Bilateral Oculomotor Research Articles

Endoskopowe leczenie chorych z wewnątrzczaszkowymi powikłaniami zapalenia zatok

Intracranial complications of sinusitis (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and current topic. Although they are nowadays relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. Infection may spread hematogenously or by direct extension. Patients with complications require surgery to remove the focus of infection from the sinuses and drain the abscess. Recently, endoscopic frontal and sphenoid sinus surgery has emerged as the preferred technique for the treatment of the most advanced and complicated chronic sinusitis. Records of 7 patients aged from 13 to 65 (mean 30.6) years treated in our department for intracranial complications between January 2002 and September 2006 were analysed retrospectively. The diagnosis of meningitis was established in 2 patients, in one case with accompanying bilateral oculomotor nerve palsy. Cavernous sinus thrombosis, frontal abscess with hemiplegia, cerebral oedema, bilateral oculomotor nerve palsy and retrobulbar optic nerve neuritis with blindness was diagnosed each in one individual. 5 endoscopic bilateral frontosphenoethmoidectomies and 2 endoscopic sphenoethmoidectomies were performed. In one case a frontosphenoethmoidectomy was combined with craniotomy. All preoperative symptoms subsided in 4 operated individuals. Vision improved in the patient with bilateral retrobulbar optic nerve neuritis. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted. No complications of the surgery were observed. Surgical treatment of the focus of infection in the sinuses can be accomplished endoscopically via an intranasal approach with less morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic effects.

Isolated bilateral oculomotor nerve palsy in pituitary apoplexy: case report and review

Pituitary tumours usually present with visual field defects; extraocular palsy is usually a sign of cavernous sinus extension and is a sign of advanced disease. We report a case of a pituitary adenoma presenting with complete, bilateral oculomotor nerve palsies, but minimal loss of visual fields, and intact abducens and trochlear nerves.

Clinical and magnetic resonance imaging features of nasopharyngeal lymphoma in two cats with concurrent intracranial mass

Lymphoma is reported to be the most common nasal and second most common intracranial neoplasm in cats. Intracranial lymphoma may occur as a primary central nervous system lymphoma or as part of multi-centric disease. Two cats were presented with histopathologically confirmed nasopharyngeal lymphoma and concurrent mass within the middle fossa of the cranial cavity, with magnetic resonance imaging suggestive of direct communication. Both cats demonstrated evidence of bilateral oculomotor nerve deficits and upper respiratory tract noise. In one cat, bilateral optic nerve deficits were also present. The magnetic resonance imaging features were similar in both cases and demonstrated a contrast-enhancing intracranial mass on the ventral aspect of the middle fossa of the cranial cavity and an adjacent mass arising from the dorsal aspect of the nasopharynx. Lymphoma should be included as an important differential diagnosis in cats presented with middle cranial fossa syndrome (in particular ophthalmoplegia) and stertor.

Metastasis to the unilateral oculomotor nucleus complex: case report

This article describes a 76 year old man that, after lung cancer surgery, showed left extrinsic oculomotor paralysis and contralateral paralysis of the superior rectus muscle associated with bilateral ptosis. Magnetic resonance imaging confirmed a rare situation characterized by an isolated metastasis in the region of the left third cranial nerve nucleus, probably compromising the superior rectus subnucleus and the central caudal nucleus, therefore justifying the bilateral oculomotor involvement.

Contiguous conventional and plexiform schwannomas

The authors present clinical, imaging, and histological features of two adult patients found to harbor a conventional schwannoma contiguous with a deep plexiform schwannoma. One patient had neurofibromatosis (NF) Type 2 (NF2), and both intracranial (bilateral oculomotor, trigeminal, acoustic, and hypoglossal schwannomas as well as meningiomas) and intraspinal (schwannomas and meningiomas) lesions. The proximal forearm lesions consisted of a conventional schwannoma and an underlying plexiform component. The second patient, who did not have NF2, presented with a similar enlarging mass in the distal arm; two contiguous lesions were resected. Both patients exhibited distinct, readily identifiable, magnetic resonance imaging features. Plexiform schwannomas are rare lesions that occur sporadically or, on occasion, in association with NF2 or meningiomas with or without multiple schwannomas. The authors believe that a more careful examination of patients with NF2 may show that these people have a higher incidence of plexiform schwannoma than previously thought. Pathological confirmation is crucial in distinguishing plexiform schwannomas from plexiform neurofibromas, because the latter are directly associated with NF1 and have a significant tendency to undergo malignant transformation. To the best of the authors' knowledge, this is the first report of a conventional schwannoma contiguous with a deep plexiform schwannoma.

