DOI: https://dx.doi.org/10.18203/2349-3933.ijam20220131
Published: 2022-01-25

Silent killer presenting as isolated oculomotor nerve palsy

Mary Stephen A., Jayasri P., Harigaravelu P. J., Baranitharan .

Abstract


Head trauma can result trivial to life threatening manifestations to a person. Subdural hemotoma is characterised by accumulation of blood in subdural space, in most cases it is a serious condition and requires prompt diagnosis and treatment for the same to provide good outcome. Large collection, mid line shift, brain herniation associated with subdural hematoma is associated with increased morbidity and mortality. However, if the collection is minimal or is places like tentorium cerebelli may not have the typical presentation and if it’s picked up using the subtle signs the devastating sequelae can be prevented. We report a 19 years old male with head trauma presenting with features of right-side isolated oculomotor nerve palsy who eventually found to have tentorial subdural hemotoma in imaging which has been intervened and complications were avoided.


Keywords


Occulomotor nerve palsy, Subdural hematoma, Tentorium, Head trauma, Cerebral herniation

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References


Lukasiewicz AM, Grant RA, Basques BA, Webb ML, Samuel AM, Grauer JN. Patient factor associated with 30-day morbidity, mortality and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program. J Neurosurg. 2016;124:760-6.

Akagi T, Miyamoto K, Kashii S, Yoshimura N. Cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy. Jpn J Ophthalmol. 2008;52:32-5.

Flanders M, Hasan J, Al-Mujaini A. Partial third cranial nerve palsy: clinical characteristics and surgical management. Can J Ophthalmol. 2012;47:321-5.

Clark ES, Gooddy W. Ipsilateral third cranial nerve palsy as a presenting sign in acute subdural hematoma. Brain. 1953;266-78.

Mizushima H, Seki T. Midbrain hemorrhage presenting with oculomotor nerve palsy: case report. Surg Neurol. 2002;58:417-20.

Diyora B, Kukreja S, Nayak N, Kamble H, Sharma A. Complete third nerve palsy: only presenting sign of extradural hematoma in an awake patient. Oman J Ophthalmol. 2014;7:103-4.