Isolated Inferior Rectus Muscle Palsy From a Solitary Metastasis to the Oculomotor Nucleus

Pusateri, Thomas J.; Sedwick, Lyn A.; Margo, Curtis E.

doi:10.1001/archopht.1987.01060050093045

Cited by 39 publications

(7 citation statements)

References 7 publications

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“…A unilateral 3rd nerve nucleus lesion would involve both, the superior rectus motoneurons, which project to the contralateral superior rectus muscle, and crossed axons from the contralateral superior rectus subnucleus, which project to the superior rectus muscle on the side of the lesion [100, 102, 103, 104, 105, 108, 109, 110, 111, 112]. Clinical signs of a 3rd nerve palsy as the sole manifestation of an MRI-documented 3rd nerve nucleus lesion are uncommon [16, 113, 114]. …”

Section: Anatomical Considerationssupporting

confidence: 39%

Cerebrovascular Brainstem Diseases with Isolated Cranial Nerve Palsies

Thömke¹,

Gutmann²,

Stoeter³

et al. 2002

Cerebrovasc Dis

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There is a significant number of individual patients with cranial nerve palsies as the sole manifestation of MRI- and, less frequently, CT-documented small brainstem infarctions or hemorrhages. The 3rd and 6th nerves are most commonly involved and, less frequently, the 4th, 5th, 7th, and 8th nerves. An intra-axial basis for such lesions may be underestimated if the diagnosis is based solely on MRI. The electrophysiologic abnormalities indicating brainstem lesions may be independent of MRI-documented morphological lesions. This paper reviews the literature on cerebrovascular brainstem diseases manifesting as isolated cranial nerve palsies. It supports the concept that small pontine and mesencephalic infarctions are the main cause of non-traumatic cranial nerve palsies in the middle-aged and elderly population. Microvascular infarction of the respective extra-axial cranial nerve segments seem to be less important.

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Section: Anatomical Considerationssupporting

confidence: 39%

Cerebrovascular Brainstem Diseases with Isolated Cranial Nerve Palsies

Thömke¹,

Gutmann²,

Stoeter³

et al. 2002

Cerebrovasc Dis

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“…29 -32 It is not clear whether the responsible lesion in these cases is in the fascicles or nucleus. Recently, Pusateri et al 32 described a patient with isolated inferior rectus paresis in whom MRI findings correlated with the autopsy findings of metastasis on the third nerve nucleus. According to Warwick's scheme, 33 the inferior rectus subnucleus is isolated from other subnuclei at the most rostral part of the oculomotor complex.…”

Section: Discussionmentioning

confidence: 45%

Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke.

Kim

Kang

Lee

et al. 1993

Stroke

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Background and Purpose: There have been few reports of strokes producing isolated or predominant ocular motor nerve palsies as a clinical manifestation.Methods: We studied seven patients with brain stem stroke who had ocular motor palsies as the only or the predominant neurological manifestation, and we correlated their clinical features with radiological findings.Results: Five patients had small strokes in the area of oculomotor nuclei or fascicles and showed various combinations of oculomotor disturbances. Three of these patients showed vertical gaze paresis of the opposite eye. One patient with a small hemorrhage near the aqueduct of Sylvius showed fourth nerve palsy on the contralateral side, and a patient with a small infarct in the pontine tegmentum showed isolated sixth nerve palsy. Nonocular minor neurological signs included trigeminal sensory changes in four patients and clumsy arm in two. Ocular and nonocular dysfunctions generally improved within several months. Radiological findings of the brain stem correlated well with the ocular signs.Conclusions: We conclude that acute brain stem stroke should be included in the differential diagnosis of isolated ocular motor nerve palsies and that appropriate diagnostic investigations should be performed in these cases.

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“…Inferior rectus palsy can occur as an isolated acquired phenomenon, possibly related to a vascular insult to the third nerve nucleus or, rarely, from a brainstem tumour (Pusateri et al 1987). The differential diagnosis in an acquired palsy includes myasthenia gravis, skew deviation and mechanical limitation.…”

Section: Inferior Rectus Musclementioning

confidence: 99%

Neurogenic Palsies

2013

Diagnosis and Management of Ocular Motility Disorders

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Isolated Inferior Rectus Muscle Palsy From a Solitary Metastasis to the Oculomotor Nucleus

Cited by 39 publications

References 7 publications

Cerebrovascular Brainstem Diseases with Isolated Cranial Nerve Palsies

Cerebrovascular Brainstem Diseases with Isolated Cranial Nerve Palsies

Isolated or predominant ocular motor nerve palsy as a manifestation of brain stem stroke.

Neurogenic Palsies

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