Bilateral Third Nerve Palsy and Temporal Arteritis

Abstract

Background: Bilateral oculomotor palsy is a rare manifestation of temporal arteritis, and to our knowledge only 1 case has been described in the literature. Objective: To investigate a possible case of temporal arteritis in a patient with bilateral third nerve palsy. Design: Case report and review. Setting: University hospital. Patient: A 65-year-old man had subacute pupilsparing bilateral third nerve palsy. Results: Temporal artery biopsy findings and response to corticosteroids are consistent with temporal arteritis. Conclusion: Temporal arteritis is a rare cause of ophthalmoplegia in elderly persons and may be unrecognized.

Diagnosis and management of third nerve palsy

“…Other important causes include trauma [3 ] and giant cell arteritis[4,5 ]. Occasionally tumor and very rarely aneurysm can result in a pupil-sparing complete third nerve palsy.…”

Simultaneous, Bilateral Ophthalmoplegia as the Presenting Sign of Paediatric Multiple Sclerosis: Case Report and Discussion of the Differential Diagnosis

“…16 Rarely, giant cell arteritis (GCA; temporal arteritis) presents with bilateral ophthalmoplegia and is typically associated with systemic symptoms, including headache, mild fever, jaw claudication, weight loss, and proximal muscle weakness. 17,18 In patients over the age of 55 with ophthalmoplegia, erythrocyte sedimentation rate, C-reactive protein, and platelet count should be obtained. Steroids should be administered if temporal arteritis is suspected, until a definitive diagnosis is made.…”

“…The lone histopathologic correlation of GCA and ophthalmoplegia suggested inflammation of the orbital vasculature with secondary extraocular muscle necrosis; 20 however, there are case reports suggest that inflammation of vessels supplying nerve fascicles may play a role. 18 Patients with acute, painful bilateral ophthalmoplegia with pupillary involvement raise the clinician's suspicion for pituitary apoplexy. 21 Carotid cavernous sinus fistula 22,23 and Tolosa-Hunt syndrome 24,25 can present in a similar fashion.…”

Temporary bilateral oculomotor nerve palsy as the sole presenting sign of a pituitary mass

“…From these it can be established that the differential diagnosis includes ruptured anterior communicating artery aneurysm,7 trauma,8 malignancy,9 Guillian–Barré syndrome,10 and multiple sclerosis 11. There are even rare reports of this presentation being associated with benign intracranial hypertension,12 temporal arteritis,13 diabetes,14 and sarcoidosis 15…”