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Lin M, Huang JJM, Jiang IW, Spencer SKR, Campbell RG, Panizza B, Sach TA, Francis IC. Sphenoid Sinus Fungal Ball Presenting as Ipsilateral Primary Aberrant Regeneration of the Third Cranial Nerve. J Neuroophthalmol 2023; 43:e253-e255. [PMID: 35482429 DOI: 10.1097/wno.0000000000001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Michael Lin
- Faculty of Medicine (ML, JJMH, IWJ, SKRS, ICF), University of New South Wales, Sydney, Australia; Department of Ophthalmology (ML), Sydney and Sydney Eye Hospital, Sydney, Australia; Department of Ophthalmology (SKRS, ICF), Prince of Wales Hospital, Sydney, Australia; Department of Otolaryngology - Head and Neck Surgery (RGC), Macquarie University Hospital, Sydney, Australia; Department of Otolaryngology - Head and Neck Surgery (RGC), Royal Prince Alfred Hospital, Sydney, Australia; Department of Otolaryngology - Head and Neck Surgery (BP), Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine (BP), University of Queensland, Brisbane, Australia; and San Radiology and Nuclear Medicine (TAS), Sydney Adventist Hospital, Sydney, Australia
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Wu X, Liang L, Wu BW, Xie SH, Wu J, Wan XC, Din H, Zhan J, Xiao LM, Tang B, Hong T. Pituitary adenoma with oculomotor cistern extension: membranous anatomy and clinical application. Acta Neurochir (Wien) 2023; 165:2985-2993. [PMID: 37672094 DOI: 10.1007/s00701-023-05784-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND The anatomical basis of pituitary adenomas (PAs) with oculomotor cistern (OC) extension as a growth corridor is overlooked in the literature. In this paper, the authors use the technique of epoxy sheet plastination to study the membranous structure of the OC and validate the results by retrospective analysis of patients with OC extension. METHODS Eighteen specimens were used to study the membranous anatomy surrounding the OC using the epoxy sheet plastination technique. Thirty-four patients with OC extension were retrospectively reviewed. RESULTS The OC consisted of two thin membranous layers. The inner layer was extended by the arachnoid layer from the posterior fossa, and the lateral layer consisted of the dura mater sinking from the roof of the cavernous sinus. The oculomotor nerve is more likely to displace with a superolateral trajectory due to the weakness of the posterior dura and the relatively large space in the medial and posterior trajectories, which is consistent with the intraoperative observations. Among the anatomical factors that affect the PA by OC extension, we found that the relative position of the internal carotid artery (ICA) and posterior clinoid process may lead to the narrowing of the OC. Of 34 cases, 28 patients achieved total resection. Among 24 preoperative patients with oculomotor nerve palsy, 16 cases were relieved to varying degrees postoperatively. There was no ICA injury or severe intracranial infection found in any of the patients. CONCLUSIONS Extension into the OC is influenced by two anatomical factors: a weak point in the dura in the posterior OC and a potential space beyond this region of the dura. Meticulous knowledge of the membranous anatomy in endoscopic endonasal surgery is required to safely and effectively resect PA with OC extension.
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Affiliation(s)
- Xiao Wu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Liang Liang
- Department of Anatomy, Anhui Medical University, NO. 81, Meishan Road, Shushan District, Hefei, Anhui, China
| | - Bo Wen Wu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Shen Hao Xie
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Jie Wu
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Xi Chen Wan
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Han Din
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Jie Zhan
- Department of Radiology, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Li Min Xiao
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China
| | - Bin Tang
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China.
| | - Tao Hong
- Department of Neurosurgery, the First Affiliated Hospital of Nanchang University, 17 Yong Wai Zheng Street, Nanchang, China.
