Skip to main content
SpringerLink
Log in

Oculomotor Nerve Palsy

  • Chapter
  • First Online:
Neuro-Ophthalmology

  • 606 Accesses

Abstract

A 59-year-old female complained of ptosis in her left eye accompanied by double vision for 2 weeks. She did not report pain or headache, however slight uncomfortable around the left frontal areas was presented. She was accepted in hospital to exclude aneurysm and the MRA was reported unremarkable. She was discharged with diagnose of oculomotor nerve paly due to diabetes mellitus. She scheduled a plastic surgeon for consulting that if operation could help her ptosis and then she was referred for neuro-ophthalmologic evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

Case 1: Oculomotor Nerve Palsy Due to Cavernous Fistula

  1. Fang C, Leavitt JA, Hodge DO, Holmes JM, Mohney BG, Chen JJ. Incidence and etiologies of acquired third nerve palsy using a population-based method. JAMA Ophthalmol. 2017;135(1):23–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Margolin E, Freund P. Third nerve palsies: review. Int Ophthalmol Clin. 2019;59(3):99–112.

    Article  PubMed  Google Scholar 

  3. Wu HC, Ro LS, Chen CJ, et al. Isolated ocular motor nerve palsy in dural carotid-cavernous sinus fistula. Eur J Neurol. 2006;13(11):1221–5.

    Article  PubMed  Google Scholar 

  4. Lin HL, Hu TT. Isolated third nerve palsy with pupillary involvement resulting from carotid-cavernous sinus fistula: a case report. Medicine (Baltimore). 2019;98(6):e14472.

    Article  Google Scholar 

Case 2: Schwannoma

  1. Margolin E, Freund P. Third nerve palsies: review. Int Ophthalmol Clin. 2019;59(3):99–112.

    Article  PubMed  Google Scholar 

  2. Celli P, Ferrante L, Acqui M, Mastronardi L, Fortuna A, Palma L. Neurinoma of the third, fourth, and sixth cranial nerves: a survey and report of a new fourth nerve case. Surg Neurol. 1992;38(3):216–24.

    Article  CAS  PubMed  Google Scholar 

  3. Yang SS, Li ZJ, Liu X, Li Y, Li SF, Zhang HD. Pediatric isolated oculomotor nerve schwannoma: a new case report and literature review. Pediatr Neurol. 2013;48(4):321–4.

    Article  PubMed  Google Scholar 

  4. Tian G, Kardon R, Feng C, et al. Oculomotor nerve palsy due to unusual causes. J Neuroophthalmol. 2021;41(2):e244–50.

    Google Scholar 

Case 3: Neurofibromatosis 2

  1. Asthagiri AR, Parry DM, Butman JA, et al. Neurofibromatosis type 2. Lancet. 2009;373(9679):1974–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Ardern-Holmes S, Fisher G, North K. Neurofibromatosis type 2. J Child Neurol. 2017;32(1):9–22.

    Article  PubMed  Google Scholar 

  3. Otsuka G, Saito K, Nagatani T, Yoshida J. Age at symptom onset and long-term survival in patients with neuro fibromatosis type 2. J Neurosurg. 2003;99:480–3.

    Article  PubMed  Google Scholar 

Case 4: Meningioma

  1. Tian G, Kardon R, Feng C, et al. Oculomotor nerve palsy due to unusual causes. J Neuroophthalmol. 2021;41(2):e244–50.

    Article  PubMed  Google Scholar 

  2. Doi K, Otani N, Hagita D, et al. A case of meningioma originating from the oculomotor nerve. World Neurosurg. 2020;143:197–201.

    Article  PubMed  Google Scholar 

Case 5: Inflammatory

  1. Park KA, Oh SY, Min JH, Kim BJ, Kim Y. Acquired onset of third, fourth, and sixth cranial nerve palsies in children and adolescents. Eye (Lond). 2019;33(6):965–73.

    Article  Google Scholar 

  2. Tsirigotaki M, Ntoulios G, Lioumpas M, Voutoufianakis S, Vorgia P. Tolosa-Hunt syndrome: clinical manifestations in children. Pediatr Neurol. 2019;99:60–3.

