eISSN 2287-1683 pISSN 1738-8767 䤎 Case Report 䤎 Journal of Trauma and Injury Vol. 30, No. 2, June, 2017 http://dx.doi.org/10.20408/jti.2017.30.2.66
Bilateral Oculomotor Nerve Palsy after Head Trauma: A Case Report
Hae Won Noh, M.D., Jae Young Song, M.D., Jong Hyun Kim, M.D., Jang Hun Kim, M.D.
Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea
We introduce a patient who was suffered from isolated traumatic bilateral oculomotor nerve palsy after head trauma. The patient presented with bilateral ptosis and abnormal pupilary responses with slightly drowsy mentality at first. Performed images demonstrated some hematomas along subarachnoid, intraventricular, subdural spaces and multiple small supratentorial contusions. There was no bony abnormality or ligament injury. We assumed that small amount of interpeduncular hematoma might be the proper lesion associated with oculomotor nerve palsies, since the clinical symptom and signs presented bilaterally and the oculomotor neural fascicles run through the interpeduncular fossa. [ J Trauma Inj 2017; 30: 66-69 ]
Key Words: Bilateral, Oculomotor nerve palsy, Head trauma
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䤇 Address for Correspondence : Jang Hun Kim, M.D. Department of Neurosurgery, Guro Hospital, Korea University Medical Center, 148, Gurodong-ro, Guro-gu, Seoul, Korea Tel : 82-2-2626-1178, Fax : 82-2-863-1684, E-mail : [email protected] Submitted : April 4, 2017 Revised : May 10, 2017 Accepted : May 10, 2017
ȇȇ Hae Won Noh, et al. Bilateral Oculomotor Nerve Palsy after Head Trauma: A Case Report
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Fig. 1. Neurologic assessment of light reflex; Initially, non-reactive pupils measuring 5 mm size were identified.
Fig. 2. Neurologic assessment of extraocular muscles; Limitations of medial and vertical movements of both eyeballs were presented.
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Fig. 3. Brain computed tomography (CT); Diffuse subarachnoid hemorrhage (SAH) on basal cistern and bilateral sylvian fissure, subdural hemorrhage (SDH) around falx were identified. Subarachnoid hemorrhage also noted in the interpeducular, left ambient and quadrigeminal cisterns.
Fig. 4. Brain magnetic resonance image (MRI); The interpeduncular cisternal hemorrhage was observed in MRI.
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ȇȇ Hae Won Noh, et al. Bilateral Oculomotor Nerve Palsy after Head Trauma: A Case Report
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im E, Chang H. Isolated oculomotor nerve palsy following minor head trauma : case illustration and literature review. BM DPNQMFUF PDVMPNPUPS QBMTZ BGUFS USBGGJD BDDJEFOU Journal of Korean Neurosurgical Society 2013; 54(5): 434-6. BOETVTQFDUFEUIFBTTPDJBUJPOXJUICJMBUFSBMEBNBHF 02) Memon MY, Paine KW. Direct injury of the oculomotor PGUIFPDVMPNPUPSOFSWFTOFBSUIFQFUSPDMJOPJEMJHB nerve in craniocerebral trauma. Journal of neurosurgery 1971; NFOU 3VTI SFWJFXFE UXP DBTFT XIJDI MBDL BOZ 35(4): 461-4. DMJOJDBMBOESBEJPMPHJDEFUBJMT ,SVHFSFUBMUSJFE 03) Patel P, Kalyanaraman S, Reginald J, Natarajan P, Ganapathy UP EFNPOTUSBUF UIF MFTJPO PG PDVMPNPUPS QBMTZ XJUI K, Suresh Bapu K, et al. Post-traumatic cranial nerve injury. Indian J Neurotrauma 2005; 2(1): 27-32. $5BOE.3*SFTQFDUJWFMZJOIJTUXPDBTFTBOEGBJMFE 04) Shuaib A, Murphy W. Mesencephalic hemorrhage and third 5IFQFSJQIFSBMMFTJPODPVMEUIFSFGPSFCFTVTQFDUFEJO nerve palsy. The Journal of computed tomography 1987; IJT SFWJFX /BLBTIJNB FU BM SFQPSUFE DPNQMFUF 11(4): 385-8. CJMBUFSBMPDVMPNPUPSQBMTZBGUFSNPUPSWFIJDMFBDDJ 05) Baker C, Cannon J. Images in clinical medicine. Traumatic EFOU *OJUJBM (MBTHPX DPNB TDBMF XBT QPPS JO UIJT cranial nerve palsy. The New England journal of medicine 2005; 353(18): 1955. DBTF BOE QUPTJT BOE PDVMPNPUPS NPUJMJUZ XBT QBS 06) Kaido T, Tanaka Y, Kanemoto Y, Katsuragi Y, Okura H. UJBMMZ SFDPWFSFE BGUFS GFX NPOUIT 1BUFM FU BM Traumatic oculomotor nerve palsy. Journal of clinical neuro- SFQSFTFOUFEUIFEJTUSJCVUJPOPGQPTUUSBVNBUJDDSB science 2006; 13(8): 852-5. OJBMOFSWFJOKVSZBGUFSIFBEUSBVNB*OUIJTBSUJDMF 07) Fujino S, Fukai H, Umeda A, Tsutsui J. [Bilateral direct injury UPUBM QBUJFOU XFSF TVGGFSFE GSPN DSBOJBM OFSWF of oculomotor nerves in craniocerebral trauma-report of a case QBMTZ BNPOH IFBE JOKVSFE QBUJFOU QBUJFOUT (authorss transl)]. No Shinkei Geka 1977; 5(10): 1065-9. 08) Rush JA, Younge BR. Paralysis of cranial nerves III, IV, and XFSFBTTPDJBUFEXJUICBTBMTLVMMGSBDUVSFQBUJFOUT VI. Cause and prognosis in 1,000 cases. Archives of ophthal- XFSFBTTPDJBUFEXJUIUIJSEOFSWFQBMTZBOEPGUIFN mology 1981; 99(1): 76-9. TVGGFSFEGSPNCJMBUFSBMQBMTJFT5IFZTVQQPTFEEJSFDU 09) Kruger M, Noel P, Ectors P. Bilateral primary traumatic ocu- JOKVSZ NFDIBOJTN BOE SPTUSPEPSBM NJECSBJO JOUFS lomotor nerve palsy. The Journal of trauma 1986; 26(12): SVQUJPOMFBEUPCJMBUFSBMPDVMPNPUPSQBMTJFT 1151-3. 10) Nakashima S, Abe M, Tabuchi K, Kairada K. [Traumatic *OPVSDBTF XFDPVMEOsUGJHVSFPVUUIFEFGJOJUFSFBTPO bilateral oculomotor nerve palsy: a case report]. No Shinkei XIZUIFPDVMPNPUPSQBMTZPDDVSSFE%VSJOHMPDBMJ[B Geka 1992; 20(4): 505-8. UJPOPGUIFMFTJPOTJUF EFNPOTUSBUFEJNBHFTPGPDV
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