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Eur J Case Rep Intern Med 2018 28;5(8):000912. Epub 2018 Aug 28.

Vascular Neurology Department, Instituto Nacional de Neurologia y Neurocirugia, Mexico City, Mexico.

Background: Bilateral third cranial nerve palsy has only been reported in a handful of conditions including some with inflammatory, tumoural and vascular causes. An urgent imaging study is mandatory to rule out vascular aetiology, mainly aneurysmal subarachnoid haemorrhage (aSAH).

Case Presentation: A 28-year-old Hispanic woman presented to the emergency department with a 21-day history of a sudden-onset and severe headache that on three occasions was accompanied by transient loss of awareness, the last episode occurring a week previously. Read More

Neuroradiology 2019 Feb 12. Epub 2019 Feb 12.

Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany.

Purpose: Especially in acute onset of ophthalmoplegia, efficient neuroradiological evaluation is necessary to assist differential diagnosis, clinical course, and treatment options.

Methods: Different manifestations of ophthalmoplegia are explained and illustrated by characteristic neuroradiological and clinical findings.

Results: To present those ophthalmoplegic disorders in a clear manner, this review refers to different neuroanatomical structures and compartments. Read More

Indian J Anaesth 2019 Jan;63(1):75-76

Department of Anaesthesiology, Sakra World Hospital, Bengaluru, Karnataka, India.

Case Rep Neurol Med 2019 10;2019:9769657. Epub 2019 Jan 10.

Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA.

Background: Pituitary metastasis of cervical adenocarcinoma is an exceedingly rare phenomenon.

Case Description: The authors present a case of a 66-year-old female with cervical adenocarcinoma who was discovered to have a rapidly growing intrasellar mass in the work-up of adrenal insufficiency and hypothyroidism. The patient underwent subsequent endoscopic endonasal subtotal resection of the mass. Read More

Neuroophthalmology 2019 Feb 23;43(1):56-57. Epub 2018 May 23.

Medical School Department of Neurology, Ege University, Bornova, Izmir, Turkey.

Lesions located in the anterior cavernous sinus or posterior orbit are known to cause divisional oculomotor palsy. We herein report a patient with fascicular infarction causing superior division paresis of the nerve. Read More

Neuroophthalmology 2019 Feb 25;43(1):53-55. Epub 2018 Apr 25.

Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.

A 61-year-old male presents with diplopia of acute onset and progressive course. He has a history of previous intracranial haemorrhage that was surgically evacuated 7 years ago and was also associated with diplopia. Examination revealed left complete oculomotor nerve paralysis with a fixed and dilated left pupil. Read More

Intern Med 2019 Feb 1. Epub 2019 Feb 1.

Department of Cardiology, Komaki City Hospital, Japan.

A 69-year-old woman was admitted to our hospital with a fever, dizziness, and headache caused by Neisseria meningitidis. After ceftriaxone was administered, she suddenly developed bilateral oculomotor nerve palsy. Intra-orbital magnetic resonance imaging using appropriate sequences revealed that her bilateral third intracranial nerves were enlarged and enhanced. Read More

J Neurol Surg A Cent Eur Neurosurg 2019 Feb 1. Epub 2019 Feb 1.

Division of Neurosurgery, Department of Surgery, King Saud University, Riyadh, Riyadh Province, Saudi Arabia.

Background:  Intracranial teratomas are rare tumors that usually present during the second decade of life. Among intracranial teratomas, suprasellar germ cell tumors in particular are extremely rare. We present the case of an 18-year-old girl who underwent a successful endoscopic transnasal resection of a suprasellar teratoma with a mixed germ cell component. Read More

Oper Neurosurg (Hagerstown) 2019 Jan 11. Epub 2019 Jan 11.

Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.