    Article  PubMed  Google Scholar 

  3. Panda BB, Parija S, Mallick J, Pujahari S. Oculomotor nerve palsy as a rare presentation and first sign of multiple myeloma. J Clin Diagn Res. 2016;10(5):ND01–3.

    PubMed  PubMed Central  Google Scholar 

  4. Tian G, Kardon R, Feng C, et al. Oculomotor nerve palsy due to unusual causes. J Neuroophthalmol. 2021;41(2):e244–50.

    Article  PubMed  Google Scholar 

Case 6: Syphilis Infectious

  1. Fang C, Leavitt JA, Hodge DO, et al. Incidence and etiologies of acquired third nerve palsy using a population-based method. JAMA Ophthalmol. 2017;135:23–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Tamhankar MA, Biousse V, Ying GS, et al. Isolated third, fourth, and sixth cranial nerve palsies from presumed microvascular versus other causes: a prospective study. Ophthalmology. 2013;120(11):2264–9.

    Article  PubMed  Google Scholar 

  3. Seeley WW, Venna N. Neurosyphilis presenting with gummatous oculomotor nerve palsy. J Neurol Neurosurg Psychiatry. 2004;75:789.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Hess CW, Rosenfeld SS, Resor SR Jr. Oculomotor nerve palsy as the presenting symptom of gummatous neurosyphilis and human immunodeficiency virus infection: clinical response to treatment. JAMA Neurol. 2013;70:1582–3.

    Article  PubMed  Google Scholar 

  5. Sá E, Silva H, Paulo CO, Duarte F, Abreu RC, Neves I, Moniz P. Teaching neuroimages: gummatous neurosyphilis: an atypical presentation in a patient with HIV. Neurology. 2018;90(10):e913–4.

    Article  Google Scholar 

  6. Yang Y, Lai C, Yan F, Wang J. Clinical significance of MRI contrast enhancement of the oculomotor nerve in ischemic isolated oculomotor nerve palsy. J Clin Neurol. 2020;16(4):653–8.

    Article  PubMed  PubMed Central  Google Scholar 

Case 7: Iatrogenic

  1. Price J, Wei WC, Chong CY. Cranial nerve damage in patients after alpha (heavy)-particle radiation to the pituitary. Ophthalmology. 1979;86(6):1161–72.

    Article  CAS  PubMed  Google Scholar 

  2. Grassmeyer JJ, Fernandes JA, Helvey JT, Kedar S. Radiation-induced bilateral oculomotor nerve palsy 20 years after radiation treatment. Neurology. 2021;96(20):955–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Tian G, Kardon R, Feng C, et al. Oculomotor nerve palsy due to unusual causes. J Neuroophthalmol. 2021;41(2):e244–50.

    Article  PubMed  Google Scholar 

  4. Miller NR, Lee AG. Adult-onset acquired oculomotor nerve paresis with cyclic spasms: relationship to ocular neuromyotonia. Am J Ophthalmol. 2004;137(1):70–6.

    Article  PubMed  Google Scholar 

Case 8: Recurrent Painful Ophthalmoplegia Neuropathy

  1. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.

    Article  Google Scholar 

  2. Smith SV, Schuster NM. Relapsing painful ophthalmoplegic neuropathy: no longer a “migraine,” but still a headache. Curr Pain Headache Rep. 2018;22:50.

    Article  PubMed  Google Scholar 

  3. McMillan HJ, Keene DL, Jacob P, Humphreys P. Ophthalmoplegic migraine: inflammatory neuropathy with secondary migraine? Can J Neurol Sci. 2007;34(3):349–55.

    Article  CAS  PubMed  Google Scholar 

  4. Gladstone JP. An approach to the patient with painful ophthalmoplegia, with a focus on Tolosa-Hunt syndrome. Curr Pain Headache Rep. 2007;11(4):317–25.

