Oculomotor Nerve Palsy Due to a Slightly Displaced Posterior Communicating Artery, Manifested by Twitching Ptosis: A Case Report and Review of Literature
Abstract
A 20-year-old woman presented with left eye ptosis without any headache and pupillary dysfunctions. After the radiological examination, the oculomotor nerve compression was detected in the interpeduncular space by the posterior communicating artery (PCoA) with normal size and shape. The patient underwent frontotemporal craniotomy, and during the surgery, the nerve was detached from the PCoA. Immediately after surgery, all symptoms disappeared. Although oculomotor nerve palsy (ONP) owing to internal carotid-PCoA aneurysm is common, vascular compression due to a non- aneurysmal PCoA is very rare. To the extent of our knowledge, this is the first case in which a slightly displaced, otherwise normal, PCoA causes ONP without any pupillary involvement. After ruling out an aneurysmal artery, this should be considered as one of the possible causes of the ONP.
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[11] mulderink ta, bendok br, yapor wy, batjer hh. third nerve paresis caused by vascular compression by the posterior communicating artery. journal of stroke and cerebrovascular diseases. 2001;10(3):139-41. https://doi.org/10.1053/ jscd.2001.25469
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[13] 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;119:142-5. https://doi.org/10.1016/j. wneu.2018.07.242
[14] Cruz FM, Blitz AM, Subramanian PS. Partial third nerve palsy and ocular neuromyotonia from displacement of posterior communicating artery detected by high-resolution MRI. J Neuroophthalmol. 2013;33(3):263-5. https://doi.org/10.1097/ WNO.0b013e31829eb397
[15] Nakagawa H, Nakajima S, Nakajima Y, Furuta Y, Nishi O, Nishi K. Bilateral Oculomotor Nerve Palsies Due to Posterior Cerebral Arterial Compression Relieved by Microvascular Decompression. Neurologia medico-chirurgica. 1991;31(1):45- 8. https://doi.org/10.2176/nmc.31.45
[16] Demetriou GA, Bell D. Isolated third cranial nerve palsy from non-aneurysmal internal carotid artery compression. QJM. 2014;107(10):855-6. https://doi.org/10.1093/qjmed/hcu061
[17] Israni A, Chakrabarty B, Kumar A, Gulati S. Partial oculomotor nerve palsy in a 7-year-old child. J Pediatr Neurosci. 2016;11(2):159-60. https://doi.org/10.4103/1817- 1745.187650
[18] Joshi S, Tee WWH, Franconi C, Prentice D. Transient oculomotor nerve palsy due to non-aneurysmal neurovascular compression. Journal of Clinical Neuroscience. 2017;45:136-7. https://doi.org/10.1016/j.jocn.2017.07.006
[19] Kheshaifati H, Al-Otaibi F, Alhejji M. Microvascular Decompression for Oculomotor Nerve Palsy: A Case Report and Literature Review. World neurosurgery. 2016;88:695. e1-. e3. https://doi.org/10.1016/j.wneu.2015.12.083
[20] Hashimoto M, Ohtsuka K, Akiba H, Harada K. Vascular compression of the oculomotor nerve disclosed by thin- slice magnetic resonance imaging. Am J Ophthalmol. 1998; 125(6):881-2. https://doi.org/10.1016/s0002-9394(98)00051-8.
