Partial third nerve palsy and ocular neuromyotonia from displacement of posterior communicating artery detected by high-resolution MRI.

Abstract

Ocular neuromyotonia is an unusual condition in which sustained, undesired contraction of one or more extraocular muscles occurs after normal muscle activation. Although most commonly reported after paraseller cranial irradiation for tumor, chronic nonaneurysmal vascular compression of the third nerve can produce partial ocular motor nerve paresis and ocular neuromyotonia. A 75-year-old woman presented with intermittent left-gaze-evoked binocular diplopia. She had an incomplete right third nerve palsy but became symptomatically diplopic and esotropic upon sustained left gaze. High-resolution brain magnetic resonance imaging showed displacement of the right posterior communicating artery and contact with the right third nerve. Gaze-evoked diplopia resolved with carbamazepine, but a partial third nerve paresis remained.

• Authors: Franz Marie Cruz, Ari M Blitz, Prem S Subramanian
• Journal: Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society (J Neuroophthalmol) Vol. 33 Issue 3 Pg. 263-5 (Sep 2013) ISSN: 1536-5166 [Electronic] United States
• PMID: 23912769 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anticonvulsants
• Carbamazepine

Topics

• Aged
• Anticonvulsants (therapeutic use)
• Carbamazepine (therapeutic use)
• Circle of Willis (pathology)
• Diplopia (drug therapy, etiology, pathology)
• Female
• Humans
• Isaacs Syndrome (diagnosis, etiology, pathology)
• Magnetic Resonance Imaging
• Oculomotor Nerve Diseases (diagnosis, etiology, pathology)
• Treatment Outcome