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Congenital isolated unilateral third nerve palsy in children: the diagnostic contribution of high-resolution MR imaging

  • Paediatric Neuroradiology
  • Published:
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Abstract

Purpose

To describe the neuroanatomical correlates of unilateral congenital isolated oculomotor palsy by means of high-resolution MRI.

Methods

Children with a clinical diagnosis of congenital isolated oculomotr palsy and with a high-resolution MRI acquisition targeted on the orbits and cranial nerves were selected and included in the study. An experienced pediatric neuroradiologist evaluated all the exams, assessing the integrity and morphology of extraocular muscles, oculomotor, trochlear and abducens nerves as well as optic nerves and globes. Clinical data and ophthalmologic evaluations were also collected.

Results

Six children (age range: 1-16 years; males: 3) were selected. All patients showed, on the affected side (left:right = 5:1), anomalies of the III nerve and extraocular muscles innervated by the pathological nerve. One patient had complete nerve agenesis, two patients showed a diffuse thinning of the nerve, from the brainstem to the orbit and 3 patients showed a distal thinning of the oculomotor nerve, starting at the level of the cavernous sinus. In all cases atrophy of corresponding muscles was noticed, but the involvement of the affected muscles varied with the nervous pattern of injury.

Conclusions

High-resolution MRI represents a valuable tool for the diagnosis of III nerve anomalies in unilateral congenital IOP, showing different patterns of nerve involvement and muscular atrophy.

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Funding

This study was partially funded by the Italian Ministry of Health, Ricerca Corrente 2019–2022, to the Scientific Institute IRCCS E.Medea.

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Authors and Affiliations

  1. Scientific Institute, IRCCS E. Medea, Bosisio Parini, Italy

    Filippo Arrigoni, Daniela Redaelli, Francesco Polenghi, Roberto Salati, Romina Romaniello & Denis Peruzzo

  2. Paediatric Radiology and Neuroradiology Department, V. Buzzi Children’s Hospital, Via Castelvetro 32, 20154, Milan, Italy

    Filippo Arrigoni

  3. Pediatric Ophthalmology Unit, Niguarda Ca’Granda Metropolitan Hospital, Milan, Italy

    Luca Rombetto, Elena Piozzi & Marco Mazza

  4. Ophthalmology Unit, Ospedale Valduce, Como, Italy

    Giorgio Mancarella

  5. Department of Ophthalmology, IRCCS Policlinico San Matteo, Pavia, Italy

    Paolo Emilio Bianchi

  6. Department of Pediatric Ophthalmology, University Hospital of Salerno, University of Salerno, Salerno, Italy

    Adriano Magli

Authors
  1. Filippo Arrigoni
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  2. Luca Rombetto
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  3. Daniela Redaelli
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  4. Giorgio Mancarella
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  5. Francesco Polenghi
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  6. Roberto Salati
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  7. Romina Romaniello
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  8. Denis Peruzzo
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  9. Paolo Emilio Bianchi
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  10. Elena Piozzi
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  11. Marco Mazza
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  12. Adriano Magli
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Corresponding author

Correspondence to Filippo Arrigoni.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This is a retrospective observational study conducted from data obtained from a larger study on pediatric high-resolution brain MRI, approved by the Ethics Committee of E. Medea Research Institute.

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Informed consent was obtained from legal guardians.

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Arrigoni, F., Rombetto, L., Redaelli, D. et al. Congenital isolated unilateral third nerve palsy in children: the diagnostic contribution of high-resolution MR imaging. Neuroradiology 65, 865–870 (2023). https://doi.org/10.1007/s00234-022-03106-5

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  • DOI: https://doi.org/10.1007/s00234-022-03106-5

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