1
|
Zhang J, Wang S, Jiang Y, Zhang Y. Oculomotor Nerve Palsy Induced by a Cerebral Developmental Venous Anomaly: A Case Report and Comprehensive Review. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943363. [PMID: 38762752 PMCID: PMC11117436 DOI: 10.12659/ajcr.943363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/02/2024] [Accepted: 03/18/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Symptoms caused by developmental venous anomalies (DVAs) are usually mild and unspecific. Despite the benign nature of DVAs, they can occasionally be symptomatic. CASE REPORT A 67-year-old woman presented with sudden diplopia and left eyelid ptosis for 10 days. A neurologic examination revealed left complete oculomotor nerve palsy. Other neurologic deficits, including eye pain or pulsatile tinnitus, were not detected. Furthermore, the visual acuity was normal. Additionally, no retinal hemorrhage, venous dilatation, or fundus tortuosity were observed. No ischemia lesions or neoplasms were observed in MRI, and no widening or enhancement of the cavernous sinus was detected in post-contrast T1-weighted images, but magnetic resonance tomography cerebral angiography (MRTA) detected an offending vessel compressing the left oculomotor nerve in the fossa interpeduncular. We hypothesized that oculomotor nerve palsy (ONP) was caused by an abnormal arterial structure. However, digital subtraction angiography (DSA) revealed no aneurysm or abnormal arterial structure in the arterial phase, while a tortuous and dilated collecting vein was detected in the venous phase, connecting the left temporal lobe to the left cavernous sinus. This indicated a typical caput medusae appearance, suggesting the mechanism of oculomotor palsy caused by compressive impairment of the DVA. The patient refused microvascular decompression surgery, and ONP persisted after 30 days. Management was conservative, with spontaneous resolution at 60 days and no recurrence during the 2-year follow-up. CONCLUSIONS ONP is rarely caused by DVAs, which are easily ignored due to their benign nature. Cerebral vein examinations are advised for patients exhibiting clinical symptoms of unknown etiology.
Collapse
Affiliation(s)
- Jianying Zhang
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, PR China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Sisi Wang
- Department of Neurology, Shanghai Pudong New Area People’s Hospital, Shanghai, PR China
| | - Ying Jiang
- Department of Neurology, Changzhou First People’s Hospital, Changzhou, Jiangsu, PR China
| | - Yue Zhang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, PR China
| |
Collapse
|
2
|
Kiyofuji S, Kin T, Kakizawa Y, Doke T, Masuda T, Yamashita J, Shono N, Nakatomi H, Morita A, Harada K, Saito N. Development of Integrated 3-Dimensional Computer Graphics Human Head Model. Oper Neurosurg (Hagerstown) 2021; 20:565-574. [PMID: 33677574 DOI: 10.1093/ons/opab012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding the complex anatomy of neurostructures is very important in various stages of medical education, from medical students to experienced neurosurgeons, and, ultimately, for the knowledge of human beings. OBJECTIVE To develop an interactive computer graphics (CG) anatomic head model and present the current progress. METHODS Based on the prior head 3-dimensional CG (3DCG) polygon model, 23 additional published papers and textbooks were consulted, and 2 neurosurgeons and 1 CG technician performed revision and additional polygon modeling. Three independent neurosurgeons scored the clear visibility of anatomic structures relevant to neurosurgical procedures (anterior petrosal and supracerebellar infratentorial approaches) in the integrated 3DCG model (i model) and patients' radiological images (PRIs) such as those obtained from computed tomography, magnetic resonance imaging, and angiography. RESULTS The i model consisted of 1155 parts (.stl format), with a total of 313 763 375 polygons, including 10 times more information than the foundation model. The i model was able to illustrate complex and minute neuroanatomic structures that PRIs could not as well as extracranial structures such as paranasal sinuses. Our subjective analysis showed that the i model had better clear visibility scores than PRIs, particularly in minute nerves, vasculatures, and dural structures. CONCLUSION The i model more clearly illustrates minute anatomic structures than PRIs and uniquely illustrates nuclei and fibers that radiological images do not. The i model complements cadaveric dissection by increasing accessibility according to spatial, financial, ethical, and social aspects and can contribute to future medical education.
