Multiple Sclerosis Presenting as Isolated Oculomotor Nerve Palsy

ABSTRACT:A 23-year old woman came to the emergency room with an isolated oculomotor nerve palsy (including pupillary dilatation) of rapid onset. Investigations and history revealed no cause. The subsequent course of events indicated a diagnosis of multiple sclerosis. While the third nerve has been shown to be involved during the course of multiple sclerosis, this is the first report of a case presenting as an isolated oculomotor nerve paralysis.

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Early Endovascular Management of Oculomotor Nerve Palsy Associated with Posterior Communicating Artery Aneurysms

Interventional Neuroradiology ◽

10.1177/159101991001600102 ◽

2010 ◽

Vol 16 (1) ◽

pp. 17-21 ◽

Cited By ~ 18

Author(s):

A. Santillan ◽

W.E. Zink ◽

J. Knopman ◽

H.A. Riina ◽

Y.P. Gobin

Keyword(s):

Nerve Palsy ◽

Clinical Presentation ◽

Endovascular Embolization ◽

Oculomotor Nerve ◽

Posterior Communicating Artery ◽

Oculomotor Nerve Palsy ◽

Endovascular Management ◽

Third Nerve Palsy ◽

The Third ◽

Third Nerve

Palsy of the third cranial nerve (oculomotor nerve, CNIII) is a well-known clinical presentation of posterior communicating artery (P-com) aneurysm. We report a series of 11 patients with partial or complete third nerve palsy secondary to P-com aneurysm. All were treated with endovascular embolization within seven days of symptom onset. Third nerve palsy symptoms resolved in 7/11 (64%), improved in 2/11 (18%) and did not change in 2/11 (18%) patients

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Left suboccipital supracerebellar transtentorial approach for resection of tectal cavernous malformation

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19394 ◽

2019 ◽

Vol 1 (2) ◽

pp. V19

Author(s):

Hussam Abou-Al-Shaar ◽

Timothy G. White ◽

Ivo Peto ◽

Amir R. Dehdashti

Keyword(s):

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Entry Zone ◽

Third Nerve Palsy ◽

History Of ◽

Tectal Plate ◽

The Right ◽

Transtentorial Approach ◽

Third Nerve

A 64-year-old man with a midbrain cavernoma and prior bleeding presented with a 1-week history of diplopia, partial left oculomotor nerve palsy, and worsening dysmetria and right-sided weakness. MRI revealed a hemorrhagic left tectal plate and midbrain cavernoma. A left suboccipital supracerebellar transtentorial approach in the sitting position was performed for resection of his lesion utilizing the lateral mesencephalic sulcus safe entry zone. Postoperatively, he developed a partial right oculomotor nerve palsy; imaging depicted complete resection of the cavernoma. He recovered from the right third nerve palsy, weakness, and dysmetria, with significant improvement of his partial left third nerve palsy.The video can be found here: https://youtu.be/ofj8zFWNUGU.

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About the so-called “recurrent paralysis of the oculomotor nerve”. Paralysis n. oculomotorii recidiva

Neurology Bulletin ◽

10.17816/nb58032 ◽

1901 ◽

Vol IX (3) ◽

pp. 104-143

Author(s):

M. M. Mering

Keyword(s):

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Nerve Paralysis

Despite the fact that 40 years have passed since the first description of recurrent oculomotor nerve palsy, this disease can not be considered as yet studied.

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Isolated oculomotor nerve palsy inspontaneous internal carotid artery dissection: case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2003000400027 ◽

2003 ◽

Vol 61 (3A) ◽

pp. 668-670 ◽

Cited By ~ 8

Author(s):

Cynthia Resende Campos ◽

Ayrton Roberto Massaro ◽

Milberto Scaff

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Nerve Palsy ◽

Internal Carotid ◽

Carotid Artery Dissection ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

The Third

Partial oculosympathetic palsy followed by ischemic manifestations in brain or retina are the main symptoms of extracranial internal carotid artery (ICA) dissection. Unusually, cranial nerves may be affected. Isolated oculomotor nerve palsy is found only rarely. CASE: We present a 50-year-old nondiabetic man who experienced acute onset of right occipital headache which spread to the right retro-orbital region. Five days later he noticed diplopia and right blurred vision sensation. Neurologic examination disclosed only impaired adduction and upward gaze of right eye, slight ipsilateral pupillary dilatation, without ptosis. Brain MRI was normal. Angiography showed right internal carotid artery dissection with forward occlusion to the base of the skull. Intravenous heparin followed by warfarin was prescribed. The headache and the oculomotor nerve deficit gradually resolved in the next three weeks. DISCUSSION: Isolated oculomotor nerve palsy is underrecognized as a clinical presentation of extracranial ICA dissection. If the angiographic evaluation is incomplete without careful study of extracranial arteries, misdiagnosis may lead to failure to initiate early treatment to prevent thromboembolic complications. For this reason we draw attention to the need for careful evaluation of cervical arteries in patients with oculomotor nerve palsy. Mechanical compression or stretching of the third nerve are possible mechanisms, but the direct impairment of the blood supply to the third nerve seems to be the most plausible explanation.