Bilateral Third Nerve Palsy and Temporal Arteritis

Bilateral oculomotor palsy is a rare manifestation of temporal arteritis, and to our knowledge only 1 case has been described in the literature. To investigate a possible case of temporal arteritis in a patient with bilateral third nerve palsy. Case report and review. University hospital. A 65-year-old man had subacute pupil-sparing bilateral third nerve palsy. Temporal artery biopsy findings and response to corticosteroids are consistent with temporal arteritis. Temporal arteritis is a rare cause of ophthalmoplegia in elderly persons and may be unrecognized.

Pupila tônica bilateral como seqüela oftálmica isolada da doença de Lyme: relato de caso

Lyme disease is a multisystemic disorder caused by Borrelia burgdorferi spirochete, transmitted by ticks. Mainly described in the northern hemisphere and rarely in Brazil. The purpose of this report is to describe a patient with Lyme disease who developed bilateral tonic pupil as the only remaining sign. A 13-year-old female with Lyme disease, presented with bilateral peripheral facial and oculomotor paralysis. After recovery from neurological abnormalities the patient sustained anisocoria, reduced fotomotor reflex, less than normal amplitude of accommodation, tonic pupil constriction for near objects and slow redialation in both eyes. Dilute 0.1% pilocarpine test was positive in both eyes, confirming the suspicion of bilateral tonic pupil. This is the first case report of bilateral tonic pupil caused by Lyme disease.

Posttraumatic pneumocephalus-induced bilateral oculomotor nerve palsy

Bilateral third nerve palsy often points to the involvement of its nucleus. Third nerve palsy as a result of posttraumatic nuclear involvement is an extremely rare condition. A 23-year-old man presented with a depressed skull fracture after acute head trauma and had Glasgow Coma Scale Score of 9. The diameters of the pupils were 6.5 and 7.5 mm and they were not reactive to light stimulation. There was bilateral ptosis. Computed tomography (CT) relieved bilateral perimesensephalic pneumocephalus. We suggested that bilateral oculomotor nerve paresis might develop in association with posttraumatic bilateral perimesensephalic pneumocephalus, which affected the nucleus of the third nerve.

Pandysautonomie isolée subaiguë : intérêt du traitement par immunoglobulines polyvalentes

Acute or sub-acute pure dysautonomia is uncommon. We report a case of sub-acute pure pandysautonomia with favorable outcome after intravenous immunoglobulin therapy. A 29-year-old right-handed student, with an uneventful medical history presented, for one month, bilateral loss of visual acuity and digestive disorders, associating diarrhea, vomiting and anorexia. Physical examination revealed bilateral intrinsec oculomotor nerve palsy, a dryness syndrome and severe orthostatic hypotension. Ophthalmologic examination showed bilateral diffuse parasympathic impairment associating an Argyll Robertson pupil and full pupil light reflex abolition. Elevated protein level (0.93g/l) was the only cerebrospinal fluid anomaly. Serum tests were negative for anti-gangliosides antibodies. The patient improved slowly after two series of intravenous immunoglobulin infusions. Clinical course and laboratory findings suggest that acute or sub-acute pure pandysautonomia events are likely to be related to acute polyradiculoneuritis. Therefore intravenous polyvalent immunoglobulin infusions should be attempted, even if their efficacy needs to be confirmed.

Congenital Fibrosis of Extraocular Muscles Type 1 with Progression of Ophthalmoplegia

Background Congenital fibrosis of the extraocular muscles type 1 (CFEOM1) is a congenital, non-progressive autosomal-dominant disorder with bilateral oculomotor nerve palsy due to mutations in the kinesin motor protein gene KIF21A. - Results We present a 60-year old patient with CFEOM1 due to the common C2860T mutation in KIF21A. At the age of 37, he complained about newly occurred diplopia, which implies the capability of binocular vision before. The divergence of both globes progressed and the poor residual movement on attempted adduction and upgaze completely disappeared during the sixths decade. Clinical and electromyographic examination showed isolated involvement of the oculomotor nerve. - Conclusion Apparently, progression of impaired ocular motility is not contradictory to the diagnosis of this congenital developmental disorder. Mechanical, contracture-like mechanisms as known from other types of strabism or persistent overuse of the reduced number of oculomotor a-motoneurons are generally considered as a reason for clinical progression. However, regarding the underlying known molecular basis of CFEOM1, a continuous disease progression due to the kinesin dysfunction cannot be excluded.

