Teaching NeuroImages: Acute isolated oculomotor nerve palsy of microvascular origin

A 73-year-old man presented with acute-onset, right-sided ptosis and pain above the right eye. His medical history noted hypertension and diabetes. On physical examination, an isolated right oculomotor palsy was noted with preserved pupillary function. An MRI scan revealed isolated swelling of superior, inferior, and medial rectus muscle at the right side (figure). No cause other than presumed microvascular oculomotor nerve ischemia was shown.1 In patients aged 50 years or older, isolated ocular motor nerve palsies are most likely due to microvascular ischemia, but other etiologies such as aneurysm, brainstem stroke, and malignancy should be ruled out with MRI.1,2

Source: Neurology - August 14, 2016 Category: Neurology Authors: van den Wijngaard, I. R., Hagenbeek, R. E., Jellema, K., Lycklama a Nijeholt, G. J. Tags: MRI, Other cerebrovascular disease/ Stroke, All Clinical Neurology, Ocular motility RESIDENT AND FELLOW SECTION Source Type: research