Isolated contralateral post-ictal oculomotor nerve palsy following supratentorial craniotomy. Case report

The authors report the unique occurrence of an isolated post-ictal contralateral oculomotor nerve (OCN) palsy following excision of a medial frontal oligoastrocytoma. A 45-year-old male presented with a history of generalized tonic clonic seizures (GTCS) for 8 years. His neurological examination was unremarkable. Magnetic resonance imaging (MRI) of the brain revealed a left frontopolar low grade glioma. Nine hours after an uneventful near total microsurgical excision, the patient had a GTCS, following which he was noted to have an isolated right-sided OCN palsy. The immediate post-ictal computed tomographic scan and magnetic resonance images acquired 2 weeks after surgery failed to reveal any abnormality. The palsy had recovered completely by the 9-month follow-up.