Bilateral visual loss and ipsilateral ophthalmoplegia due to unilateral sphenoid sinus mucocele

Bilateral impaired visual acuity, unilateral oculomotor and trochlear nerve paresis, and headache due to sphenoid sinus mucocele is rare. An 81-year-old woman developed bilateral headache, left-sided ptosis, bilateral visual impairment, diplopia, and rhinorrhea. Neurologic examination revealed bilaterally reduced visual acuity and left-sided paresis of the oculomotor and trochlear nerves. Spiral CT and T2-weighted MRI of the perinasal sinuses revealed a left-sided sphenoid sinus mucocele with bony destruction of the surrounding walls and involvement of the orbital apex. Endonasal transsphenoidal drainage of the mucocele led to a complete recovery of the cranial nerve palsies and marked improvement of visual acuity. Sphenoid sinus mucocele can present with bilateral visual loss and unilateral oculomotor and trochlear nerve paresis. Endoscopic drainage of the mucocele can lead to almost complete recovery.

Oculomotor Nerve Invasion of Acute Myelogenous Leukemia Demonstrated by Magnetic Resonance Imagin

A 53-year-old male was diagnosed as having acute myelogenous leukemia (M2, FAB). He complained of double vision and right blepharoptosis after receiving remission induction chemotherapy. Magnetic resonance imaging (MRI) showed enlargement of the bilateral oculomotor nerves. Intrathecal injections of methotrexate and cytosine arabinoside were partially effective and repeated MRI showed shrinkage of the enlarged oculomotor nerves, after therapy. This case shows the importance of MRI in the early diagnosis of CNS leukemia.

Bilateral internal ophthalmoplegia as a feature of oculomotor fascicular syndrome disclosed by magnetic resonance imaging

To describe the magnetic resonance imaging features of bilateral internal ophthalmoplegia as an oculomotor fascicular syndrome. A 55-year-old man was initially examined with bilateral photophobia. Neuro-ophthalmologic examinations disclosed preganglionic bilateral internal ophthalmoplegia. Magnetic resonance imaging of the brainstem was performed. Magnetic resonance imaging disclosed high-intensity areas on T2-weighted images along medial portions of the bilateral oculomotor fascicles in the mesencephalon. These findings suggest that mesencephalic lesions may selectively cause bilateral internal ophthalmoplegia as a partial oculomotor fascicular syndrome.

Providing distinct vergence and version dynamics in a bilateral oculomotor network

Given reported interactions between vergence and version dynamics, ocular reflexes cannot be properly modelled as separate independent subsystems. Using a model structure compatible with known anatomy, we show that a single bilateral system can produce results consistent with observed data both at the central and ocular levels. This model provides for both vergence and conjugate integrators in a single controller, and explains the observed modulation on abducens interneurons and mesencephalic vergence cells during vergence responses. Reported interactions between version and vergence would then be a natural consequence of a shared premotor network. Major implications include: the need to record both eyes in a protocol, since cross-talk is always possible; and adaptation to monocular changes could be distributed in all motor projections to both eyes.

Central Diabetes Insipidus Complicating Congenital Toxoplasmosis: A Case Report

Central Diabetes Insipidus Complicating Congenital Toxoplasmosis: A Case Report

“Top of the basilar artery” syndrome and thalamic aphasia: A case report

Patients with midbrain infarction are usually comatose and have a poor prognosis. We report a case of "top of the basilar artery" syndrome in an 84-year-old right-handed man with infarction of medial basal thalamus, superior colliculus, pretectal area, medial longitudinal fasciculus, oculomotor nucleus, and left occipital lobe documented by magnetic resonance imaging. The clinical manifestations included right homonymous hemianopsia, bilateral oculomotor palsy, spastic dysarthria, and thalamic aphasia, which correlated with radiological findings. The presentation is unusual because of the extent of involvement in a fairly alert patient with a "pseudo-coma" pattern due to bilateral ptosis and thalamic aphasia.

Partial Bilateral Oculomotor Nucleus Lesion Following Surgery of a Fourth Ventricle Ependymoma

Abstract The authors present a patient who underwent surgery for an ependymoma filling the fourth ventricle and the Sylvian aqueduct and thus extending to the posterior third ventricle. The tumor was totally removed and postoperatively a partial bilateral third nerve palsy developed. Only levator palpebrae and rectus superior were involved. Those subnuclei are located most medially close to the Sylvian aqueduct and such a clinical presentation is of anatomical interest.

