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Bum Sun Kwon - One of the best experts on this subject based on the ideXlab platform.
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isolated Oculomotor Nerve Palsy in mild traumatic brain injury a literature review
American Journal of Physical Medicine & Rehabilitation, 2020Co-Authors: Bum Sun KwonAbstract:BACKGROUND: Isolated Oculomotor Nerve Palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of Oculomotor Nerve Palsy. METHODS: We performed a search for all clinical studies of isolated Oculomotor Nerve Palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following keywords: traumatic brain injury, isolated Oculomotor Nerve Palsy, mild head trauma, management, and prognosis. RESULTS: We identified 14 cases of isolated Oculomotor Nerve Palsy after mild traumatic brain injury. In three cases, steroids were used to manage the Oculomotor Nerve Palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0months ± 5.3 months with a range of 0.5 to 18 months. CONCLUSION: This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies Oculomotor Nerve palsies, steroid therapy to reduce related brain edema, and Oculomotor rehabilitation with training eye movement behavior.
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Isolated Oculomotor Nerve Palsy in Mild Traumatic Brain Injury.
American journal of physical medicine & rehabilitation, 2020Co-Authors: Taeyeon Kim, Kiyeun Nam, Bum Sun KwonAbstract:BACKGROUND Isolated Oculomotor Nerve Palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of Oculomotor Nerve Palsy. METHODS We performed a search for all clinical studies of isolated Oculomotor Nerve Palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following key words: traumatic brain injury, isolated Oculomotor Nerve Palsy, mild head trauma, management, and prognosis. RESULTS We identified 14 cases of isolated Oculomotor Nerve Palsy after mild traumatic brain injury. In three cases, steroids were used to manage the Oculomotor Nerve Palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0 ± 5.3 mos with a range of 0.5-18 mos. CONCLUSIONS This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies Oculomotor Nerve palsies, steroid therapy to reduce related brain edema, and Oculomotor rehabilitation with training eye movement behavior.
Jeong-min Hwang - One of the best experts on this subject based on the ideXlab platform.
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Magnetic Resonance Imaging in 14 Patients with Congenital Oculomotor Nerve Palsy
Clinical Neuroradiology, 2019Co-Authors: Hee Kyung Yang, Jeong-min HwangAbstract:Purpose To elucidate the imaging findings of congenital Oculomotor Nerve Palsy by evaluating the Oculomotor Nerve and extraocular muscles on magnetic resonance (MR) imaging in a relatively large series of 14 patients with congenital Oculomotor Nerve Palsy. Methods Ophthalmologic examination of 14 consecutive patients diagnosed with congenital Oculomotor Nerve Palsy, and MR imaging of the orbit and Oculomotor Nerves were performed. Results Of the 14 patients with congenital Oculomotor Nerve Palsy, 13 patients (93%) were unilateral and 12 patients (86%) had incomplete Palsy. On MR imaging, 5 patients (36%) had hypoplasia or aplasia of the Oculomotor Nerve with variable degrees of extraocular muscle atrophy on the affected side. Of the 14 patients, nine (64%) had normal-sized Oculomotor Nerves with or without muscle atrophy. The most frequently involved muscles were the inferior rectus (64%) and medial rectus (50%), followed by the superior rectus (29%) and inferior oblique muscles (14%). None of the 14 patients showed an abnormal abducens Nerve. Conclusion Congenital Oculomotor Nerve Palsy was mostly incomplete and hypoplasia or aplasia of the Oculomotor Nerve was apparent in one third of patients showing variable degrees of extraocular muscle atrophy, mostly of the medial rectus and inferior rectus muscles.
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Magnetic Resonance Imaging in 14 Patients with Congenital Oculomotor Nerve Palsy.
