Kiss-Bodolay Daniel, Steffen Heimo, Vargas María Isabel, Schaller Karl
Department of Neurosurgery, Geneva University Hospital, Geneva, Switzerland.
Department of Ophthalmology, Geneva University Hospital, Geneva, Switzerland.
Surg Neurol Int. 2023 Jun 2;14:194. doi: 10.25259/SNI_180_2023. eCollection 2023.
Isolated inferior rectus muscle palsy is a rare entity and even more rarely induced by an anatomical conflict. We report here a clinical case of third cranial nerve (CN III) compression in its cisternal segment by an idiopathic uncal protrusion in a patient presenting an isolated inferior rectus muscle palsy.
We report a case of an anatomical conflict between the uncus and the CN III in the form of a protrusion and highly asymmetrical proximity of the uncus and asymmetrically thinned nerve diameter deviated from its straight cisternal trajectory on the ipsilateral side were supported by an altered diffusion tractography along the concerned CN III. Clinical description, review of the literature, and image analysis were done including CN III fiber reconstruction using a fused image from diffusion tensor imaging images, constructive interference in steady state, and T2-fluid-attenuated inversion recovery images on a dedicated software (BrainLAB AG).
This case illustrates the importance of anatomical-clinical correlation in cases of CN deficits and supports the use of new neuroradiologically based interrogation methods such as CN diffusion tractography to support anatomical CN conflicts.
孤立性下直肌麻痹是一种罕见的病症，由解剖结构冲突导致的情况更为罕见。我们在此报告一例因特发性钩回突出导致脑池段动眼神经（CN III）受压的临床病例，该患者表现为孤立性下直肌麻痹。
我们报告了一例钩回与动眼神经之间存在解剖结构冲突的病例，表现为钩回突出，且钩回与动眼神经高度不对称接近，同侧神经直径不对称变细且偏离其脑池段直线轨迹，沿相关动眼神经的弥散张量成像改变支持了这一情况。进行了临床描述、文献回顾及图像分析，包括使用来自弥散张量成像图像、稳态构成干扰及T2液体衰减反转恢复图像的融合图像在专用软件（BrainLAB AG）上进行动眼神经纤维重建。
该病例说明了在动眼神经功能缺损病例中解剖学与临床相关性的重要性，并支持使用基于神经放射学的新检查方法，如动眼神经弥散张量成像，以辅助诊断解剖学上的动眼神经冲突。
