Pupil sparing incomplete third nerve palsy secondary to a cavernous sinus meningioma: challenges in management

Background:  The diagnosis of incomplete third nerve palsy can be clinically challenging because the aetiologies, as well as presentations, can be variable and subtle. The optometric clinician should be familiar with the association of third nerve palsy with compressive lesions, including the clinic...

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Published inClinical and experimental optometry Vol. 90; no. 2; pp. 132 - 138
Main Authors Shechtman, Diana L, Woods, Albert D, Tyler, Julie A
Format Journal Article
LanguageEnglish
Published Melbourne, Australia Taylor & Francis 01.03.2007
Blackwell Publishing Asia
Subjects
Aged
Cavernous Sinus
Eye Movements
Humans
incomplete palsy
Magnetic Resonance Imaging
Male
Meningeal Neoplasms - complications
Meningeal Neoplasms - diagnosis
meningioma
Meningioma - complications
Meningioma - diagnosis
Oculomotor Nerve Diseases - etiology
Oculomotor Nerve Diseases - physiopathology
oculomotor nerve palsy
Ophthalmoplegia - etiology
Ophthalmoplegia - physiopathology
Pupil
pupillary sparing
third nerve palsy
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Summary:Background:  The diagnosis of incomplete third nerve palsy can be clinically challenging because the aetiologies, as well as presentations, can be variable and subtle. The optometric clinician should be familiar with the association of third nerve palsy with compressive lesions, including the clinical presentations and management of these patients. Case report:  We present a 68-year-old hypertensive male complaining of intermittent diplopia for the previous six months. Neurological examination revealed a mild deficit in adduction, reduced range of vertical motility and questionable ptosis, all limited to the OD. No pupillary involvement was noted. MRI revealed a cavernous sinus meningioma. The patient elected against surgery, choosing MRI every six months. Conclusion:  Due to the subtle clinical presentation of incomplete pupil sparing third nerve palsy, this ophthalmoplegia may be easily overlooked. The associated aetiologies of palsy of cranial nerve three (CN3) carry increased risk of morbidity and mortality. Management should include evaluation for mass lesions and/or vascular aetiologies, regardless of pupillary involvement.
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ISSN:0816-4622
1444-0938
DOI:10.1111/j.1444-0938.2006.00104.x