Clinical neuroradiology, 2019Co-Authors: Hee Kyung Yang, Jae Hyoung Kim, Jeong-min HwangAbstract:PURPOSE To elucidate the imaging findings of congenital Oculomotor Nerve Palsy by evaluating the Oculomotor Nerve and extraocular muscles on magnetic resonance (MR) imaging in a relatively large series of 14 patients with congenital Oculomotor Nerve Palsy. METHODS Ophthalmologic examination of 14 consecutive patients diagnosed with congenital Oculomotor Nerve Palsy, and MR imaging of the orbit and Oculomotor Nerves were performed. RESULTS Of the 14 patients with congenital Oculomotor Nerve Palsy, 13 patients (93%) were unilateral and 12 patients (86%) had incomplete Palsy. On MR imaging, 5 patients (36%) had hypoplasia or aplasia of the Oculomotor Nerve with variable degrees of extraocular muscle atrophy on the affected side. Of the 14 patients, nine (64%) had normal-sized Oculomotor Nerves with or without muscle atrophy. The most frequently involved muscles were the inferior rectus (64%) and medial rectus (50%), followed by the superior rectus (29%) and inferior oblique muscles (14%). None of the 14 patients showed an abnormal abducens Nerve. CONCLUSION Congenital Oculomotor Nerve Palsy was mostly incomplete and hypoplasia or aplasia of the Oculomotor Nerve was apparent in one third of patients showing variable degrees of extraocular muscle atrophy, mostly of the medial rectus and inferior rectus muscles.
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magnetic resonance imaging in three patients with congenital Oculomotor Nerve Palsy
British Journal of Ophthalmology, 2009Co-Authors: Jae Hyoung Kim, Jeong-min HwangAbstract:The underlying pathology of congenital Oculomotor Nerve Palsy has not been determined. A previous MRI study reported that only one out of three patients showed bilateral Oculomotor Nerve hypoplasia; the two remaining patients had subarachnoid Oculomotor Nerves of normal size.1 This variability suggests heterogeneity in the pathogenesis of congenital Oculomotor Nerve Palsy. This report describes the use of MRI to verify the pathology of the extraocular muscles as well as the cranial Nerves in three patients with congenital Oculomotor Nerve Palsy. This study was undertaken following the tenets of the Declaration of Helsinki and received an approval from Institutional Review Board of Seoul National University Bundang Hospital. A 6-month-old girl presented with an inability to elevate the right eye. There was an intermittent exotropia of 20 dioptres (PD). Ductions and versions showed underaction of elevation, depression and adduction OD (fig 1A). MRI showed normal right and left Oculomotor Nerves and slightly atrophic right inferior rectus (fig …
Chung Hun Kim - One of the best experts on this subject based on the ideXlab platform.
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Traumatic Oculomotor Nerve Palsy.
Archives of plastic surgery, 2015Co-Authors: Dong Bee Kook, Byung Ho Park, Euna Hwang, Chung Hun KimAbstract:Oculomotor Nerve Palsy generally presents with mydriasis, blepharoptosis, and impairment of extraocular muscle movement. The incidence of primary traumatic Oculomotor Nerve Palsy in craniocerebral trauma is approximately 1.2% [1]. The causes of Oculomotor Nerve Palsy are congenital, traumatic, vascular, migrainous, and parainfectious. Especially in children, it is often caused by congenital factors, postnatal trauma, or infections [2]. Previous reports indicated that complete recovery is unusual [3]. Here, we report a case of a child with traumatic Oculomotor Nerve Palsy accompanying an orbitozygomaticomaxillary fracture. To our knowledge, it is the first such case report to appear in a Korean plastic surgery journal and is of note because the patient experienced a near-complete recovery, contrary to the grave prognoses described in previous case reports. An 8-year-old girl was admitted to the hospital after a car accident. The patient had no specific past history. Right periorbital swelling was too severe for the patient to be able to open her right eye, and therefore the pupil size discrepancy was only recognized after four days. The right pupil was dilated up to 5.5 mm, compared with 2.0 mm dilation on the unaffected side. The complete impairment of eye adduction was also noted in the affected eye. However, results of the forced duction test were normal. Thus, her right eyeball was deviated to the inferolateral side in the neutral gaze (right exotropia) (Fig. 1). Complete blepharoptosis remained in the right upper eyelid after the periorbital swelling subsided seven days after the trauma. These findings were consistent with Oculomotor Nerve Palsy. Visual acuity was normal at 20/20. The laboratory data, other aspects of the medical history, and the review of systems were in the normal range. There were also no specific neurological abnormalities except Oculomotor Nerve Palsy. A facial computed tomography scan displayed a right orbitozygomaticomaxillary fracture and a nasal bone fracture, which were so minimal that they were not expected to affect Oculomotor Nerve function. Magnetic resonance images also revealed no abnormal