Collapse
Affiliation(s)
- Satoshi Kiyofuji
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Yukinari Kakizawa
- Department of Neurosurgery, Japanese Red Cross Society Suwa Hospital, Suwa, Japan
| | | | - Taisuke Masuda
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Juli Yamashita
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology, Sapporo, Japan
| | - Naoyuki Shono
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | | | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Kanako Harada
- Department of Mechanical Engineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
3
|
Dowlati E, Rotter J, Zhou T, Jha RT, Armonda RA. Posterior communicating artery infundibulum with oculomotor nerve palsy treated with microvascular decompression: a case report and 2-dimensional technical operative video. Br J Neurosurg 2020:1-4. [DOI: 10.1080/02688697.2020.1812522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Juliana Rotter
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Tianzan Zhou
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - R. Tushar Jha
- Department of Neurosurgery, Boston Medical Center, Boston, MA, USA
| | - Rocco A. Armonda
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Neurosurgery, MedStar Washington Hospital Center, Washington, DC, USA
| |
Collapse
|
4
|
Sivasubramaniyan KM, Nagarajan K, Rajeswari A, Sathiaprabhu A. A Case of Oculomotor Nerve Palsy caused by Neurovascular Compression by the Fetal Posterior Communicating Artery with a Review of Literature. Neurol India 2020; 67:1390-1392. [PMID: 31744989 DOI: 10.4103/0028-3886.271270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kulumani M Sivasubramaniyan
- Department of Radio-diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Krishnan Nagarajan
- Department of Radio-diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Aghoram Rajeswari
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Anbazhagan Sathiaprabhu
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| |
Collapse
|
5
|
Belotti F, Zanin L, Fontanella MM, Panciani PP. The oculomotor neurovascular conflict: Literature review and proposal of management. Clin Neurol Neurosurg 2020; 195:105920. [PMID: 32474258 DOI: 10.1016/j.clineuro.2020.105920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND The Oculomotor nerve (OCN) lies in a close relationship with large arteries inside the basal cisterns. Therefore, it may be compressed by vascular malformations or aneurysms. Nevertheless, the compression is not always related to pathologic conditions. Indeed, some cases of neurovascular conflicts of the OCN have been described in the literature. METHODS A case of neurovascular conflict of the OCN resolved after steroid treatment is reported. Additionally, a systematic literature review of those cases was performed. RESULTS OCN palsy due to a neurovascular conflict has been described as acute or chronic persistent palsy, or with an intermittent presentation. Symptoms result from compression, although asymptomatic compression is not uncommon. Surgical treatment, pharmacological treatment, and observation have been reported as options in the literature. Microvascular decompression was employed effectively in some cases of OCN neurovascular conflict. Nevertheless, other cases were treated successfully with steroids (persistent presentation) and carbamazepine (intermittent presentation). A management algorithm based on the results of the literature review is proposed. CONCLUSIONS Treatment options for OCN neurovascular conflicts and their results are heterogeneous. Based on the literature review, the pharmacological treatment seems to be the most appropriate first-line approach, reserving surgery for refractory cases. Collecting clinical information about new cases will allow defining treatment standards for this rare condition.
