Related Experiment Videos
Inferior division third nerve paresis from an orbital dural arteriovenous malformation
L G Gray1, S L Galetta, B Hershey
1Department of Neurology, Hahneman University, Philadelphia, Pennsylvania, USA.
Summary
Isolated third nerve palsies affecting only the inferior division are uncommon. This report details a rare case of pupil-involving palsy caused by an intraorbital arteriovenous malformation, persisting even after spontaneous thrombosis.
Area of Science:
- Ophthalmology
- Neurology
- Vascular Surgery
Background:
- Third cranial nerve (oculomotor nerve) palsies can result from various pathologies affecting the nerve or its nucleus.
- Isolated inferior division third nerve palsies are particularly rare, with specific etiological considerations.
- Intraorbital dural arteriovenous malformations (AVMs) are uncommon vascular lesions that can present with diverse neurological symptoms.
Observation:
- A patient presented with an isolated, pupil-involving inferior division third cranial nerve palsy.
- The palsy was attributed to an intraorbital dural arteriovenous malformation.
- The arteriovenous malformation underwent spontaneous thrombosis during observation.
Findings:
- Despite the spontaneous thrombosis of the intraorbital dural arteriovenous malformation, the patient's third nerve palsy persisted.
- This case represents the first reported instance of an inferior division third nerve palsy specifically caused by an orbital dural arteriovenous malformation.
Implications:
- This case highlights a rare cause of third nerve palsy, emphasizing the need to consider vascular lesions in the differential diagnosis.
- The persistence of the palsy post-thrombosis suggests potential mechanisms beyond direct vascular compression or occlusion, such as ischemic or inflammatory changes.
- Further investigation into the pathophysiology of nerve damage in such cases is warranted for improved understanding and management strategies.