The Effect of Cerebellar Midline Lesions on Eye Movements

The oculomotor vermis (lobulus VI, VII) and its immediate output structure, the caudal part of the fastigial nucleus (fastigial oculomotor region, FOR), participate in the generation of saccades and smooth pursuit eye movements. Lesions to these cerebellar midline structures lead to step-size error dysmetria, with saccades to visual targets being either too large (hypermetric) or too small (hypometric). Smooth pursuit eye movements can have a reduced gain (cogwheel smooth pursuit).An analysis of lesion data in humans and monkeys revealsI. Lesions to the oculomotor vermis have the opposite effect to lesions of the FOR. Whereas a unilateral oculomotor vermis lesion causes hypometric ipsilateral and hypermetric contralateral saccades, FOR lesions lead to hypometric contralateral and hypermetric ipsilateral saccades. Furthermore, bilateral oculomotor vermis lesions lead to hypometric saccades, and bilateral FOR lesions to hypermetric saccades.2. Saccade and smooth pursuit disorders are related. Hypometric sac...

Internuclear neurons in the ocular motor system of frogs

Medial and lateral rectus motoneurons of frogs were localized after retrograde labeling with horseradish peroxidase (HRP) injected in the medial rectus muscle or applied on the cut end of the abducens nerve. Coordinates of these cell columns were used as target areas for the injection of small amounts of HRP (20-60 nl) and [3H]leucine (25-40 nl) and as search areas for retrogradely and anterogradely labeled internuclear neurons (INT) in in vivo and in vitro experiments. HRP injection in the medial rectus subdivision of the oculomotor nucleus (n = 6) resulted in retrograde labeling of cell bodies in the contralateral principal abducens nucleus. On the average about 16 cells per animal were found. Somatic diameters were about 13.5 +/- 2.8 microns (n = 32). The number and the size of these abducens internuclear neurons (AbINT) are smaller than those of lateral rectus motoneurons (n = 75; diameter: 19 +/- 3.2 microns). A crossed projection of AbINT to medial rectus motoneurons in the contralateral oculomotor nucleus is further supported by autoradiographic results. Following injection of [3H]leucine into the abducens nucleus, a high density of silver grains was visible within the contralateral oculomotor nucleus, mainly in the caudal part of the oculomotor nucleus, where medial rectus motoneurons are located. Injection of [3H]leucine in vivo (n = 4) and in vitro (n = 3) resulted in a similar high density of silver grains within the contralateral oculomotor nucleus, but the background level of silver grains was significantly higher after in vitro (264 +/- 38/2,500 microns2) than after in vivo injections (195 +/- 17/2,500 microns2). HRP injection in the principal abducens nucleus (n = 9) resulted in retrograde labeling of cell bodies in the medial rectus subdivisions of the bilateral oculomotor nuclei. Ipsilateral projections predominated, with about 10 (+/- 8) labeled cells over contralateral projections (about 3 +/- 2). Average diameters of these oculomotor internuclear neurons (OcINT) were again smaller (10.8 +/- 2 microns; n = 18) than those of medial rectus motoneurons (14.4 +/- 3 microns; n = 52). In addition, retrogradely labeled cells were consistently encountered in the bilateral vestibular nuclei, the cerebellar nuclei, the dorsal brainstem caudal to the abducens nuclei, and ipsilaterally in the pretectum. Most of the vestibular neurons were located in the rostral part of the vestibular nuclear complex. These neurons might constitute part of the three-neuronal arc of the vestibulo-ocular reflex in the frog. Labeled cells in the pretectum were restricted to the ipsilateral posterior thalamic nucleus (P).(ABSTRACT TRUNCATED AT 400 WORDS)

Bilateral Congenital Oculomotor Nerve Palsy in a Child with Brain Anomalies

We treated a 3-month-old boy with bilateral congenital oculomotor nerve palsy in whom a magnetic resonance imaging scan demonstrated a developmental brain anomaly in the region of the basal ganglia. The pupil was normal on one side, and there was no aberrant regeneration of the oculomotor nerve. We could find no evidence for a peripheral oculomotor nerve lesion. This demonstrates that congenital oculomotor nerve palsy can be caused by brainstem disease. Embryologically, basal ganglia and oculomotor nuclei develop at the same time, and the Edinger-Westphal nucleus develops later. Thus, pupil sparing does not exclude a central origin for congenital oculomotor nerve palsy.