J Korean Neurosurg Soc.  2013 Nov;54(5):434-436. 10.3340/jkns.2013.54.5.434.

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

• Kim E
• Chang H

• KMID: 2138363
• DOI: http://doi.org/10.3340/jkns.2013.54.5.434

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.

Keyword

Computed tomography; Head injury; Magnetic resonance imaging; Oculomotor nerve; Oculomotor nerve palsy

MeSH Terms

Adult
Craniocerebral Trauma*
Diagnosis
Female
Head Injuries, Closed
Head*
Humans
Magnetic Resonance Imaging
Oculomotor Nerve Diseases*
Oculomotor Nerve*
Orbit
Walking

Figure

• 

  Fig. 1 Appearance and examination of ocular movement and pupil size on initial presentation. Note bruises on the face and the right side of her neck. The patient can't elevate the right upper eyelid which is completely drooped (A). The right eye has limited motion in up, down, and medial gazes with lateral deviation (B).

• 

  Fig. 2 Axial T1-weighted magnetic resonance image reveals no abnormalities in the third nerve and the midbrain.

• 

  Fig. 3 Multiplanar reconstruction magnetic resonance images using contrast-enhanced spoiled gradient-recalled sequences clearly depict the oculomotor nerves (ONs) (arrows) in head trauma patient. A : Initial image shows focal swelling of the right ON at the posterior petroclinoid ligament, but no gadolinium enhancement. B and C : Axial and sagittal reconstruction images obtained 16 days after the injury reveal diffuse thickening and enhancement of the cisternal portion of the right ON. D : Follow-up study confirms virtually complete resolution of the enhancement of the nerve itself.

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