Case Of Oculomotor Nerve Palsy Research Articles

Case of Oculomotor Nerve Palsy Caused by Impending Ruptured Internal Carotid-Posterior Communicating Aneurysm of Only 2.5 mm

Case of Oculomotor Nerve Palsy Caused by Impending Ruptured Internal Carotid-Posterior Communicating Aneurysm of Only 2.5 mm

The Dolenc technique was used to clip 14 cases of ruptured basilar apex aneurysms and posterior cerebral artery aneurysms.

ObjectiveTo investigate the surgical techniques and their clinical effects for ruptured basilar artery apex and posterior cerebral aneurysms via the Dolenc approach.MethodsWe retrospectively analyzed the clinical data of 14 patients with ruptured basilar artery apex and posterior cerebral aneurysms who underwent surgical clipping by the Dolenc approach from July 2017 to June 2020 in Beijing Tiantan Hospital affiliated with Capital Medical University and Lianyungang Hospital affiliated with Xuzhou Medical University. The modified Rankin scale (mRs) scores were used to evaluate the prognosis of patients.ResultsAll 14 cases of aneurysms were successfully clipped. Overall, 1, 2, and 1 cases of postoperative new-onset visual loss, oculomotor nerve palsy, and contralateral hemiplegia, respectively, were reported. Digital subtraction angiography (DSA) or computed tomography angiography (CTA) examination of the aneurysm within 2 weeks after surgery revealed that the aneurysm was completely clipped without residue. The observations during the follow-up within 12–18 months after surgery were as follows: 1 case of vision loss returned to normal, 2 cases of oculomotor nerve palsy, 1 case of return to normal, 1 case of improved, 1 case of contralateral hemiplegia improved after rehabilitation treatment, and 1 case of hydrocephalus ventriculoperitoneal shunt surgery was performed. Overall, 11, 2, and 1 case had mRs scores of 0, 1, and 2, respectively. No death was reported.ConclusionFor the small number of basilar apical and posterior cerebral aneurysms treated non-invasively, the Dolenc approach may offer advantages over other modalities.

Combined endoscopic endonasal and transorbital multiportal approach for complex skull base lesions involving multiple compartments.

This study defines the specific areas that connect the surgical corridors of the endoscopic endonasal (EEA) and transorbital approach (TOA) to identify adequate clinical applications and perspectives of this combined multiportal approach. Consecutive patients who underwent combined EEA and TOA procedures for various pathologies involving multiple compartments of the skull base were enrolled. A total of eight patients (2 chondrosarcomas, 2 meningiomas, 2 schwannomas, 1 glioma, and 1 traumatic optic neuropathy) were included between August 2016 and April 2021. The cavernous sinus (CS) was targeted as the connection area of the combined approach in four patients with tumors infiltrating the middle cranial fossa (MCF) and central skull base through the CS. For two patients with MCF tumors extending into the infratemporal fossa (ITF), the horizontal portion of the greater sphenoid wing and the foramen ovale were utilized as the connection area. In the remaining 2 patients, connection was achieved through the optic canal (OC). Gross total and near total resection was achieved in 5 patients with tumors, and circumferential removal of bone composing the OC was performed in one patient with traumatic compressive optic neuropathy. Postoperative complications included one cardiac arrest due to underlying cardiovascular disease and one case of oculomotor nerve palsy. The combined EEA and TOA procedure is a useful strategy for complex lesions involving multiple compartments of the skull base. Herein, we identified the specific areas connecting the two surgical approaches, allowing a common path for EEA and TOA procedures.