Cavernous malformations (CM) of the anterior midbrain are best reached through an orbitozygomatic (OZ) approach with removal of the orbital rim and wide Sylvian fissure dissection. Our surgical video demonstrates this approach to resect a ruptured CM in a 36-yr-old woman who presented with headaches, left face and left arm paresthesias/weakness, and right-sided partial oculomotor nerve (CN III) palsy. Initial magnetic resonance imaging (MRI) showed a midbrain CM, and the patient was managed conservatively. Read More

J Stroke Cerebrovasc Dis 2019 Jan 9. Epub 2019 Jan 9.

Department of Neurology, Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.

A 54-year-old male with a history of left posterior parietal ischemic stroke, epilepsy, tobacco and marijuana smoking, and alcohol abuse, presented with acute left visual loss and diplopia. On examination, he had reduced left visual acuity and a left oculomotor nerve palsy. CT angiogram from aortic arch to circle of Willis identified extensive thrombus occluding the left common and internal carotid arteries, extending to the left ophthalmic artery. Read More

Somatosens Mot Res 2018 Dec 28:1-11. Epub 2018 Dec 28.

b Department of Neurology , The Affiliated Hospital of Xuzhou Medical University , Xuzhou , China.

Oculomotor nerve palsy (ONP) is an important and common clinical diagnosis. Its main features are diplopia and ptosis. Its aetiologies are various and complex. Read More

Arch Soc Esp Oftalmol 2018 Dec 20. Epub 2018 Dec 20.

Sección de Motilidad Ocular, Departamento de Oftalmología, HGU Gregorio Marañón, Madrid, España.

Objective: To present a report of the ocular motility disorders, treatment and outcomes of myasthenia gravis (MG).

Material And Method: A retrospective study was performed on the data of patients with MG. An evaluation was made using mean age, gender, initial diagnosis, ocular deviation, time of onset of clinical characteristics, treatment and results. Read More

Medicine (Baltimore) 2018 Dec;97(51):e13766

Rationale: Convergent strabismus fixus is an ocular motor abnormality in which the eye is fixed in adduction. This condition is mostly associated with high myopia and is caused by a displacement of the extraocular muscles. We report a nonmyopic woman with convergent strabismus fixus due to aneurysms. Read More

BMC Ophthalmol 2018 Dec 17;18(1):325. Epub 2018 Dec 17.

Department of Ophthalmology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, #81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.

Background: To compare clinical characteristics according to the laterality of objective ocular torsion in patients with unilateral superior oblique palsy (SOP).

Methods: This retrospective study included all patients with a diagnosis of unilateral SOP. They were classified into subgroups according to correspondence between the paretic eye and the extorted eye using fundus photography. Read More

J Neurol 2019 Feb 17;266(2):476-479. Epub 2018 Dec 17.

Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea.

To define the prevalence and characteristics of single ocular motor nerve palsy (OMNP) associated with positive serum anti-GQ1b antibody. We performed a prospective multicenter study that recruited 82 patients with single OMNP without identifiable causes from the history and neuroimaging in six neurology clinics of university hospitals. We measured serum anti-GQ1b antibody in all participants. Read More

eNeurologicalSci 2019 Mar 19;14:28-30. Epub 2018 Nov 19.

Salus University, Neuro-ophthalmic Disease Department, 8360 Old York Rd, Elkins Park, PA 19027, United States.

A 66 year-old woman presented with a pupil-sparing partial third cranial nerve palsy with aberrant regeneration. Imaging revealed a cystic lesion in the right cavernous sinus, demonstrating signal characteristics consistent with arachnoid cyst. Oculomotor synkinesis and a pupil-sparing third cranial nerve palsy from an arachnoid cyst of the cavernous sinus have not been previously reported. Read More

Korean J Ophthalmol 2018 Dec;32(6):478-482

Kim's Eye Hospital, Seoul, Korea.

Purpose: The aim of this study was to investigate the quantitative effect of inferior oblique (IO) 10- and 14-mm recession on postoperative horizontal deviation.

