Complete, Pupil-Sparing Third Nerve Palsy in a Patient With a Malignant Peripheral Nerve Sheath Tumor

Fard, Masoud Aghsaei; Montgomery, Elizabeth A.; Miller, Neil R.

doi:10.1001/archophthalmol.2011.122

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…Others have reported that ITCNP may also occur due to nasopharyngeal carcinoma, oculomotor schwannoma, malignant peripheral nerve sheath tumours and temporal lobe tumours (anaplastic astrocytoma and glioblastoma multiforme). [23][24][25][26] The highest incidence of ITCNP due to tumours was reported to be 13.6%. 12 Patients with tumours tend to present with complex ophthalmoplegia or mixed cranial nerve palsies, due to the tumour compression.…”

Section: Discussionmentioning

confidence: 99%

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Nurul-Ain

Hitam

Shatriah

et al. 2022

J Health Sci Med Res

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Objective: This study aimed to study the aetiologies, clinical profile and recovery of isolated third cranial nerve palsy (ITCNP) patients, at a tertiary neuro-ophthalmology center on the East Coast Peninsular of Malaysia. Material and Methods: This was a retrospective study, involving 33 patients with newly diagnosed ITCNP, who were treated at the Hospital of the Universiti Sains, Malaysia; from January 2018 to December 2019, with a follow up period ranging from 18 to 24 months. The demographic data, clinical features and aetiologies of the patients were analysed. Results: Patients’ ages ranged from 14 to 79 years (mean: 48, 50 years of age). The main aetiology was microvascular ischemia (39.4%), followed by trauma (30.3%), aneurysm (15.2%), tumour (9.1%) and undetermined cause (6.1%). Neuroimaging was performed for those indicated cases; with either computed tomography (CT), CT angiography, digital subtraction angiography, magnetic resonance imaging (MRI) with contrast or MRI angiography. Two-thirds of the patients (66.7%) had periorbital pain, which included 30.8% of patients with microvascular ischemia and 60.6% had pupil involvement; which was also found in 23.1% of patients with microvascular ischemia. Complete external third nerve palsy occurred in 18.2% of patients, and aberrant regeneration was observed in 36.4% of patients. Complete recovery occurred in 48.5%, of all patients, having microvascular ischemia and undetermined causes. Conclusion: The aetiologies, clinical profile and recovery of ITCNP patients in our institution are comparable to those reported in other previous studies. Patients with microvascular ischemia may also demonstrate periorbital pain and anisocoria. Neuroimaging remains the gold standard and the best tool via which to exclude other sinister and lifethreatening aetiologies.

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Section: Discussionmentioning

confidence: 99%

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Nurul-Ain

Hitam

Shatriah

et al. 2022

J Health Sci Med Res

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“…Obstructive lesions and prenatal infection can cause bilateral cranial nerve palsies, which have been linked to other cranial nerve palsies, such as the fourth and sixth. A compressive lesion isn't necessarily caused by frequent pupil involvement in youngsters, as it is in adults [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Idiopathic unilateral third nerve palsy with pupillary sparring in 10-year-old child -a case report

Khan

Adnan

Ahmad

et al. 2022

Annals of Medicine &Amp; Surgery

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“…This patient had complete resolution of 3NP 1 month after resection of the lesion, indicating that the mass may have been causing 3NP through compression, inflammation, or focal ischemia in the anterior cavernous sinus. However, based on the painless onset and resolution 7 months after onset, a 3NP may have been multifactorial and included ischemic or inflammatory etiologies (21).…”

Section: Discussionmentioning

confidence: 99%

Importance of the “Rule of the Pupil” in the Modern Neuroimaging Era

Garg¹,

Micieli²

2021

Journal of Neuro-Ophthalmology

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The "Rule of the Pupil" states that when aneurysms compress the oculomotor nerve, a dilated or sluggishly reactive pupil will result. In previous decades, when cerebral angiography was required to detect an intracranial aneurysm, the "Rule of the Pupil" was used to determine the relative risk of angiography and the likelihood of aneurysmal compression in patients with third nerve palsies (3NPs). Noninvasive imaging including computed tomography angiography (CTA) and magnetic resonance angiography has become readily accessible and can detect all aneurysms large enough to cause 3NPs. It is therefore recommended that all patients with 3NP undergo neuroimaging regardless of pupil status because the consequences of missing an aneurysm are high. The question therefore remains as to whether the "Rule of the Pupil" still has relevance in today's era of modern neuroimaging. We describe a 73-year-old man who developed a left complete, pupilsparing 3NP and was found to have a paraclinoid meningioma in the left cavernous sinus. As compressive lesions are expected to impair the iris sphincter muscle, no intervention was recommended and his 3NP spontaneously improved within 3 months. We also describe a 54-year-old woman with diabetes and a complete 3NP with a dilated, nonreactive pupil. Initial CTA was reported as normal, but re-review of imaging revealed a posterior communicating artery aneurysm and immediate intervention to coil the aneurysm occurred. The "Rule of the Pupil" is still important in the modern neuroimaging era as demonstrated in cases of incidentally found lesions along the course of the oculomotor nerve and missed radiological findings.

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Complete, Pupil-Sparing Third Nerve Palsy in a Patient With a Malignant Peripheral Nerve Sheath Tumor

Cited by 7 publications

References 6 publications

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Idiopathic unilateral third nerve palsy with pupillary sparring in 10-year-old child -a case report

Importance of the “Rule of the Pupil” in the Modern Neuroimaging Era

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