1/16. Weber's syndrome secondary to subarachnoid hemorrhage.BACKGROUND: Since a large intracranial hemorrhage is a space-occupying mass, it may cause the brain to shift, resulting in neurologic deficits both at the location of the bleeding and at a site distal to the hemorrhage. A parietal lobe hemorrhage may push the brain downward, causing the uncus of the temporal lobe to herniate through the tentorial notch, compressing the midbrain. The signs of parietal lobe damage, uncal herniation, and several midbrain syndromes that effect ocular motility are discussed. CASE REPORT: A 66-year-old Hispanic man came to us with a history of a subarachnoid hemorrhage that involved the right parietal lobe. Several signs of damage to both the right parietal lobe and midbrain were evident, including an ipsilateral third nerve paresis with contralateral hemiplegia, Weber's syndrome. CONCLUSION: A patient who survives a subarachnoid hemorrhage may demonstrate permanent residual neurologic deficits subsequent to the acute event. The presentation is particularly complex when the hemorrhage is large and damage occurs at multiple locations. Damage at the level of the midbrain is evident when the findings include Weber's syndrome, which is one of several syndromes that involves the oculomotor nerve.- - - - - - - - - - ranking = 1keywords = subarachnoid (Clic here for more details about this article) |
2/16. Bilateral third and unilateral sixth nerve palsies as early presenting signs of metastatic prostatic carcinoma.PURPOSE: To report four cases of cranial nerve palsy, which presented to the ophthalmologist as the only or one of the earliest manifestations of prostatic carcinoma. This is an infrequent complication of metastatic prostatic carcinoma usually only occurring late in the disease process in those with a history of prostatic carcinoma. methods: The case records of four patients with a history of a cranial nerve palsy who attended the ophthalmology department and who had a recent or subsequent diagnosis of prostatic carcinoma were reviewed. RESULTS: diplopia caused by lesions affecting the third and sixth nerves sometimes in association with sensory symptoms may be a manifestation of metastatic prostatic carcinoma. These findings are consistent with base of the skull metastases from the condition.Two patients are still alive 54 months and 12 months after the diagnosis. One of the patients died 13 months after the diagnosis of prostatic carcinoma was made and the other died 21 months after the diagnosis from an unrelated hypertensive brain haemorrhage. CONCLUSIONS: Any patient presenting with diplopia must have an adequate past medical history taken and in an elderly gentleman this should include symptoms of prostatic disease. If indicated urological referral and measurement of prostate specific antigen may be performed.In patients whose cranial nerve palsy is complicated by other sensory signs or those in whom no sign of recovery occurs in 2 months, a contrast CT scan asking for bone windows to be included may be helpful in delineating any pathology.radiotherapy may be useful for the treatment of metastatic prostatic carcinoma causing cranial nerve palsies with some patients experiencing either complete or partial resolution of their symptoms. The effect of newer hormonal agents or chemotherapy on this aspect of the disease is not well documented in current literature.- - - - - - - - - - ranking = 0.02193769782744keywords = haemorrhage (Clic here for more details about this article) |
3/16. Balint's syndrome in a 10-year-old male.A 10-year-old male was referred with difficulties at school. He had particular difficulty with reading long words, following the sequence of text down a page, writing words in the correct order, writing words in line, and copying from the blackboard. He had a history of infective endocarditis complicated by intracerebral haemorrhage at the age of three years. Detailed history taking revealed symptoms typical of 'dorsal stream' pathology, namely a deficit of 'vision for action'. This included a spatial disorder of attention (simultanagnosia), defective hand and foot movements under visual control (optic ataxia), and acquired oculomotor apraxia which are consistent with Balint's syndrome. Strategies were suggested for coping with the symptoms and one year later a distinct improvement in adapting to the disability was found.- - - - - - - - - - ranking = 0.02193769782744keywords = haemorrhage (Clic here for more details about this article) |
4/16. Superior division paresis of the oculomotor nerve caused by cryptococcal meningitis.A case of cryptococcal meningitis with unilateral paresis of the superior division of the oculomotor nerve was reported. The ocular signs were completely improved by antifungal therapy. This case demonstrates that divisional oculomotor paresis occurred in the subarachnoid portion of the third cranial nerve before its anatomic bifurcation.- - - - - - - - - - ranking = 0.16666666666667keywords = subarachnoid (Clic here for more details about this article) |
5/16. Transient oculomotor nerve paresis in congenital distal basilar artery aneurysm.The clinical and pathologic findings of a 10-month-old girl with congenital heart disease who died after rupture of a congenital distal basilar artery aneurysm are reported. The patient developed transient minimal oculomotor nerve paresis 7 days prior to suffering a massive subarachnoid hemorrhage. The finding of transient third nerve dysfunction, particularly in the context of recurrent syncope, should prompt investigation for an intracranial arterial aneurysm.- - - - - - - - - - ranking = 0.16666666666667keywords = subarachnoid (Clic here for more details about this article) |
