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Isolated contralateral post-ictal oculomotor nerve palsy following supratentorial craniotomy. Case report

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Abstract

The authors report the unique occurrence of an isolated post-ictal contralateral oculomotor nerve (OCN) palsy following excision of a medial frontal oligoastrocytoma. A 45-year-old male presented with a history of generalized tonic clonic seizures (GTCS) for 8 years. His neurological examination was unremarkable. Magnetic resonance imaging (MRI) of the brain revealed a left frontopolar low grade glioma. Nine hours after an uneventful near total microsurgical excision, the patient had a GTCS, following which he was noted to have an isolated right-sided OCN palsy. The immediate post-ictal computed tomographic scan and magnetic resonance images acquired 2 weeks after surgery failed to reveal any abnormality. The palsy had recovered completely by the 9-month follow-up.

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Authors and Affiliations

  1. Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Manish Singh Sharma, Karanjit Singh Narang & Bhawani Shankar Sharma

Authors
  1. Manish Singh Sharma
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  2. Karanjit Singh Narang
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  3. Bhawani Shankar Sharma
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Corresponding author

Correspondence to Manish Singh Sharma.

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Comment

This is an interesting report of a contralateral third nerve palsy coming on in the postoperative period following left frontal intrinsic tumor resection.

The various possibilities for this development have been considered by the authors, who ultimately decided that the cause was likely to be trans-tentorial herniation.

If this is so, it is unusual that it has not been reported before. Why do we not see it more frequently in individuals in status epilepticus?

Is the location of the tumor relevant in some way, with the potential for rapid spread of any seizure to the temporal lobes?

The patient was described as being normotensive, and random blood sugar was within normal limits.

Other risk factors for vascular disease, including smoking and hypercholesterolemia, would be relevant in a vascular etiology.

Although uncommon, complete palsy can occur from an ischemic etiology.

Brian Brophy

Royal Adelaide Hospital, Australia

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Singh Sharma, M., Singh Narang, K. & Shankar Sharma, B. Isolated contralateral post-ictal oculomotor nerve palsy following supratentorial craniotomy. Case report. Acta Neurochir 151, 999–1000 (2009). https://doi.org/10.1007/s00701-009-0337-y

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  • DOI: https://doi.org/10.1007/s00701-009-0337-y

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