Methods: Patients (22 men and 18 women) who underwent IO recession were divided into two groups for comparison studies: group 1 (10-mm IO recession, 15 patients) and group 2 (14-mm IO recession, 25 patients). Preoperative and postoperative horizontal deviations were measured, and the resulting horizontal deviations from the 10- and 14-mm IO recession surgeries were compared. Read More

Neuroophthalmology 2018 Oct 9;42(5):316-317. Epub 2018 Jan 9.

Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Lesions of the central nucleus of the third cranial nerve in midbrain leads to bilateral ptosis. We present a case of a 14 year old boy, who was found to have B/L non-correctable ptosis and medial rectus palsy. There was a ring enhancing lesion in the midbrain in contrast MRI which resolved with treatment. Read More

J Neurosurg 2018 Oct 1:1-9. Epub 2018 Oct 1.

OBJECTIVEOcclusive treatment of posterior communicating artery (PCoA) aneurysms has been seen as a fairly uncomplicated procedure. The objective here was to determine the radiological and clinical outcome of patients after PCoA aneurysm rupture and treatment and to evaluate the risk factors for impaired outcome.METHODSIn a retrospective clinical follow-up study, data were collected from 620 consecutive patients who had been treated for ruptured PCoA aneurysms at a single center between 1980 and 2014. Read More

Asian J Neurosurg 2018 Oct-Dec;13(4):1269-1272

Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India.

Cranial nerve schwannomas usually arise from sensory nerve and the occurrence of schwannoma in a motor nerve is rare, especially in sporadic cases. Oculomotor nerve schwannomas (ONS) are rare and they are unique as they arise from motor nerve. ONS palsy may or may not be the presenting feature of oculomotor schwannoma. Read More

Asian J Neurosurg 2018 Oct-Dec;13(4):1148-1157

Department of Neurosurgery, Fujita Health University, Banbuntane Hotokukai Hospital, Nagoya, Japan.

Introduction: Basilar aneurysms represent 5%-7% of all intracranial aneurysms. The main goal of open surgery is to achieve complete obliteration of the aneurysmal sac using minimal invasive technique while emphasizing on avoidance of complication.

Materials And Methods: We performed a retrospective cohort study of nine cases of unruptured basilar tip aneurysm referred to the Fujita Health University Banbuntane-Hotokukai Hospital, Japan. Read More

MBio 2018 11 20;9(6). Epub 2018 Nov 20.

Department of Pathology, University of California, San Diego, La Jolla, California, USA

Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common prion disease in humans and has been iatrogenically transmitted through corneal graft transplantation. Approximately 40% of sCJD patients develop visual or oculomotor symptoms and may seek ophthalmological consultation. Here we used the highly sensitive real-time quaking-induced conversion (RT-QuIC) assay to measure postmortem prion seeding activities in cornea, lens, ocular fluid, retina, choroid, sclera, optic nerve, and extraocular muscle in the largest series of sCJD patient eyes studied by any assay to date. Read More

No Shinkei Geka 2018 Nov;46(11):1007-1012

Department of Neurosurgery, Odawara Municipal Hospital.

Benedikt syndrome is caused by a rare type of brain damage to the red nucleus and nearby locations. Clinically, it presents as ipsilateral oculomotor palsy and specific contralateral involuntary movement. These involuntary movements may affect activities of daily living(ADLs)in affected patients. Read More

J Clin Neurosci 2019 Jan 16;59:62-67. Epub 2018 Nov 16.

Department of Neurosurgery, Qilu Hospital of Shandong University and Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, China; Shandong Key Laboratory of Brain Function Remodeling, China. Electronic address:

The recovery of oculomotor nerve palsy (ONP) due to posterior communicating aneurysm (PComAA) remains largely undefined. This retrospective study was undertaken to investigate predictors of nerve recovery in patients with ONP due to PComAA. A total of 102 patients with ONP due to PComAA who had undergone either endovascular coiling (63 cases) or surgical clipping (39 cases) between 2012 and 2017 were retrospectively analyzed. Read More

World Neurosurg 2019 Feb 15;122:453. Epub 2018 Nov 15.

