Traumatic Oculomotor Nerve Palsy Research Articles

Traumatic oculomotor nerve palsy treated with transnasal endoscopic decompression through the optic strut.

To present a surgical treatment regimen of transnasal endoscopic decompression through the optic strut for traumatic oculomotor nerve palsy based on the anatomical study of the superior orbital fissure and the oculomotor nerve fissure segment. The bone structure of the oculomotor nerve fissure segment and the important bone anatomical landmarks of the lateral wall of the sphenoidal sinus were identified on a dried skull and a cadaveric head, respectively, using a nasal endoscope, and a surgical plan was determined. Decompression was conducted on the orbital apex, the superior orbital fissure, the optic canal and the optic strut of the two patients in sequence, after which the degree and range of decompression were identified by three-dimensional (3D) computed tomography (CT). The oculomotor nerve had a close correlation with the lateral surface of the optic strut. The transnasal endoscope was employed to identify the lateral optic-carotid recess (LOCR), as well as the positions of the optic nerve, internal carotid artery (ICA), and superior orbital fissure, collectively called the "optic strut triangle". The surgical plans for decompression of the orbital apex, superior orbital fissure, optic canal, and optic strut and the necessity of optic strut drilling were determined, and the surgical procedures for safe drilling of the optic strut were elaborated. After surgery, the two patients had significantly improved symptoms, without complications. In addition, their postoperative CT showed that the medial margin of the superior orbital fissure was fully decompressed. The optic strut triangle is a crucial anatomical landmark in the decompression of the oculomotor nerve, and optic strut drilling is necessary for such decompression. For patients with traumatic oculomotor nerve palsy and fractures of the medial wall of the superior orbital fissure on CT, the oculomotor nerve fissure segment can be decompressed in an effective, complete and safe manner as per the surgical plan of decompressing the orbital apex, superior orbital fissure, optic canal and optic strut in turn under a transnasal endoscope, conducive to the recovery of neurological function of patients.

Etiology, localization of the lesion, and prognosis for patients firstly diagnosed in ophthalmology department with oculomotor nerve palsy.

Oculomotor nerve palsy is a kind of disease with many causes, showing eye movement disorders, abnormal eyelid position, and/or damage of the pupil. The etiology of oculomotor nerve palsy in different departments is different. The study discussed the etiology, localization of the lesion, and prognosis for oculomotor nerve palsy firstly diagnosed in department of ophthalmology. Clinical data of 137 hospitalized patients with oculomotor nerve palsy at the Department of Ophthalmology, the First Medical Center of PLA General Hospital from 2009 to 2018 were retrospectively collected. The etiology and its distribution characteristics in different age groups, the location of the lesion, and the prognosis of patients were analyzed. In 137 patients, the top 3 causes for oculomotor nerve palsy were head trauma (38.69%), cavernous sinus lesions (12.40%), and orbital inflammation (9.49%). Other causes included intracranial aneurysm, the intracranial space-occupying lesion, cerebral vessel diseases, infection, orbital tumors, diabetes, the operation of nasal cavity. Traumatic oculomotor nerve palsy was more common in young adults aged 20-49 years and in the patients with cerebral vascular disease in elderly people aged 60-69 years, while diabetic oculomotor nerve palsy is common in middle-aged and elderly people aged 50-69 years. The age distribution of other etiological types was relatively balanced. Seventy-five cases of orbital apex lesions were due to trauma, inflammation, infection, and tumor; 40 cases of cavernous sinus lesions were due to inflammation, tumor, and thrombosis; 6 cases of subarachnoid lesions were due to aneurysms, tumors, and trauma; 5 cases were oculomotor nucleus lesions were due to infarction; 11 cases could not be allocated because of unknown etiology. After treatment, the corrected visual acuity of oculomotor nerve palsy side was not significantly improved. The patients with oculomotor nerve palsy caused by intracranial aneurysm, cerebrovascular disease, and diabetes mellitus had the highest proportion of partial or complete recovery from ptosis and ocular dyskinesia. Oculomotor nerve palsy is a common cause of ophthalmoplegia and diplopia. Head trauma, cavernous sinus lesions, and orbital inflammation are the most common causes for oculomotor nerve palsy first diagnosed in ophthalmology department. Traumatic oculomotor nerve palsy is common in adolescents. Oculomotor nerve palsy caused by diabetes and cerebrovascular disease are common in the middle-aged and elderly people. Most of the lesions locate in the orbital apex and cavernous sinus. The prognosis of corrected visual acuity is poor. The prognosis of ptosis and ocular dyskinesia caused by intracranial aneurysm, cerebrovascular disease, and diabetes is good. Figuring out the cause timely and accurately is the basis and key to treat oculomotor nerve palsy.

Traumatic oculomotor nerve palsy: Unique case of isolated mydriasis and ptosis following head injury

Abstract A rare case of partial cranial nerve 3 (CN3) paresis following a traumatic brain injury presented with isolated ptosis and mydriasis due to a hemorrhagic lesion in the ipsilateral tegmentum of midbrain. All the extraocular muscles that control eye movements were spared. The anatomy of CN3 nuclei and their fascicular organization is reviewed.

