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Localization of traumatic oculomotor nerve palsy to the midbrain exit site by magnetic resonance imaging
L J Balcer1, S L Galetta, L J Bagley
1Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, USA.
Purpose:
To present the magnetic resonance imaging findings for a patient with traumatic oculomotor nerve injury.
Methods:
We examined a patient with a right pupil-involving oculomotor nerve palsy after severe closed head trauma.
Results:
Magnetic resonance imaging of the brain demonstrated marked signal hypointensity on gradient-echo T2*-weighted images consistent with hemorrhage at the midbrain exit site of the right oculomotor nerve.
Conclusions:
Distal fascicular damage or partial rootlet avulsion is a mechanism of injury in some traumatic oculomotor nerve palsies. Gradient-echo T2*-weighted magnetic resonance imaging is the most sensitive method to detect hemorrhagic changes associated with shearing injury.