J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2418-3777
Case Report

Paresis of the Oculomotor Nerve due to Neurovascular Conflict with Superior Cerebellar Artery

Matúš Kuniak
1   Department of Neurosurgery, Bory Pentahospitals, Bratislava, Slovakia
,
Anna Šebová
3   Department of Radiology, Bory Pentahospitals, Bratislava, Slovakia
,
Marcela Kuniaková
4   Institute of Medical Biology, Genetics, and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
,
Martin Sameš
2   Second Faculty of Medicine, Charles University, Prague, Czech Republic
5   Neurosurgery Department, Faculty of Medicine, University J.E.Purkyne, Masaryk Hospital, Usti nad Labem, Czech Republic
› Author Affiliations
Funding None.

Abstract

Background Neurovascular conflict between the oculomotor nerve and a posterior circulation cerebral artery is a relatively frequent radiologic finding; however, it manifests minimally clinically (by slower photoreaction on the ipsilateral side). Sustained paresis of the oculomotor nerve that arose directly due to neurovascular conflict between the superior cerebral artery (SCA) and the oculomotor nerve, and resolved after microvascular decompression, is extremely rare and has not yet been published.

Methods A 34-year-old female patient presented with an advancing ptosis and downward gaze on one side. Differential diagnostics ruled out all other causes of the oculomotor paresis. Magnetic resonance imaging showed significant compression of the oculomotor nerve by an aberrant SCA on the ipsilateral side. Neurovascular decompression performed microsurgically resulted in near complete resolution of the symptoms.

Results This case report aims to present a case of a rare clinical condition caused by a generally common anatomical variation. This variation proved to be the only cause of the patient's symptoms, which resolved after microsurgical restoration of the neuroanatomy.

Conclusions Oculomotor nerve paresis caused directly by neurovascular conflict is an extremely rare diagnosis. Microvascular decompression should be considered in these cases, if other causes have been excluded.

Informed Consent and Patient Details

Informed consent was obtained in accordance with the local authority.


Authors' Contribution

Mat.K. and M.S. were involved in writing the original draft and developing the methodology. All the authors were involved in writing, review, and editing of the manuscript and formal analysis. Visualization was done by Mat.K. and A.Š. Data curation was done by Mat.K. and Mar.K. Conceptualization was done by Mat.K., A.Š., and Mar.K. Supervision of the study was done by M.S. All the authors have read and agreed to the published version of the manuscript.




Publication History

Received: 17 June 2024

Accepted: 17 September 2024

Accepted Manuscript online:
19 September 2024

Article published online:
21 November 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Good EF. Ptosis as the sole manifestation of compression of the oculomotor nerve by an aneurysm of the posterior communicating artery. J Clin Neuroophthalmol 1990; 10 (01) 59-61
  • 2 Lee AG. Third cranial nerve (oculomotor nerve) palsy in adults. UpToDate. 2023. Accessed May 15, 2024 at: https://medilib.ir/uptodate/show/5246
  • 3 Tsutsumi S, Sugiyama N, Ueno H, Ishii H. Oculomotor nerve segment between proximal posterior and superior cerebellar arteries: an MRI study. Surg Radiol Anat 2022; 44 (11) 1475-1480
  • 4 Tan T, Tee JW, Wang YY. Oculomotor nerve palsy secondary to aberrant posterior cerebral artery. BMJ Case Rep 2014; 2014: bcr2014205063
  • 5 Natori Y, Rhoton Jr AL. Microsurgical anatomy of the superior orbital fissure. Neurosurgery 1995; 36 (04) 762-775
  • 6 Raza HK, Chen H, Chansysouphanthong T, Cui G. The aetiologies of the unilateral oculomotor nerve palsy: a review of the literature. Somatosens Mot Res 2018; 35 (3–4): 229-239
  • 7 Keane JR. Third nerve palsy: analysis of 1400 personally-examined inpatients. Can J Neurol Sci 2010; 37 (05) 662-670
  • 8 Rush JA. Causes and prognosis in 4,278 cases of paralysis of the oculomotor, trochlear, and abducens cranial nerves. Am J Ophthalmol 1992; 114 (06) 777-778
  • 9 Sivasubramaniyan KM, Nagarajan K, Rajeswari A, Sathiaprabhu A. A case of oculomotor nerve palsy caused by neurovascular compression by the fetal posterior communicating artery with a review of literature. Neurol India 2019; 67 (05) 1390-1392
  • 10 Hashimoto Y, Hideyama T, Yamagami A, Sasaki T, Maekawa R, Shiio Y. A case of ocular neuromyotonia caused by neurovascular compression of the oculomotor nerve by the elongated superior cerebellar artery. J Neurol 2016; 263 (06) 1236-1238
  • 11 Joshi S, Tee WWH, Franconi C, Prentice D. Transient oculomotor nerve palsy due to non-aneurysmal neurovascular compression. J Clin Neurosci 2017; 45: 136-137
  • 12 Liang C, Du Y, Lin X, Wu L, Wu D, Wang X. Anatomical features of the cisternal segment of the oculomotor nerve: neurovascular relationships and abnormal compression on magnetic resonance imaging. J Neurosurg 2009; 111 (06) 1193-1200