Oculomotor Nerve

METHODS: We applied a phase-plane technique that compared each eye's velocity as a function of change in position (normalized displacement) in 22 patients with disease variously affecting the brainstem reticular formation, the abducens nucleus, the medial longitudinal fasciculus, the oculomotor nerve, the abducens nerve, the neuromuscular junction, or the extraocular muscles; 10 age-matched subjects served as controls.  

Cross sections of the inferior oblique, inferior rectus (IR), and medial rectus muscles were determined together because each is innervated by the common inferior division of the oculomotor nerve.  

We report the first adult case of Influenza A virus infection with acute unilateral oculomotor nerve palsy. Unlike previous reports, our patient showed isolated unilateral oculomotor nerve palsy as soon as she developed general symptoms with Influenza A infection, and demonstrated no significant increases of anti-ganglioside antibodies including anti-GQ1b IgG antibody.  

We report a rare case of oculomotor nerve palsy and choroidal tuberculous granuloma associated with tuberculous meningoencephalitis. 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. 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..  

The rapid reversibility of the oculomotor nerve palsy with immunosuppression suggests lymphocytic infiltration or autoantibodies as the cause rather than a vasculitic process, which would have led to irreversible or slowly, partially reversible ischaemic damage..  

Ophthalmoplegia is a serious and not common problem among patients with diabetes mellitus; the oculomotor nerve was most frequently affected in our case-report.  

We present a patient with an isolated oculomotor nerve palsy due to central nervous system leukemia with bone marrow findings consistent with myelofibrosis without any blasts.  

Patients in group A were treated with simple pedicle clipping of the aneurysm while patients in group B were treated with pedicle clipping of the aneurysm and decompression of the oculomotor nerve. CONCLUSIONS: Early diagnosis and surgical treatment of patients with unilateral oculomotor palsy induced by posterior communicating aneurysm are important to full postoperative recovery of the oculomotor nerve. No correlation was found, however, between decompression of the oculomotor nerve, such as excision or puncture of the aneurysm, and postoperative recovery time..  

CONCLUSION: Isolated neurogenic blepharoptosis after medial orbital wall reconstruction is a rare but favorable disease that may result from ischemic damage at the end portion of the superior branch of the oculomotor nerve in the orbit.  

PATIENTS AND METHODS: We report 21 multiple sclerosis patients who presented unusual initial pictures (acute brachial pain n=4, headache n=6, ptosis n=1, oculomotor nerve palsy n=1, peripheral facial palsy n=1, throat pain n=1, hypoglossal nerve palsy n=1, visual field defect n=2, epilepsia n=2, and coma n=2) as the first manifestations in the absence of other obvious symptoms or signs.  

In cases with induced oculomotor nerve palsy, coils had been densely packed in the superolateral part of the anterior CS.  

Otherwise, oculomotor nerves affection is rare and might occur in about 10% of cases. In this case report we present 61 years old female with GBS (acute motor and sensory axonal neuropathy subtype) associated with bilateral oculomotor nerve palsy.  

oculomotor nerve paresis caused by internal carotid-posterior communicating artery (IC-PC) aneurysm usually manifests with pupillary dysfunction. Recently, we treated three patients with unruptured IC-PC aneurysms initially manifesting as pupil-sparing oculomotor nerve paresis, which resolved after clipping of the aneurysms. Review of the 56 patients admitted to our hospital with unruptured IC-PC aneurysms between January 2000 and December 2006 identified 6 patients with oculomotor nerve disturbances, and the 3 present cases with pupil sparing. The incidence of IC-PC aneurysms manifesting as pupil-sparing oculomotor nerve paresis may be increasing with improved accessibility to medical services and wider awareness of oculomotor nerve paresis as a symptom of cerebral aneurysms. Cerebral angiography should be performed in patients with pupil-sparing oculomotor nerve paresis..  

To report a case of aberrant regeneration followed by acute palsy of the oculomotor nerve caused by intracranial aneurysm. Acute palsy of the oculomotor nerve in the right eye was diagnosed and neurological examination was requested. The diagnosis of the aberrant regeneration of the oculomotor nerve after acute palsy was formulated based on anamnesis and ophthalmological follow-up tests..  

We report a 4-year-old boy who developed acute unilateral oculomotor nerve palsy following Norovirus infection. Physical examination showed only the left oculomotor nerve palsy.  