findings associated with Oculomotor Nerve Palsy. A cerebrospinal fluid test was not performed because there was no leakage of cerebrospinal fluid. One week after the trauma, an operation was performed to address the facial bone fracture. We employed steroid therapy to reduce periorbital swelling and possible endoneurial edema, in order to prevent secondary neuronal damage. Solu-Medrol (1 mg/kg, methylprednisolone) was injected intravenously for four days after the operation. After postoperative day five, prednisolone was administered and tapered gradually for six days. During the first three weeks, there was little improvement of levator function and the pupillary reflex (Fig. 1). However, at four weeks post-trauma, the movement of the paretic extraocular muscles and the state of ptosis were slightly improved. Levator function was measured at 3 mm (Table 1, Fig. 2). After 20 weeks, levator function was gradually improved and a measurement of 6.5 mm elevation was taken. However, pupillary function had not recovered to its normal range (Figs. 3, ,4).4). One year after the trauma, levator function and pupillary function had almost recovered to the normal range (Fig. 5). The patient is still being followed and is expected to improve further. In adults, common causes of Oculomotor Nerve Palsy are aneurysms, trauma, diabetes mellitus, and neoplasms. The relevant neoplasms are mostly pituitary adenomas and metastatic tumors [4]. The prognosis of Oculomotor Nerve Palsy varies according to its etiology and associated cranial Nerve problems. In children, common causes are congenital factors, trauma, inflammation, neoplasms, aneurysms, and others [4]. The exact pathophysiology of Oculomotor Palsy is not well understood. However, it is generally assumed that lesions in the sphenocavernous region, the orbital apex, and the brain stem may affect the Oculomotor Nerve. Direct injury or indirect compression can also result in Palsy. If the cause is inflammation, postinfectious neuropathy may affect the Nerve, but this mechanism of pathogenesis is not well understood [4]. Clinically, pupillary function shows great variability. Pupil-sparing Oculomotor Palsy can be caused by the infarction of the Oculomotor Nerve. Such patients may have diabetes mellitus [5]. Oculomotor Nerve Palsy that presents with smaller pupils may be due to Horner's syndrome or diabetic autonomic neuropathy. Partial Oculomotor Nerve Palsy can resolve in one to three months [4]. The improvement of visual acuity has been known to be difficult to achieve [2]. Many patients may develop amblyopia. In fact, in pediatric cases of Oculomotor Nerve Palsy, it is difficult to measure visual acuity quantitatively because young children are incompliant. However, regardless of the practical difficulties involved in measuring the visual acuity of children, visual acuity is known to be impaired in this condition. In our case, we saw a considerable improvement of levator function during the first 20 weeks. During the first eight weeks, about 50% of levator function was recovered. However, medial rectus muscle function had not recovered at that point. It was necessary to wait at least six months for the recovery of function in the pupil and medial rectus muscle because only a small restoration of the pupil size was noted after five months. One year after the trauma, levator and pupillary function almost recovered to the normal range (Fig. 5). Based on the course of the patient's recovery, we surmise that these functions will continue to improve with time. The patient is still being followed. Fortunately, the patient's visual acuity is normal. In our case, treatment was limited to early steroid therapy and occlusion therapy. The prognosis of Oculomotor Nerve Palsy varies according to its etiology and the associated neurological problems. Some authors suggest waiting for at least six months before strabismus surgery, which permits the cause of Oculomotor Palsy to be evaluated and allows for possible spontaneous recovery [2]. A surgical approach, including strabismus surgery and ptosis surgery, should be considered according to the degree of recovery. We suggest that plastic surgeons keep in mind that facial trauma may occur in combination with various cranial Nerve injuries and therefore should evaluate patients with facial trauma for the symptoms and signs of cranial Nerve injuries. Fig. 1 One week post-trauma. Complete ptosis and a dilated pupil were noted. Fig. 2 Four weeks post-trauma. The movement of paretic extraocular muscles and the amount of ptosis were somewhat improved. Levator function was measured as no more than 3 mm. Fig. 3 Eight weeks post-trauma. Levator function was improved compared to at 4 weeks. Fig. 4 Twenty weeks post-trauma. Levator function was gradually improved, as shown by a measurement of 6.5 mm elevation. However, pupillary function had not recovered to the normal range. Fig. 5 One year post-trauma. Levator and papillary function had almost recovered to the normal range. Table 1 Flowsheet of ocular examination
Taeyeon Kim - One of the best experts on this subject based on the ideXlab platform.