    Article  PubMed  Google Scholar 

  5. Lee D, Kim WJ, Kim MM. Recurrent isolated oculomotor nerve palsy caused by schwannoma in a pediatric patient. Indian J Ophthalmol. 2018;66(9):1367–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chewning RH, Sasson AD, Jordan LC, Tamargo RJ, Gailloud P. Acute third cranial nerve palsy from a third cranial nerve schwannoma presenting as a saccular aneurysm on three-dimensional computed tomography angiography: case illustration. J Neurosurg. 2008;108(5):1037.

    Article  PubMed  Google Scholar 

Case 9: Recurrent Painful Ophthalmoplegia Neuropathy and Schwannoma

  1. Al-Holou SN, DeLuca C, Gatteau RE, Legge RH. Schwannoma masquerading as recurrent painful ophthalmoplegic neuropathy: a diagnostic dilemma. J Pediatr Ophthalmol Strabismus. 2020;57:e68–70. Published 2020 Aug 19.

    Article  PubMed  Google Scholar 

  2. Kim R, Kim JH, Kim E, Yang HK, Hwang JM, Kim JS. Oculomotor nerve tumors masquerading as recurrent painful ophthalmoplegic neuropathy: report of two cases and review of the literature. Cephalalgia. 2015;35(9):825–30.

    Article  PubMed  Google Scholar 

  3. Petruzzelli MG, Margari M, Furente F, et al. Recurrent painful ophthalmoplegic neuropathy and oculomotor nerve schwannoma: a pediatric case report with long-term MRI follow-up and literature review. Pain Res Manag. 2019;2019:5392945. Published 2019 Sep 25.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lee D, Kim WJ, Kim MM. Recurrent isolated oculomotor nerve palsy caused by schwannoma in a pediatric patient. Indian J Ophthalmol. 2018;66(9):1367–9.

    Article  PubMed  PubMed Central  Google Scholar 

Case 10: Weber Syndrome

  1. Ogawa K, Suzuki Y, Takahashi K, Kamei S, Ishikawa H. Clinical study of eleven patients with midbrain infarction-induced oculomotor nerve palsy. J Stroke Cerebrovasc Dis. 2016;25(7):1631–8.

    Article  PubMed  Google Scholar 

  2. Ismail II, Al-Hashel JY, John JK, Ibrahim M. Isolated oculomotor nerve palsy secondary to fascicular midbrain infarction. Neurosciences (Riyadh). 2019;24(3):245–6.

    Article  Google Scholar 

Case 11: Claude Syndrome

  1. Seo SW, Heo JH, Lee KY, et al. Localization of Claude’s syndrome. Neurology. 2001;57(12):2304–7.

    Article  CAS  PubMed  Google Scholar 

  2. Ortiz de Mendivil A, Alcalá-Galiano A, Ochoa M, Salvador E, Millán JM. Brainstem stroke: anatomy, clinical and radiological findings. Semin Ultrasound CT MR. 2013;34(2):131–41.

    Article  PubMed  Google Scholar 

  3. Witsch J, Narula R, Amin H, Schindler JL. Mystery case: bilateral Claude syndrome. Neurology. 2019;93(13):599–600.

    Article  PubMed  Google Scholar 

  4. Amano E, Komatuzaki T, Ishido H, et al. Pitfalls in the diagnosis of pupil-sparing oculomotor nerve palsy without limb ataxia: a case report of a variant of Claude’s syndrome and neuroanatomical analysis using diffusion-tensor imaging. J Clin Neurosci. 2018;47:120–3.

    Article  PubMed  Google Scholar 

Case 12: Nucleus Lesion

  1. Ogawa K, Suzuki Y, Takahashi K, Kamei S, Ishikawa H. Clinical study of eleven patients with midbrain infarction-induced oculomotor nerve palsy. J Stroke Cerebrovasc Dis. 2016;25(7):1631–8.

    Article  PubMed  Google Scholar 

  2. Biousse, V，Newman, NJ. Diplopia[M]// In: Biousse V, Newman, NJ. Neuro-ophthalmology illustrated. 1st edn. New York: Thieme, 2008:382–388.

    Google Scholar 

Case 13: Oculomotor Nerve Paresis with Cyclic Spasms

  1. Loewenfeld IE, Thompson HS. Oculomotor paresis with cyclic spasms. A critical review of the literature and a new case. Surv Ophthalmol. 1975;20:81–124.