Department of Neurosurgery, Changzheng Hospital, Naval Medical University, Neurosurgical Institute of Shanghai, Neurosurgical Institute of PLA, Shanghai, China. Electronic address:

This surgical video demonstrates a transclinoid-transcavernous approach for the resection of a cavernous sinus hemangioma (Video 1). The patient is a 42-year-old woman who presented with headache and blurred vision. Magnetic resonance imaging (MRI) demonstrated an enhancing mass in the right-side cavernous sinus and sella. Read More

Headache 2018 Nov 15. Epub 2018 Nov 15.

Neurology Clinic, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.

Magn Reson Med Sci 2018 Nov 9. Epub 2018 Nov 9.

Department of Neurology and Strokology, Nagasaki University Hospital.

World Neurosurg 2019 Feb 1;122:102-105. Epub 2018 Nov 1.

Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima-city, Hiroshima, Japan.

Background: Superior cerebellar artery (SCA) aneurysm arising from the SCA itself is rare, and treatment of this aneurysm is challenging because of the important anatomic structures, such as the perforating arteries to the brainstem and cranial nerves. We describe a successful coil embolization with a Low-profile Visualized Intraluminal Support Junior (LVIS Jr.) stent for the proximal SCA dissecting aneurysm. Read More

Epilepsy Behav 2018 Dec 26;89:37-41. Epub 2018 Oct 26.

Stanford Neurosurgery, 213 Quarry Road, Palo Alto, CA 94304, USA. Electronic address:

Background: Laser interstitial thermal therapy (LITT) is a minimally invasive alternative with less cognitive risks compared with traditional surgery for focal drug-resistant epilepsy.

Objective: We describe seizure outcomes and complications after LITT in our cohort with intractable mesial temporal lobe epilepsy (MTLE).

Material And Methods: We prospectively tracked Stanford's MTLE cases treated with LITT from October 2014 to October 2017. Read More

Invest Ophthalmol Vis Sci 2018 Oct;59(12):5201-5209

Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, United States.

Purpose: Proper control of eye movements is critical to vision, but relatively little is known about the molecular mechanisms that regulate development and axon guidance in the ocular motor system or cause the abnormal innervation patterns (oculomotor synkinesis) seen in developmental disorders and after oculomotor nerve palsy. We developed an ex vivo slice assay that allows for live imaging and molecular manipulation of the growing oculomotor nerve, which we used to identify axon guidance cues that affect the oculomotor nerve.

Methods: Ex vivo slices were generated from E10. Read More

Rinsho Shinkeigaku 2018 Nov 27;58(11):668-672. Epub 2018 Oct 27.

Department of Neurology, Dokkyo Medical University.

A 56-year-old man noted sudden onset of headache, fever, right pupil-spared oculomotor nerve palsy and consciousness disturbance. Swelling of pituitary with T high intensity on brain MRI suggested the diagnosis of pituitary apoplexy. Considering significant decrease of pituitary anterior lobe hormone and central diabetes insipidus, high dose of hydrocortisone was administered. Read More

Clin Interv Aging 2018 12;13:1981-1985. Epub 2018 Oct 12.

Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,

Background: Whether conservative treatment or surgical management is the most appropriate treatment for pituitary apoplexy (PA) is controversial. In general, if severe symptoms of compression occur, such as oculomotor nerve palsy, neurosurgery is performed to relieve the compression of anatomical structures near the PA.

Case Description: We describe the case of a 79-year-old man who was found to have an intrasellar pituitary incidentaloma. Read More

NMC Case Rep J 2018 Oct 20;5(4):111-113. Epub 2018 Sep 20.

Department of Neurosurgery, Sendai Medical Center, Sendai, Miyagi, Japan.