The operative procedures consisted of the following components; 1) fronto-temporal craniotomy with translocation of orbito-zygomatico-malar bone for PA, 2) preservation of lateral branches of the superficial sylvian veins, 3) resection of plica dural folds to increase the operative field up to the oculomotor nerve (OMN).  

RESULTS: The neurovascular relationships in the lateral wall of the cavernous sinus that are visible by the endonasal transsphenoidal approach but not visible by the transcranial microsurgical approach are as follows: between the oculomotor nerve and the tentorial artery, between the distal segment of the trochlear nerve and the tentorial artery, between the ophthalmic nerve and the inferolateral trunk, and between the abducens nerve and the inferolateral trunk. The neurovascular relationships visible by the transcranial microsurgical approach but not visible by the transsphenoidal endoscopic approach are as follows: between the oculomotor nerve and the superoproximal artery, when present, and between the proximal segment of the trochlear nerve and the superoproximal artery.  

Neuro-ophthalmic examination revealed a right oculomotor nerve palsy. The patient received intravenous steroid for 10 days with no recovery of the oculomotor nerve palsy. He underwent trans-sphenoid tumor resection followed by complete recovery of the oculomotor nerve and no sign of tumor in postoperative MRI, two weeks after the surgery..  

In placoderms, the first hinge-jawed fish, oculomotor nerve diameters remained constant, but nerve lengths were ten times longer than in the jawless osteostraci.  

The evolution consisted of paraneoplastic fever and crossed-syndrome with right hemiparesia and left common oculomotor nerve paralysis.  

In all patients the shrinkage of the neoplasm was accompanied by notable improvement of the preexistent oculomotor nerve palsy.  

Isolated traumatic oculomotor nerve palsy caused by minor head trauma is extremely rare. Constructive interference in steady-state magnetic resonance imaging demonstrated a slightly rough-shaped oculomotor nerve near the posterior petroclinoid ligament. Our case suggests that even minor head trauma can cause isolated oculomotor palsy, and that the posterior petroclinoid ligament is a candidate structure for causing oculomotor nerve palsy without intracranial hemorrhage and skull fracture..  

Next, opening of the roof of the CS was performed by incising the dura in the oculomotor trigone medial and parallel to the oculomotor nerve and lateral to ICA; the incision progressed posteriorly toward the dorsum sellae.  

At operation, a coil mass effect was noted and one coil penetrated the fibres of the right oculomotor nerve..  

BACKGROUND: Diplopia related to neurosurgical procedures is often consecutive to oculomotor nerve lesions.  

The final clinical outcome involved residual right hemiparesis and left oculomotor nerve (III) palsy.  

Although computed tomography indicated minor brain injury caused by retraction in three patients with ruptured aneurysm of the basilar artery bifurcation, no patients experienced new neurological deficits other than transient ipsilateral oculomotor nerve paresis.  

The trochlear and oculomotor nerves were cut, and their proximal stumps were labeled simultaneously with different retrograde fluorescent tracers.  

She presented with right abducent and oculomotor nerve paresis.  

For this purpose, we have studied age-dependent ultrastructural changes in the rat oculomotor nerve with electron microscopy and also demonstrated collagen structure of the neural sheaths with immunohistochemical techniques.  

The left oculomotor nerve was being pinched between the arteriosclerotic PCA and the SCA. Microvascular decompression was carried out, and the oculomotor nerve palsy improved. CONCLUSION: Arteriosclerotic PCA and SCA may compress the oculomotor nerve.  

We report an unusual case of partial oculomotor nerve palsy occurring after functional endoscopic sinus surgery, without anatomical disruption of the extra-ocular muscles.  

Two patients with primary oculomotor nerve palsy due to direct mild head injury are reported. Except for the persistent oculomotor nerve palsy, both the patients recovered fully within one week. Neither demonstrated a history that was suggestive of a cause for their oculomotor nerve palsy. As the underlying pathophysiologic mechanism underlying the oculomotor nerve palsy we suspected mild injury to the pupillomotor fibers at the anterior petroclinoidal ligament and that of the pupillary fibers at the posterior petroclinoidal ligament.  

In 3 patients, who achieved complete angiographic obliteration immediately, the left oculomotor nerve palsy remained unchanged after the operation.  