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Isolated Oculomotor Nerve Palsy in Mild Traumatic Brain Injury.
American journal of physical medicine & rehabilitation, 2020Co-Authors: Taeyeon Kim, Kiyeun Nam, Bum Sun KwonAbstract:BACKGROUND Isolated Oculomotor Nerve Palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of Oculomotor Nerve Palsy. METHODS We performed a search for all clinical studies of isolated Oculomotor Nerve Palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following key words: traumatic brain injury, isolated Oculomotor Nerve Palsy, mild head trauma, management, and prognosis. RESULTS We identified 14 cases of isolated Oculomotor Nerve Palsy after mild traumatic brain injury. In three cases, steroids were used to manage the Oculomotor Nerve Palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0 ± 5.3 mos with a range of 0.5-18 mos. CONCLUSIONS This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies Oculomotor Nerve palsies, steroid therapy to reduce related brain edema, and Oculomotor rehabilitation with training eye movement behavior.
Dong Bee Kook - One of the best experts on this subject based on the ideXlab platform.
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Traumatic Oculomotor Nerve Palsy.
Archives of plastic surgery, 2015Co-Authors: Dong Bee Kook, Byung Ho Park, Euna Hwang, Chung Hun KimAbstract:Oculomotor Nerve Palsy generally presents with mydriasis, blepharoptosis, and impairment of extraocular muscle movement. The incidence of primary traumatic Oculomotor Nerve Palsy in craniocerebral trauma is approximately 1.2% [1]. The causes of Oculomotor Nerve Palsy are congenital, traumatic, vascular, migrainous, and parainfectious. Especially in children, it is often caused by congenital factors, postnatal trauma, or infections [2]. Previous reports indicated that complete recovery is unusual [3]. Here, we report a case of a child with traumatic Oculomotor Nerve Palsy accompanying an orbitozygomaticomaxillary fracture. To our knowledge, it is the first such case report to appear in a Korean plastic surgery journal and is of note because the patient experienced a near-complete recovery, contrary to the grave prognoses described in previous case reports. An 8-year-old girl was admitted to the hospital after a car accident. The patient had no specific past history. Right periorbital swelling was too severe for the patient to be able to open her right eye, and therefore the pupil size discrepancy was only recognized after four days. The right pupil was dilated up to 5.5 mm, compared with 2.0 mm dilation on the unaffected side. The complete impairment of eye adduction was also noted in the affected eye. However, results of the forced duction test were normal. Thus, her right eyeball was deviated to the inferolateral side in the neutral gaze (right exotropia) (Fig. 1). Complete blepharoptosis remained in the right upper eyelid after the periorbital swelling subsided seven days after the trauma. These findings were consistent with Oculomotor Nerve Palsy. Visual acuity was normal at 20/20. The laboratory data, other aspects of the medical history, and the review of systems were in the normal range. There were also no specific neurological abnormalities except Oculomotor Nerve Palsy. A facial computed tomography scan displayed a right orbitozygomaticomaxillary fracture and a nasal bone fracture, which were so minimal that they were not expected to affect Oculomotor Nerve function. Magnetic resonance images also revealed no abnormal findings associated with Oculomotor Nerve Palsy. A cerebrospinal fluid test was not performed because there was no leakage of cerebrospinal fluid. One week after the trauma, an operation was performed to address the facial bone fracture. We employed steroid therapy to reduce periorbital swelling and possible endoneurial edema, in order to prevent secondary neuronal damage. Solu-Medrol (1 mg/kg, methylprednisolone) was injected intravenously for four days after the operation. After postoperative day five, prednisolone was administered and tapered gradually for six days. During the first three weeks, there was little improvement of levator function and the pupillary reflex (Fig. 1). However, at four weeks post-trauma, the movement of the paretic extraocular