Dermoid tumors originating from the cavernous sinus are typically intradural, and thus, presentation with ophthalmoplegia is uncommon. Infantile dermoid tumors originating from the interdural space of the lateral wall of the cavernous sinus are also very rare. We herein present a 4-year-old infantile case of a dermoid cyst that was embedded in the lateral wall of the cavernous sinus. Read More

Brain Dev 2019 Feb 6;41(2):150-157. Epub 2018 Oct 6.

Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address:

Objectives: Defects in DNA damage responses or repair mechanisms cause numerous rare inherited diseases, referred to as "DNA-repair defects" or "DNA damage deficiency", characterized by neurodegeneration, immunodeficiency, and/or cancer predisposition. Early accurate diagnosis is important for informing appropriate clinical management; however, diagnosis is frequently challenging and can be delayed, due to phenotypic heterogeneity. Comprehensive genomic analysis could overcome this disadvantage. Read More

Perm J 2018 ;22

Surgeon in the Department of Otolaryngology-Head and Neck Surgery at the Oakland Medical Center in CA

Introduction: Vidian nerve schwannomas are exceedingly rare, with only 7 cases reported since 2006. Patients presenting with ocular symptoms have been reported in only 1 case.

Case Presentation: A 54-year-old woman presented with a 3-month history of right periorbital pressure, third cranial nerve palsy, and visual field defect. Read More

Asian J Neurosurg 2018 Jul-Sep;13(3):555-559

Department of Neurosurgery, National Neuroscience Institute, Singapore.

Introduction: Surgical oculomotor nerve palsy(ONP), defined by ptosis, ophthalmoplegia, diplopia and pupillary dilatation, is associated with intracranial aneurysms, especially posterior communicating artery (PcomA) aneurysms. Treatment of PcomA aneurysms include endovascular coiling and surgical clipping. This study retrospectively compared the recovery of ONP in patients who underwent endovascular coiling or surgical clipping. Read More

World Neurosurg 2019 Jan 27;121:e475-e480. Epub 2018 Sep 27.

Department of Neurological Surgery, University of Texas Southwestern Medical Center, Houston, Texas, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Houston, Texas, USA.

Background: Pupillary light reflex examinations are intrinsic to any good neurological examination. Consistent evidence has shown that automated pupillometry assessments provide superior accuracy and interrater correlation compared with bedside eye examinations. Pupillary indexes such as the neurological pupil index (NPI) can also provide several hours of warning before the advent of herniation syndromes or third nerve palsy. Read More

J Neurol Surg B Skull Base 2018 Oct 16;79(Suppl 4):S311-S315. Epub 2018 Jul 16.

Department of Neurosurgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.

 The main purpose of this article is to assess the effectiveness and safety of surgery via the endoscopic endonasal approach (EEA) for cavernous sinus (CS) lesion in patients with nonfunctioning pituitary adenomas (NFPA).  Retrospective study.  Keio University Hospital. Read More

Sultan Qaboos Univ Med J 2018 May 9;18(2):e202-e207. Epub 2018 Sep 9.

Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.

Stroke is a common medical emergency resulting from numerous pathophysiological mechanisms and with varied clinical manifestations; as such, the diagnosis of stroke requires diligent clinical assessment. When different stroke syndromes occur in the same patient, it may cause a dilemma in terms of diagnosis and management. This continuing medical education article describes an interesting patient with recurrent neurological events, highlighting the complex pathophysiological processes associated with cerebrovascular syndromes. Read More

Intern Med 2019 Feb 12;58(3):433-436. Epub 2018 Sep 12.

Department of Neurology, Nagoya University Graduate School of Medicine, Japan.

An otherwise healthy 44-year-old woman exhibited isolated unilateral oculomotor nerve palsy accompanied by an influenza A infection. An intra-orbital MRI scan revealed that her right third intracranial nerve was enlarged and enhanced. She recovered completely during the first month after treatment with oseltamivir phosphate. Read More

Acta Neurochir (Wien) 2018 Nov 8;160(11):2187-2189. Epub 2018 Sep 8.