6/16. Aneurysmal oculomotor nerve palsy in an 11-year-old boy.Cerebral aneurysms are rare in children. When they occur, they usually present with a history of subarachnoid hemorrhage. Gabianelli et al. (1) recently reported a 14-year-old girl with an isolated oculomotor nerve palsy due to aneurysm. In their discussion, they state that arteriography is, "Unnecessary in patients under 10 (years of age) if the symptoms and signs of subarachnoid hemorrhage are absent or high resolution computerized tomography scan or adequate magnetic resonance imaging scan is normal." To date, their patient is the youngest reported in the literature with an isolated oculomotor nerve palsy proved to be caused by cerebral aneurysm. We report herein an 11-year-old boy who presented with an oculomotor nerve palsy due to aneurysm with minimal preceding symptoms and no other signs of intracranial disease.- - - - - - - - - - ranking = 0.33333333333333keywords = subarachnoid (Clic here for more details about this article) |
7/16. Unilateral oculomotor nerve paresis associated with anterior communicating artery aneurysm rupture--two case reports.Two cases of complete unilateral oculomotor nerve palsy occurred after subarachnoid hemorrhage (SAH) due to a ruptured anterior communicating artery aneurysm. A 61-year-old female suffered left oculomotor nerve paresis after mild SAH. This paresis was probably related to pre-existing oculomotor nerve stretching caused by abnormal positioning of the posterior cerebral and superior cerebellar arteries in the premesencephalic cistern. A 70-year-old female suffered right oculomotor nerve paresis after severe SAH. Elevated intracranial pressure might have caused this paresis, but the reason for the unilateral occurrence was undetermined. Both patients were treated by clipping of the aneurysm, and the signs of oculomotor nerve paresis gradually resolved. A pattern of pupil-sparing paresis was observed during the early recovery stage in both patients.- - - - - - - - - - ranking = 0.16666666666667keywords = subarachnoid (Clic here for more details about this article) |
8/16. Isolated oculomotor nerve palsy due to head injury.Traumatic isolated oculomotor nerve palsy with negative imaging studies is extremely rare. We reported such a case who after head injury had normal brain computerized tomography (CT), magnetic resonance imaging (MRI), and angiography. The absence of other neurological signs and normal brain MRI indicated the lesion was most likely within the subarachnoid space, as the other important structures near the third nerve, such as the brainstem, cavernous sinus and orbit, were undamaged. The prognosis of traumatic oculomotor palsy is usually poor. Generally speaking, patients experience more rapid and complete recovery of ptosis than of extraocular movements, while pupillary size and light reflex show the least degree of recovery. Further case collections with modern imaging studies are needed to clarify the mechanisms and clinical characteristics associated with this phenomenon.- - - - - - - - - - ranking = 0.16666666666667keywords = subarachnoid (Clic here for more details about this article) |
9/16. Dissociated unilateral convergence paralysis in a patient with thalamotectal haemorrhage.A 47 year old male was admitted in a comatose state. CT scan showed a haemorrhage in the right pulvinar thalamus descending into the right part of the lamina quadrigemina. He presented with anisocoria, prompt bilateral pupillary light reaction, and unilateral convergence paralysis contralateral to the lesion in combination with upward gaze palsy. During an observation period of two months, the convergence reaction returned to normal. MRI showed a lacunar lesion ventral to superior right colliculus. angiography revealed an arteriovenous malformation (right posterior cerebral artery--sinus rectus) as the possible cause of the haemorrhage.- - - - - - - - - - ranking = 0.13162618696464keywords = haemorrhage (Clic here for more details about this article) |
10/16. Concomitant ectatic posterior communicating artery and tentorial meningioma as a source of oculomotor palsy: case report.OBJECTIVE AND IMPORTANCE: Although non-aneurysmal vascular compression of the oculomotor nerve is rare, it should be considered in the evaluation of unilateral oculomotor palsy. CLINICAL PRESENTATION: A 36-year-old non-diabetic man presented with two months of intermittent retro-orbital headache and third nerve paresis caused by compression of the oculomotor nerve between an ectatic, atherosclerotic posterior communicating artery (PComA) and a small tentorial meningioma. At operation, the subarachnoid portion of the nerve, prevented from migrating posteriorly and laterally by the meningioma, was grooved by the apex of the artery's loop. INTERVENTION: Microvascular decompression (MVD) of the artery loop from the nerve and resection of the meningioma were performed. Postoperatively, the patient's retro-orbital headache and oculomotor paresis, with the exception of mild anisocoria, resolved. Tumor infiltrating the posterior tentorium and lateral cavernous sinus was treated by Cyberknife radiosurgery five months later. One year after surgery, the patient had improvement in his headaches, full extra-ocular movements, and minimal residual anisocoria. CONCLUSION: Only one other report describes MVD of the third nerve from PComA compression. A review is presented of MVD carried out for similar cases of non-aneurysmal vascular compression of the oculomotor nerve. By analogy from cases in which an aneurysm is the compressing vascular structure, prompt surgical treatment is advocated. Complete evaluation of an isolated third nerve palsy should include MRI sequences designed to detect vascular compression of cranial nerves.- - - - - - - - - - ranking = 0.16666666666667keywords = subarachnoid (Clic here for more details about this article) |
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