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Apoplectic headache and oculomotor nerve palsy: An unusual presentation of multiple sclerosis

Neurology ◽

10.1212/wnl.40.9.1465 ◽

1990 ◽

Vol 40 (9) ◽

pp. 1465-1465 ◽

Cited By ~ 19

Author(s):

B. S. Galer ◽

R. B. Lipton ◽

S. Weinstein ◽

L. Bello ◽

S. Solomon

Keyword(s):

Multiple Sclerosis ◽

Nerve Palsy ◽

Oculomotor Nerve ◽

Unusual Presentation ◽

Oculomotor Nerve Palsy

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Functional anatomy of headache: circle of Willis aneurysms, third cranial nerve and pain

Headache Medicine ◽

10.48208/headachemed.2011.18 ◽

2011 ◽

pp. 82-88

Author(s):

Marcelo Moraes Valença ◽

Luciana P. A. Andrade-Valença ◽

Carolina Martins

Keyword(s):

Cranial Nerve ◽

Nerve Palsy ◽

Functional Anatomy ◽

Circle Of Willis ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Microsurgical Anatomy ◽

Third Nerve Palsy ◽

The Right ◽

Third Nerve

Patients with intracranial aneurysm located at the internal carotid artery-posterior communicating artery (ICA-PComA) often present pain on the orbit or fronto-temporal region ipsilateral to the aneurysm, as a warning sign a few days before rupture. Given the close proximity between ICA-PComA aneurysm and the oculomotor nerve, palsy of this cranial nerve may occurduring aneurysmal expansion (or rupture), resulting in progressive eyelid ptosis, dilatation of the pupil and double vision. In addition, aneurysm expansion may cause compression not only of the oculomotor nerve, but of other skull base pain-sensitive structures (e.g. dura-mater and vessels), and pain ipsilateral to the aneurysm formation is predictable. We reviewed the functional anatomy of circle of Willis, oculomotor nerve and its topographical relationships in order to better understand the pathophysiology linked to pain and third-nerve palsy caused by an expanding ICAPComA aneurysm. Silicone-injected, formalin fixed cadaveric heads were dissected to present the microsurgical anatomy of the oculomotor nerve and its topographical relationships. In addition, the relationship between the right ICA-PComA aneurysm and the right third-nerve is also shown using intraoperative images, obtained during surgical microdissection and clipping of an unruptured aneurysm. We also discuss about when and how to investigate patients with headache associated with an isolated third-nerve palsy.

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Isolated oculomotor nerve palsy with pupillary dilatation: A rare presentation of internal carotid artery dissection

Journal of the Postgraduate Institute of Medicine ◽

10.4038/jpgim.8305 ◽

2021 ◽

Vol 8 (1) ◽

pp. 132

Author(s):

Sanchayan Thanancheyan ◽

Ghetheeswaran Srivickneswaran ◽

Nisanthan Selvaratnam ◽

Sivagamasundary Uthayakumaran ◽

Sivakajani Balakumar

Keyword(s):

Carotid Artery ◽

Nerve Palsy ◽

Internal Carotid ◽

Carotid Artery Dissection ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Artery Dissection ◽

Internal Carotid Artery Dissection ◽

Rare Presentation ◽

Pupillary Dilatation

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Ophthalmoplegic Migraine in Infancy

PEDIATRICS ◽

10.1542/peds.61.6.886 ◽

1978 ◽

Vol 61 (6) ◽

pp. 886-888

Author(s):

William C. Robertson ◽

Eugene R. Schnitzler

Keyword(s):

Young Children ◽

Pediatric Patient ◽

Nerve Palsy ◽

Rare Complication ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Ophthalmoplegic Migraine ◽

Unusual Finding ◽

Third Nerve

Isolated oculomotor nerve palsy is an unusual finding in the pediatric patient. Third nerve weakness is a rare complication of vascular headaches, and there are few reported cases of so-called ophthalmoplegic migraine (OM) in young children. Recently we have seen a 12-month-old girl with OM that appeared to respond to treatment with propranolol.

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Aberrant regeneration in idiopathic oculomotor nerve palsy

Journal of Neurosurgery ◽

10.3171/jns.1980.52.6.0854 ◽

1980 ◽

Vol 52 (6) ◽

pp. 854-856 ◽

Cited By ~ 5

Author(s):

Jose F. Laguna ◽

Michael S. Smith

Keyword(s):

Nerve Palsy ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Content Type ◽

Third Nerve Palsy ◽

Aberrant Regeneration ◽

Oculomotor Function ◽

Third Nerve ◽

Fine Print

✓ Aberrant regeneration of the oculomotor nerve usually follows injury to the nerve by posterior communicating artery aneurysms or trauma. A case of idiopathic third nerve palsy with pupillary involvement occurred in an otherwise healthy 38-year-old man. Follow-up examination 32 months later showed evidence of oculomotor function with aberrant regeneration.

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