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Choi YM, Kim N. Frontalis Sling Using a Silicone Rod for Ptosis in Third Nerve Palsy: Cosmesis Versus Safety. Korean J Ophthalmol 2022; 36:159-167. [PMID: 35067023 PMCID: PMC9013560 DOI: 10.3341/kjo.2021.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate the results of the frontalis sling operation using a silicone rod for the correction of ptosis in patients with third nerve palsy with a focus on corneal safety. Methods Patients with third nerve palsy who underwent the frontalis sling operation using a silicone rod between 2008 and 2019 were included in this study. The medical records of all patients were reviewed, and their clinical characteristics and postoperative outcomes were analyzed. In this retrospective, interventional case series, the main outcome measures were eyelid contour, eyelid height by margin reflex distance, and corneal status. Results Twenty-four eyes of 18 patients (12 male and six female patients) were included. The mean age at the time of surgery was 35.1 years (range, 5–64 years). Twelve patients underwent a unilateral ptosis operation, and six patients received a bilateral ptosis operation. The mean follow-up period was 32.1 months (range, 2–87 months). Most patients (21 of 24 eyes, 88%) showed poor Bell’s phenomenon on preoperative examination. Satisfactory eyelid height and eyelid contour were achieved in almost all patients (mean postoperative margin reflex distance, +1.2 mm) postoperatively. Although corneal erosions were detected for several months in eight of 24 eyes after surgery, these findings were well controlled medically with artificial tear eye drops and ointments. Conclusions Frontalis sling surgery using a silicone rod can safely and effectively correct ptosis without severe corneal complications in patients with third nerve palsy. Our study outlines a new method to define the postoperative safety outcome by specifically focusing on categorized corneal status.
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Affiliation(s)
- Yong Min Choi
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea
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Seifelnasr M, Theodorsson M, Hart J, O'Sullivan E. Rare presentation of sarcoidosis with optic neuropathy and third nerve palsy. BMJ Case Rep 2021; 14:e246024. [PMID: 34764122 PMCID: PMC8587621 DOI: 10.1136/bcr-2021-246024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/04/2022] Open
Abstract
Sarcoidosis is a systemic, idiopathic and granulomatous disease, which most commonly affects the skin, lungs and lymph nodes but can affect virtually any organ. Neurosarcoidosis can be the presenting or the only clinical manifestation accounting for 5%-15% of sarcoid diagnoses. In contrast to uveitis which is the most common ophthalmic manifestation, neuro-ophthalmic signs are uncommon in sarcoidosis. Optic neuropathy is the most common neuro-ophthalmic sign (70% in one series). Sarcoid-related optic neuropathy commonly presents with a picture similar to optic neuritis. Less commonly, optic nerve involvement occurs secondary to compressive lesions, or from direct granulomatous infiltration. Neuroimaging is crucial to identify the location of the lesion. We describe a case of sarcoid-related compressive optic neuropathy and third nerve palsy and highlight the challenging nature of neurosarcoidosis in a patient without a prior diagnosis of the disease.
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Affiliation(s)
- Mohamed Seifelnasr
- Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
- Ophthalmology, Alexandria University, Alexandria, Egypt
| | | | - Jonathan Hart
- Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Eoin O'Sullivan
- Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
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Paul R, Gayen B, Sarkar R. Subdural Haemorrhage Presenting with Isolated Unilateral 3rd Cranial Nerve Palsy. J Assoc Physicians India 2018; 66:104-105. [PMID: 31315342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Rudrajit Paul
- Associate Professor, Dept. of Medicine, Midnapore Medical College, Medinipur, West Bengal
| | - Biplab Gayen
- Assistant Professor, Dept. of Medicine, Midnapore Medical College, Medinipur, West Bengal
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Lei Y, Meng X, Zhao Q, Wu L, Wu M, Du Y. [Professor WU Lianzhong's experience in the treatment of oculomotor nerve palsy with acupuncture based on the interactions of twelve muscle regions and opposing needling theory]. Zhongguo Zhen Jiu 2018; 38:757-760. [PMID: 30014672 DOI: 10.13703/j.0255-2930.2018.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
It was to introduce professor WU Lianzhong's experience in the treatment of oculomotor nerve palsy with acupuncture based on the interactions of twelve muscle regions and opposing needling theory. In the treatment, the TCM syndrome differentiation is taken as the general principle, the theory of the interactions of twelve muscle regions and opposing needling as the specific feature. The contrary needling is used at Hanyan (GB 4) and Juliao (ST 3) on the healthy side. The meridian-collateral and the exterior-interior differentiations are adopted to identify the syndromes. At the early stage of the disease, the treating principle focuses on expelling wind, eliminating cold and promoting the circulations of meridians and collaterals. The shallow needling, less acupoints and gentle stimulation are required. At the middle and late stage, the treating principle concentrates on strengthening the antipathogenic qi and harmonizing qi and blood. The deep needling, the multiple acupoints and the strong stimulation are applied. Additionally, the four-needling technique at Fengchi (GB 20), the multiple shallow needling at the eyelid margin, the opposing needling and the quantity of needling sensation are used in combination, which were developed by professor WU. With those comprehensivemethods, the symptoms of oculomotor nerve palsy are relieved and the significant clinical therapeutic effects achieved.