muscles and the state of ptosis were slightly improved. Levator function was measured at 3 mm (Table 1, Fig. 2). After 20 weeks, levator function was gradually improved and a measurement of 6.5 mm elevation was taken. However, pupillary function had not recovered to its normal range (Figs. 3, ,4).4). One year after the trauma, levator function and pupillary function had almost recovered to the normal range (Fig. 5). The patient is still being followed and is expected to improve further. In adults, common causes of Oculomotor Nerve Palsy are aneurysms, trauma, diabetes mellitus, and neoplasms. The relevant neoplasms are mostly pituitary adenomas and metastatic tumors [4]. The prognosis of Oculomotor Nerve Palsy varies according to its etiology and associated cranial Nerve problems. In children, common causes are congenital factors, trauma, inflammation, neoplasms, aneurysms, and others [4]. The exact pathophysiology of Oculomotor Palsy is not well understood. However, it is generally assumed that lesions in the sphenocavernous region, the orbital apex, and the brain stem may affect the Oculomotor Nerve. Direct injury or indirect compression can also result in Palsy. If the cause is inflammation, postinfectious neuropathy may affect the Nerve, but this mechanism of pathogenesis is not well understood [4]. Clinically, pupillary function shows great variability. Pupil-sparing Oculomotor Palsy can be caused by the infarction of the Oculomotor Nerve. Such patients may have diabetes mellitus [5]. Oculomotor Nerve Palsy that presents with smaller pupils may be due to Horner's syndrome or diabetic autonomic neuropathy. Partial Oculomotor Nerve Palsy can resolve in one to three months [4]. The improvement of visual acuity has been known to be difficult to achieve [2]. Many patients may develop amblyopia. In fact, in pediatric cases of Oculomotor Nerve Palsy, it is difficult to measure visual acuity quantitatively because young children are incompliant. However, regardless of the practical difficulties involved in measuring the visual acuity of children, visual acuity is known to be impaired in this condition. In our case, we saw a considerable improvement of levator function during the first 20 weeks. During the first eight weeks, about 50% of levator function was recovered. However, medial rectus muscle function had not recovered at that point. It was necessary to wait at least six months for the recovery of function in the pupil and medial rectus muscle because only a small restoration of the pupil size was noted after five months. One year after the trauma, levator and pupillary function almost recovered to the normal range (Fig. 5). Based on the course of the patient's recovery, we surmise that these functions will continue to improve with time. The patient is still being followed. Fortunately, the patient's visual acuity is normal. In our case, treatment was limited to early steroid therapy and occlusion therapy. The prognosis of Oculomotor Nerve Palsy varies according to its etiology and the associated neurological problems. Some authors suggest waiting for at least six months before strabismus surgery, which permits the cause of Oculomotor Palsy to be evaluated and allows for possible spontaneous recovery [2]. A surgical approach, including strabismus surgery and ptosis surgery, should be considered according to the degree of recovery. We suggest that plastic surgeons keep in mind that facial trauma may occur in combination with various cranial Nerve injuries and therefore should evaluate patients with facial trauma for the symptoms and signs of cranial Nerve injuries. Fig. 1 One week post-trauma. Complete ptosis and a dilated pupil were noted. Fig. 2 Four weeks post-trauma. The movement of paretic extraocular muscles and the amount of ptosis were somewhat improved. Levator function was measured as no more than 3 mm. Fig. 3 Eight weeks post-trauma. Levator function was improved compared to at 4 weeks. Fig. 4 Twenty weeks post-trauma. Levator function was gradually improved, as shown by a measurement of 6.5 mm elevation. However, pupillary function had not recovered to the normal range. Fig. 5 One year post-trauma. Levator and papillary function had almost recovered to the normal range. Table 1 Flowsheet of ocular examination