사암침으로 호전된 동공산대를 동반한 동안신경마비 1례

This study aims to report a case of oculomotor nerve palsy with mydriasis improved by Sa-Am acupuncture (大腸正格). The patient visited our clinic due to Right oculomotor nerve palsy with symptoms such as periocular pain, diplopia, vertigo, ptosis, eye adduction disorder, and mydriasis on November 11th, 2019. For the treatment, Sa-Am acupuncture (大腸正格) which used to give a significant effect on eye diseases and headaches and to remove toxins from the body was performed every time the patient visited the clinic. About a month after the treatment, ptosis disappeared, and eye adduction disorder also changed from -2 to 2 points, showing a significant improvement. Subjective symptoms such as vertigo, diplopia, and eye pain also significantly decreased from 13 to 4 points. At the second month of treatment, the eye adduction disorder improved to a normal level, and subjective ocular discomforts disappeared. The pupil size decreased from 5 mm to 2.5 mm. After 3-4 months from the start of treatment, most of the symptoms including the light reflex returned to normal. After a total of 32 acupunctures treatment, subjective symptoms such as periocular pain, diplopia and vertigo, as well as ptosis and eye adduction disorder disappeared, and the pupil size, including the light reflex, also improved to the normal level.

A Case of Oculomotor Nerve Palsy Caused by a Postoperative Sphenoid Sinus Cyst

【はじめに】副鼻腔嚢胞の中で蝶形骨洞嚢胞の頻度は比較的低い。蝶形骨洞は視神経，動眼神経，滑車神経，外転神経と近接するため，蝶形骨洞に病変が生じると視器障害を発症しやすく，不可逆的な機能障害を防ぐため，早期治療が必要である。今回，術後性蝶形骨洞嚢胞による動眼神経麻痺が，亜急性期の手術により改善した例を報告する。【症例】77歳女性。20歳時に両側副鼻腔炎で副鼻腔根本術，60歳時に左内視鏡下篩骨洞手術を受けた。初診日17日前より左鼻奥の疼痛を自覚した。初診日4日前に複視，左開眼障害を発症し，近医耳鼻咽喉科を受診した。CTで左蝶形骨洞嚢胞を指摘され，当院当科を紹介された。【既往歴・合併症】無症候性ラクナ梗塞に対してアスピリン内服中であった。【初診時所見】左眼瞼下垂，左眼の下転障害・内転障害を認めた。CTで左蝶形骨洞に周囲を圧排する軟部陰影を認め，蝶形骨洞上外側と中隔の骨欠損を認めた。【治療】入院日に緊急手術として左蝶形骨洞嚢胞を広く開放した。術翌日から左眼瞼下垂，左眼下転障害・内転障害が改善した。【考察と結語】蝶形骨洞嚢胞は視器障害を併発する頻度が高く，症状の頻度は，視力障害，眼球運動障害，眼球突出の順に多いとされている。本例のように，眼球運動障害は視力障害と異なり，発症から日数が経過しても手術により改善する例がある。よって，このような例には日数が経過していても積極的に治療介入すべきである。

Treatment of blepharoptosis with pseudo-Graefe phenomenon caused by oculomotor nerve paralysis: report of three cases

Objective To explore the treatment of unilateral blepharoptosis caused by oculomotor nerve paralysis with pseudo-Graefe phenomenon after craniocerebral trauma or operation. Methods Three patients suffered from blepharoptosis caused by oculomotor nerve paralysis with pseudo-Graefe phenomenon were collected in this study and the modified levator resection technique was applied to correct ptosis. The observation index after operation included the height of upper palpebral margin, the radian of double eyelid, the change of eye movement and the corresponding upper eyelid height, the eye closure function and the incidence of exposure keratitis. Results One case of oculomotor nerve palsy with moderate ptosis achieved an ideal height of upper eyelid after surgery, two cases of oculomotor nerve palsy with severe ptosis were undercorrection. All the three patients had smooth double eyelid radian, no obvious change of eye movement and corresponding upper eyelid height compared with preoperative. The two severe ptoses could close eyes well, but the moderate ptosis patient couldnot close eyes completely. Conclusions The technique of modified levator resection is an effective method to treat the moderate ptosis caused by oculomotor nerve paralysis with pseudo-Graefe phenomenon, but the results are unfavorable in the treatment of severe ptosis. Key words: Oculomotor nerve; Paralysis; Blepharoptosis; Pseudo-Graefe phenomenon, ptosis; Modified levator resection technique

Traumatic oculomotor nerve palsy.

