Fluctuating Pupil Sparing Oculomotor Nerve Palsy With Intracranial Spontaneous Dissecting Aneurysm

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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T cell acute lymphoblastic leukaemia presenting with sudden onset right oculomotor nerve palsy with normal neuroradiography and cerebrospinal fluid studies

BMJ Case Reports ◽

10.1136/bcr.01.2012.5685 ◽

2012 ◽

Vol 2012 (mar26 1) ◽

pp. bcr0120125685-bcr0120125685

Author(s):

V. R. Bhatt ◽

M. Naqi ◽

R. Bartaula ◽

S. Murukutla ◽

S. Misra ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

T Cell ◽

Acute Lymphoblastic Leukaemia ◽

Lymphoblastic Leukaemia ◽

Nerve Palsy ◽

Sudden Onset ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy

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Cavernous internal carotid artery aneurysm presenting with ipsilateral oculomotor nerve palsy: A case report

Radiology Case Reports ◽

10.1016/j.radcr.2021.03.008 ◽

2021 ◽

Vol 16 (6) ◽

pp. 1339-1342

Author(s):

Nizar Almaghrabi ◽

Yousef Fatani ◽

Abeer Saab

Keyword(s):

Case Report ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Nerve Palsy ◽

Internal Carotid ◽

Artery Aneurysm ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm

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Oculomotor Nerve Palsy Due To Posterior Communicating Artery Aneurysm: Clipping vs Coiling

Neurochirurgie ◽

10.1016/j.neuchi.2021.03.012 ◽

2021 ◽

Author(s):

Alexandrina S. Nikova ◽

Georgios S Sioutas ◽

Katerina Sfyrlida ◽

Grigorios Tripsianis ◽

Michael Karanikas ◽

...

Keyword(s):

Nerve Palsy ◽

Artery Aneurysm ◽

Oculomotor Nerve ◽

Posterior Communicating Artery ◽

Oculomotor Nerve Palsy ◽

Aneurysm Clipping ◽

Posterior Communicating Artery Aneurysm

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Pituitary Apoplexy Causing Compression of Third Cranial Nerve—Management

Indian Journal of Neurosurgery ◽

10.1055/s-0039-1694849 ◽

2019 ◽

Vol 08 (02) ◽

pp. 119-122

Author(s):

Václav Masopust

Keyword(s):

Cavernous Sinus ◽

Nerve Palsy ◽

Clinical Symptoms ◽

Rapid Development ◽

Sella Turcica ◽

Oculomotor Nerve ◽

Oculomotor Nerve Palsy ◽

Future Research ◽

Third Nerve Palsy ◽

Increased Pressure

AbstractLesions of the oculomotor nerve as the first sign of pituitary adenoma are rare. The cause of such lesions without other clinical symptoms is discussed in this study. A small cohort of 4 patients (3.1%) with oculomotor nerve palsy (third nerve palsy) as the only neurologic deficit, from 129 patients who got operated upon for pituitary adenomas, is presented. In this group (mean age: 55 years, range: 36–65 years), all patients (two women and two men) underwent surgery. In two cases, there was arrested pneumatization and thickened bone. In the remaining two cases, a macroscopically visible, very solid opaque diaphragm was present, after the removal of the tumor and thickened bone. Complete adjustment was observed in all patients within 1 week after the surgery. Two factors that seem to increase the high risk for the development of oculomotor nerve palsy are that the cavernous sinus may be the only weak structure surrounding the sella turcica when the diaphragm and bone are thickened; and the rapid development of increased pressure in this region. The increased pressure on the cavernous sinus during the anatomical variations is the primary cause for lesions on the oculomotor nerve. However, this conjecture cannot be statistically demonstrated because of the small number of cases. Future research should be conducted on larger samples to increase statistical inference and generalizability.

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Resolution of Oculomotor Nerve Palsy Secondary to Posterior Communicating Artery Aneurysms

Neurosurgery ◽

10.1227/neu.0000000000000965 ◽

2015 ◽

Vol 77 (6) ◽

pp. 931-939 ◽

Cited By ~ 20

Author(s):

D. Jay McCracken ◽

Brendan P. Lovasik ◽

Courtney E. McCracken ◽

Justin M. Caplan ◽

Nefize Turan ◽

...

Keyword(s):

Median Time ◽

Coil Embolization ◽

Nerve Palsy ◽

Aneurysm Rupture ◽

Small Sample ◽

Oculomotor Nerve ◽

Full Recovery ◽

Posterior Communicating Artery ◽

Oculomotor Nerve Palsy ◽

Time To Treatment

BACKGROUND: Previous studies have attempted to determine the best treatment for oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PCoA) aneurysms, but have been limited by small sample sizes and limited treatment. OBJECTIVE: To analyze the treatment of ONP secondary to PCoA with both coiling and clipping in ruptured and unruptured aneurysms. METHODS: Data from 2 large academic centers was retrospectively collected over 22 years, yielding a total of 93 patients with ONP secondary to PCoA aneurysms. These patients were combined with 321 patients from the literature review for large data analyses. Onset symptoms, recovery, and time to resolution were evaluated with respect to treatment and aneurysm rupture status. RESULTS: For all patients presenting with ONP (n = 414) 56.6% of those treated with microsurgical clipping made a full recovery vs 41.5% of those treated with endovascular coil embolization (P = .02). Of patients with a complete ONP (n = 229), full recovery occurred in 47.3% of those treated with clipping but in only 20% of those undergoing coiling (P = .01). For patients presenting with ruptured aneurysms (n = 130), full recovery occurred in 70.9% compared with 49.3% coiled patients (P = .01). Additionally, although patients with full ONP recovery had a median time to treatment of 4 days, those without full ONP recovery had a median time to treatment of 7 days (P = .01). CONCLUSION: Patients with ONP secondary to PCoA aneurysms treated with clipping showed higher rates of full ONP resolution than patients treated with coil embolization. Larger prospective studies are needed to determine the true potential of recovery associated with each treatment.

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