A review of isolated third nerve palsy without subarachnoid hemorrhage using computed tomographic angiography as the first line of investigation
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.
Article: Stroke.International Review of Neurobiology 02/2005; 67:203-38. DOI:10.1016/S0074-7742(05)67007-9 · 2.46 Impact Factor
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ABSTRACT: We review the question of diagnosis of painful and relatively isolated ophthalmoplegia due to diseases affecting the ocular motor nerves. For each clinical setting, we provide an overview of the main causes and a practical way to approach the diagnosis. As vascular malformations should always be kept in mind in patients with painful ophthalmoplegia, emergency neuroradiological investigations may be needed. However, the etiological scope is wide and the rationale for choosing the more appropriate examination and its optimal timing depends exclusively on the clinical evaluation. Despite advances in investigation techniques, diagnosis may remain difficult or even unresolved in a certain number of patients. We discuss successively paralysis of the third, sixth and fourth nerve, paralysis of several ocular motor nerves, recurrent ophthalmoplegia and ischaemic ocular motor palsies, which are the most frequent cause.Revue Neurologique 05/2005; 161(5):531-542. DOI:10.1016/S0035-3787(05)85087-8 · 0.60 Impact Factor
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ABSTRACT: The neuroimaging evaluation of isolated third nerve palsy in adults remains controversial. We aim to define diagnostic yield for neuroimaging of third nerve palsy (TNP) by degree of internal and external dysfunction using previously published imaging guidelines. All cases of TNP evaluated at a tertiary care center between 1990 and April 2004 were reviewed. Inclusion criteria were neurologically isolated TNP in adults with adequate documentation of the ocular examination, neuroimaging, and follow-up. Exclusion criteria were neurologically non-isolated TNP, TNP occurring in children, and TNP secondary to a known etiology; lack of adequate follow-up; and insufficient documentation of the ocular exam. Published imaging guidelines based on degree of external and internal dysfunction were applied to our cohort to determine compliance with and the diagnostic yield of neuroimaging recommendations. One hundred and eight cases were reviewed. Of the 91 excluded cases, there were 14 cases of aneurysm or subarachnoid hemorrhage. Of the 17 included cases, presumed ischemia (10), aneurysm (2), and ocular myasthenia (3) were the most common causes of isolated TNP. Neuroimaging was performed in 16 cases (94.1%). The neuroimaging strategy was concordant with neuroimaging recommendations in 7 cases (41.2% concordance). Failure to perform noninvasive angiography accounted for 7 cases (70.0%) of nonconcordance. The diagnostic yield of all neuroimaging studies performed was 68.8%; diagnostic yield in cases concordant with published neuroimaging recommendations was 100%. The degree of external and internal dysfunction can direct the type of neuroimaging performed in TNP.Canadian Journal of Ophthalmology 03/2007; 42(1):110-5. DOI:10.1139/I06-099 · 1.30 Impact Factor