Binoc Vis Strab Q 17: 43–48Ĭaksen H, Acar N, Odabas D, Cakin C, Tuncer O, Atas B (2002) Isolated left oculomotor nerve palsy following measles. Am J Perinatol 21(3): 153–155īrady-McCreery KM, Speidel S, Hussein MA, Coats DK (2002) Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies. Scand J Rheumatol 26(4): 327–328īonebrake RG, Fleming AD, Carignan EM, Hoover DK (2004) Severe preeclampsia presenting as third nerve palsy. Semin Neurol 20: 55–74īondenson J, Asman P (1997) Giant cell arteritis presenting with oculomotor nerve palsy. J Neuroophthalmol 24: 3–10īiousse V, Newman NJ (2000) Third nerve palsies. Ophthalmol Clin No Amer 14: 169–185īhatti MT, Peters KR, Firment C, Mericle RA (2004) Delayed exacerbation of third nerve palsy due to aneurysmal regrowth after endovascular coil embolization. J Neuroophthalmol 24: 225–227īennett JL, Pelak VS (2001) Palsies of the third, fourth, and sixth cranial nerves. Arch Neurol 43: 1015–1020īayramlar H, Miman MC, Demirel S (2004) Inferior oblique paresis, mydriasis, and accommodative palsy as temporary complications of sinus surgery. Neurology 64: 759–760īartleson JD, Trautmann JC, Sundt TM (1986) Minimal oculomotor nerve paresis secondary to unruptured intracranial aneurysm. Acta Neurol Scand 108(2): 139–141Īzran MS, Waljee A, Biousse V, Frankel M, Newman NJ (2005) Episodic third nerve palsy with cryptococcal meningitis. Jpn J Ophthalmol 46(5): 540–547Īydin MD, Aydin N (2003) A neuro-Behcet's lesion in oculomotor nerve nucleus. Surg Neurol 57(6): 423–426Īoki K, Sakaue T, Kubota N, Maruo T (2002) Outcome of surgery for bilateral third nerve palsy. Dentomaxillofac Radiol 33: 342–344Īrle JE, Abrahams JM, Zager EL, Taylor C, Galetta SL (2002) Pupil-sparing third nerve palsy with preoperative improvement from a posterior communicating artery aneurysm. acute painful pupil involved third nerve palsy) however probably still require strong consideration for catheter angiography but this decision must be individualized.Īkan H, Cihan B, Celenk C (2004) Sphenoid sinus mucocele causing third nerve paralysis: CT and MR findings. Patients with high risk for aneurysm (e.g. In these patients, the risks of catheter angiography is probably higher than the risks for aneurysm and CTA or MRA is probably sufficient to exclude aneurysm. The lowest risk categories for aneurysm are the isolated dilated pupil without ptosis or motility deficit (generally not a third nerve palsy but more commonly the tonic pupil, pharmacologic dilation, or iris damage) and the isolated, pupil-spared but otherwise complete external dysfunction third nerve palsy in a vasculopathic patient. Patients with a moderate or uncertain risk of aneurysm and a lower risk for catheter angiography or if there is a low confidence in the quality or the interpretation of the institutional MRA (or CTA) may still require catheter angiography in select circumstances. elderly, renal failure, iodinated contrast allergy, risk of stroke) then MRI and MRA (or CTA) may be a reasonable alternative to catheter angiography.
CONCLUSIONS: If the clinician is highly confident in the capability, availability, and reliability of the neuroradiologist and of their institutional experience and quality of less invasive non-catheter MRA and CTA and if the risk of aneurysm is low or if the risk of angiography is high (e.g. The issues surrounding the use of catheter angiography in third nerve palsy are reviewed. A properly performed and interpreted MRA or CTA probably will be able to detect greater than 95% of aneurysms producing a third nerve palsy. Advances in MRA and CTA technology have reduced but not eliminated our dependence upon catheter angiography in this setting. pupillary) dysfunction are generally used to guide the choice of initial neuroimaging. somatic) motor dysfunction and the presence or absence of internal (i.e.
Although it is clear that non-isolated third nerve palsies require imaging directed at the topographical localization of the clinical findings, the evaluation of the neurologically isolated third nerve palsy remains controversial. RESULTS: The patient with an isolated third nerve palsy might have a vasculopathic (and typically benign, self limited course) etiology or a life threatening intracranial posterior communicating artery aneurysm. METHODS: Clinical opinion-perspective and literature review. magnetic resonance angiography (MRA) and computerized tomography angiography (CTA)) in the evaluation of patients with a third nerve palsy. PURPOSE: To discuss the controversies surrounding the indications for catheter angiography versus non-catheter and less invasive angiography techniques (e.g.
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