Isolated unilateral IIIrd nerve palsy as the only sign of chronic subdural haematoma

Mishra, Avinash; Shukla, Siddharth; Baranwal, Vinod Kumar; Patra, Vikram; Chaudhary, Bhanu

doi:10.1016/j.mjafi.2013.07.009

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…ischaemic lesions. 6 Traumatic ONP is mostly seen in severe head injuries along with associated skull or cervical spine fractures and intracranial injuries. 7 When faced with such a case initially all other additional injuries should be ruled out by a thorough clinical/neurological examination, followed by urgent imaging (CT scan, MRI).…”

Section: Discussionmentioning

confidence: 99%

Isolated unilateral oculomotor nerve palsy following a mild head injury

Mishra¹,

Aggarwal²,

Vichare

et al. 2015

Medical Journal Armed Forces India

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Section: Discussionmentioning

confidence: 99%

Isolated unilateral oculomotor nerve palsy following a mild head injury

Mishra¹,

Aggarwal²,

Vichare

et al. 2015

Medical Journal Armed Forces India

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“…Also, in reviewing the literature, several reports of similar cases with isolated FDP had a prior history of microvascular disease (e.g., due to diabetes mellitus) or nerve injury (e.g., prior herpes zoster ophthalmicus), potentially predisposing the patient to OMN injury. [17][18][19][20][21][22][23][24][25][26] Our patient also had diabetes mellitus type II, and chronic microangiopathic changes might have contributed to the early development of an OMN palsy. NPi changes without altered consciousness among patients with traumatic brain injury have been described in the context of other mechanisms.…”

Section: Discussionmentioning

confidence: 99%

Fixed, Dilated, and Conversing—Unreactive Pupil With Preserved Consciousness Indicating Acutely Rising Intracranial Pressure due to Traumatic Intraparenchymal Contusions: Case Report and Review of the Literature

McAvoy

Lee

Boop

et al. 2021

The Neurohospitalist

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Patients with fixed and dilated pupils (FDPs) due to rising intracranial pressure (ICP) typically experience a deterioration in consciousness. We describe an exceptional case of a patient with bifrontal contusions who developed worsening edema and a unilaterally FDP while maintaining consciousness and the ability to communicate. A 58-year-old man with history of hypertension and diabetes mellitus type II presented after being assaulted, with bifrontal contusions and right frontal intraparenchymal hemorrhage. On hospital day 8, his right pupil became fixed (NPi 0) and dilated (4.8 mm). The patient was drowsy, arousable to tactile stimuli, answering questions, oriented to place and time, following commands on his right side, maintaining Glasgow Coma Scale of 14 (E4, V5, M6). He described complete loss of vision and could not identify objects or count fingers. His gaze was dysconjugate with impaired vertical excursion and inability to fully abduct to the right side. Corneal reflexes were intact bilaterally. Hypertonic saline and mannitol produced no improvement in his pupillary exam. Head computed tomography showed worsening midline shift and interval increase in subfalcine herniation related to increased peri-hematoma edema. We performed an emergent right-sided decompressive hemicraniectomy with durotomy and duraplasty. His pupil became reactive 5 hours after surgery. While FDP without deterioration of consciousness has been described due to traumatic subdural and epidural hematomas, we report this unusual constellation as a sign of rising ICP and impeding herniation due to intraparenchymal contusions, highlighting that any pupillary change warrants prompt work-up and intervention.

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Spontaneous chronic subdural hematoma as the cause of oculomotor cranial nerve palsy: A narrative review

Pellegrini

Interlandi²,

Cuna³

et al. 2022

Brain Circ

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Acute complete third nerve palsy with pupillary involvement is usually caused by a posterior communicating artery aneurysm (i.e. “the rule of the pupil”). The pupillary fibers run peripherally in the third nerve and are thus susceptible to the external compression. Headache is usually present, and urgent diagnosis and treatment are warranted. Rarely, however, neuroimaging shows other causes of third nerve palsy. In this study, we perform a literature review of spontaneous chronic subdural hematoma that, although rarely, may cause an acute pupil-involving third nerve palsy as a false localizing sign. We review the localizing, nonlocalizing, and false localizing nature of ocular motor cranial nerve palsy in this setting.

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Isolated unilateral IIIrd nerve palsy as the only sign of chronic subdural haematoma

Cited by 3 publications

References 9 publications

Isolated unilateral oculomotor nerve palsy following a mild head injury

Isolated unilateral oculomotor nerve palsy following a mild head injury

Fixed, Dilated, and Conversing—Unreactive Pupil With Preserved Consciousness Indicating Acutely Rising Intracranial Pressure due to Traumatic Intraparenchymal Contusions: Case Report and Review of the Literature

Spontaneous chronic subdural hematoma as the cause of oculomotor cranial nerve palsy: A narrative review

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