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Diffusion Tensor Imaging Tractography Detecting Isolated Oculomotor Nerve Damage After Traumatic Brain Injury
Timothée Jacquesson1, Carole Frindel2, Francois Cotton3
1Department of Neurosurgery B, Skull Base Multi-disciplinary Unit, Neurological Hospital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; Department of Anatomy, University of Lyon 1, Lyon, France; CREATIS Laboratory, CNRS UMR 5220 - INSERM U1044, Villeurbanne, France.
World Neurosurgery
|February 4, 2017
Summary
A traumatic bus accident caused complete oculomotor nerve palsy in a young woman. Advanced MRI techniques, including diffusion tensor imaging, precisely identified nerve damage, aiding diagnosis and prognosis.
Area of Science:
- Neuroscience
- Radiology
- Trauma Surgery
Background:
- Oculomotor nerve palsy can result from various etiologies, including trauma.
- Diagnosing the precise site and extent of nerve injury is crucial for patient management.
- Advanced neuroimaging plays a vital role in evaluating traumatic brain and nerve injuries.
Observation:
- A 24-year-old female sustained an isolated complete oculomotor nerve palsy after being struck by a bus.
- Initial computed tomography (CT) scan ruled out skull base fractures.
- Petechial cerebral hemorrhages, sparing the brainstem, were noted on T2*-weighted MRI.
Findings:
- T2 constructive interference in steady state imaging suggested partial sectioning of the left oculomotor nerve near the superior orbital fissure.
- Diffusion tensor imaging (DTI) fiber tractography confirmed a distinct interruption (sharp arrest) of the left oculomotor nerve.
- These findings highlight the utility of advanced MRI in visualizing nerve integrity.
Implications:
- Diffusion tensor imaging fiber tractography offers valuable insights into white matter fiber damage.
- This technique may enhance the diagnostic accuracy and prognostic assessment of traumatic nerve injuries.
- The findings underscore the potential of DTI in cases of isolated cranial nerve palsies post-trauma.
