A surprising cause of isolated oculomotor nerve palsy with pupillomotor palsy

Mahale, Rohan; Mehta, Anish; Shankar, Abhinandan K; Buddaraju, Kiran; Srinivasa, Rangasetty

doi:10.4103/0972-2327.173300

Cited by 5 publications

(5 citation statements)

References 4 publications

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Section: Discussionmentioning

confidence: 99%

“…7 Single cases of third cranial nerve palsy are reported by carotid cavernous sinus fistula, zoster, carcinomatous or criptococcal meningitis, ophthalmoplegic migraine, cavernous sinus thrombosis, chronic subdural hematoma, and viral infection. [7][8][9] Intracranial aneurysms are particularly concerning because of the risk of subarachnoid hemorrhage upon carrying substantial morbidity and mortality. 7 Blepharoptosis due to oculomotor nerve palsy can be related to unruptured intracranial aneurysm in the intracavernous/supraclinoid tract of the internal carotid artery or posterior communicating artery, with a risk as high as 34%-56%.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Telltale Botox: Botulinum Toxin Injection by an Expert Hand as an Intracranial Aneurysm Detector

Caddia,

Jaber,

Granata

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Summary: Complications in aesthetic medicine can be considered a consequence of the inexperience of the performing physician, but in some cases, they can unveil far more serious conditions, hitherto silent. We present a case of a 48-year-old patient who, following botulinum toxin type A (Botox) injection for treatment of forehead wrinkles, returned to our attention 12 days later for a discrete, newly onset right eyelid ptosis. This ptosis was a telltale sign of the presence of an intracranial aneurysm closely related with the oculomotor nerve. The lack of compensatory action by the frontalis muscle in maintaining the eyelid in position allowed us to highlight the extrinsic compression deficit of the oculomotor nerve. Subsequently, the patient underwent endovascular treatment of the aneurysm, leading to complete resolution of the case.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Telltale Botox: Botulinum Toxin Injection by an Expert Hand as an Intracranial Aneurysm Detector

Caddia,

Jaber,

Granata

et al. 2023

Plastic and Reconstructive Surgery - Global Open

View full text Add to dashboard Cite

show abstract

“…The important causes of third nerve palsy are posterior communicating artery aneurysm, stroke, diabetes mellitus, vasculitis, tumors, meningitis, and trauma [3][4][5][6][7]. If the underlying pathology is microvascular ischemia as in diabetes and vasculitis, the pupillary function is generally not affected because the autonomic parasympathetic fibers that cause pupillary constriction are located on the periphery of the cross-section of the nerve.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Complete Oculomotor Palsy in Tubercular Meningitis

Gaba

Gupta

Lamba

et al. 2020

Cureus

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A 20-year-old female presented to the emergency department with fever, anorexia, headache, and neck stiffness for two weeks with recent onset of diplopia and ptosis. She was found to have bilateral symmetrical and complete oculomotor palsy. The diagnosis of tubercular meningitis (TBM) was established on magnetic resonance imaging of the brain and cerebrospinal fluid examination. The oculomotor palsy was attributed to tubercular exudates along the ventral surface of midbrain. Although cranial nerves palsies are common in TBM, such a pattern is rarely seen and has been reported only in the context of tuberculoma in midbrain. She was treated with anti-tubercular therapy for nine months, but there was only partial recovery of the oculomotor function.

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“…However, there are no associated findings on the CT chest, and the absence of symptoms and signs of other organ system involvement go against these etiologies. Viral, bacterial, and fungal infections have been reported with third nerve palsy [11][12][13]. Recurrent self-resolving episodes, absence of infectious focus anywhere in the body, and negative CSF culture suggest otherwise.…”

Section: Metabolicmentioning

confidence: 99%