Traumatic oculomotor nerve palsy.

Isolated oculomotor nerve palsy as a paraneoplastic manifestation of gastric diffuse large B-cell lymphoma: A case report.

Isolated oculomotor nerve palsy (ONP) is rare. The major causes are aneurysm of the posterior communicating artery, microvascular ischemia, neoplasm, inflammation and trauma. The present study reports the case of a 72-year-old female with left isolated pupil-sparing ONP and severe anemia as the initial manifestations of gastric diffuse large B-cell lymphoma (DLBCL). Systemic chemotherapy without any central nervous system (CNS)-directed treatment led to a complete resolution of the ONP, suggesting that it was most likely to be a paraneoplastic phenomenon. If CNS involvement cannot be demonstrated by brain magnetic resonance imaging and cerebrospinal fluid assessment, the present case suggests that it may be acceptable to omit CNS-directed therapy in such cases of ONP, since it may be paraneoplastic in nature and may resolve following successful treatment of the underlying malignancy.

Oculomotor Nerve Palsy due to an Odontogenic Abscess Originating from the Mandibular Third Molar

We report a case of oculomotor nerve palsy (ONP) as a result of odontogenic infection originating from the third molar, which is considered rare.

A case of oculomotor nerve palsy associated with antimitotic spindle apparatus

In this case report, we describe a case of isolated oculomotor nerve palsy associated with antibodies to mitotic spindle apparatus (anti-MSA). A 28-year-old female patient had acute, painful vertical diplopia. She had limited depression and adduction in the right eye. There was no relative afferent pupillary defect. Brain magnetic resonance imaging showed no abnormal findings. Laboratory tests were all negative, with the exception of positive anti-MSA, She had an excellent and rapid response to treatment with corticosteroids, and completely recovered after two weeks of steroid pulse therapy.

A Case of Oculomotor Nerve Palsy and Choroidal Tuberculous Granuloma Associated with Tuberculous Meningoencephalitis

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. A 15-year-old male visited our hospital for an acute drop of the left eyelid and diplopia. He has been on anti-tuberculous drugs (isoniazid, rifampin) for 1 year for his tuberculous encephalitis. A neurological examination revealed a conscious clear patient with isolated left oculomotor nerve palsy, which manifested as ptosis, and a fundus examination revealed choroidal tuberculoma. Other anti-tuberculous drugs (pyrazinamide, ethambutol) and a steroid (dexamethasone) were added. After 3 months on this medication, ptosis of the left upper eyelid improved and the choroidal tuberculoma decreasedin size, but a right homonymous visual field defect remained. When a patient with tuberculous meningitis presents with abrupt onset oculomotor nerve palsy, rapid re-diagnosis should be undertaken and proper treatment initiated, because the prognosis is critically dependent on the timing of adequate treatment.

Isolated Oculomotor Nerve Palsy in Churg-Strauss Syndrome

A 30-year-old man with bronchial asthma complained of horizontal diplopia. Partial oculomotor nerve palsy with restrictions of elevation and adduction, and mydriasis was observed in the left eye. Cranial magnetic resonance imaging demonstrated an infarct lesion in the territory of the left superior median mesencephalic branch of the posterior cerebral artery. Based on bronchial asthma, hypereosinophilia, mononeuropathy multiplex, pulmonary eosinophilia and positive perinuclear antineutrophil cytoplasmic antibody in the serum, the patient was diagnosed as having Churg-Strauss syndrome. This is the first case of oculomotor nerve palsy due to midbrain infarction associated with Churg-Strauss syndrome.

Ocular complications after intracarotid BCNU for intracranial tumors

112 patients with intracranial tumors treated with intracarotid BCNU to a cumulative dose of 370 mg/m2 body surface have been examined retrospectively for ocular complications. Average follow-up was 494 days (range 5 months-5 years). The rate of ocular complications was 2.7%. There was 1 case of hemorrhagic glaucoma with amaurosis and an accompanying oculomotor palsy, 1 case of retinal branch artery occlusion combined with third nerve paresis and 1 case of oculomotor palsy.