METHODS: The incomplete oculomotor palsy was followed clinically, and the precise anatomical relation of the aneurysm to the subarachnoid oculomotor nerve was investigated during clipping surgery for the aneurysm. Examination during clipping surgery showed that the aneurysm was located below the oculomotor nerve in the subarachnoid space about 6.5 mm from its exit from the midbrain. The differences in severity and resolution time of the palsies of the extraocular muscles suggested that the fibers destined for the superior levator and the superior rectus were concentrated on the caudomedial portion of the subarachnoid oculomotor nerve. CONCLUSIONS: The functional distribution of fibers within the subarachnoid oculomotor nerve about 6.5 mm from its exit from the midbrain succeeds to that of the intraparenchymal oculomotor nerve..  

Laterocaudal group in the vicinity of the tentorial margin: oculomotor nerve, posterior cerebral artery PCA with posterior communicating artery Pcom, medial posterior choroidal artery, A.  

Cranial MRI showed pathologic contrast enhancement of the right oculomotor nerve at its exit point from the mesencephalon, and the CSF displayed slight pleocytosis. Isolated neuritis of the oculomotor nerve is a rare parainfectious manifestation of infectious mononucleosis..  

All subjects undergoing MRI had normal intracranial oculomotor nerves (CN3).  

OBJECTIVE: To evaluate the surgical options in treating strabismus caused by different degrees of oculomotor nerve palsy. METHODS: Surgical procedures for 13 patients with unilateral oculomotor nerve palsy were retrospectively studied. Of five patients with total oculomotor nerve paralysis, three underwent transposition of the superior oblique tendon to the superior site of the medial rectus insertion. The other two patients, having total oculomotor nerve paralysis combined with trochlear nerve palsy, underwent fixation of the globe to the anterior lacrimal crest by half a tendon width of the medial rectus.  

On examining the patient the following manifestations were observed: compromise of the right common oculomotor nerve, up and down vertical gaze palsy, dysmetry of the right limbs and mild long tract signs in the left limbs. CONCLUSIONS: Cerebellar compromise ipsilateral to a lesion in the common oculomotor nerve in mesencephalic infarcts is a very uncommon clinical variant.  

The tumor most often implicated is a cavernous or parasellar meningioma, but any tumor that causes compression or disruption along the course of the oculomotor nerve may cause primary or secondary misdirection.  

The diameter of the oculomotor nerve (CN3) within the superior orbital fissure was measured as 2.10 mm on the right and 2.09 mm on the left.  

Whereas three of these patients had an uneventful postoperative course, the remaining patient experienced transient right oculomotor nerve palsy and left-sided motor weakness.  

The artery was dissected free of the nerve, and vascular decompression was achieved with complete resolution of the oculomotor nerve paresis.  

At the first visit, oculomotor nerve palsy with internal ophthalmoplegia was observed in his left eye. After 3 months, the oculomotor nerve palsy was completely resolved, except for the pseudo-Graefe sign. The Pseudo-Graefe sign observed in our case suggested the existence of recurrent oculomotor nerve palsy, which is an important indicator for ophthalmoplegic migraine..  

There was no infection, bleeding, further vision impairment, oculomotor nerve injury or other cranial nerve injury symptom owing to surgery.  

They noted improvement in all preoperative symptoms, except for bilateral oculomotor nerve paralysis in one individual, and were asymptomatic to ophthalmological examination.  

In most cases, ocular neuromyotonia follows months or years after radiotherapy to the sellar and parasellar region and involves the oculomotor nerve.  

A 51-year-old woman presented with a parasellar mass causing decreased visual acuity, oculomotor nerve paresis and retro-orbital headaches without endocrinological dysfunction.  

Isolated oculomotor nerve palsy is uncommon as an initial presentation of malignant tumors of the sphenoid sinus. Neurological examination revealed complete left oculomotor nerve palsy. Following six cycles of chemotherapy, the left oculomotor nerve palsy that had been previously observed was completely resolved. CONCLUSION: It is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, although it is extremely rare.  

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..  

There was no impairment of oculomotor nerve function.  

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. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted.  

Initial digital subtraction angiography did not reveal the CS dural AVF, which appeared simultaneously with the enlargement of the meningioma and lead to right oculomotor nerve paresis.  

The main postoperative complications included oculomotor nerve paralysis, abducent nerve palsy, and trigeminal nerve damages.  

Contrast-enhanced magnetic resonance imaging performed during symptomatic and postsymptomatic periods in patients with ophthalmoplegic migraine may hold great value in identifying the pathophysiologic features of oculomotor nerve palsies. Complete resolution of enhancement of the oculomotor nerve on repeat imaging adds to the few cases that have shown such findings in patients with recurrent ophthalmoplegic migraine.  

Its clinical presentation more often includes rapid development of impaired consciousness, severe headache, visual disturbance and variable association of oculomotor nerve palsy.  

We assessed the close proximity of this ligament to the oculomotor nerve.  

We describe a patient with ophthalmoplegic migraine and internal ophthalmoplegia with alternating unilateral involvement and bilateral involvement in whom brain MRI scan showed alternating gadolinium enhancement on the cisternal portion of the oculomotor nerve..  

We demonstrate that the characteristics of the headaches were identical to usual migraine without oculomotor nerve palsy for each case.  

They can sometimes objectify an inflammatory process of the cavernous sinus in Tolosa-Hunt syndrome or a reversible enhancement and thickening of the cisternal segment of the oculomotor nerve during an ophthalmoplegic migraine.  

In 19 of 21 aneurysms, it provided the following additional information to the findings of 3D DSA, MR images or both: the passing course in the brain tissues of perforating arteries near or originating from an aneurysm, and/or the spatial relationship between an aneurysm and an oculomotor nerve.  

We report an NMC affecting the oculomotor nerve. Magnetic resonance imaging scans demonstrated a small nodular lesion on the left oculomotor nerve, similar to the findings for a schwannoma. INTERVENTION: The tumor was resected with the parental oculomotor nerve, which was reconstructed using a peroneal nerve graft.  

A quantitative MRI technique was developed to study the oculomotor nerve (CN3) and applied to congenital fibrosis of extraocular muscles (CFEOM) and congenital oculomotor palsy.  

Our model predictions are validated by comparing spread of predicted activation to observed effects of oculomotor nerve stimulation in a PD patient.  

The investigators assessed clinical features of oculomotor nerve dysfunction and focal head pain.  

CASE DESCRIPTION: We report the case of a 34-year-old woman presenting with a right oculomotor nerve palsy. A right pterional approach was undertaken, and the roof of the CS was opened just above the oculomotor nerve toward the superior orbital fissure.  

Lateral rectus (LR) muscles were structurally abnormal in seven subjects, with structural and motility evidence of oculomotor nerve (CN3) innervation from vertical rectus EOMs leading to A or V patterns of strabismus in three cases.  

We used high-resolution magnetic resonance imaging (hrMRI) of the oculomotor nerve and affected extraocular muscles (EOMs) to investigate oculomotor palsy. In the orbit and along the intracranial oculomotor nerve, hrMRI at 1- to 2-mm thickness was performed. Structural abnormalities of the oculomotor nerve and associated changes in EOM volume and contractility were evaluated. hrMRI demonstrated the oculomotor nerve at the midbrain and at EOMs in all cases, and in two cases with previous normal neuroimaging elsewhere that demonstrated contrast-enhancing tumors on the oculomotor nerve. One patient with apparently unilateral congenital inferior division oculomotor palsy had no detectable ipsilateral and a hypoplastic contralateral oculomotor nerve exiting the midbrain. CONCLUSIONS: hrMRI provides valuable information in patients with oculomotor palsy, such as structural abnormalities of the orbit and oculomotor nerve, and atrophy and diminished contractility of innervated EOMs.  

The ocular motor nerves were stimulated with a monopolar electrode intracranially, and the polarity of the waves was recorded using surface electrodes placed around the eyeball, yielding precise information concerning the locations of the oculomotor nerve and/or abducent nerve.  

The course of the oculomotor nerve on the clivus was abnormal in a patient with petroclival meningioma. Normally, the oculomotor nerve originates from the brainstem and enters the oculomotor trigone. In this patient, the oculomotor nerve entered the dura mater at the upper clivus, behind the posterior clinoid process, and coursed parallel to the basilar artery. This entrance is lower than the normal entry point of the oculomotor nerve. The abnormal entrance of the oculomotor nerve may reflect an atypical developmental relationship among the cranial nerves, meninges, and bones during embryogenesis..  

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