Intrinsic hematoma of the oculomotor nerve: case report and review of the literature.

Abstract:

OBJECTIVE AND IMPORTANCE:Intrinsic oculomotor nerve hematoma is an exceptional cause of third nerve palsy. This case report illustrates the clinical, radiological, and intraoperative relevance of this rare pathological finding. CLINICAL PRESENTATION:A 25-year-old woman with a 12-year history of gross total resection of cerebellar medulloblastoma and posterior whole-brain radiotherapy presented with complete left oculomotor palsy. Magnetic resonance imaging revealed a left-sided, perimesencephalic cistern, small, round lesion with a fluid level. Digital subtraction angiography demonstrated no evidence of vascular abnormalities. INTERVENTION:A pterional craniotomy was performed, and the left oculomotor nerve was exposed. A blackish intrinsic lesion was detected in its cisternal segment near the uncus. The lesion was incised, and liquid compatible with a subacute noncoagulated hematoma was drained. Three months after surgery, the patient had partial recovery from diplopia and extraocular muscle function. CONCLUSION:We reviewed the literature and found four cases of oculomotor nerve intrinsic hematoma. These cases were all associated with hematological diseases, trauma, or solid tumors, and, as a group, these patients had poor outcomes. In the present report, the possibility of radiotherapy-induced vasculopathy as a predisposing factor is discussed. Surgical removal of an intrinsic nerve hematoma is probably helpful in the functional recovery of these patients.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Ratilal BO,Galo SM,Luiz CA

doi

10.1227/01.neu.0000166687.59462.42

keywords:

subject

Has Abstract

pub_date

2005-08-01 00:00:00

pages

E370; discussion E370

issue

2

eissn

0148-396X

issn

1524-4040

pii

00006123-200508000-00032

journal_volume

57

pub_type

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