Traumatic oculomotor nerve palsy.

Traumatic oculomotor nerve palsy.

MRI Findings of Oculomotor Nerve Palsy in Mild Traumatic Brain Injury: Case Report and Review of the Literature

Isolated traumatic oculomotor nerve palsy associated with mild traumatic brain injury (TBI) is rarely reported in literature and has not been associated with magnetic resonance imaging (MRI) findings until this case report. We report the case of a 55-year-old man with complete left side traumatic oculomotor nerve palsy, 7 mm non-reactive dilated pupil, and ptosis after a helmeted bicycle accident. Mild sulcal subarachnoid hemorrhage was seen on computed tomography (CT) at presentation. MRI during hospitalization showed contrast enhancement of the cisternal segment of the left oculomotor nerve, near the rootlets as it exits the brainstem. He was followed for 18 months with near resolution of oculomotor nerve palsy, but persisting enhancing lesion on MRI at the third nerve outlet from the brainstem, suggestive of partial avulsion. Isolated oculomotor nerve palsy after mild TBI is extremely rare. After review of the literature, we are the first to show radiographic evidence of injury to the oculomotor nerve in a patient with mild TBI . MRI studies may be helpful in a patient with isolated oculomotor nerve palsy to identify the type of injury to the nerve, to rule out underlying pathology concurrent with the TBI , and may also indicate prognosis for recovery. doi: http://dx.doi.org/10.4021/jnr233w

MRI Findings of Oculomotor Nerve Palsy in Mild Traumatic Brain Injury: Case Report and Review of the Literature

Isolated traumatic oculomotor nerve palsy associated with mild traumatic brain injury (TBI) is rarely reported in literature and has not been associated with magnetic resonance imaging (MRI) findings until this case report. We report the case of a 55-year-old man with complete left side traumatic oculomotor nerve palsy, 7 mm non-reactive dilated pupil, and ptosis after a helmeted bicycle accident. Mild sulcal subarachnoid hemorrhage was seen on computed tomography (CT) at presentation. MRI during hospitalization showed contrast enhancement of the cisternal segment of the left oculomotor nerve, near the rootlets as it exits the brainstem. He was followed for 18 months with near resolution of oculomotor nerve palsy, but persisting enhancing lesion on MRI at the third nerve outlet from the brainstem, suggestive of partial avulsion. Isolated oculomotor nerve palsy after mild TBI is extremely rare. After review of the literature, we are the first to show radiographic evidence of injury to the oculomotor nerve in a patient with mild TBI . MRI studies may be helpful in a patient with isolated oculomotor nerve palsy to identify the type of injury to the nerve, to rule out underlying pathology concurrent with the TBI , and may also indicate prognosis for recovery. J Neurol Res. 2013;3(5):163-165 doi: https://doi.org/10.4021/jnr233w

Traumatic oculomotor nerve palsy: a literature review

Aim: To review traumatic oculomotor nerve (IIIN) palsy, looking at the prognosis, site of lesion and mechanism of recovery.Methods: A literature review was undertaken in order to research opinions on the prognosis following a traumatic UIN palsy. The nuclear, fascicular midbrain, subarachnoid, cavernous sinus and orbital portions were investigated and the prognosis discussed.Results: Trauma affecting the nuclear region alone is rare, but IIIN palsy can occur indirectly as a result of haemorrhage, and spontaneous recovery may be expected. Direct nuclear palsy following trauma is not prone to recovery. The midbrain is highly vulnerable to damage caused by rootlet avulsion and recovery may be further limited by post-traumatic fusion deficiency. The cavernous sinus is particularly prone to damage hut the prognosis is generally good, as is that for trauma affecting the region of the superior orbital fissure.Conclusion: IIIN palsy as a result of trauma is not a common finding, and the extent of the trauma and the site of the lesion will, in part, determine the prognosis for recovery. The mechanism of recovery is by axonal regeneration, by a process of Wallerian degeneration and new cellular cord formation. Prognosis is unaffected by age. Consideration should be given to aetiology and the site of the traumatic lesion in the management of traumatic IIIN palsy.

Localization of Traumatic Oculomotor Nerve Palsy to the Midbrain Exit Site by Magnetic Resonance Imaging

To present the magnetic resonance imaging findings for a patient with traumatic oculomotor nerve injury. We examined a patient with a right pupil-involving oculomotor nerve palsy after severe closed head trauma. Magnetic resonance imaging of the brain demonstrated marked signal hypointensity on gradient-echo T2*-weighted images consistent with hemorrhage at the midbrain exit site of the right oculomotor nerve. Distal fascicular damage or partial rootlet avulsion is a mechanism of injury in some traumatic oculomotor nerve palsies. Gradient-echo T2*-weighted magnetic resonance imaging is the most sensitive method to detect hemorrhagic changes associated with shearing injury.