A review of isolated third nerve palsy without subarachnoid hemorrhage using computed tomographic angiography as the first line of investigation.

Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China.
Clinical Neurology and Neurosurgery (Impact Factor: 1.23). 01/2005; 107(1):27-31. DOI: 10.1016/j.clineuro.2004.02.023
Source: PubMed

ABSTRACT Digital subtraction angiography is recognized as the standard investigation for isolated third nerve palsy thought to be caused by an expanding aneurysm. We reviewed our experience in using computed tomographic angiography (CTA) as the first line investigation for patients presenting with isolated third nerve palsy without subarachnoid hemorrhage.
We retrieved the medical records of 34 patients who had presented with isolated third nerve palsy without associated subarachnoid hemorrhage to our institution between January 1998 and July 2001. The clinical history, course and outcome as well as the radiological data was reviewed.
A total of nine structural lesions (26%) were noted as the etiology of the third nerve palsy. All of the five posterior communicating artery aneurysms were picked up by the CTA. Neither the presence nor the absence of painful complete third nerve palsy was of diagnostic value for intracranial aneurysm.
A good quality CTA is sufficient to detect a compressive aneurysm and may detect other structural lesions. This allows neurosurgeons to plan the management of patients with isolated third nerve palsy. Patients in whom CTA results are inconclusive should be further investigated with catheter angiography.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate whether multidetector computed tomographic angiography (CTA) scanners can detect a clinically significant intracranial aneurysm in the circle of Willis causing an isolated third nerve palsy (ITNP). Retrospective cross-sectional study. One hundred thirty-seven patients who presented with an ITNP were examined by multidetector CTA scanners. All patients whose symptoms were caused by a compressive cerebral aneurysm were identified. The remaining patients were observed clinically to exclude the possibility of a missed cerebral aneurysm causing the ITNP. No patient underwent diagnostic conventional cerebral angiography (CCA), but all patients who underwent treatment underwent CCA at the time of the treatment. Accurate identification of a cerebral aneurysm that may cause an ITNP. A cerebral aneurysm causing an ITNP was detected in 27 patients (19.7%). The smallest maximal diameter of a clinically significant aneurysm was 5.7 mm. Of the 27 patients, 25 underwent endovascular coiling at which time CCA confirmed the aneurysm. In no case was another lesion found by CCA. Of the patients without an aneurysm, 81 of 110 (74%) made a complete spontaneous recovery. In no patient was there clinical evidence to suggest that a compressive cerebral aneurysm had been missed on CTA. Multidetector CTA is a safe and effective diagnostic imaging tool in detecting clinically significant aneurysms when a patient presents with an acute ITNP. We no longer perform CCA to detect a causative aneurysm or determine the type of treatment offered in these patients.
    Ophthalmology 03/2008; 115(8):1411-5. · 5.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Computed tomographic angiography (CTA) is a well-established non-invasive investigation for this neurological presentation to exclude intracranial aneurysms. However, dural arteriovenous fistulae with anterograde venous drainage only can be missed by CTA. Here we reported two patients with painful complete third nerve palsy and dural carotid cavernous fistulae with anterograde venous drainage only missed by CTA. The natural history and management option are discussed. In patients with persistent symptoms or without vasculopathic risk factors, magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) should be considered to exclude the diagnosis.
    Clinics and practice. 09/2011; 1(4):e110.
  • Human Immunology - HUM IMMUNOL. 01/2011; 72.