    Article  CAS  PubMed  Google Scholar 

  2. Salman MS, Klassen SF, Clark IH. Congenital oculomotor nerve paresis with isolated cyclic pupillary spasms. J Neuroophthalmol. 2015;35(4):371–3.

    Article  PubMed  Google Scholar 

  3. Tian G, Kardon R, Feng C, et al. Oculomotor nerve palsy due to unusual causes. J Neuroophthalmol. 2021;41(2):e244–50.

    Article  PubMed  Google Scholar 

  4. Nan H, Li R, Zhu L, Wang Q, Wang J, Jing Y. Oculomotor paresis with cyclic spasms in Chinese populations: a review of the Chinese literature and a case report. Pediatr Neurosurg. 2021;56(4):361–8.

    Article  PubMed  Google Scholar 

  5. Gadoth A, Kipervasser S, Korczyn AD, Neufeld MY, Kesler A. Acquired oculomotor nerve paresis with cyclic spasms in a young woman, a rare subtype of neuromyotonia. J Neuroophthalmol. 2013;33:247–8.

    Article  PubMed  Google Scholar 

  6. Miller NR, Lee AG. Adult-onset acquired oculomotor nerve paresis with cyclic spasms: relationship to ocular neuromyotonia. Am J Ophthalmol. 2004;137(1):70–6.

    Article  PubMed  Google Scholar 

Case 14: Ocular Neuromyotonia

  1. Sychev YV, McInnis CP. Abducens ocular neuromyotonia as a delayed complication of oropharyngeal carcinoma treated with radiation. Head Neck. 2016;38(Suppl 1):E2428–31.

    Article  PubMed  Google Scholar 

  2. Kung NH, Bucelli RC, McClelland CM. Ocular neuromyotonia associated with chronic inflammatory demyelinating polyneuropathy. Neuro-ophthalmology. 2015;39:240–2.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hashimoto Y, Hideyama T, Yamagami A, et al. A case of ocular neuromyotonia caused by neurovascular compression of the oculomotor nerve by the elongated superior cerebellar artery. J Neurol. 2016;263:1236–8.

    Article  PubMed  Google Scholar 

  4. Chung SM, Lee AG, Holds JB, et al. Ocular neuromyotonia in Graves dysthyroid orbitopathy. Arch Ophthalmol. 1997;115:365–70.

    Article  CAS  PubMed  Google Scholar 

  5. Miller NR. Adult-onset acquired oculomotor nerve paresis with cyclic spasms: relationship to ocular neuromyotonia. Am J Ophthalmol. 2004;137:70–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Eye and ENT Hospital, Fudan University, Shanghai, Shanghai, China

    Guohong Tian & Xinghuai Sun

  2. Shanghai Deji Hospital, Shanghai, China

    Jianjun Tang

Authors
  1. Guohong Tian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xinghuai Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jianjun Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Guohong Tian .

Editor information

Editors and Affiliations

  1. Eye & ENT Hospital, Fudan University, Shanghai, Shanghai, China

    Guohong Tian

  2. Eye & ENT Hospital, Fudan University, Shanghai, Shanghai, China

    Xinghuai Sun

1 Electronic Supplementary Material

Oculomotor nerve paresis with cyclic spasms. On paresis phase, the patient shows left ptosis and left pupil dilation. On spasm phase, the left ptosis reverse and the left pupil shows miosis.

Ocular neuromyotonia patient during episodes of diplopia, the left eye shows esotropia and hypertropia with limitation of abduction and depression for about 40 seconds, after then the movement of left eye shows no limitation of abduction or depression.

Rights and permissions

Reprints and permissions

Copyright information

© 2022 People's Medical Publishing House, PR of China

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tian, G., Sun, X., Tang, J. (2022). Oculomotor Nerve Palsy. In: Tian, G., Sun, X. (eds) Neuro-Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-19-4668-4_17

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-4668-4_17

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-4667-7

  • Online ISBN: 978-981-19-4668-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation