Acute Oculomotor Nerve Palsy Caused by Compression from an Aberrant Posterior Communicating Artery

Haider, Ali S; Gottlich, Caleb; Sumdani, Hasan; Layton, Kennith F.; Doughty, Kyle

doi:10.7759/cureus.3920

Cited by 11 publications

(13 citation statements)

References 8 publications

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“…A study conducted by Krayenbuhl et al [ 14 ] suggested that in about 55% of elderly patients, the PCA was a “curve” that generally develop to tortuosity and dilation, which easily leads to neurovascular conflict. Secondly, the ON originates from the midbrain and traverses between the PCA and the SCA, then runs parallelly to the PcomA[ 15 ]. So, the ON often contacts the medial trunk of the PCA when it travels to the interpeduncular fossa, while the SCA spreads out beneath the oculomotor nerve and has little contact with the nerve[ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review

Zhang¹,

Wei²,

Wang³

et al. 2022

WJCC

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BACKGROUND Aneurysm compression, diabetes, and traumatic brain injury are well-known causative factors of oculomotor nerve palsy (ONP), while cases of ONP induced by neurovascular conflicts have rarely been reported in the medical community. Here, we report a typical case of ONP caused by right posterior cerebral artery (PCA) compression to increase neurosurgeons’ awareness of the disease and reduce misdiagnosis and recurrence. CASE SUMMARY A 54-year-old man without a known medical history presented with right ONP for the past 5 years. The patient presented to the hospital with right ptosis, diplopia, anisocoria (rt 5 mm, lt 2.5 mm), loss of duction in all directions, abduction, and light impaired pupillary reflexes. Magnetic resonance angiography and computed tomography venography examinations showed no phlebangioma, aneurysm, or intracranial lesion. After conducting oral glucose tolerance and prostigmin tests, diabetes and myasthenia gravis were excluded. Cranial nerve magnetic resonance imaging showed that the right PCA loop was in direct contact with the cisternal segment of the right oculomotor nerve (ON). Microvascular decompression (MVD) of the culprit vessel from the ON through a right subtemporal craniotomy was carried out, and the ONP symptoms were significantly relieved after 3 mo. CONCLUSION Vascular compression of the ON is a rare pathogeny of ONP that may be refractory to drug therapy and ophthalmic strabismus surgery. MVD is an effective treatment for ONP induced by neurovascular compression.

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Section: Discussionmentioning

confidence: 99%

Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review

Zhang¹,

Wei²,

Wang³

et al. 2022

WJCC

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“…PCA aneurysms are the most common types of aneurysms to form in the basal cistern and frequently involves in isolated OMNP due to their anatomical location. 14,15 The oculomotor nerve originates from the midbrain on the medial side of the cerebral peduncles and extends forward and laterally between the posterior cerebral artery and superior cerebellar artery. 15 Our patients presented with OMNP as result of compression by an aneurysm at the bifurcation of PCA.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from the intraocular muscular involvement during OMNP, pupillary involvement is also higher suspicion of compression because the pupillomotor fibers and their vascular component originates from overlying pia course along the superficial as well as superomedial aspect of the oculomotor nerve. 14,16 Also, trauma, stroke, post-surgical inflammation, neoplasms as well as microvascular damage from chronic disease have been implicated as cause of OMNP. 14,17 Our patient condition was initially misdiagnosed as an acute cerebral infarction and treated with aspirin, clopidogrel, fluvastatin and mecobalamin with no improvement.…”

Section: Discussionmentioning

confidence: 99%

“…14,16 Also, trauma, stroke, post-surgical inflammation, neoplasms as well as microvascular damage from chronic disease have been implicated as cause of OMNP. 14,17 Our patient condition was initially misdiagnosed as an acute cerebral infarction and treated with aspirin, clopidogrel, fluvastatin and mecobalamin with no improvement. We utilized CTA to detect the aneurysm between the C4 segment of the left ICA and the bifurcation of the left PCA.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report

Zhou

Richard

Yin-sheng

et al. 2021

Veins and Lymphatics

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Contrast-induced encephalopathy (CIEP) is a rare complication after endovascular therapy. The etiology of CIEP is still a matter of debate. We present a rare occurrence of CIEP in a known hypertensive and type 2 diabetic patient after endovascular coiling of cerebral aneurysm with oculomotor nerve palsy. A 68-year old female presented with seven days history of headache and left ptosis or blepharoptosis with mild mydriasis. The headaches were localized mainly at the left side of the nose, orbit, and upper forehead while the left ptosis was associated with blurred vision. Computed tomography angiography revealed an aneurysm in between the C4 segment of the left internal carotid artery (ICA) and the bifurcation of the left posterior communicating artery. Digital subtraction angiography further confirmed the aneurysm. We used the transarterial approach to assess the aneurysm and subsequent coiling. Iohexol (Omnipaque) contrast agent was used during the endovascular procedure. The patient’s condition deteriorated into acute confusion state with cardinal symptomology of CIEP immediately after the operation. Computed tomography scan revealed cortical contrast enhancement in the vascular territory of the ICA as well as edema. Her symptomatology resolved 48 hours after treated with anticonvulsants, intracranial pressure reduction and hydration. Chronic hypertension as well as type 2 diabetics may be critical predisposing factors to CIEP. CIEP should be suspected in patients presenting with acute confusion state after endovascular therapy. Massive edema with ischemic brain changes in white matter of the brain before endovascular procedure should rise suspicion of CIEP.

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“…Vascular etiology for cranial neuropathy encompasses a wide range of pathophysiology ranging from extrinsic compression, such as due to an aneurysm or coursing artery or due to ischemia from thrombosis. Posterior communicating artery aneurysm is a common etiology causing oculomotor nerve palsy, which can develop directly via mass effect of the growing aneurysm or indirectly after rupture of the aneurysm and adjacent clot formation 26. In addition, multiple cranial neuropathies can result from carotid cavernous fistula (CCF) and cavernous sinus thrombosis (CST), which can lead to CN III, IV, V1, V2, and VI polyneuropathy.…”

Section: Vascular Pathologymentioning

confidence: 99%

A Pictorial Review of Cranial Nerves Imaging Anatomy and Pathology: Part 2—Pathology

Kulkarni¹,

Tiwana²,

Sobieh³

et al. 2022

Contemporary Diagnostic Radiology

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Cranial nerve pathology can range from the neoplasm, inflammation, infection, vascular, autoimmune, injury, and developmental abnormalities to anatomic variations. Involvement of cranial nerve can have a significant functional impact on the patient ranging from denervation, sensory, and motor deficits to autonomic abnormalities. Identification of common cranial nerve pathology is essential in adequately understanding basis of clinical presentation and guiding further management and follow-up. In this article, we present a summary of common pathologies affecting cranial nerves.

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Acute Oculomotor Nerve Palsy Caused by Compression from an Aberrant Posterior Communicating Artery

Cited by 11 publications

References 8 publications

Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review

Microvascular decompression for a patient with oculomotor palsy caused by posterior cerebral artery compression: A case report and literature review

Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report

A Pictorial Review of Cranial Nerves Imaging Anatomy and Pathology: Part 2—Pathology

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