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Affiliation(s)
- Yun Lei
- Tianjin University of TCM, Tianjin 300193,China; The First Affiliated Hospital of Tianjin University of TCM, Tianjin 300381
| | - Xianggang Meng
- The First Affiliated Hospital of Tianjin University of TCM, Tianjin 300381
| | - Qi Zhao
- The First Affiliated Hospital of Tianjin University of TCM, Tianjin 300381
| | - Lianzhong Wu
- The First Affiliated Hospital of Tianjin University of TCM, Tianjin 300381
| | - Menghan Wu
- The First Affiliated Hospital of Tianjin University of TCM, Tianjin 300381
| | - Yuzheng Du
- The First Affiliated Hospital of Tianjin University of TCM, Tianjin 300381
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Affiliation(s)
- David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Mass Eye and Ear, and Harvard Medical School
| | - Yoshihiro Yonekawa
- Department of Ophthalmology, Boston Children's Hospital, Mass Eye and Ear, and Harvard Medical School
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Mass Eye and Ear, and Harvard Medical School
| | - Linda R Dagi
- Department of Ophthalmology, Boston Children's Hospital, Mass Eye and Ear, and Harvard Medical School
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Khawam E, Fahed D. Review: oculomotor cranial nerve palsies: symptoms, problems and non-surgical preoperative management of the resultant complex incomitant strabismus and monocular and binocular vision disturbances. Binocul Vis Strabolog Q Simms Romano 2012; 27:23-34. [PMID: 22404089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this presentation is first to describe the symptoms and problems encountered in cranial nerve palsies (CNP). The purpose is also to describe the different means of treatment during the observational preoperative period and their positive or negative impact on each of the symptoms and problems. Finally, we will present our way of handling these patients in their preoperative period: practical, inexpensive, and unsophisticated means that keep the patient comfortable and prevent the secondary untoward effects that can take place.
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Furuno Y, Sasajima H, Tatsuzawa K, Owada K, Mineura K. [Orbital schwannoma developing from the superior branch of the oculomotor nerve--case report]. No Shinkei Geka 2006; 34:45-9. [PMID: 16440696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Orbital schwannoma accounts for 1-6% of all orbital tumors and it is not easy to identify the origin of the tumor because of the anatomy of the orbit. A case of orbital schwannoma developing from the superior branch of the oculomotor nerve is reported. A 74-year-old female was admitted to our hospital with the chief complaint of left exophthalmus. MR imaging revealed a space-occupying lesion in the left orbit. Operation was performed through the transcranial approach. It was noticed that the tumor was developing from the nerve that runs into the superior rectus muscle or the levator palpebrae superioris muscle, and it was diagnosed as a schwannoma on frozen section histology during surgery. The tumor was successfully removed and, postoperatively, no additional defects occurred. Careful consideration of microsurgical anatomy is essential for surgery of orbital schwannoma especially when it's necessary to cut the nerves.