Collapse
Affiliation(s)
- Francesco Belotti
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
| | - Luca Zanin
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Marco Maria Fontanella
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| | - Pier Paolo Panciani
- Unit of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy
| |
Collapse
|
6
|
Busch CM, Prickett JT, Stein R, Cuoco JA, Marvin EA, Witcher MR. Meckel Cave Epidermoid Cyst Presenting as Multiple Cranial Nerve Deficits Due to Indirect Tumoral Compression of the Cavernous Sinus: A Case Report and Literature Review. World Neurosurg 2019; 121:88-94. [DOI: 10.1016/j.wneu.2018.09.206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/15/2022]
|
7
|
Fukami S, Akimoto J, Fukuhara H, Kohno M. Microvascular Decompression for Oculomotor Nerve Palsy Due to Compression by Infundibular Dilatation of Posterior Communicating Artery. World Neurosurg 2018; 119:142-145. [DOI: 10.1016/j.wneu.2018.07.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022]
|
8
|
Chen M, Song HM, Li MH, Wang W, Li YD. Outflow angle measurement: a simple approach for the differential diagnosis of intracranial protrusion with a branch artery arising from its top. Surg Radiol Anat 2017; 39:911-919. [DOI: 10.1007/s00276-017-1820-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 11/28/2016] [Indexed: 11/28/2022]
|
9
|
BOZKURT MF, DINC E, EKEN E, BOZKURT S, SUNDU C. A Rare Cause of Sudden Ptosis: Posterior Communicating Artery Aneurysm. Turk J Emerg Med 2016; 15:90-2. [PMID: 27336071 PMCID: PMC4910024 DOI: 10.5505/1304.7361.2015.90001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/23/2014] [Indexed: 11/16/2022] Open
Abstract
A forty-seven-year-old female patient was admitted to our clinic with sudden ptosis and diplopia without pain. She had no trauma or systemic disease history. Ptosis and mydriasis were observed in her left eye. Eye movement was restricted all directions without lateral. Isolated oculomotor nerve paralysis was diagnosed based on clinical findings, and posterior communicating artery aneurysm was observed in magnetic resonance angiography.
Collapse
Affiliation(s)
| | - Erdem DINC
- Department of Ophthalmology, Mersin University, Mersin, Turkey
| | - Emis EKEN
- Clinic of Neurology, Silifke State Hospital, Mersin, Turkey
| | - Seyran BOZKURT
- Department of Emergency, Mersin University, Mersin, Turkey,Correspondence: Merve Fatma BOZKURT, M.D. Faculty of Medicine, Department of ophthalmology, Ciftlikkoy Campus, Mersin University, 33110 Mersin, TurkeyCorrespondence: Merve Fatma BOZKURT, M.D. Faculty of MedicineDepartment of ophthalmologyCiftlikkoy CampusMersin UniversityMersin33110Turkey
| | - Cem SUNDU
- Department of Ophthalmology, Mersin University, Mersin, Turkey
| |
Collapse
|
10
|
Abstract
A 64-year-old man presented with a 2-day history of acute onset painless left ptosis. He had no other symptoms; importantly pupils were equal and reactive and eye movements were full. There was no palpable mass or swelling. He was systemically well with no headache, other focal neurological signs, or symptoms of fatigue. CT imaging showed swelling of the levator palpebrae superioris suggestive of myositis. After showing no improvement over 5 days the patient started oral prednisolone 30 mg reducing over 12 weeks. The ptosis resolved quickly and the patient remains symptom free at 6 months follow-up. Acute ptosis may indicate serious pathology. Differential diagnoses include a posterior communicating artery aneurysm causing a partial or complete third nerve palsy, Horner's syndrome, and myasthenia gravis. A careful history and examination must be taken. Orbital myositis typically involves the extraocular muscles causing pain and diplopia. Isolated levator myositis is rare.
Collapse
Affiliation(s)
| | - David Janicek
- Department of Ophthalmology, Singleton Hospital, Swansea, UK
| |
Collapse
|
11
|
Vlajković S, Vasović L, Trandafilović M, Jovanović I, Ugrenović S, Đorđević G. Infundibular dilatation of the posterior communicating artery in a defined population. Ann Anat 2015; 197:50-8. [DOI: 10.1016/j.aanat.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/02/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022]
|