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

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.

Left suboccipital supracerebellar transtentorial approach for resection of tectal cavernous malformation

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.

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

2010 ◽  
Vol 16 (1) ◽  
pp. 17-21 ◽  
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

Aberrant regeneration in idiopathic oculomotor nerve palsy

1980 ◽  
Vol 52 (6) ◽  
pp. 854-856 ◽  
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.

scholarly journals A rare case of iii cranial nerve palsy - mucormycosis involving the right maxillary and ethmoidal sinus

2021 ◽  
Vol 9 (3) ◽  
pp. 181-184
Author(s):  
K. Praveen Gandhi ◽  
◽  
V. Sakthivel ◽  
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Rare Case ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
The Right ◽  
Rule Out

IIIrd Cranial nerve palsy, known as oculomotor nerve palsy, may result from various causes,however, the etiology remains unknown in some instances. This case report aims to present theauthors' experience with a case of IIIrd cranial nerve palsy, together with a review of the literature.Many etiologies have been associated with isolated oculomotor nerve palsies. We report the case ofa patient who presented with right maxillary and ethmoidal sinusitis with IIIrd cranial nerve palsyassociated with mucormycosis. Careful examinations to rule out other causes must be done and thentreatment with antifungals should be considered after early diagnosis.

scholarly journals Pituitary Apoplexy Causing Compression of Third Cranial Nerve—Management

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.

scholarly journals Post traumatic isolated ipsilateral oculomotor nerve palsy

2019 ◽  
pp. 188-190
Author(s):  
Praveen Kumar ◽  
Sharad Pandey ◽  
Kulwant Singh ◽  
Mukesh Sharma ◽  
Prarthana Saxena
Keyword(s):  
Subdural Hematoma ◽  
Nerve Palsy ◽  
Chronic Subdural Hematoma ◽  
Oculomotor Nerve Palsy ◽  
Rare Presentation ◽  
Third Nerve Palsy ◽  
Common Causes ◽  
History Of ◽  
Post Traumatic ◽  
Third Nerve

The common causes of isolated third nerve palsy are microvascular infarction, intracranial aneurysm, diabetes, hypertension and atherosclerosis. Here we are presenting a case of 26-year female presenting with a history of head injury two months back. She presented with ptosis on the left side. On computed tomography, a large left-sided chronic subdural hematoma with significant midline shift was found. Isolated ipsilateral third nerve palsy is a rare presentation with unilateral chronic subdural hematoma. Improvement in ptosis after surgery indicate a good neurological outcome.

scholarly journals Oculomotor schwannoma causing a progressive complete third-nerve palsy

2019 ◽  
Vol 12 (8) ◽  
pp. e230272
Author(s):  
Emily Bentley ◽  
Ronak Ved ◽  
Caroline Hayhurst
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Mri Findings ◽  
Gadolinium Contrast ◽  
Management Options ◽  
Third Nerve Palsy ◽  
History Of ◽  
Suprasellar Cistern ◽  
Third Nerve

A 69-year-old woman presented with an 8-month history of diplopia and examination findings consistent with a right third-nerve palsy. Head MRI identified the presence of a 5.8 mm, nodular, isointense lesion in the suprasellar cistern, which demonstrated enhancement with gadolinium contrast. The lesion did not show any evidence of growth over a 3-month follow-up period. These MRI findings, alongside the clinical features, suggest oculomotor nerve schwannoma. Oculomotor schwannomas are a rare cause of third-nerve palsy. The presenting features and management options for oculomotor schwannomas are discussed to provide a framework for the diagnosis and management of these patients.

scholarly journals Delayed Pneumocephalus-Induced Cranial Neuropathy

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Neena I. Marupudi ◽  
Monika Mittal ◽  
Sandeep Mittal
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Nerve Compression ◽  
Neurological Deficits ◽  
Oculomotor Nerve Palsy ◽  
Cranial Neuropathy ◽  
Cranial Nerve Deficit ◽  
Moderate Amount ◽  
Interpeduncular Cistern

Pneumocephalus is a common occurrence after cranial surgery, with patients typically remaining asymptomatic from a moderate amount of intracranial air. Postsurgical pneumocephalus rarely causes focal neurological deficits; furthermore, cranial neuropathy from postsurgical pneumocephalus is exceedingly uncommon. Only 3 cases have been previously reported that describe direct cranial nerve compression from intracranial air resulting in an isolated single cranial nerve deficit. The authors present a patient who developed dysconjugate eye movements from bilateral oculomotor nerve palsy. Direct cranial nerve compression occurred as a result of postoperative pneumocephalus in the interpeduncular cistern. The isolated cranial neuropathy gradually recovered as the intracranial air was reabsorbed.

