Oculomotor Nerve Palsy
Claim CME CreditPOINT OF CARE INFORMATION
This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.
Learning Objectives
As a result of participation in this activity, participants should be able to:
- Provide improved patient care.
- Greater knowledge of the imaging characteristics of the patient's disease.
- Understand a better approach to interpretation of studies.
Faculty Disclosure
Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.
CME Advisory Committee Disclosure:
Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.
Continuing Medical Education Credit
Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CA0479-Oculomotor Nerve Palsy
CA0479-Oculomotor Nerve Palsy
Case ReportHistory
Exam
Prior Study
Findings
Brain and Brainstem
The region of the third, fourth and/or sixth cranial nerve nucleus and the respective tract within the brainstem to the root entry zone as well as the median longitudinal fasciculus and ocular-vestibular pathways are normal.
General Meninges, Cisternal Segment and Root Entry Zone
There is no generalized or focal abnormal meningeal (dural and/or pia-arachnoid) enhancement is not present.
There is abnormal enhancement and enlargement of the cisternal segment of the right third cranial nerve, however, there is no structural abnormality along the cisternal segment of the third, fourth and/or sixth cranial nerves. There is no abnormal enhancement at the 3rd nerve root entry zone along the ventral midbrain.
There is no posterior communicating or other cerebral aneurysm present.
Cavernous sinus and Paracavernous Structures
There is abnormal enhancement and enlargement of the right 3rd cranial nerve in its paracavernous “dural tunnel”.
There is no more extensive structural abnormality along course of the third, fourth and/or sixth cranial nerve within (sixth) and/or adjacent to (third and fourth) the cavernous sinus.
There is no cavernous or clinoid segment aneurysm or carotid-cavernous fistula.
Orbit, Extraocular Muscles, Sinonasal Region and Skull Base
The right 3rd nerve enhances and remains enlarged in superior orbital fissure and at the orbital apex. The extraocular muscles are normal and the intraconal and/or extraconal orbital fat appears normal.
There is no pathologic process arising within the orbit, sinonasal structures or skull base that might produce secondary loss of normal ocular motility or vision by involving extraocular muscles.
Impression
Given the acute onset sarcoid and granulomatous infectious/inflammatory disease seems very unlikely as an etiology.
No finding to explain the patient's papilledema.