Isolated Oculomotor Nerve Palsy Following Minor Head Trauma : Case Illustration and Literature Review

Abstract

Isolated oculomotor nerve palsy (ONP) attributable to mild closed head trauma is a distinct rarity. Its diagnosis places high demands on the radiologist and the clinician. The authors describe this condition in a 36-year-old woman who slipped while walking and struck her face. Initial computed tomography did not reveal any causative cerebral and vascular lesions or orbital and cranial fractures. Enhancement and swelling of the cisternal segment of the oculomotor nerve was seen during the subacute phase on thin-sectioned contrast-enhanced magnetic resonance images. The current case received corticosteroid therapy, and then recovered fully in 13 months after injury. Possible mechanism of ONP from minor head injury is proposed and previous reports in the literature are reviewed.

Bilateral Extensive Ossification of the Posterior Petroclinoid Ligament: An Anatomical Case Report and Literature Review

“…[5][6][7][8]32 Topographically, the oculomotor nerve crosses the pPCL, and at this point it is thought to be susceptible to damage as the brainstem moves downward. 6,8,[32][33][34][35] In such cases, the pPCL acts as a fulcrum, thus focally stretching the fascicules of the oculomotor nerve. Contusion against the pPCL may explain the mechanism of oculomotor nerve palsy seen even after minor head trauma without identifiable lesions.…”

“…Contusion against the pPCL may explain the mechanism of oculomotor nerve palsy seen even after minor head trauma without identifiable lesions. [32][33][34][35] This may also lead to tearing of the pupillomotor fibers located on the ventromedial surface of the oculomotor nerve. 6,8,32 In the event of calcification or ossification of the pPCL, the dural sheath of the oculomotor nerve may be fixed much more than usual that may potentially result in greater susceptibility of the nerve to injury.…”

“…[32][33][34][35] This may also lead to tearing of the pupillomotor fibers located on the ventromedial surface of the oculomotor nerve. 6,8,32 In the event of calcification or ossification of the pPCL, the dural sheath of the oculomotor nerve may be fixed much more than usual that may potentially result in greater susceptibility of the nerve to injury. In a specific example, Patwardhan 35 described isolated unilateral oculomotor nerve neuropraxia in a patient with calcified pPCL following a trivial domestic fall, even though no clinical or radiologic signs of head injury were noted.…”

An insight into the vision impairment following traumatic brain injury

“…However, cranial nerve VI injury is generally associated with a flexion-extension injury which results from the vertical movement of the brain following trauma. An elevated intracranial pressure due to edema or hemorrhage results in delayed abducens injury which also affect cranial nerve VI injury (Chen et al, 2005; Coello et al, 2010; Dhaliwal et al, 2006; Kim and Chang, 2013; Ventura et al, 2014). …”

Frontobasal Fractures

“…133 There might be an enhancement in the oculomotor cistern in the MRI. [134][135][136] Clinical findings include ptosis, mydriasis, impaired motion of the eye, and pupillary reaction.…”