Department of Ophthalmology, Department of General Surgery, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania;
Rom J Morphol Embryol. 2022 Jul-Sep;63(3):575-580. doi: 10.47162/RJME.63.3.13.
The diagnosis and management of the alteration of the normal function of the oculomotor nerve (third cranial nerve) varies depending on the characteristics of the paralysis, the age of the patient, and the associated symptoms and signs. Oculomotor nerve palsy may be caused by lesions located anywhere from the oculomotor nucleus to the termination of the third nerve in the extraocular muscles. Although there have been significant advances in neuroimaging to facilitate early diagnosis, the management of a patient presenting with isolated oculomotor palsy is still challenging. This review tackles the case of a 52-year-old patient, with a history of pulmonary tuberculosis (at the age of five), referred to the Department of Ophthalmology, St. Spiridon Emergency Clinical Hospital, Iaşi, Romania. The patient had diplopia accompanied by right eyelid ptosis, symptoms that began suddenly 10 days before hospitalization. The clinical examination showed right eye grade II palpebral ptosis, exotropia with limitation of eyeball movements in adduction, supra-∕infraduction. Biomicroscopic examination of the anterior pole revealed the presence of anisocoria and light-near dissociation on the affected side. Numerous investigations were performed to identify the cause, starting with tumoral markers, which were within normal limits. Magnetic resonance angiography (MRA) was performed, and posterior communicating artery aneurysm was ruled out. The endocrinology examination and hormonal laboratory tests were also within normal parameters. Due to suspicions of generalized tuberculosis raised by the infectious disease doctor or presence of secondary lesions, thoraco-abdomino-pelvic computed tomography (CT) scan with contrast agent was done and its findings required gastroenterological exploration. After various explorations, the certainty diagnosis was set by histopathological examination, which revealed gastric adenocarcinoma.
动眼神经（第三颅神经）正常功能改变的诊断和处理取决于麻痹的特征、患者的年龄以及相关的症状和体征。动眼神经麻痹可由从动眼神经核到眼外肌的第三神经终末的任何部位的病变引起。尽管神经影像学有了显著的进步，有助于早期诊断，但对于表现为孤立性动眼神经麻痹的患者的处理仍然具有挑战性。本综述涉及一位 52 岁患者的病例，该患者有肺结核病史（五岁时），被转诊到罗马尼亚雅西圣斯皮里东紧急临床医院眼科。患者出现复视伴右眼上睑下垂，这些症状在住院前 10 天突然出现。临床检查显示右眼上睑下垂 2 级，外斜视，眼球内收运动受限，上转和下转受限。眼前节检查显示受影响侧存在瞳孔不等大和光近分离。为了确定病因，进行了许多检查，首先是肿瘤标志物检查，结果在正常范围内。进行了磁共振血管造影（MRA）检查，排除了后交通动脉瘤。内分泌检查和激素实验室检查也在正常参数范围内。由于传染病医生怀疑存在全身性结核病或存在继发性病变，进行了胸腹部盆腔 CT 扫描并使用造影剂，其结果需要进行胃肠探索。经过各种探索，最终通过组织病理学检查确定了明确的诊断，该检查显示胃腺癌。
