axial MRI showed a small midbrain infarct in the oculomotor nucleus region, we concluded that she had an isolated, pupil-sparing, bilateral oculomotor nuclear palsy caused by midbrain infarct.
Cerebral Infarction/*complications/diagnosis ; Female ; Human ; Magnetic Resonance Imaging ; *Mesencephalon ; Middle Aged ; Ophthalmoplegia/diagnosis/*etiology/physiopathology

Child ; Cranial Nerves ; pathology ; Eyelids ; Female ; Humans ; Male ; Ophthalmoplegia ; etiology ; Polyradiculopathy ; complications

Aged ; Animals ; Diabetes Complications ; Diagnosis, Differential ; Female ; Humans ; Ophthalmoplegia ; diagnosis ; etiology ; Tolosa-Hunt Syndrome ; diagnosis

OBJECTIVETo compare clinical therapeutic effects of electroacupuncture (EA) combined with acupoint-injection and simple acupuncture on oculomotor paralysis induced by aneurysm of cerebral posterior communicating artery.

METHODSSeventy-eight cases were randomly divided into an acupuncture group and an EA plus acupoint-injection group. In the acupuncture group, Jingming (BL 1), Qiuhou (EX-HN 7), Chengqi (ST 1), etc., were selected and the EA plus acupoint-injection group were treated by the same method as in the acupuncture group, in combination with EA and local acupoint injection of adenosine cobaltamine. After treatment of 3 months, their therapeutic effects were compared.

RESULTSThe total effective rate was 41.7% in the acupuncture group and 77.8% in the EA plus acupoint-injection group, with a very significant difference between the two groups (P<0.01). The therapeutic effect in the patients who received the operation within 2 weeks after attack was better than that in those who received the operation over 2 weeks after attack (P<0.01); the therapeutic effect in the patients who received acupuncture treatment within 1 month after the operation was better than that over 1 month after the operation(P<0.01).

CONCLUSIONEA plus acupoint-injection is an effective method for oculomotor paralysis induced by aneurysm of cerebral posterior communicating artery, with a better therapeutic effect than that of simple acupuncture, and early diagnosis, surgery and timely acupuncture treatment are closely related with its prognosis.

Acupuncture Points ; Adult ; Electroacupuncture ; methods ; Female ; Humans ; Injections ; Intracranial Aneurysm ; complications ; Male ; Middle Aged ; Ophthalmoplegia ; etiology ; therapy

BACKGROUNDOculomotor palsy is a common complication in patients with posterior communicating aneurysm. This study was conducted to investigate the postoperative recovery of patients with posterior communicating aneurysm complicated with oculomotor palsy and to analyze the factors influencing length of recovery.

METHODSFrom 2000 to 2006, 148 patients with posterior communicating aneurysm were treated at our hospital, with 74 of them having concurrent unilateral oculomotor palsy. All of the patients underwent craniotomy after the diagnosis by means of whole-brain digital subtraction angiography (DSA). The patients were divided into two groups for observation of postoperative recovery during the follow-up period. Patients in group A were treated with simple pedicle clipping of the aneurysm while patients in group B were treated with pedicle clipping of the aneurysm and decompression of the oculomotor nerve.

RESULTSOf the 40 patients in group A, 20 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10 - 40 days. Fourteen patients underwent surgery within 14 - 30 days, of whom 12 completely recovered within 30 - 90 days and 2 cases recovered incompletely. The remaining six patients underwent surgery after more than 30 days; of these, four patients recovered completely and two recovered incompletely. Of the 34 cases in group B, 15 underwent surgery within 14 days and completely recovered from oculomotor palsy in 10 - 40 days. Sixteen patients underwent surgery in 14 - 30 days, of whom 14 completely recovered in 30 - 90 days and 2 recovered incompletely. The remaining three patients underwent surgery after more than 30 days, of whom two patients recovered completely and one recovered incompletely.

CONCLUSIONSEarly diagnosis and surgical treatment of patients with unilateral oculomotor palsy induced by posterior communicating aneurysm are important to full postoperative recovery of the oculomotor nerve. No correlation was found, however, between decompression of the oculomotor nerve, such as excision or puncture of the aneurysm, and postoperative recovery time.

Adult ; Aged ; Female ; Humans ; Intracranial Aneurysm ; complications ; pathology ; surgery ; Male ; Middle Aged ; Ophthalmoplegia ; etiology ; pathology ; surgery ; Treatment Outcome

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.
Adolescent ; Adult ; Aged ; Cavernous Sinus ; Humans ; Middle Aged ; Oculomotor Nerve Diseases/etiology* ; Ophthalmoplegia ; Prognosis ; Retrospective Studies ; Young Adult

A case of painful ophthalmoplegia with unilateral ocular pain, fixed eyeball to all directions of gaze, and loss of vision is presented. After intensive steroid therapy, conjunctival chemosis subsided markedly, but no improvement was seen in other clinical signs. We took a CT scan of orbit brain and performed nasopharyngeal biopsy and open biopsy through craniectomy. Based on the results of clinical features and findings of the CT scan and tissues, we diagnosed painful ophthalmoplegia secondary to nasopharyngeal carcinoma metastasized to orbital apex and brain.
Brain Neoplasms/pathology/secondary ; Carcinoma, Squamous Cell/*complications/pathology/secondary ; Female ; Humans ; Middle Aged ; Nasopharyngeal Neoplasms/*complications/pathology ; Ophthalmoplegia/*etiology ; Orbital Neoplasms/pathology/secondary ; Pain/*etiology

PURPOSE: To present a case of peripheral T-cell lymphoma presenting as painful ophthalmoplegia. METHODS: A 61-year-old woman presented with a 2-week history of headache and eyeball pain. Examination showed mild exophthalmos, complete ophthalmoplegia, and ptosis of the left eye. Under the impression of nonspecific orbital inflammation, she was treated with oral prednisone with initial response. Two months later, she revisited the clinic with exacerbated symptoms. Anterior orbitotomy and incisional biopsy was performed for the inferior rectus muscle lesion. RESULTS: Histopathologic examination revealed an infiltrate of atypical lymphoid cells between degenerative muscle bundles. It was consistent with peripheral T-cell lymphoma. A metastatic workup was performed without any evidence of extraorbital tumor. The patient was recommended to be treated with chemotherapy, however, refused to take the treatment. The patient died of progression of the disease in a month. CONCLUSIONS: T-cell lymphoma in the orbit can present as painful ophthalmoplegia and take a rapid clinical course. The disease should be regarded as one of the differential diagnosis for painful ophthalmoplegia refractory to corticosteroid therapy.
Tomography, X-Ray Computed ; Pain/diagnosis/*etiology ; Orbital Neoplasms/*complications/diagnosis ; Ophthalmoplegia/diagnosis/*etiology ; Middle Aged ; Lymphoma, T-Cell/*complications/diagnosis ; Humans ; Female ; Fatal Outcome ; Diagnosis, Differential ; Biopsy