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Affiliation(s)
- Yuichi Furuno
- Department of Neurosurgery, Kyoto Prefectural University of Medicine, Japan
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Vadalà R, Africa E, Pauciulo A, Santa Lorusso V, Filograna L, Tartaglione T. Unusual lesion of the thalamic pineal region: role of conventional MRI and DWI in the differential diagnosis. Rays 2005; 30:215-20. [PMID: 16512066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
The case of a 53-year-old female patient admitted to the Emergency department with symptoms from right third cranial nerve of acute onset, is presented. Cranial CT, performed in emergency, documented an intra-axial mass which required an in-depth diagnostic study with cranial MRI after contrast administration. Conventional MRI and DWI helped in correct lesion characterization and in the differential diagnosis with other brain disorders.
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Affiliation(s)
- Rita Vadalà
- Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy
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Affiliation(s)
- Roberto Ochoa
- Emergency Medicine Residency Program, Texas Tech University-HSC El Paso, 6090 Surety Drive, El Paso, TX 79905, USA.
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Abstract
Paresis of the oculomotor nerve is a very rare complication of an unruptured arteriosclerotic fusiform aneurysm of the basilar artery. A handful of cases are described in the world literature. A fifty-four-year-old man with a history of hypertension and diabetes mellitus presented with painless partial oculomotor palsy of sudden onset. A cerebral angiogram demonstrated a tortuous fusiform deformity of the basilar artery and the origin of the posterior cerebral arteries, indicative of an arteriosclerotic aneurysmal dilation. A sudden onset of a pupil-sparing ophthalmoplegia is the typical history of a microvascular infarct of the third nerve, whereas pupillary sparing in aneurysmal oculomotor paresis is a very rare event. Special emphasis has been placed on the pupillary size as a guide for the indication of arteriography. The many exceptions to this rule suggest that cerebral arteriography may be indicated more often than generally believed.
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Affiliation(s)
- E Soria
- VA Medical Center, Buffalo, New York
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JOHNSTON AC, PRATT-JOHNSON JA. THE OCULAR SEQUELAE OF THIRD CRANIAL NERVE PALSY. Can Med Assoc J 1963; 89:871-3. [PMID: 14069610 PMCID: PMC1921927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
The ocular sequelae in nineteen patients who had suffered from a complete paralysis of the third cranial nerve were analyzed. In eleven of these patients, the paralysis was associated with an aneurysm of the internal carotid artery system. None of the cases in this group showed complete recovery of the third nerve function; however, six recovered sufficiently to permit binocular single vision in most fields of gaze. Two cases of aberrant regeneration of the third nerve were diagnosed.Trauma accounted for four cases of third nerve paralysis. One of these recovered completely and one showed features of aberrant regeneration. Of the cases of oculomotor paralysis associated with herpes zoster ophthalmicus, encephalitis, or an obscure etiology (two cases), all recovered completely.
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BURIAN HM, VAN ALLEN MW. Cyclic oculomotor paralysis. Am J Ophthalmol 1963; 55:529-37. [PMID: 14017020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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BURIAN HM, VAN ALLEN MW. Cyclic oculomotor paralysis. Trans Am Ophthalmol Soc 1962; 60:276-92. [PMID: 14017021 PMCID: PMC1316494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
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PECKER J. [Apropos of some oto-neuro-ophthalmological problems caused by surgical treatment of Parkinson's disease]. Rev Otoneuroophtalmol 1961; 33:244-7. [PMID: 14484830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
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DI FIORE JA. Diabetic oculomotor neuropathy. Report of a case. Am J Ophthalmol 1960; 50:808-10. [PMID: 13722468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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SMITH JL. Some unusual motility problems of neuro-ophthal-mological importance. Am Orthopt J 1960; 10:138-42. [PMID: 13832035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/24/2023]
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BOUCHET M, PIALOUX P, PECKER J. [Oculomotor nerve paralysis cured by trephining of maxillary sinus]. Ann Otolaryngol 1954; 71:832-4. [PMID: 13229057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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ETCHEPAREBORDA JA, GONI AR, CASTRO JA. [Benedikt syndrome following trauma; associated Parinaud syndrome]. Rev Asoc Med Argent 1948; 62:743-745. [PMID: 18111074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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WOLFF E. A note on the position of the eye in a third nerve palsy. Br J Ophthalmol 1947; 31:427. [PMID: 20250993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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