Magnetic resonance angiography and clinical evaluation of third nerve palsies and posterior communicating artery aneurysms

2006 ◽  
Vol 105 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Mark J. Kupersmith ◽  
Gordon Heller ◽  
Terry A. Cox
Keyword(s):  
Magnetic Resonance ◽  
Cranial Nerve ◽  
Mr Angiography ◽  
Nerve Palsy ◽  
Source Imaging ◽  
Third Nerve Palsy ◽  
Pupil Function ◽  
Group 2 ◽  
Third Nerve ◽  
Group 1

Object The authors conducted a study to determine the utility of the clinical profile and magnetic resonance (MR) angiography in evaluating patients with isolated third cranial nerve palsies or posterior communicating artery (PCoA) aneurysms. Methods Three-dimensional time-of-flight MR angiography was performed in a consecutive series of patients with isolated acute third cranial nerve palsy not due to a ruptured aneurysm and in patients with unruptured PCoA aneurysms. A neuroradiologist, masked to the identities of the patients, interpreted reformatted maximum intensity projection (MIP) and source images of the PCoAs and aneurysms. The investigators assessed clinical features of oculomotor nerve dysfunction and focal head pain. Cases involving cranial third nerve palsy without aneurysms were classified as Group 1 (no case entailed catheter-based angiography), and cases involving PCoA aneurysms seen on MR angiography (42 cases confirmed by catheter-based angiography) were classified as Group 2. The mean age of the 73 patients in Group 1 was 60.1 years and that of the 45 patients in Group 2 was 59.1 years (p = 0.37). The pattern and severity of oculomotor (p = 0.61) and lid (p = 0.83) dysfunction and pain frequency (p = 0.2) were similar for the 73 patients with vasculopathy in Group 1 and the 15 symptomatic patients in Group 2. Abnormal pupils were observed in 38% of the patients in Group 1 and 80% of those in Group 2 (p = 0.016). In cases of complete external third nerve palsy, nine of 22 in Group 1 and none of four in Group 2 had normal pupil function. For all patients, source imaging showed 206 PCoAs (85%) and MIP imaging demonstrated 120 PCoAs (49%). Of 48 aneurysms (three bilateral), MIP imaging showed 44 (92%) and source imaging showed 47 (98%). Only a 2-mm aneurysm seen on catheter-based angiography was missed by MR angiography. Symptomatic aneurysms were equal or greater than 4 mm in size. Conclusions Only the presence of complete external third nerve palsy and normal pupil function allowed ischemia to be clinically distinguished from a PCoA aneurysm in a patient with isolated third nerve palsy and no subarachnoid hemorrhage. When source image MR angiography demonstrates normal findings, catheter-based angiography need not be performed in these patients, even if pupil function is abnormal.

Bevacizumab-induced isolated oculomotor nerve palsy in glioblastoma multiforme

2021 ◽  
pp. 107815522110668
Author(s):  
Ezgi Değerli ◽  
Gülin Alkan ◽  
Nihan Şentürk Öztaş ◽  
Şahin Bedir ◽  
Sümeyra Derin ◽  
...  
Keyword(s):  
Side Effects ◽  
Glioblastoma Multiforme ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Growth Factor Receptor ◽  
Recurrent Glioblastoma ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Recurrent Glioblastoma Multiforme ◽  
Systemic Side Effects

Introduction: Bevacizumab, a monoclonal antibody against the vascular endothelial growth factor receptor, is the standard treatment of recurrent glioblastoma multiforme. In addition to common systemic side effects of bevacizumab, there are rare cases of cranial nerve palsy. Case report: We report a case of transient oculomotor nerve palsy after systemic administration of bevacizumab. Twenty-four hours after the systemic infusion of bevacizumab, transient oculomotor nerve palsy developed in a 49-year-old male patient. In the cranial MRI, there was no malignancy-related progression. Management and outcome: Bevacizumab treatment was discontinued. Methylprednisolone was started considering that bevacizumab increased the inflammatory response. Oculomotor nerve palsy resolved in 14 days. Discussion: There are many side effects of bevacizumab whose mechanisms of action have not been fully explained. Cranial nerve involvement is rarely reported. Our case is the first reported case of bevacizumab-induced oculomotor nerve palsy.

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