[2] Haider AS, Gottlich C, Sumdani H, Layton KF, Doughty K. Acute Oculomotor Nerve Palsy Caused by Compression from an Aberrant Posterior Communicating Artery. Cureus. 2019;11(1):e3920. https://doi.org/10.7759/cureus.3920
[3] Babbitz JD, Harsh GRt. Concomitant ectatic posterior communicating artery and tentorial meningioma as a source of oculomotor palsy: case report. Neurosurgery. 2005;57(6):E1316; discussion E. https://doi.org/10.1227/01. neu.0000187448.96386.03
[4] Tsutsumi S, Miranda JC, Ono H, Yasumoto Y. The cisternal segments of the oculomotor nerve: a magnetic resonance imaging study. Surg Radiol Anat. 2017;39(3):323-31. https:// doi.org/10.1007/s00276-016-1725-7
[5] Tan T, Tee JW, Wang YY. Oculomotor nerve palsy secondary to aberrant posterior cerebral artery. BMJ case reports. 2014;2014:bcr2014205063. https://doi.org/10.1136/bcr- 2014-205063
[6] Fukushima Y, Imai H, Yoshino M, Kin T, Takasago M, Saito K, et al. Ptosis as partial oculomotor nerve palsy due to compression by infundibular dilatation of posterior communicating artery, visualized with three-dimensional computer graphics: case report. Neurol Med Chir. 2014; 54(3): 214–218. https://doi. org/10.2176%2Fnmc.cr2012-0383
[7] Raza HK, Chen H, Chansysouphanthong T, Cui G. The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature. Somatosens Mot Res. 2018;35(3-4):229-39. https:// doi.org/10.1080/08990220.2018.1547697
[8] Silva Jr EBd, Ramina R, Meneses MSd, Kowacs PA, Silva EBd. Bilateral oculomotor nerve palsies due to vascular conflict. Arq Neuropsiquiatr. 2010;68:819-21. https://doi.org/10.1590/ s0004-282x2010000500030
[9] Fairbanks C, White JB. Oculomotor nerve palsy in the setting of an anterior cerebral A2 segment aneurysm. J Neurointerv Surg. 2011;3(1):74-6. https://doi.org/10.1136/jnis.2010.002964
[10] Elazab NE, Riel-Romero RM, Gonzalez-Toledo E. Internal carotid artery agenesis and basilar artery aneurysm with third nerve palsy. Pediatr Neurol. 2010;42(6):451-4. https://doi. org/10.1016/j.pediatrneurol.2010.02.002
[11] mulderink ta, bendok br, yapor wy, batjer hh. third nerve paresis caused by vascular compression by the posterior communicating artery. journal of stroke and cerebrovascular diseases. 2001;10(3):139-41. https://doi.org/10.1053/ jscd.2001.25469
[12] Kojo N, Lee S, Otsuru K, Takagi S, Shigemori M, Watanabe M. A case of ophthalmoplegic migraine with cerebral aneurysm. No Shinkei Geka. 1988;16(5 Suppl):503-7. PMID: 3399004
[13] 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;119:142-5. https://doi.org/10.1016/j. wneu.2018.07.242
[14] Cruz FM, Blitz AM, Subramanian PS. Partial third nerve palsy and ocular neuromyotonia from displacement of posterior communicating artery detected by high-resolution MRI. J Neuroophthalmol. 2013;33(3):263-5. https://doi.org/10.1097/ WNO.0b013e31829eb397
[15] Nakagawa H, Nakajima S, Nakajima Y, Furuta Y, Nishi O, Nishi K. Bilateral Oculomotor Nerve Palsies Due to Posterior Cerebral Arterial Compression Relieved by Microvascular Decompression. Neurologia medico-chirurgica. 1991;31(1):45- 8. https://doi.org/10.2176/nmc.31.45
[16] Demetriou GA, Bell D. Isolated third cranial nerve palsy from non-aneurysmal internal carotid artery compression. QJM. 2014;107(10):855-6. https://doi.org/10.1093/qjmed/hcu061
[17] Israni A, Chakrabarty B, Kumar A, Gulati S. Partial oculomotor nerve palsy in a 7-year-old child. J Pediatr Neurosci. 2016;11(2):159-60. https://doi.org/10.4103/1817- 1745.187650
[18] Joshi S, Tee WWH, Franconi C, Prentice D. Transient oculomotor nerve palsy due to non-aneurysmal neurovascular compression. Journal of Clinical Neuroscience. 2017;45:136-7. https://doi.org/10.1016/j.jocn.2017.07.006
[19] Kheshaifati H, Al-Otaibi F, Alhejji M. Microvascular Decompression for Oculomotor Nerve Palsy: A Case Report and Literature Review. World neurosurgery. 2016;88:695. e1-. e3. https://doi.org/10.1016/j.wneu.2015.12.083
[20] Hashimoto M, Ohtsuka K, Akiba H, Harada K. Vascular compression of the oculomotor nerve disclosed by thin- slice magnetic resonance imaging. Am J Ophthalmol. 1998; 125(6):881-2. https://doi.org/10.1016/s0002-9394(98)00051-8.
| Files | ||
| Issue | Vol 7 No 3 (2022): May-June | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v7i3.11124 | |
| Keywords | ||
| Oculomotor nerve Posterior communicating artery Ptosis Oculomotor nerve palsy Nerve decompression surgery | ||
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How to Cite
1.
Tafakhori A, Soltani Khaboushan A, Taghilou A, Shafiee S. Oculomotor Nerve Palsy Due to a Slightly Displaced Posterior Communicating Artery, Manifested by Twitching Ptosis: A Case Report and Review of Literature. CRCP. 2022;7(3):138-143.
