Diabetic Oculomotor Nerve Palsy Displaying Enhancement of the Oculomotor Nerve in the Orbit and Cavernous Sinus on MRI

Abstract

<b><i>Introduction:</i></b> Imaging data were scarce on diabetic oculomotor nerve palsy (ONP). Our study explored the MRI features and their clinical implications for diabetic ONP. <b><i>Methods:</i></b> Fifty-nine patients with a clinical diagnosis of diabetic ONP were recruited from our department between January 2015 and December 2019. Orbital MRI was retrospectively analyzed, and follow-up scans were obtained for 5 patients. Based on the ocular motor nerve palsy scale, the difference in the scores on the first and last hospital days was defined as the improvement score and was used to assess the treatment effects in all. <b><i>Results:</i></b> Thirty-eight (64.41%) patients presented thickening and enhancement of the cavernous segment and inferior division of the intraorbital segment of the ipsilateral oculomotor nerve, with the cisternal segment spared in all. After complete resolution of symptoms, follow-up MRI in 5 patients revealed that the enhancement was less obvious compared with the previous images. 6 patients in the enhancement group and 4 patients in the nonenhancement group were treated with 80 mg of methylprednisolone. Significant differences were not detected in the median improvement scores between patients with and those without corticosteroid use (<i>p</i> = 0.240). <b><i>Conclusion:</i></b> Thickening and enhancement of the unilateral oculomotor nerve were common imaging findings in diabetic ONP, and they persisted after complete resolution of symptoms in some patients. The cavernous segment and the inferior division of the intraorbital segment were simultaneously involved, and the cisternal segment was often spared. Refraining from corticosteroids was recommended even with nerve enhancement.

Cerebral small vessel disease as imaging biomarker predicting ocular cranial nerve palsy of presumed ischemic origin at admission

“…Currently, only a few studies have reported findings suggestive of OCNPi. One study group showed enhancement of the third cranial nerve on thin-section MRI but did not confirm the same findings of the fourth or sixth cranial nerves, and further validation is needed 18 , 19 . WMH was associated with OCNPi regardless of the cranial nerve involved in this study.…”

Ocular Manifestations of Diabetes: A Cross-Sectional Study

“…39 (2): 149-153 (most common). 7 Conjunctival diseases include tortuous vessels, pingueculae and pterygia. 8 Lesions involving cornea (diabetic keratopathy) include reduced corneal sensitivity characterized by the progressive loss of nerve fibers (leading to reduced blink rate, tear film instability and dry eye), recurrent corneal erosions, superficial punctate keratitis, delayed epithelial healing.…”

Automatic oculomotor nerve identification based on data‐driven fiber clustering

“…OCN can be affected by many diseases, such as external brain injury (Nakagawa, Toda, Shibao, & Yoshida, 2017), congenital OCN palsy (Yang, Kim, & Hwang, 2020), and brain tumors (Inoue, Hashiguchi, Moroki, & Tokuda, 2020; Li et al, 2018; Taniguchi et al, 2018). Research (Tam, Lonngi, & Demer, 2018; Zhao, Li, Chang, Wang, & Sun, 2021) suggested that identifying the location of OCN is important in guiding diseases that involve the OCN.…”

“…Research (Tam, Lonngi, & Demer, 2018;Zhao, Li, Chang, Wang, & Sun, 2021) suggested that identifying the location of OCN is important in guiding diseases that involve the OCN.…”