Department of Neurosurgery, Neurocenter of the Southern Switzerland, Regional Hospital of Lugano, Via Tesserete 46, 6903, Lugano, Switzerland.

Background: Posterior communicating artery aneurysms sometimes present with partial or complete oculomotor nerve palsy, due to direct oculomotor nerve compression, irritation by subarachnoid blood, or both. Superiority of surgical clipping over endovascular coiling in terms of postoperative outcome is still controversial.

Method: Direct oculomotor nerve decompression by opening of the anterior petroclinoid ligament during aneurysm clipping is performed as a simple and feasible surgical maneuver which allows to improve the decompression effect obtained by aneurysm exclusion. Read More

Graefes Arch Clin Exp Ophthalmol 2019 Jan 4;257(1):199-205. Epub 2018 Sep 4.

Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.

Background: To investigate prognostic factors in patients with augmented superior rectus transposition (SRT) for sixth nerve palsy.

Methods: Thirteen patients who were diagnosed with sixth nerve palsy and underwent augmented SRT between January 2015 and February 2017 in EENT Hospital of Fudan University were reviewed retrospectively. Data including age, sex, etiology of the abducens nerve palsy, degree of pre- and postoperative deviation in the primary position, pre- and postoperative abduction deficit, any induced vertical or torsional deviations, reoperations, and other complications was collected. Read More

Oper Neurosurg (Hagerstown) 2018 Aug 30. Epub 2018 Aug 30.

Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Brainstem cavernous malformations (CMs) account for 15% to 18% of all intracranial CMs1 and 13% of all cerebrovascular pathology in the posterior fossa.1,2 This video demonstrates the resection of a pontomesencephalic CM through a pretemporal approach through the oculomotor-tentorial triangle (OTT).3 A 49-yr-old woman presented with an acute onset of left hemiparesis, diplopia, vertigo, partial oculomotor, and facial palsy. Read More

World Neurosurg 2018 Sep 2;117:413-418. Epub 2018 Jul 2.

Department of Neurology, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran. Electronic address:

Background: Central nervous system tuberculoma is the most severe manifestation of extrapulmonary tuberculosis with high mortality. Cavernous sinus tuberculoma (CST) is a very rare central nervous system tuberculoma with few cases reported in the literature.

Case Description: A 57-year-old woman was admitted to our clinic with acute diplopia and headache limited to the right side. Read More

Neural Regen Res 2018 Oct;13(10):1851-1856

Ocular Motility Disorder Treatment & Rehabilitation Center, Department of Acupuncture, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.

Objective and accurate assessment of the degree of ocular motor nerve palsy is helpful not only in the evaluation of prognosis, but also for the screening of treatment methods. However, there is currently no comprehensive measure of its severity. In this study, we designed the Ocular Motor Nerve Palsy Scale and investigated its validity and reliability. Read More

Indian J Ophthalmol 2018 09;66(9):1367-1369

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.

Isolated schwannomas of motor nerves to extraocular muscles are uncommon. In addition, most previous studies on oculomotor nerve schwannoma discuss adult patients, and pediatric cases are rare. We report a 10-year-old girl who developed recurrent oculomotor nerve palsy caused by schwannoma without any vascular malformation. Read More

Can J Ophthalmol 2018 Aug 11;53(4):e138-e140. Epub 2017 Dec 11.

Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan; National Taiwan University Hospital, Taipei, Taiwan. Electronic address:

Case Rep Neurol Med 2018 9;2018:9720843. Epub 2018 Jul 9.

NYC Health + Hospitals/Queens, Icahn School of Medicine at Mount Sinai, USA.

Early disseminated Lyme disease typically presents with cardiac, rheumatologic, or neurologic symptoms. Though uncommon, can invade the central nervous system and cause neuroborreliosis. In these patients, facial palsy, headache, and stiffness of the neck are the most common presenting symptoms. Read More