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Oculomotor Nerve Paralysis

Damage of the eye movement nerve of nerve of oculomotor lesion; III. cranial nerve paralysis; Okulomotoriusparese


Presentation

  • We present a case of bilateral oculomotor nerve paralysis induced by alpha II-interferon in a patient with hairy-cell leukemia. After the drug was withdrawn, the neurological abnormalities disappeared.[ncbi.nlm.nih.gov]
  • We present the MRI findings in isolated oculomotor nerve involvement by Lyme disease and discuss the differential diagnosis.[ncbi.nlm.nih.gov]
  • Lower cranial nerve involvement, leading to respiratory, swallowing, and cardiac difficulties, was also present. Pathologic examination of the brainstem showed absent or hypoplastic third, seventh, tenth, and twelfth nerve nuclei.[ncbi.nlm.nih.gov]
  • In this article, we present the case of a 9-year-old girl who developed unilateral nerve paralysis as a secondary complication of neurobrucellosis and recovered without sequel after treatment.[ncbi.nlm.nih.gov]
  • Sphenoid sinus mucocoele presenting with isolated oculomotor nerve palsy. J Laryngol Otol. 1997 5;111(5):471–473. PMID: 9205613. 10. Lin CJ, Kao CH, Kang BH, Wang HW. Frontal sinus mucocele presenting as oculomotor nerve palsy.[e-ceo.org]
Diplopia
  • Diplopia may be a complication after refractive surgery. Ocular lesions, including diplopia, can be amongst the presenting features of Creutzfeldt-Jakob disease (CJD), especially new variant CJD [ 4 ].[patient.info]
  • Prism spectacles may relieve diplopia for some patients.[aapos.org]
  • […] not appreciate diplopia when overcorrect until 50Δ BI 8. 4.[slideshare.net]
  • A 53-year-old man presented to the emergency department with diplopia, left-sided ptosis, unsteady gait, headache, and left eye pain that had persisted for four days.[aafp.org]
  • Sudden onset of diplopia, divergent squint, ptosis and dilated pupil may herald Subarachnoid Haemorrhage (SAH) and death When an adult complains of recent onset diplopia think of a 3rd nerve palsy where the eyes diverge 6th nerve palsy where the eyes[eyes.gp-surgery.com]
Strabismus
  • Paralytic strabismus poses a significant diagnostic and therapeutic challenge. [1] The prevalence of paralytic strabismus is variable in different studies.[jovr.org]
  • […] due to nerve palsy ( H49.0 - H49.2 ) Strabismus (congenital) (nonparalytic) H50.9 ICD-10-CM Diagnosis Code H50.9 Unspecified strabismus 2016 2017 2018 2019 Billable/Specific Code paralytic H49.9 ICD-10-CM Diagnosis Code H49.9 Unspecified paralytic strabismus[icd10data.com]
  • J Pediatr Ophthalmol Strabismus . 1991;28:10–13. Salazar-León JA, Ramírez-Ortíz MA, Salas-Vargas M. The surgical correction of paralytic strabismus using fascia lata. J Pediatr Ophthalmol Strabismus . 1998;35:27–32.[healio.com]
  • Two common ones are Strabismus - a disorder in which the two eyes don't line up in the same direction. This results in "crossed eyes" or "walleye."[icdlist.com]
  • The limitations of eye movements resulting from the condition are generally so severe that the affected individual is unable to maintain normal alignment of their eyes when looking straight ahead, leading to strabismus and, as a consequence, double vision[en.wikipedia.org]
Blepharoptosis
  • Equal size pupils without blepharoptosis (top) in the interval between attacks of left-sided blepharoptosis, and maximally enlarged pupil during an attack (bottom, arrow) (with written permission of the patient).[frontiersin.org]
  • Keywords : Blepharoptosis ; Mucocele ; Oculomotor nerve INTRODUCTION A mucocele is a slowly progressing benign lesion caused by the retention of mucous secretions and expansion due to the continuous obstruction of the orifice of the sinus or a minor salivary[e-ceo.org]
  • Generally, patients present with blepharoptosis, limitation in eye movements accompanied by strabismus and a dilated pupil reacting to light. [9] Most reports have stated ischemia as the most common cause of the oculomotor nerve paralysis. [4] , [5] Although[jovr.org]
Unilateral Ptosis
  • A few key points once more: The oculomotor palsy is characterized by unilateral ptosis and an eye that is down and out. Pupil dilation suggests compression, possibly by berry aneurysm.[eyes.gp-surgery.com]
  • Thus, unilateral ptosis indicates that only the brainstem fascicles were affected.[frontiersin.org]
  • A patient with acute CN III palsy usually presents with a sudden onset of unilateral ptosis and ophthalmoplegia, which is frequently accompanied by significant eye or head pain––depending on the underlying cause. 1-4 Such patients often complain of double[reviewofoptometry.com]
Pupillary Abnormality
  • Therefore, while almost all forms ('medical third' and 'surgical third') cause ptosis and impaired movement of the eye, pupillary abnormalities are more commonly associated with trauma and the 'surgical third' than with ischemia, ie the 'medical third[en.wikipedia.org]
  • For more details about oculomotor nerve lesions and drugs affecting pupillary size, see the learning card pupillary abnormalities.[amboss.com]
Withdrawn
  • After the drug was withdrawn, the neurological abnormalities disappeared. The more frequent neurological psychiatric, and electroencephalographic side effects are reviewed.[ncbi.nlm.nih.gov]
Cranial Nerve Involvement
  • Lower cranial nerve involvement, leading to respiratory, swallowing, and cardiac difficulties, was also present. Pathologic examination of the brainstem showed absent or hypoplastic third, seventh, tenth, and twelfth nerve nuclei.[ncbi.nlm.nih.gov]
  • Neurobrucellosis affects the second, third, sixth, seventh, and eighth cranial nerves. Involvement of the oculomotor nerves is a very rare complication in neurobrucellosis although several adult cases have been reported.[ncbi.nlm.nih.gov]
Radiculopathy
  • Neurobrucellosis is most frequently observed with meningitis and has numerous complications, including meningocephalitis, myelitis, cranial nerve paralyses, radiculopathy, and neuropathy.[ncbi.nlm.nih.gov]

Workup

  • Nevertheless, basic workup must be done.[eyewiki.aao.org]
  • Antibody—negative Toxoplasma PCR—negative Varicella Zoster PCR—negative Urine Studies Histoplasma Antigen Assay—negative Imaging Studies MRI brain with contrast, MRA head with contrast CT chest/abdomen/pelvis with contrast Transesophageal Ultrasound The workup[eyerounds.org]

Treatment

  • In this article, we present the case of a 9-year-old girl who developed unilateral nerve paralysis as a secondary complication of neurobrucellosis and recovered without sequel after treatment.[ncbi.nlm.nih.gov]
  • Helps you make optimal use of the newest drug therapies, including Anti-VEGF treatment for wet ARMD and bevacizumab treatment for complications of diabetes.[books.google.com]
  • Clinical characteristics of primary paranasal sinus mucoceles and their surgical treatment outcome. Korean J Otolaryngol-Head Neck Surg. 1998 11;41(11):1436–1439. 7. Friedmann G, Harrison S.[e-ceo.org]
  • Compressive lesions (eg, aneurysm or tumor) that are treated endovascularly or surgically may also improve or resolve following treatment.[emedicine.com]
  • Medical intervention was conducted following the Optic Neuritis Treatment Trial (ONTT) guidelines.[ingentaconnect.com]

Prognosis

  • Prognosis The prognosis of an oculomotor palsy depends on the etiology. Posttraumatic, postinfectious, postinflammatory, and ischemic oculomotor palsies may partially or completely recover spontaneously.[emedicine.com]
  • Causes and prognosis in 4278 cases of paralysis of the oculomotor, trochlear, and adbucens cranial nerves. Am J Ophthalmol . 1992;113:489–496. PubMed Google Scholar 9. Rush JA, Younge BR. Paralysis of cranial nerves III, IV. and VI.[link.springer.com]
  • Risk Factors and prognosis of isolated ischemic third, fourth, or sixth cranial nerve palsies in the Korean population. J Neuroophthalmol 2015;35:37–40. 13. Gross G, Schöfer H, Wassilew S, et al.[synapse.koreamed.org]
  • Prognosis is good. Many people get better over 3 to 6 months. However, some people have permanent eye muscle weakness.[medlineplus.gov]
  • Prognosis : guarded. Pathogenesis Etiology Inflammatory diseases, eg distemper Canine distemper disease, granulomatous meningoencephalitis Granulomatous meningoencephalomyelitis. Space occupying lesions, eg neoplasia Brain: neoplasia.[vetstream.com]

Etiology

  • No ophthalmological or neurological etiologies were apparent. A mucocele of the right posterior ethmoid sinus was observed with radiology.[e-ceo.org]
  • Etiology Clinical features Extorsion of the eye : inability to depress and adduct the eyeball simultaneously (the pupil shoots upward during attempted adduction of the eyeball) Diplopia ( double vision ) Mild esotropia Trigeminal nerve lesion (V) Etiology[amboss.com]
  • The most common known etiology is a posterior communicating artery aneurysm. This is a medical emergency.[eyewiki.aao.org]
  • Epidemiology Frequency United States Oculomotor nerve palsy is uncommon, and its frequency varies depending on the etiology.[emedicine.com]
  • etiology of third nerve palsy (50%) followed by congenital causes (30.8%).[jovr.org]

Epidemiology

  • This study was performed to determine epidemiologic and etiologic distribution and results of strabismus surgery in patients with third nerve palsy referred to our clinic as a tertiary center over a 10-year period.[jovr.org]
  • Epidemiology Frequency United States Oculomotor nerve palsy is uncommon, and its frequency varies depending on the etiology.[emedicine.com]
  • Diagnosis: Third Nerve Palsy with Contralateral Hemiplegia Secondary to Midbrain Fungal Abscess Epidemiology of a midbrain fungal abscess Immunocompromised Individuals Use of chronic immunomodulators Stem cell transplant Solid organ transplant Leukemia[eyerounds.org]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of nerve palsy in the orbit caused by mucoceles is not well-known.[e-ceo.org]
  • Pathophysiology Anatomy and function The oculomotor nerve serves two functions: Movement of the eye. Pupillary constriction. These functions are controlled by differing nuclear areas.[vetstream.com]
  • In some cases, the precise site of the lesion is clear, whereas in others, the location of the lesion is speculative. [1] Pathophysiology To understand the pathophysiology of the oculomotor nerve palsy it is essential to know its track.[eyewiki.aao.org]
  • Pathophysiology The anatomical relationship of the various portions of the oculomotor (third) cranial nerve accounts for many of the clinical features of third cranial nerve palsy as outlined below.[emedicine.com]
  • Multiple sclerosis: current pathophysiological concepts. Lab Invest 2001 ; 81 : 263 –281 Poser CM. The peripheral nervous system in multiple sclerosis: a review and pathogenetic hypothesis. J Neurol Sci 1987 ; 79 : 83 –90 Waxman SG.[ajnr.org]

Prevention

  • Echothiophate, by preventing acetylcholine hydrolysis, may have allowed this transmitter to accumulate and to produce miosis.[ncbi.nlm.nih.gov]
  • To further clarify, classically a posterior communicating artery aneurysm will cause compression of the entire third nerve and so prevent ANY nerve signal conduction thus affecting the somatic system and also the autonomic.[en.wikipedia.org]
  • Non-surgical treatments: patching in visually immature children to prevent amblyopia occlusion or prisms to relieve diplopia in visually mature individual (especially during the observation period) botulinum toxin injection of the antagonist muscle(s)[www2.medicine.mcgill.ca]
  • Prevention of ocular complications of herpes zoster ophthalmicus by adequate treatment with acyclovir. Klin Monbl Augenheilkd 1991;198:358–360. 12. Jung JS, Kim DH.[synapse.koreamed.org]
  • The principles of treatment are to resect the cyst, including the sinus mucosa, completely to prevent recurrence and to secure the orifice of the nasal sinus. Either an extranasal or an intranasal approach may be used.[e-ceo.org]

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